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Kaur M, Misra S, Swarnkar P, Patel P, Das Kurmi B, Das Gupta G, Singh A. Understanding the role of hyperglycemia and the molecular mechanism associated with diabetic neuropathy and possible therapeutic strategies. Biochem Pharmacol 2023; 215:115723. [PMID: 37536473 DOI: 10.1016/j.bcp.2023.115723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023]
Abstract
Diabetic neuropathy is a neuro-degenerative disorder that encompasses numerous factors that impact peripheral nerves in the context of diabetes mellitus (DM). Diabetic peripheral neuropathy (DPN) is very prevalent and impacts 50% of diabetic patients. DPN is a length-dependent peripheral nerve lesion that primarily causes distal sensory loss, discomfort, and foot ulceration that may lead to amputation. The pathophysiology is yet to be fully understood, but current literature on the pathophysiology of DPN revolves around understanding various signaling cascades involving the polyol, hexosamine, protein-kinase C, AGE, oxidative stress, and poly (ADP ribose) polymerase pathways. The results of research have suggested that hyperglycemia target Schwann cells and in severe cases, demyelination resulting in central and peripheral sensitization is evident in diabetic patients. Various diagnostic approaches are available, but detection at an early stage remains a challenge. Traditional analgesics and opioids that can be used "as required" have not been the mainstay of treatment thus far. Instead, anticonvulsants and antidepressants that must be taken routinely over time have been the most common treatments. For now, prolonging life and preserving the quality of life are the ultimate goals of diabetes treatment. Furthermore, the rising prevalence of DPN has substantial consequences for occupational therapy because such therapy is necessary for supporting wellness, warding off other chronic-diseases, and avoiding the development of a disability; this is accomplished by engaging in fulfilling activities like yoga, meditation, and physical exercise. Therefore, occupational therapy, along with palliative therapy, may prove to be crucial in halting the onset of neuropathic-symptoms and in lessening those symptoms once they have occurred.
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Affiliation(s)
- Mandeep Kaur
- Department of Pharmacology, ISF College of Pharmacy, GT Road, Ghal Kalan, Moga142001, Punjab, India
| | - Sakshi Misra
- Department of Pharmacology, ISF College of Pharmacy, GT Road, Ghal Kalan, Moga142001, Punjab, India
| | - Priyanka Swarnkar
- Department of Pharmacology, ISF College of Pharmacy, GT Road, Ghal Kalan, Moga142001, Punjab, India
| | - Preeti Patel
- Department of Pharmaceutical Chemistry, ISF College of Pharmacy, GT Road, Ghal Kalan, Moga 142001, Punjab, India
| | - Balak Das Kurmi
- Department of Pharmaceutics, ISF College of Pharmacy, GT Road, Ghal Kalan, Moga 142001, Punjab, India
| | - Ghanshyam Das Gupta
- Department of Pharmaceutics, ISF College of Pharmacy, GT Road, Ghal Kalan, Moga 142001, Punjab, India
| | - Amrita Singh
- Department of Pharmacology, ISF College of Pharmacy, GT Road, Ghal Kalan, Moga142001, Punjab, India.
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Kocyigit BF, Sagtaganov Z, Yessirkepov M. The effectiveness of yoga as a form of exercise in the management of rheumatic diseases. Rheumatol Int 2023; 43:795-801. [PMID: 36856817 DOI: 10.1007/s00296-023-05291-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 02/18/2023] [Indexed: 03/02/2023]
Abstract
Yoga, a long-standing Indian tradition, has gained popularity globally, inspiring many different disciplines to employ it as a complementary treatment for various diseases. Yoga is primarily composed of numerous physical poses and positions that are coupled with breathing techniques, profound relaxation, and meditation. There are many types of yoga with varying levels of difficulty. Yoga, consisting of various poses and postures with distinct postural mechanics, is frequently highlighted as an exercise that improves both physical and mental health. Applying the proper techniques to yoga poses can boost balance, strength, and flexibility while also improving general health and quality of life. In addition to its physical benefits, it is recognized that yoga enhances an individual's mood, anxiety, and depression levels and their ability to deal with stress. Rheumatic diseases affect many different organs, particularly the musculoskeletal structures, and negatively impact patients' quality of life. Maintaining a sufficient level of exercise is essential to preserve and enhance physical function in addition to pharmaceutical therapy, the mainstay of rheumatic disease treatment. In treatment guidelines for many rheumatic diseases, exercise, and physiotherapy techniques are stressed as the most substantial component of non-pharmacological treatment. This review considered yoga a form of exercise outside of traditional practices. From this perspective, we aimed to summarize the efficacy of yoga practices on various rheumatic diseases. Additionally, we aimed to highlight possible mechanisms of action.
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Affiliation(s)
- Burhan Fatih Kocyigit
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey.
| | - Zhaxybek Sagtaganov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
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Harnessing the benefits of yoga for myositis, muscle dystrophies, and other musculoskeletal disorders. Clin Rheumatol 2022; 41:3285-3297. [PMID: 35854165 PMCID: PMC9295887 DOI: 10.1007/s10067-022-06280-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 06/01/2022] [Accepted: 06/16/2022] [Indexed: 12/02/2022]
Abstract
The recent global increase in popularity of home-based yoga, an ancient Indian technique practiced for thousands of years, has translated into its use as a complementary therapy for a multitude of ailments. This review aims to examine the published literature regarding the effects of yoga therapy on systemic chronic diseases; in particular on the inflammatory myopathies (IMs) and other muscle disorders. Despite the fact that the evidence base for yoga in inflammatory myositis is in its infancy, collateral results in other disorders such as muscular dystrophies are promising. A beneficial effect of yoga in chronic pain has been shown alongside an improvement in motor function and muscle strength. Patients with Duchenne muscular dystrophy with respiratory involvement may find improvement in lung function. Elderly patients may experience reduction in falls secondary to an improvement in balance while practicing long-term yoga therapy. Further benefits are improving disorders of mental health such as depression and anxiety. A reported improvement in overall quality of life further suggests its efficacy in reducing morbidity in patients with chronic diseases, who often suffer co-existent psychological comorbidities.
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Srijithesh PR, Mythirayee S. Exercise and Asana Yoga in Parkinson's Disease: A Critical Analysis of Evidence and Definition. Neurol India 2022; 70:1702-1704. [PMID: 36076698 DOI: 10.4103/0028-3886.355084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- P R Srijithesh
- Department of Neurology, National Institute of Mental Health and Neuroscience, Bengaluru, Karnataka, India
| | - S Mythirayee
- Department of Neurology, National Institute of Mental Health and Neuroscience, Bengaluru, Karnataka, India
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Sankalp, Dada T, Yadav RK, Sharma HB, Netam RK, Kochhar KP. Effect of Tratak (Yogic Ocular Exercises) on Intraocular Pressure in Glaucoma: An RCT. Int J Yoga 2022; 15:59-69. [PMID: 35444375 PMCID: PMC9015087 DOI: 10.4103/ijoy.ijoy_160_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/31/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION In healthy subjects, the intraocular pressure (IOP) is maintained by a dynamic equilibrium between continuous production of aqueous humor by ciliary bodies and continuous outflow through the two drainage pathways: trabecular meshwork and uveoscleral outflow. Here, we hypothesized that yogic ocular exercises, including extraocular muscles exercise, and modified Tratak Kriya (mTK), might reduce the IOP as well as stress and improve quality of life (QoL) in patients with glaucoma. METHODOLOGY A parallel two-arm randomized controlled trial (RCT) was conducted in glaucoma patients (Control group and Intervention group). Control group patients were on standard medical treatment and intervention group patients practiced a Yoga-based lifestyle intervention (YBLI) for 4 weeks as add-on therapy with their standard medical treatment. All Participants were assessed at baseline day 1, day 14 (D14), and day 28 (D28). A minimum of 30 patients were recruited in each group. RESULTS We did not observe any statistically significant different mean IOP of right (IOP-r) or, left eyes at any time point as well as cortisol level and QoL between the two groups. However, with in intervention group, there was a reduction in IOP-r at D14 (15.54 ± 2.81 mmHg) and D28 (15.24 ± 3.1 mmHg), P = 0.006 and 0.001, respectively, compared to their baseline IOP (16.26 ± 2.98). CONCLUSION Based on the present RCT, yoga-based ocular exercises practiced here cannot be recommended for management of raised IOP in glaucoma patients. Further larger studies are warranted with yoga-based interventions in patients with glaucoma. CLINICAL TRIAL REGISTRATION NUMBER CTRI/2016/03/006703.
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Affiliation(s)
- Sankalp
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Tanuj Dada
- Department of Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Raj Kumar Yadav
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India,Address for correspondence: Dr. Raj Kumar Yadav, Department of Physiology, All India Institute of Medical Sciences, New Delhi - 110 029, India. E-mail:
| | | | - Ritesh Kumar Netam
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwal Preet Kochhar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Xaviar S, Das S, Tiwari S. An Audit of the Quality of Reporting and Bias of Studies on Yoga in Epilepsy. Neurol India 2022; 70:2009-2014. [DOI: 10.4103/0028-3886.359244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
BACKGROUND Functional movement disorder (FMD), a conversion disorder characterized by involuntary movements, is difficult to treat. METHODS We aimed to assess the effects of anodal transcranial direct current stimulation (tDCS) and yoga in FMD patients (n=5). TDCS of the right temporoparietal junction, a brain region relevant in the sense of self-agency, was conducted. Subjects underwent both sham and anodal tDCS with a washout period of 3 weeks. Yoga was used as a mode of exercise, as well as in conjunction with stimulation to sustain potential changes in neural plasticity. RESULTS A total of 5 subjects completed the study [mean age: 52 (SE: 4) y, disease duration: 5 (SE: 1.6) y], undergoing both sham and anodal tDCS. Anodal tDCS does not appear to be superior to sham tDCS in alleviating symptoms and disability, but combining tDCS and yoga appears to lead to mild improvement noted on clinical observation, based on the change in the efficacy index of Clinical Global Impression found in 4 subjects. CONCLUSION Our study results suggest that anodal tDCS is not superior to sham tDCS in alleviating subjective symptoms and disability in FMD. However, interpretation of these results is limited due to the small number of stimulation sessions and number of subjects. Future studies using more frequent stimulation sessions are needed to further determine whether anodal tDCS may have a therapeutic effect in this patient group compared with sham tDCS.
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CEREZER MARIANAFELIN, NEDEL SHEILASPOHR, CHRISTMANN MORGANA, NUNES LARISSASANTOS, VIEIRA IGORSOARES, BADKE MARCIOROSSATO, BRANCO JERÔNIMOCOSTA. LAVENDER ESSENTIAL OIL FOR SPINAL PAIN IN OBESE WOMEN: A CLINICAL TRIAL. COLUNA/COLUMNA 2021. [DOI: 10.1590/s1808-185120212003243743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective To analyze the effect of lavender essential oil associated with massage on spinal pain levels in obese women. Methods The sample included 49 obese women, between 20 and 60 years of age, randomly assigned to three groups: control (n=15), intervention (n=19) and placebo (n=15). The intervention and placebo groups were submitted to eight 35-minute sessions, twice a week for one month, but the essential oil of Lavandula angustifolia was used only in the intervention group. A placebo was used for the placebo group and the control group received no intervention. Pain levels were measured before and after the intervention using the Visual Analog Scale. Results There was a significant decrease in total spinal pain (p=0.004), in the cervical region (p=0.003) and in the lumbar region (p=0.008) in the intervention group. Conclusion Lavender essential oil had a positive impact on the reduction of pain in the spine of obese women, as well as in the specific areas of the cervical and lumbar regions compared to the control and placebo groups. Level of evidence I; Randomized clinical trial.
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Affiliation(s)
| | | | | | | | | | | | - JERÔNIMO COSTA BRANCO
- Universidade Franciscana, Brazil; Universidade Franciscana, Brazil; Universidade Católica de Pelotas, Brazil
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Jones K, Hawke F, Newman J, Miller JA, Burns J, Jakovljevic DG, Gorman G, Turnbull DM, Ramdharry G. Interventions for promoting physical activity in people with neuromuscular disease. Cochrane Database Syst Rev 2021; 5:CD013544. [PMID: 34027632 PMCID: PMC8142076 DOI: 10.1002/14651858.cd013544.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The World Health Organization (WHO) recommends that people of all ages take regular and adequate physical activity. If unable to meet the recommendations due to health conditions, international guidance advises being as physically active as possible. Evidence from community interventions of physical activity indicate that people living with medical conditions are sometimes excluded from participation in studies. In this review, we considered the effects of activity-promoting interventions on physical activity and well-being in studies, as well as any adverse events experienced by participants living with inherited or acquired neuromuscular diseases (NMDs). OBJECTIVES: To assess the effects of interventions designed to promote physical activity in people with NMD compared with no intervention or alternative interventions. SEARCH METHODS On 30 April 2020, we searched Cochrane Neuromuscular Specialised Register, CENTRAL, Embase, MEDLINE, and ClinicalTrials.Gov. WHO ICTRP was not accessible at the time. SELECTION CRITERIA We considered randomised or quasi-randomised trials, including cross-over trials, of interventions designed to promote physical activity in people with NMD compared to no intervention or alternative interventions. We specifically included studies that reported physical activity as an outcome measure. Our main focus was studies in which promoting physical activity was a stated aim but we also included studies in which physical activity was assessed as a secondary or exploratory outcome. DATA COLLECTION AND ANALYSIS We used standard Cochrane procedures. MAIN RESULTS The review included 13 studies (795 randomised participants from 12 studies; number of participants unclear in one study) of different interventions to promote physical activity. Most studies randomised a minority of invited participants. No study involved children or adolescents and nine studies reported minimal entry criteria for walking. Participants had one of nine inherited or acquired NMDs. Types of intervention included structured physical activity support, exercise support (as a specific form of physical activity), and behaviour change support that included physical activity or exercise. Only one included study clearly reported that the aim of intervention was to increase physical activity. Other studies reported or planned to analyse the effects of intervention on physical activity as a secondary or exploratory outcome measure. Six studies did not report results for physical activity outcomes, or the data were not usable. We judged 10 of the 13 included studies at high or unclear risk of bias from incomplete physical activity outcome reporting. We did not perform a meta-analysis for any comparison because of differences in interventions and in usual care. We also found considerable variation in how studies reported physical activity as an outcome measure. The studies that reported physical activity measurement did not always clearly report intention-to-treat (ITT) analysis or whether final assessments occurred during or after intervention. Based on prespecified measures, we included three comparisons in our summary of findings. A physical activity programme (weight-bearing) compared to no physical activity programme One study involved adults with diabetic peripheral neuropathy (DPN) and reported weekly duration of walking during and at the end of a one-year intervention using a StepWatch ankle accelerometer. Based on the point estimate and low-certainty evidence, intervention may have led to an important increase in physical activity per week; however, the 95% confidence interval (CI) included the possibility of no difference or an effect in either direction at three months (mean difference (MD) 34 minutes per week, 95% CI -92.19 to 160.19; 69 participants), six months (MD 68 minutes per week, 95% CI -55.35 to 191.35; 74 participants), and 12 months (MD 49 minutes per week, 95% CI -75.73 to 173.73; 70 participants). Study-reported effect estimates for foot lesions and full-thickness ulcers also included the possibility of no difference, a higher, or lower risk with intervention. A sensor-based, interactive exercise programme compared to no sensor-based, interactive exercise programme One study involved adults with DPN and reported duration of walking over 48 hours at the end of four weeks' intervention using a t-shirt embedded PAMSys sensor. It was not possible to draw conclusions about the effectiveness of the intervention from the very low-certainty evidence (MD -0.64 hours per 48 hours, 95% CI -2.42 to 1.13; 25 participants). We were also unable to draw conclusions about impact on the Physical Component Score (PCS) for quality of life (MD 0.24 points, 95% CI -5.98 to 6.46; 35 participants; very low-certainty evidence), although intervention may have made little or no difference to the Mental Component Score (MCS) for quality of life (MD 5.10 points, 95% CI -0.58 to 10.78; 35 participants; low-certainty evidence). A functional exercise programme compared to a stretching exercise programme One study involved adults with spinal and bulbar muscular atrophy and reported a daily physical activity count at the end of 12 weeks' intervention using an Actical accelerometer. It was not possible to draw conclusions about the effectiveness of either intervention (requiring compliance) due to low-certainty evidence and unconfirmed measurement units (MD -8701, 95% CI -38,293.30 to 20,891.30; 43 participants). Functional exercise may have made little or no difference to quality of life compared to stretching (PCS: MD -1.10 points, 95% CI -5.22 to 3.02; MCS: MD -1.10 points, 95% CI -6.79 to 4.59; 49 participants; low-certainty evidence). Although studies reported adverse events incompletely, we found no evidence of supported activity increasing the risk of serious adverse events. AUTHORS' CONCLUSIONS We found a lack of evidence relating to children, adolescents, and non-ambulant people of any age. Many people living with NMD did not meet randomised controlled trial eligibility criteria. There was variation in the components of supported activity intervention and usual care, such as physical therapy provision. We identified variation among studies in how physical activity was monitored, analysed, and reported. We remain uncertain of the effectiveness of promotional intervention for physical activity and its impact on quality of life and adverse events. More information is needed on the ITT population, as well as more complete reporting of outcomes. While there may be no single objective measure of physical activity, the study of qualitative and dichotomous change in self-reported overall physical activity might offer a pragmatic approach to capturing important change at an individual and population level.
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Affiliation(s)
- Katherine Jones
- Cochrane Pain, Palliative and Supportive Care, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Mental Health and Neuroscience Network and Acute and Emergency Care Network, Cochrane, London, UK
| | - Fiona Hawke
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Ourimbah, Australia
| | - Jane Newman
- Wellcome Centre for Mitochondrial Research, Newcastle University and NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - James Al Miller
- c/o Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Joshua Burns
- University of Sydney School of Health Sciences, Faculty of Medicine and Health, Sydney, Australia
| | - Djordje G Jakovljevic
- Cardiovascular and Lifestyle Medicine Theme, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Grainne Gorman
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, UK
| | - Douglass M Turnbull
- Mitochondrial Research Group, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Gita Ramdharry
- Queen Square Centre for Neuromuscular Diseases, University College Hospital NHS Foundation Trust and UCL Institute of Neurology, London, UK
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Sharma K, Pannu V, Sayal N, Bhalla A, Anand A. Effects of one month of Common Yoga Protocol practice appear to be mediated by the angiogenic and neurogenic pathway: A pilot study. Explore (NY) 2020; 17:451-457. [PMID: 33059980 DOI: 10.1016/j.explore.2020.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 09/03/2020] [Accepted: 09/13/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To examine the molecular effects of mindful activities such as yoga and meditation DESIGN: This was an open label single arm exploratory yoga intervention study. STUDY PARTICIPANTS 64 healthy individuals within the age of 18-60 years were recruited for this one month yoga intervention study. INTERVENTION Common Yoga Protocol (CYP) is a standardized yoga protocol released by Ministry of AYUSH, India for International Yoga Day. It includes all aspects of yoga i.e. asanas, pranayama and meditation. It is designed for adoption by all age groups for the health of community. OUTCOME MEASURES The participants were assessed for biochemical parameters including Fasting Sugar and Lipid profile. The molecular markers of neurogenesis (i.e. Brain derived Neurotropic Factor, BDNF) and Angiogenesis (i.e. Vascular Endothelial Growth Factor, VEGF and Angiogenin) along with Amyloid β (marker related to neuro-degenerative diseases) were assessed. All the assessments were made at baseline and after one month of the intervention. RESULTS After one month of CYP practice High Density Lipoprotein (HDL) levels increased significantly (p<0.001), although other biochemical parameters i.e. fasting sugar and other lipid assessments were found to be unaltered. Angiogenesis marker, angiogenin was increased significantly (p<0.002), other angiogenesis marker VEGF did not show any change along with BDNF, marker of neurogenesis. Amyloid β levels were also unaltered. Even though individual levels of VEGF and Amyloid β did not show any change, proportion of VEGF to Amyloid β showed a significant increase (p<0.001) after one month of CYP intervention indicating that the change in VEGF levels was significantly higher than the change in Amyloid β levels. CONCLUSION CYP practice may influence cell survival pathways mediated by angiogenic and neurogenic cross talk. Hence, CYP can be considered as a preventive measure for diseases associated with impaired angiogenic and neurogenic mechanism. This is the first study to examine the effects of CYP at the molecular level.
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Affiliation(s)
- Kanupriya Sharma
- Neuroscience Research Lab, Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Viraaj Pannu
- Government Medical College and Hospital, Sector-32, Chandigarh, India
| | - Natasha Sayal
- Neuroscience Research Lab, Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine,, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay Anand
- Neuroscience Research Lab, Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Mateen FJ. Multiple sclerosis in resource-limited settings: Research opportunities in an unequal world. Neurology 2020; 93:176-180. [PMID: 31332086 DOI: 10.1212/wnl.0000000000007837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This position piece is meant to extend the humanitarian argument for assisting people with multiple sclerosis (MS) in resource-limited settings, in this case, through research. It is also meant to highlight areas of strength of some low- and middle-income countries (LMICs), and therefore emphasize how the field of MS could best be served globally by more research with and for resource-limited populations. Possible areas of particular strength include (1) ethnicity, genetic diversity, and migration studies; (2) analysis of possibly emerging environmental and lifestyle-related risk factors; (3) understanding the immune system when exposed to novel pathogens and various infectious agents; (4) reverse innovation to promote better point-of-care diagnostic tests; (5) high participation rates in clinical registries and research; (6) appreciation of MS in special populations including a higher focus on pediatrics and pregnancy; (7) culturally adept means of treatment and rehabilitating disability; (8) models of care delivery for chronic, complex neurologic diseases; and (9) use of off-label, generic, and less commonly implemented disease-modifying therapy sequences. Strategies for strengthening the MS research landscape include (1) creation of centers of research excellence in LMICs and twinning of institutions between high- and low-income countries; (2) standardization of research procedures and reduction of bureaucracies; (3) consensus meetings and network building; (4) opening additional avenues for publications and expanding the types of available publications; (5) identifying and establishing dedicated funding mechanisms; (6) focus on local relevance; and (7) setting expectations to include patients from LMICs in international clinical trials. These underutilized opportunities build an argument that global partnerships for research and knowledge coordination could better reach across populations, geographies, economies, and expertise.
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Affiliation(s)
- Farrah J Mateen
- From the Department of Neurology, Massachusetts General Hospital; and Harvard Medical School, Boston, MA.
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Venkatesh HN, Ravish H, Wilma Delphine Silvia CR, Srinivas H. Molecular Signature of the Immune Response to Yoga Therapy in Stress-related Chronic Disease Conditions: An Insight. Int J Yoga 2020; 13:9-17. [PMID: 32030016 PMCID: PMC6937878 DOI: 10.4103/ijoy.ijoy_82_18] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The world Health Organization defines health as complete well-being in terms of physical, mental and social, and not merely the absence of disease. To attain this, individual should adapt and self-mange the social, physical and emotional challenges of life. Exposure to chronic stress due to urbanization, work stress, nuclear family, pollution, unhealthy food habits, lifestyle, accidental death in the family, and natural calamities are the triggering factors, leading to hormonal imbalance and inflammation in the tissue. The relationship between stress and illness is complex; all chronic illnesses such as cardiovascular disease and asthma have their root in chronic stress attributed by inflammation. In recent times, yoga therapy has emerged as an important complementary alternative medicine for many human diseases. Yoga therapy has a positive impact on mind and body; it acts by incorporating appropriate breathing techniques and mindfulness to attain conscious direction of our awareness of the present moment by meditation, which helps achieve harmony between the body and mind. Studies have also demonstrated the important regulatory effects of yoga therapy on brain structure and functions. Despite these advances, the cellular and molecular mechanisms by which yoga therapy renders its beneficial effects are inadequately known. A growing body of evidence suggests that yoga therapy has immunomodulatory effects. However, the precise mechanistic basis has not been addressed empirically. In this review, we have attempted to highlight the effect of yoga therapy on immune system functioning with an aim to identify important immunological signatures that index the effect of yoga therapy. Toward this, we have summarized the available scientific evidence showing positive impacts of yoga therapy. Finally, we have emphasized the efficacy of yoga in improving physical and mental well-being. Yoga has been a part of Indian culture and tradition for long; now, the time has come to scientifically validate this and implement this as an alternative treatment method for stress-related chronic disease.
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Affiliation(s)
- H N Venkatesh
- Department of Human Genetics, NIMHANS, Bangalore, India
| | - H Ravish
- Department of Neurochemistry, NIMHANS, Bangalore, India
| | - C R Wilma Delphine Silvia
- Department of Biochemistry, Bowring and Lady Curzon Medical College and Research Institute, Bangalore, India
| | - H Srinivas
- Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
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Green E, Huynh A, Broussard L, Zunker B, Matthews J, Hilton CL, Aranha K. Systematic Review of Yoga and Balance: Effect on Adults With Neuromuscular Impairment. Am J Occup Ther 2019; 73:7301205150p1-7301205150p11. [PMID: 30839270 DOI: 10.5014/ajot.2019.028944] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This systematic review examines the efficacy of yoga as a neuromuscular intervention for community-dwelling populations at risk for falls to determine its utility for use in occupational therapy intervention. Populations included older adults and adults with traumatic brain injury (TBI), cerebrovascular accident (CVA), dementia and Alzheimer's disease (AD)-type dementia, multiple sclerosis (MS), and Parkinson's disease (PD). Benefits of yoga include improved posture control, improved flexibility of mind and body, relaxation, and decreased anxiety and stress. A systematic review of the literature was conducted to understand the salutary benefits of yoga for clients who are at risk for falls because of neuromuscular issues. Moderate evidence supports the use of yoga to decrease the risk for falls for community-dwelling older adults and people with CVA, dementia and AD-type dementia, and MS. Studies involving people with TBI and PD did not include strong enough evidence to be able to make a clear classification.
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Affiliation(s)
- Ellen Green
- Ellen Green, MOT, OTR/L, is Occupational Therapist PRN, The Shepherd Center, Atlanta, GA
| | - Annette Huynh
- Annette Huynh, MOT, OTR, is Occupational Therapist, Texas Children's Hospital, The Woodlands, TX
| | - Lori Broussard
- Lori Broussard, MOT, OTR, is Occupational Therapist, Conroe Regional Medical Center, Conroe, TX
| | - Brady Zunker
- Brady Zunker, MOT, OTR/L, is Occupational Therapist, Whitehall of Deerfield Healthcare Center, Deerfield, IL
| | - Jerril Matthews
- Jerril Matthews, MOT, OTR, is Occupational Therapist, Pate Rehabilitation Center, Dallas, TX
| | - Claudia L Hilton
- Claudia L. Hilton, PhD, MBA, OTR, FAOTA, is Associate Professor and Distinguished Teaching Professor, Occupational Therapy Department, University of Texas Medical Branch, Galveston;
| | - Karen Aranha
- Karen Aranha, PhD, OTR, is Assistant Professor, Occupational Therapy Department, Texas Tech University, Lubbock
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Silveira K, Smart CM. Cognitive, physical, and psychological benefits of yoga for acquired brain injuries: A systematic review of recent findings. Neuropsychol Rehabil 2019; 30:1388-1407. [DOI: 10.1080/09602011.2019.1583114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Kristen Silveira
- Department of Psychology, University of Victoria, Victoria, Canada
| | - Colette M. Smart
- Department of Psychology, University of Victoria, Victoria, Canada
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, Canada
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Harris A, Austin M, Blake T, Bird M. Perceived benefits and barriers to yoga participation after stroke: A focus group approach. Complement Ther Clin Pract 2019; 34:153-156. [DOI: 10.1016/j.ctcp.2018.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/29/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
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Hampson N, King L, Eriksson LM, Smee H. The effects of relaxation training on depression and anxiety in people living with long-term neurological conditions. Disabil Rehabil 2019; 42:2100-2105. [PMID: 30653375 DOI: 10.1080/09638288.2018.1554009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Purpose: The present study investigated the effects of a relaxation training program on self-reported depression and anxiety in participants living with long-term neurological conditions, including acquired brain injury, stroke, Parkinson's disease, and multiple sclerosis.Materials and methods: A five-session relaxation training program, plus a follow-up session was offered to people living with a long-term neurological condition as part of routine clinical practice, and was delivered in their own homes. A self-report measure (Hospital Anxiety and Depression Scale) was administered at the pre- and post-intervention time points and at follow-up, around 5 weeks after the final session. Participants also completed an individual assessment of change questionnaire at follow-up, reporting on subjective views of observed changes.Results: Statistically significant improvements were found on measures of both anxiety and depression following completion of the relaxation program. Scores at follow-up (mean = 5 weeks) revealed the improvement was maintained for anxiety, and there was further significant improvement for depression. Reliable change analyses from pre- to post-intervention demonstrated a clinically significant decrease in anxiety scores for 47% of participants and in depression scores for 30% of participants. No clinically significant increase in depression and anxiety was identified from pre- to post-intervention, and this was generally maintained at follow-up.Conclusion: Relaxation training is proposed as a clinically effective treatment for anxiety and depression in people living with long-term neurological conditions, which could in turn lead to better functional outcomes of neurorehabilitation. The program investigated here has additional benefits of being delivered in people's own homes, which overcomes barriers to attending hospital, and is consistent with trends towards home as opposed to hospital care. This program may also be less costly to administer as it can be delivered as part of a stepped-care program by therapy assistants under supervision from qualified staff, and encourages self-management over the longer term. Design limitations may reduce the generalisability of these findings, but are clinically encouraging and should stimulate further research.Implications for RehabilitationRelaxation training…• could be offered as an effective first-line intervention, as an alternative to medication to treat anxiety and depression to people living with Long-Term Neurological Conditionsis a self-management strategy which can be taught in people's own homes, if getting out of the house is difficultcan be delivered as a stepped-care intervention via therapy assistants, helping to reduce costs and demands on rehabilitation servicesmay help to improve the functional outcomes of wider rehabilitation interventions by addressing psychological issues which can be a barrier.
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Affiliation(s)
- Natalie Hampson
- Department of Paediatric Clinical Psychology, Sheffield Children's Hospital, Sheffield, UK
| | - Lorraine King
- Department of Clinical Neuropsychology, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Hannah Smee
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Vasudha MS, Manjunath NK, Nagendra HR. Changes in MIDAS, Perceived Stress, Frontalis Muscle Activity and Non-Steroidal Anti-Inflammatory Drugs Usage in Patients with Migraine Headache without Aura following Ayurveda and Yoga Compared to Controls: An Open Labeled Non-Randomized Study. Ann Neurosci 2018; 25:250-260. [PMID: 31000965 DOI: 10.1159/000492269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/19/2018] [Indexed: 01/03/2023] Open
Abstract
Background There has been a significant increase in the use of complementary and integrative medicine to provide long-term healing solutions in migraine headache patients. Knowing the limitations of conventional medical approach, the present study evaluated the influence of two Indian traditional systems of medicine on migraine-related disability, autonomic variables, perceived stress, and muscle activity in patients with migraine headache without aura. Methods Thirty subjects recruited to the Ayurveda and Yoga (AY) group underwent traditional Panchakarma (Bio-purification) using therapeutic Purgation followed by yoga therapy, while 30 subjects of control (CT) group continued on symptomatic treatment (non-steroidal anti-inflammatory drugs [NSAID's]) for 90 days. Migraine disability assessment score, perceived stress, heart rate variability (HRV), and surface electromyography (EMG) of frontalis muscle were measured on day 1, day 30, and day 90 in both groups. Results Significant reduction in migraine disability and perceived stress scores were observed in the AY group. The low-frequency component of the HRV decreased significantly, the high-frequency component increased and their ratio showed improved sympathovagal balance. The EMG showed decreased activity of the frontalis muscle in the AY group compared to the control group. Conclusion The integrative approach combining Ayurveda and Yoga therapy reduces migraine-related disability, perceived stress, sympathetic arousal, and muscle tension.
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Affiliation(s)
- M S Vasudha
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) A Deemed to be University, Bengaluru, India
| | - N K Manjunath
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) A Deemed to be University, Bengaluru, India
| | - H R Nagendra
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) A Deemed to be University, Bengaluru, India
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Sharif K, Watad A, Coplan L, Lichtbroun B, Krosser A, Lichtbroun M, Bragazzi NL, Amital H, Afek A, Shoenfeld Y. The role of stress in the mosaic of autoimmunity: An overlooked association. Autoimmun Rev 2018; 17:967-983. [PMID: 30118900 DOI: 10.1016/j.autrev.2018.04.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/04/2018] [Indexed: 12/22/2022]
Abstract
Stress is defined as the pscyophysiological reaction in which the steady state is disturbed or threatened. Stress is not always perceived as a negative response. Stress results when environmental demands exceed an individuals' adaptive capacities. Autoimmune diseases are heterogeneous group of chronic diseases which occur secondary to loss of self antigen tolerance. The etiopathogenesis of autoimmune disease is uncertain. Genetic factors as well as environmental factors appear to interplay, leading to a cascade of events resulting in disease onset. Stress has been postulated to play a role in disease onset in the genetically susceptible patients. During the stress response, catecholamines and glucocorticoids are released from locus coeruleus and adrenal gland. These biomolecules exert control over various immune cells in the innate and adaptive arms of the immune system, thereby altering the cytokine profile released. The increase of IL-4 promotes T-helper 2 (Th2) cell differentiation, while the decrease in IL-12 and the increased IL-10 production reduce the number of T-helper 1 (Th1) cells. The relationship between stress and autoimmune diseases is intricate. Stress has been shown to be associated with disease onset, and disease exacerbations in rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, multiple sclerosis, Graves' disease as well as other autoimmune conditions. In certain conditions such as psoriasis, stress has been implicated in delaying lesion clearance upon the application of standard treatment regimes. Finally, psychological therapy and cognitive behavioral therapy aimed to reduce stress levels was shown to be effective in influencing better outcomes in many autoimmune diseases. The purpose of this paper is to closer inspect the clinical evidence regarding the role of stress on influencing the various aspects of disease entities.
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Affiliation(s)
- Kassem Sharif
- Department of Medicine 'B', Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Abdulla Watad
- Department of Medicine 'B', Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Louis Coplan
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Alec Krosser
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Nicola Luigi Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Howard Amital
- Department of Medicine 'B', Israel; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arnon Afek
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Tel-Aviv University, Head of The Mosaic of Autoimmunity Project, Saint Petersburg State University, Israel; Head of The Mosaic of Autoimmunity Project, Saint Petersburg State University, Russia.
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Kanhere SV, Bagadia DR, Phadke VD, Mukherjee PS. Yoga in Children with Epilepsy: A Randomized Controlled Trial. J Pediatr Neurosci 2018; 13:410-415. [PMID: 30937081 PMCID: PMC6413605 DOI: 10.4103/jpn.jpn_88_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Context: Majority of epilepsy begins in childhood. Twenty to thirty percent of patients may not respond to antiepileptic drugs. Yoga as a complementary therapy has been found to be beneficial in adults, but has not yet been studied in children with epilepsy. Aim: To study the effect of yoga on seizure and electroencephalogram (EEG) outcome in children with epilepsy. Setting and Design: A randomized controlled trial was conducted in the pediatric neurology outpatient department of a tertiary care teaching hospital. Materials and Methods: Twenty children aged 8–12 years with an unequivocal diagnosis of epilepsy on regular antiepileptic drugs were enrolled. Yoga therapy was provided to 10 children (study group) and 10 children formed the control group. Yoga therapy was given as 10 sessions of 1h each. We compared seizure frequency and EEG at baseline, 3, and 6 months. Statistical analysis was carried out using standard statistical tests. A P value of <0.05 was considered significant. Results: No children had seizures at the end of 3 and 6 months in the study group. In the control group, at 3 and 6 months, four and three children, respectively, had seizures. Eight children each in both the groups had an abnormal EEG at enrollment. At the end of 6 months, one EEG in the study group and seven in the control group were abnormal (P = 0.020). Conclusion: Yoga as an additional therapy in children with epilepsy leads to seizure freedom and significant improvement in EEG at 6 months.
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Affiliation(s)
- Sujata V Kanhere
- Department of Pediatrics, K. J. Somaiya Medical College and Research Centre, Mumbai, Maharashtra, India
| | - Deepak R Bagadia
- K. J. Somaiya Bharatiya Sanskriti Peetham, Mumbai, Maharashtra, India
| | - Varsha D Phadke
- Department of Pediatrics, K. J. Somaiya Medical College and Research Centre, Mumbai, Maharashtra, India
| | - Priyashree S Mukherjee
- Department of Pediatrics, K. J. Somaiya Medical College and Research Centre, Mumbai, Maharashtra, India
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Abstract
BACKGROUND Stroke is a major health issue and cause of long-term disability and has a major emotional and socioeconomic impact. There is a need to explore options for long-term sustainable interventions that support stroke survivors to engage in meaningful activities to address life challenges after stroke. Rehabilitation focuses on recovery of function and cognition to the maximum level achievable, and may include a wide range of complementary strategies including yoga.Yoga is a mind-body practice that originated in India, and which has become increasingly widespread in the Western world. Recent evidence highlights the positive effects of yoga for people with a range of physical and psychological health conditions. A recent non-Cochrane systematic review concluded that yoga can be used as self-administered practice in stroke rehabilitation. OBJECTIVES To assess the effectiveness of yoga, as a stroke rehabilitation intervention, on recovery of function and quality of life (QoL). SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched July 2017), Cochrane Central Register of Controlled Trials (CENTRAL) (last searched July 2017), MEDLINE (to July 2017), Embase (to July 2017), CINAHL (to July 2017), AMED (to July 2017), PsycINFO (to July 2017), LILACS (to July 2017), SciELO (to July 2017), IndMED (to July 2017), OTseeker (to July 2017) and PEDro (to July 2017). We also searched four trials registers, and one conference abstracts database. We screened reference lists of relevant publications and contacted authors for additional information. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared yoga with a waiting-list control or no intervention control in stroke survivors. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from the included studies. We performed all analyses using Review Manager (RevMan). One review author entered the data into RevMan; another checked the entries. We discussed disagreements with a third review author until consensus was reached. We used the Cochrane 'Risk of bias' tool. Where we considered studies to be sufficiently similar, we conducted a meta-analysis by pooling the appropriate data. For outcomes for which it was inappropriate or impossible to pool quantitatively, we conducted a descriptive analysis and provided a narrative summary. MAIN RESULTS We included two RCTs involving 72 participants. Sixty-nine participants were included in one meta-analysis (balance). Both trials assessed QoL, along with secondary outcomes measures relating to movement and psychological outcomes; one also measured disability.In one study the Stroke Impact Scale was used to measure QoL across six domains, at baseline and post-intervention. The effect of yoga on five domains (physical, emotion, communication, social participation, stroke recovery) was not significant; however, the effect of yoga on the memory domain was significant (mean difference (MD) 15.30, 95% confidence interval (CI) 1.29 to 29.31, P = 0.03), the evidence for this finding was very low grade. In the second study, QoL was assessed using the Stroke-Specifc QoL Scale; no significant effect was found.Secondary outcomes included movement, strength and endurance, and psychological variables, pain, and disability.Balance was measured in both studies using the Berg Balance Scale; the effect of intervention was not significant (MD 2.38, 95% CI -1.41 to 6.17, P = 0.22). Sensititivy analysis did not alter the direction of effect. One study measured balance self-efficacy, using the Activities-specific Balance Confidence Scale (MD 10.60, 95% CI -7.08,= to 28.28, P = 0.24); the effect of intervention was not significant; the evidence for this finding was very low grade.One study measured gait using the Comfortable Speed Gait Test (MD 1.32, 95% CI -1.35 to 3.99, P = 0.33), and motor function using the Motor Assessment Scale (MD -4.00, 95% CI -12.42 to 4.42, P = 0.35); no significant effect was found based on very low-grade evidence.One study measured disability using the modified Rankin Scale (mRS) but reported only whether participants were independent or dependent. No significant effect was found: (odds ratio (OR) 2.08, 95% CI 0.50 to 8.60, P = 0.31); the evidence for this finding was very low grade.Anxiety and depression were measured in one study. Three measures were used: the Geriatric Depression Scale-Short Form (GCDS15), and two forms of State Trait Anxiety Inventory (STAI, Form Y) to measure state anxiety (i.e. anxiety experienced in response to stressful situations) and trait anxiety (i.e. anxiety associated with chronic psychological disorders). No significant effect was found for depression (GDS15, MD -2.10, 95% CI -4.70 to 0.50, P = 0.11) or for trait anxiety (STAI-Y2, MD -6.70, 95% CI -15.35 to 1.95, P = 0.13), based on very low-grade evidence. However, a significant effect was found for state anxiety: STAI-Y1 (MD -8.40, 95% CI -16.74 to -0.06, P = 0.05); the evidence for this finding was very low grade.No adverse events were reported.Quality of the evidenceWe assessed the quality of the evidence using GRADE. Overall, the quality of the evidence was very low, due to the small number of trials included in the review both of which were judged to be at high risk of bias, particularly in relation to incompleteness of data and selective reporting, and especially regarding the representative nature of the sample in one study. AUTHORS' CONCLUSIONS Yoga has the potential for being included as part of patient-centred stroke rehabilitation. However, this review has identified insufficient information to confirm or refute the effectiveness or safety of yoga as a stroke rehabilitation treatment. Further large-scale methodologically robust trials are required to establish the effectiveness of yoga as a stroke rehabilitation treatment.
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Affiliation(s)
- Maggie Lawrence
- Glasgow Caledonian UniversityDepartment of Nursing and Community Health, School of Health and Life SciencesA101f, Govan Mbeki BuildingGlasgowUKG4 0BA
| | - Francisco T Celestino Junior
- Glasgow Caledonian UniversitySchool of Health and Life SciencesCaledonian Court, Dundas 3‐4Dobbies LoanGlasgowUKG4 0JF
| | - Hemilianna HS Matozinho
- Glasgow Caledonian UniversitySchool of Health and Life SciencesCaledonian Court, Dundas 3‐4Dobbies LoanGlasgowUKG4 0JF
| | - Lindsay Govan
- University of GlasgowHealth Economics and Health Technology Assessment, Institute of Health and Wellbeing1 Lilybank GardensGlasgowUKG12 8RZ
| | - Jo Booth
- Glasgow Caledonian UniversityDepartment of Health & Community SciencesCowcaddens RoadGlasgowUKG4 0BA
| | - Jane Beecher
- Queen Elizabeth University HospitalRotational Physiotherapy1345 Govan RoadGovanGlasgowUKG51 4TF
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Mooventhan A, Nivethitha L. Evidence based effects of yoga in neurological disorders. J Clin Neurosci 2017; 43:61-67. [DOI: 10.1016/j.jocn.2017.05.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/22/2017] [Indexed: 12/13/2022]
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Ulanowski EA, Danzl M, Schwartz V, Reed C. A qualitative examination of physiotherapist led community-based yoga for individuals with Huntington's disease. Complement Ther Clin Pract 2017; 28:146-151. [PMID: 28779922 DOI: 10.1016/j.ctcp.2017.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study is to examine community-based yoga, led by a physiotherapist, for individuals affected by Huntington's disease (HD). METHODS Qualitative case study methodology was used to examine the Hatha yoga led by a certified yoga instructor who was a neurologic physiotherapist. Data collection included participant observations, semi-structured interviews with the instructor, and structured participant surveys. Data were coded and thematically analyzed. Strategies for rigor included field engagement, triangulation, member checks, and reflexivity. OUTCOMES Five major themes emerged regarding the value and role of yoga for individuals affected by HD: [1] Emphasis on mindfulness, [2] Yoga is modifiable and accessible, [3] Precise communication, [4] Yoga fosters a sense of community, and [5] Poses tailored to HD-specific deficits. CONCLUSIONS Yoga led by a physiotherapist can be tailored to enable participation by those affected by HD, addresses HD-specific deficits, and promotes a sense of community to supplement traditional physiotherapy.
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Affiliation(s)
- Elizabeth A Ulanowski
- Doctor of Physical Therapy Program, School of Movement and Rehabilitation Sciences, College of Health Professions, Bellarmine University, 2001 Newburg Road, Louisville, KY, 40205, USA.
| | - Megan Danzl
- Doctor of Physical Therapy Program, School of Movement and Rehabilitation Sciences, College of Health Professions, Bellarmine University, 2001 Newburg Road, Louisville, KY, 40205, USA
| | - Victoria Schwartz
- Doctor of Physical Therapy Program, School of Movement and Rehabilitation Sciences, College of Health Professions, Bellarmine University, 2001 Newburg Road, Louisville, KY, 40205, USA
| | - Chelsea Reed
- Doctor of Physical Therapy Program, School of Movement and Rehabilitation Sciences, College of Health Professions, Bellarmine University, 2001 Newburg Road, Louisville, KY, 40205, USA
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Kakde N, Metri KG, Varambally S, Nagaratna R, Nagendra HR. Development and validation of a yoga module for Parkinson disease. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2017; 14:/j/jcim.ahead-of-print/jcim-2015-0112/jcim-2015-0112.xml. [PMID: 28343166 DOI: 10.1515/jcim-2015-0112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/17/2017] [Indexed: 11/15/2022]
Abstract
Background Parkinson's disease (PD), a progressive neurodegenerative disease, affects motor and nonmotor functions, leading to severe debility and poor quality of life. Studies have reported the beneficial role of yoga in alleviating the symptoms of PD; however, a validated yoga module for PD is unavailable. This study developed and validated an integrated yoga module(IYM) for PD. Methods The IYM was prepared after a thorough review of classical yoga texts and previous findings. Twenty experienced yoga experts, who fulfilled the inclusion criteria, were selected validating the content of the IYM. A total of 28 practices were included in the IYM, and each practice was discussed and rated as (i) not essential, (ii) useful but not essential, and (iii) essential; the content validity ratio (CVR) was calculated using Lawshe's formula. Results Data analysis revealed that of the 28 IYM practices, 21 exhibited significant content validity (cut-off value: 0.42, as calculated by applying Lawshe's formula for the CVR). Conclusions The IYM is valid for PD, with good content validity. However, future studies must determine the feasibility and efficacy of the developed module.
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Agarwal D, Gupta PP, Sood S. Assessment for Efficacy of Additional Breathing Exercises Over Improvement in Health Impairment Due to Asthma Assessed using St. George's Respiratory Questionnaire. Int J Yoga 2017; 10:145-151. [PMID: 29422745 PMCID: PMC5793009 DOI: 10.4103/0973-6131.213472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Breathing exercises have been described to be useful in asthma management by few researchers in the past. Objective: To assess the efficacy of breathing exercises (Pranayamas) added to regular optimal medications in asthma patients in improving health impairment using St. George's Respiratory Questionnaire (SGRQ). Methods: Sixty stable asthma patients (34 females) receiving optimal treatment at our institute for 3 months or more as per the Global Initiative for Asthma guidelines were included in the study. They performed seven breathing exercises under supervision at yoga center of our institute for 3 months in addition to their regular medications. SGRQ (1 month symptoms version) was used to assess the quality of life before and after breathing exercises intervention for following subsets: Symptom score, activity score, impact score, and total score to assess the efficacy of breathing exercises. Results: Of 60 asthma patients, 34 were females and 26 were males, and their mean age was 25.45 ± 5.41 years. Their baseline spirometric values were as follow: Forced expiratory volume in 1 s (FEV1) - 2.492 ± 0.358 L and peak expiratory flow rate (PEFR) - 283.82 ± 51.12 L/min. The SGRQ scores after breathing exercises intervention decreased from 45.98 ± 5.61 to 38.78 ± 4.92 for symptom subset, from 15.45 ± 3.33 to 12.34 ± 2.39 for activity subset, from 17.95 ± 4.22 to 12.12 ± 3.82 for impact subset, and from 25.83 ± 8.31 to 19.20 ± 7.09 for total scores. All these reductions were statistically highly significant (P < 0.001). Decrease in symptoms, activity, and total SGRQ scores each was significantly correlated with FEV1, FEV1/forced vital capacity (FVC) ratio, and PEFR; decrease in impact score was significantly related only with FEV1/FVC ratio. Conclusions: Breathing exercises significantly decreased all component scores of SGRQ, signifying a global improvement in health impairment due to asthma; this improvement was in addition to that was achieved with optimal asthma therapy alone.
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Affiliation(s)
- Dipti Agarwal
- Department of Physiology Postgraduate Institute of Medical Sciences, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Prem Parkash Gupta
- Department of TB and Respiratory Medicine, Postgraduate Institute of Medical Sciences, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Sushma Sood
- Department of Physiology Postgraduate Institute of Medical Sciences, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India
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Nikolaev EL, Poluektov MG, Vasil'eva NV, Golenkov AV. Psychotherapy in treatment and rehabilitation of patients with multiple sclerosis. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:132-140. [DOI: 10.17116/jnevro2017117121132-140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Rogers KA, MacDonald M. Therapeutic Yoga: Symptom Management for Multiple Sclerosis. J Altern Complement Med 2015; 21:655-9. [PMID: 26270955 DOI: 10.1089/acm.2015.0015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Multiple sclerosis (MS) is the most common autoimmune inflammatory demyelinating disease of the central nervous system, affecting over 2.3 million people worldwide. According to the National Institute of Neurological Disorders and Stroke, the age of disease onset is typically between 20 and 40 years, with a higher incidence in women. Individuals with MS experience a wide range of symptoms, including declining physical, emotional, and psychological symptoms (e.g., fatigue, imbalance, spasticity, chronic pain, cognitive impairment, bladder and bowel dysfunction, visual and speech impairments, depression, sensory disturbance, and mobility impairment). To date, both the cause of and cure for MS remain unknown. In recent years, more individuals with MS have been pursuing alternative methods of treatment to manage symptoms of the disease, including mind-body therapies such as yoga, meditation, breathing, and relaxation techniques. It has been suggested that the practice of yoga may be a safe and effective way of managing symptoms of MS. Therefore, the purpose of this paper is to summarize the most relevant literature on exercise and mind-body modalities to treat MS symptoms and, more specifically, the benefits and potential role of yoga as an alternative treatment of symptom management for individuals with MS. The article also discusses future directions for research.
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Affiliation(s)
- Kim A Rogers
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University , Corvallis, OR
| | - Megan MacDonald
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University , Corvallis, OR
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Frank R, Larimore J. Yoga as a method of symptom management in multiple sclerosis. Front Neurosci 2015; 9:133. [PMID: 25983675 PMCID: PMC4415403 DOI: 10.3389/fnins.2015.00133] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 04/01/2015] [Indexed: 11/17/2022] Open
Abstract
Multiple Sclerosis (MS) is an immune-mediated process in which the body's immune system damages myelin in the central nervous system (CNS). The onset of this disorder typically occurs in young adults, and it is more common among women. Currently, there is no cure and the long-term disease progression makes symptomatic management critical for maintaining quality of life. Several pharmacotherapeutic agents are approved for treatment, but many patients seek complementary and alternative interventions. Reviews have been conducted regarding broad topics such as mindfulness-based interventions for people diagnosed with MS and the impact of yoga on a range of neurological disorders. The objective of the present review is to examine the potential benefits of yoga for individuals with MS and address its use in managing symptoms including pain, mental health, fatigue, spasticity, balance, bladder control, and sexual function.
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Affiliation(s)
- Rachael Frank
- Department of Biology and Neuroscience Program, Agnes Scott College Decatur, GA, USA
| | - Jennifer Larimore
- Department of Biology and Neuroscience Program, Agnes Scott College Decatur, GA, USA
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González-González L, Pérez-Cortéz JG, Flores-Aldana M, Macías-Morales N, Hernández-Girón C. [Antioxidant use as dietary therapy in patients with multiple sclerosis]. Medwave 2015; 15:e6065. [PMID: 25629306 DOI: 10.5867/medwave.2015.01.6065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 12/22/2014] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Multiple sclerosis is an immune-mediated disease that produces chronic inflammation and neural degeneration. The disease progresses with acute attacks that result in myelin inflammation. This in turn increases oxidative stress and favors the appearance of reactive oxygen species. Reactive oxygen species damage neural cells causing apoptosis. The etiology of multiple sclerosis remains unknown and current therapy is aggressive and expensive. Recently, complementary and alternative medicine therapies have been proposed to control pathogenesis and symptoms of this disease. It is believed that these therapies help slow the progression of multiple sclerosis and improve survival. METHODS We conducted a MEDLINE/PubMed search using the following MeSH terms: diet, multiple sclerosis, antioxidants. We selected the main articles containing multiple sclerosis and diet. RESULTS We analyzed three case control studies that evaluated different dietary approaches in multiple sclerosis. For this review, we also included five experimental studies that studied the efficacy of lipoic acid in humans and rodents in diseases like multiple sclerosis, experimental autoimmune encephalomyelitis, and breast cancer.
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Affiliation(s)
- Laura González-González
- Escuela de Nutrición, Universidad Latinoamericana, Cuernavaca, México. Address: Av. Universidad N°. 655, CP 62100, Cuernavaca, Morelos, México.
| | | | - Mario Flores-Aldana
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Nayeli Macías-Morales
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Carlos Hernández-Girón
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
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Pan Y, Yang K, Wang Y, Zhang L, Liang H. Could yoga practice improve treatment-related side effects and quality of life for women with breast cancer? A systematic review and meta-analysis. Asia Pac J Clin Oncol 2015; 13:e79-e95. [PMID: 25560636 DOI: 10.1111/ajco.12329] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 11/27/2022]
Abstract
AIM To determine if yoga as a complementary and alternative therapy was associated with enhanced health and treatment-related side effects in patients with breast cancer. This systematic review examines whether yoga practice provides any measurable benefit, both physically and psychologically, for women with breast cancer. METHODS PubMed, EMBASE and the Cochrane Library for randomized controlled trials (RCTs) throughout June 2013. We evaluated the quality of the included studies by the Cochrane Handbook 5.2 standards and analyzed the data using the Stata software, version 10.0. Meta-regression and subgroup analysis were also performed to identify additional predictors of outcome and to assess heterogeneity. RESULTS Sixteen RCTs with a total of 930 participants were included. Comparing yoga groups to control groups, there was a statistically significant difference in overall health-related quality of life, depression, anxiety and gastrointestinal symptoms. Meta-regression analyses revealed that the duration of yoga practice and type of control group partly explained the heterogeneity. Subgroup analyses revealed that yoga had a positive effect on anxiety only when it had been practiced for longer than 3 months. Only the wait-list control group showed an effect of yoga on physical well-being. CONCLUSION The current evidence demonstrates that yoga practice could be effective in enhancing health and managing some treatment-related side effects for patients recovering from breast cancer. In future clinical studies, clinicians should consider the patient's wishes along with the current best evidence of the effects of yoga practice in their clinical decision-making.
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Affiliation(s)
- Yuanqing Pan
- Department of Medical Psychology, Lanzhou University, Lanzhou, Gansu, China
| | - Kehu Yang
- Evidence-Based Medicine Center, Key Laboratory of Clinical Translational Research and Evidence-Based Medicine of Gansu Province, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Yuliang Wang
- Department of Orthopaedic Surgery, the 2nd Hospital of Lanzhou University, Lanzhou, Gansu, China
| | | | - Haiqing Liang
- Department of Neurosurgery, the Affiliated Hospital of Logistics University of CAPF, Tianjin, China
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Namjooyan F, Ghanavati R, Majdinasab N, Jokari S, Janbozorgi M. Uses of complementary and alternative medicine in multiple sclerosis. J Tradit Complement Med 2014; 4:145-52. [PMID: 25161918 PMCID: PMC4142451 DOI: 10.4103/2225-4110.136543] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic, disabling, recurrent demyelination of the central nervous system (CNS). It could affect different regions in the brain and spinal cord, and according to the domain which is affected, it could cause different symptoms such as motor, sensory, or visual impairment; fatigue; bowel, bladder, and sexual dysfunction; cognitive impairment; and depression. MS patients also face reduced quality of life. Drugs that are used in MS are not fully efficient and patients suffer from many symptoms and adverse effects. Today there is an increasing trend of using complementary and alternative medicine (CAM). People are more likely to use this type of treatment. Using appropriate lifestyle and CAM therapy can subside some of the symptoms and could improve the quality of life in these patients. Many people with MS explore CAM therapies for their symptoms. This review is aimed to introduce CAM therapies that could be used in MS patients.
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Affiliation(s)
- Foroogh Namjooyan
- Department of Pharmacognosy, Marine Natural Pharmaceutical Research Center, School of Pharmacy, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Rahil Ghanavati
- Department of Traditional Pharmacy, School of Pharmacy, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nastaran Majdinasab
- Department of Neurology, School of Medicine, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shiva Jokari
- Jundishapur University of Medical Sciences, Arvand International Branch, Abadan, Iran
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Muhammad CM, Moonaz SH. Yoga as Therapy for Neurodegenerative Disorders: A Case Report of Therapeutic Yoga for Adrenomyeloneuropathy. Integr Med (Encinitas) 2014; 13:33-39. [PMID: 26770098 PMCID: PMC4684133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Yoga is a promising therapeutic modality for neurodegenerative diseases. This case study presents a therapeutic yoga protocol for adrenomyeloneuropathy (AMN) and its effect on a patient's quality of life (QOL), agility, balance, and peripheral dexterity. A 61-y-old man diagnosed with AMN who was experiencing (1) peripheral neuropathy in his legs and feet, (2) lower-back pain (LBP), and (3) osteoarthritis received 60-min weekly therapeutic yoga sessions for a 10-mo period. Yoga therapy included hatha yoga asanas (poses) and pranayama (breathing exercises). Hatha yoga asanas were aligned with 7 Berg Balance Scale (BBS) indicators to measure improvement in balance and range of motion. The 10-mo course of therapeutic yoga resulted in improved LBP; improved flexion of the patient's hips, knees, and ankles; improved propulsion phase of walking; and improvement in the patient's ability to stand and balance without an assistive device. The effect of yoga therapy on the patient in this case study aligns with current QOL improvements noted in current research on yoga therapy for neurological disorders. The described concepts and methods of employing therapeutic yoga provide insights for clinicians into a modality that is low risk and low cost and that can support individuals with other neurological disorders, such as multiple sclerosis (MS), fibromyalgia (FM), and diseases of the peripheral nervous system. Further study is warranted to help determine the safety and efficacy of yoga therapy for these conditions.
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Use of Complementary and Alternative Medicine in Treating Individuals with Traumatic Brain Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-013-0019-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Affiliation(s)
- Arvind Kankane
- Department of Neurology, Maharani Laxmibai Medical College Jhansi, Uttar Pradesh, India,For correspondence: Dr. Arvind Kankane, Asst. Professor, Department of Neurology, Maharani Laxmibai Medical College, Jhansi, Uttar Pradesh - 284 128, India. E-mail:
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