A Case Study Supporting Medical Therapeutic Yoga for Geriatric Rehabilitation and Wellness
This week we are speaking with Rebecca Meehan, PT, WCS, PYT-C, co-founder and owner of Embody Physiotherapy and Wellness. She enthusiastically talks about how Medical Therapeutic Yoga (MTY) improves quality of life in older adults, even after many years and habits of leading a more sedentary lifestyle. Rebecca recently presented a case study, which we highlight below, in July 2016 at the Exercise and Physical Activity in Aging Conference II: Blending Research and Practice. Her case study exemplifies such encouraging outcomes.
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Rebecca, tell us what prompted you to carry out this case study of medical therapeutic yoga in geriatric wellness.
This case study began when the Physical Therapy (PT) program at Chatham University in Pittsburgh asked me to speak with students about “Wellness Through the Lifecycle”. I focused on the “geriatric” phase. I hoped to make several points to the students and the PTs in attendance. First, we should not decide that someone is “too old” to do a program, has “too many health problems,” or that because of orthopedic problems and postural changes, we cannot make positive changes in their life. This individual in my case study is proof of that! I also feel strongly that working with people of different ages can have an impact on their friends and family in different life stages (grandparents and grandchildren for instance). This case study was a great example of encouraging ways to create movement and wellness changes.
You and your patient together have achieved great results! What, if anything, in your findings surprised you?
I think that she was more surprised than I was! She truly felt like she could not make positive and lasting changes. I was unsure, initially, how she would “stick” to the classes and the work as it was somewhat outside of her comfort zone. She is now a big proponent!
In the introduction the patient states, “she felt all of her problems were due to “age” and “arthritis” and that "little could be done without medication or surgery”. Do you find this mentality common with other geriatric patients? How, as health care providers (HCPs), do we go about changing that preconceived mentality?
Sadly, we do hear this a lot from clients, and even more sadly from other HCPs. Certainly, pharma and our mentality of “a pill for everything”, and “what do you expect as you age?” is a negative. I think that we must continue to speak loudly and persistently about the benefits of healthy moving, strength, and balance. Sometimes (ok, often), people think that it is too slow and too “hard”. I like to talk about how we are progressing, layering, and building their abilities and thus their health too.
Talk more about the patient’s level in confidence change over her course of treatment.
As so many people who are not “athletes” do believe, she was unsure of herself in a class setting. “What if i can’t keep up?” she would say. This has improved. Her sense of being able to make changes within her own health (diet and weight loss) has also improved. She also enjoys being out and moving more. Let’s be realistic, if it does not feel good to walk or ride a bike, or you worry about your balance, you don’t aren't going to do it (and she just got a lovely new bike!). I think that her confidence shines in the way she carries herself and in her clothing choices as well. She will never want to be the center of attention, but she does not shy away like she did before.
I love your discussion question. PTs as integrative healthcare providers: How do we bridge rehab and wellness? What are your thoughts on this?
The insurance model places physical therapy as a rehab approach rather than a proactive/preventive approach. If PTs work within that model, they do not look past 6-8 weeks. The APTA (American Physical Therapy Association) is beginning to go back to PT as a holistic and preventive movement specialty. However, we have given much of the non-rehab to “trainers” and yoga and pilates instructors. Some of these instructors are quite good, but many are not. We (physical therapists) need to look at what we have to offer in the full spectrum of prevention, health, wellness, rehab, and beyond. I guess speak loudly and carry big sticks?
What are your big take aways or “ah-ha’s” from this case study? How do you plan to apply that to your clinical practice?
Our standard range of motion/muscle strength documentation does not tell us enough. With this particular population, we need to better and more consistently measure thoracic kyphosis, considering photos for better before and after. This is a good example of the need to use functional movement evaluation, Professional Yoga Therapy diagnostic algorithms, and client outcome forms for evaluation and re-checks. Making our evals functional demonstrates real change to the client and to other healthcare professionals as well.
Also, it's important to think outside of the injury/rehab box and look at prevention. One of the things that I think really spoke to S. the first time I evaluated her was my concern for her pre-diabetes and very sedentary lifestyle. She did not feel that her job responsibilities allowed her to increase her daily movement (too disruptive to stand up every 30 min and move). But when I discussed with her the research for diabetes and the impact of movement, a light went off, and she did it..not for the sake of her back, but for her diabetes (even though it certainly benefitted her back).
We also need to ask what it is that THEY want to do or can’t do now. Decreasing back pain isn’t good enough if they still aren't able to play the flute for 2 hrs without pain, or can’t get up and down from the floor. This means spending time speaking with and getting to know the individual and learning exactly what their expectations are.
In your experience, what are the biggest barriers geriatric patients face in incorporating a yoga therapy centered approach into their rehab and wellness journeys? What trends have you observed for your geriatric patients for which you utilize MTY?
All clients, but especially older clients, are often told what they “should not do”, or that if they do yoga, "no bends, twists, and stick with chairs". We need to individualize programs and scale them for our clients of all ages. Studio programs for older folks tend to go “gentle”, and gym based programs are either not scaled down, or do so to the point of “silver sneakers”. Everyone deserves choices. We as clinicians need to remember that change IS POSSIBLE in the older client.
From a physical therapist’s perspective, what are some important considerations for someone age 65 years old+ who is currently sedentary and looking to improve their balance, stability, coordination, and functional movement abilities?
Have a good idea of where they are physically (PT wellness check up). Assess basic movement, balance, and breath (if you can’t breathe well, increasing activity of any sort is tough!) and then scale the activity up as needed.
How many times have we heard, “My doctor told me to start _____(name an activity)." Then they go out and walk 5 miles for the first time in a decade, are sore, and think “exercise is bad for me”. Alternatively, they go to a really basic “chairs class” and are bored. There is something for everyone. I think this is one of the reasons to speak to a movement specialist (ie. physical therapist) about where you are, where you want to be, and how you can picture yourself getting there. Working with someone in person (or even via the web as tele-medicine is becoming an option for many of us) to get started and then assist in progressing is a great way to begin and then stick with the program. We need to find creative ways to set individuals up for success!
It sounds like, based on the statistics, that a majority of the geriatric population would benefit from yoga! How does one safely and wisely begin to practice yoga, especially if they have any medical conditions and/or have been inactive for quite some time.
Same answer as above really. And this is where working within the framework of Medical Therapeutic Yoga, a Professional Yoga Therapist is great….combining the medical, physical, and mental, and educating on the entire biopsychosocial approach to wellness. I will say, that even as therapists, we need to be aware of the individual physiology and not to be afraid of progressing. It’s not all about being in chairs and doing “easy stuff”. Our bodies, brains, and spirit respond to scaled challenges. We need to build muscle and bone, or at a minimum prevent further loss, and create space and mobility. We need to encourage individuals who have been led to believe that they “can’t or shouldn’t” that they can move and live more fully- whatever that looks like to them!
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About Rebecca Meehan
Rebecca M. Meehan, PT, WCS, PYT-C
Rebecca received her Bachelor's Degree in Physical Therapy from the Medical College of Virginia, Virginia Commonwealth University in 1982. Her early practice focused on acute care, orthopedics, and sports medicine, and she began work with Women's Health in 1994. She is a board certified Women's Health Specialist, has completed the 3 levels of course work in Bones for Life, and is currently obtaining her certification and credentials as a Medical Therapeutic Yoga provider and practitioner through the Professional Yoga Therapy Institute. Rebecca has a strong interest in Wellness and Prevention and utilizes Medical Therapeutic Yoga in those areas. She utilizes hands on and manual techniques along with movement and strength techniques when working with clients post injury or illness.
In addition to working with PT and other students, she teaches in the community. Rebecca is an active participant with the Birthworkers of Western PA, the APTA, the Section on Women's Health, and the PPTA, has participated in numerous local organizations, and is a mentor with Nurture PA, a mom to mom mentoring program. Rebecca enjoys traveling and spending time with family and friends, and uses gardening and cooking as "therapy".