An Exercise in Communication for People with Parkinson's
Studies indicate that yoga is beneficial as a complimentary intervention in an individual’s management of motor as well as non-motor symptoms of Parkinson’s disease (PD).(1)
Results support that yoga practice – particularly when designed for people with PD – eases such symptoms as:
• slow movement in the body (bradykinesia)
• stiff movement in the body (rigidity)
• sleep disturbances and anxiety
and provides “improved overall fitness and quality of life.”2 The basis of practicing yoga practice is awareness. Paired with movement, the effects of both are felt primarily in the body (spine, torso, extremities). Yoga practice for PD combines a guided awareness of the body at rest and in motion with focused movement specific to PD. Benefits include improvement in gait, pace, transitioning between movements, posture and balance(3)
The motor symptoms of PD, however, also affect motion in the face. Bradykinesia and rigidity manifest as late-to-react expression or little to no facial movement. Facial “masking,” or immobility of the face, often causes misperceptions of inattentiveness or apathy. Overall health issues can also arise, such as teeth grinding, tension headaches, sleep disturbance.
Over time, symptoms can lead to a withdrawal from social interaction and decreased quality of life.(4)
Create a yoga practice for PD that eases motor symptoms in the face. Base it on what has shown to be beneficial in the body. Include:
• poses that are specific to the muscular makeup of actions of the face
• techniques that enhance awareness of positioning and motion in the face
• step-by-step cues
• connections to specific, related body poses • sequencing of breath work and movement to increase facial mobility.
To practice face yoga for PD, combine focused movement and guided awareness, as with (body) yoga for PD.
Awareness Bringing awareness to how the face moves requires additional means than the body since:
• the face contains more than 40 muscles (one leg contains 13)
• facial muscles are small
• some movement in the face is autonomic (or involuntary; the leg muscle action is voluntary)
• individuals cannot see the muscle-response action except for in reflection.
In addition, people living with PD often lose the sense of where the body is in the space, adding more difficulty in bringing awareness to these muscles. Tools that provide feedback that can help include:
• mirror • massage • repetition.
Poses and sequences involve some overall stretching and strengthening but focus on techniques specific to facial movement patterns of varying expressions. Face yoga practice can include:(5)
• warmups • poses • cues.
As with facial expressions – which at times involve the face only (for example, a quick smile or bit of doubt) and at times are connected to body movement (as with surprise or adoration) – some poses target the face while others are woven into the body yoga session
Exercise such as yoga has been shown to be helpful for people with Parkinson’s, particularly in motor symptoms in the body. Studies are beginning to connect PD’s facial muscle impairment to a negative impact on quality of life, particularly related to communication. Very few studies have been conducted to date on beneficial interventions. Applying a yoga approach has thus far received positive responses from people who have facial immobility among their Parkinson’s symptoms. Further study is needed.
1 Sharma, N. K., Robbins, K., Wagner, K., Colgrove, Y. M. A randomized controlled pilot study of the therapeutic effects of yoga in people with Parkinson’s disease. Int J Yoga (serial online). August 2015; 8:74-9.
2) Mehta, R. H., Barretto, M. The influence of Iyengar yoga on the quality of life of patients with Parkinson’s disease. Scientific Evidence of the Therapeutic Efficacy of Iyengar Yoga. Compilation: Parkinson’s disease and movement disorder society of India. 2012.
4. Gunnery, S. D., Tickle-Degnen, L. Decreased facial expressivity and stigma in people with Parkinson’s disease. Nonverbal pre-conference paper. February 2015.
5. Brach, J. S., Van Swearingen, J. M. Physical Therapy for Facial Paralysis: A Tailored Treatment Approach. PT Journal. April 1999; Vol 70: 4:397-404. 6. Bochnak, R. Behind the mask of Parkinson’s. Tufts Journal January 2010.
Argue, J. Parkinson’s Disease & the Art of Moving. CA (New Harbinger 2000); Hagen, A. The Yoga Face. London (Penguin 2007).