At Cathy Rees' yoga class, you won't see anyone attempt a downward-facing dog — many participants are in wheelchairs, and almost all of them suffer from dementia.
Instead, Rees has adapted the principles of yoga, which aims to align the body's seven chakras, or points of energy, to the abilities of the residents of Copper Ridge, a center for dementia care in Sykesville.
Her yoga class, now in its fourth month, is an experiment of sorts. A handful of studies have suggested that yoga can be used to improve the overall physical and mental well-being of dementia patients, so Rees wants to craft a dementia-specific yoga program that can be studied and refined by researchers.
"This whole thing, in my mind, is kind of groundbreaking," said Rees, a certified yoga teacher.
On a recent Wednesday morning, Rees greeted her dozen class members individually in a sunny lounge at Copper Ridge. "Hi, Carol, good to see you today," said Rees, rubbing the woman's back. "There's that beautiful smile."
Rees doesn't hesitate to break the rules of yoga; last week, the group danced to 1940s jazz to open one of the chakras.
In more traditional exercises, patients moved their shoulders in circular motions, stretched their fingers and coordinated their breath with movement.
Even when she talks about chakras, Rees is focused on concrete results. "I like to do things that are research- and evidence-based," she said.
Rees and her colleague Sherry Healy, director of the Community Center for Health and Wellness at Copper Ridge, said they hope to present a yoga program for dementia to researchers at the Copper Ridge Institute, the center's research arm, by the fall. The institute, affiliated with the Johns Hopkins University School of Medicine, could further refine the program and publish research within a few years, she said.
Rees added that researchers face the challenge of not being able to get reliable results by simply asking patients how the yoga makes them feel. Instead, "you have to observe and compare their behavior before and after the yoga," she said.
During her class, Rees switched seamlessly between leading the group and working with individuals. Taking hold of their hands, she engaged their fingers and arms in circular motions.
"This is crazy," said Warren Kendig, smiling.
Before, Kendig was slumped over and holding his head in his arms. After Rees coaxed him to move his arms in circles, he straightened his posture and looked around as if he had awakened from a nap.
When the group sang "This Land Is Your Land," Kendig harmonized and imitated a trombone.
To engage dementia patients the way Rees does is a victory, Healy said.
"What you have to understand is that a lot of these people have attention spans of about three seconds," she said.
While the yoga clicked for some patients, others drifted off, their heads falling to their chests.
A 2014 study by researchers at Teesside University in England reported improvements in the physical and mental health of dementia patients who participated in an exercise program that included yoga and meditation. Dementia is not itself an illness but a set of symptoms that includes memory loss, personality changes, and loss of cognitive and emotional control, according to the National Institute of Neurological Disorders and Stroke. Yoga is already a well-established treatment for anxiety disorders and depression, Rees said.
Nancy McPartland, a psychotherapist at the University of Maryland Center of Integrative Medicine, uses yoga to treat mental health issues like anxiety, depression and addiction. McPartland said her work at the center involves "trying to find the proof for everyone else for what [yoga practitioners] already know" — that yoga therapy works.
McPartland said yoga keeps people focused on the present moment. "It's a moving meditation."