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."
As a form of meditation, yoga strengthens the prefrontal cortex, the area of the brain responsible for keeping anxiety and emotions in check.
McPartland added that the deep breathing and chanting involved in yoga cause fibers in the nose to release nitric oxide, which in turn activates a nerve that causes the body to relax.
"All that vibration is meaningful," Rees said of the breathing and singing in her class. "It activates different receptors and creates activity in the brain."
Rees isn't the first person to offer yoga to dementia patients. Keswick Multi-Care Center, an assisted living center in Baltimore, offers a yoga class for its residents, including those with dementia. But the program "didn't get a lot of traction," said CEO Carmel Roques.
Now Keswick is incorporating movement exercises into its brain health initiative for seniors living in St. Mary's Roland View Towers, a housing complex in Baltimore. The principle behind the initiative is that mental health requires physical health.
Teesside's 2014 study noted that yoga could also boost the psychological well-being of caregivers and reduce their stress-related pain. Rees said the caregivers of dementia patients — often their family members — are under enormous stress.
Healy runs a support group for patients' families that uses movement and physical touch as a way for them to connect to their relatives with dementia. Since talking becomes difficult as the symptoms worsen, Healy teaches family members "how to communicate 'I love you deeply' through movement," Rees said.
Rees has been a professional caregiver for the majority of her life; during her 30 years as a nurse, she worked in a shock trauma unit, a hospice for HIV patients and a women's health clinic, she said. But Rees never worked exclusively with dementia patients until she came to Copper Ridge.
Healy taught Rees to stoop to seated patients' eye level to engage with them. Other techniques, like using physical contact on the patients' upper bodies, came naturally "as a nurse and a mom," Rees said.
If research confirms that Rees' methods are effective, more dementia caregivers might experiment with using yoga. Healy said she and Rees want to offer the program to people outside Copper Ridge as soon as possible. But she added that "we really are still learning" precisely how yoga can help people with dementia.
At one of Rees' classes, a woman was experiencing what Healy called "extreme anxiety," talking unintelligibly, her expression distraught.
But after doing some of the yoga movements and holding Raven — a small charcoal poodle, Copper Ridge's "therapy dog" — the woman gradually calmed down.
"When I left [the class] I felt a kind of peaceful aura," Rees said later. These are the kind of successes that Rees strives for — "the engagement, the eye contact, the smiles, the reaching of their hand and talking to me."
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