One Size Does Not Fit All!
About the Author
Laurie Bachner is a certified Chair Yoga Instructor in NYC with a background in dance from Juilliard, Martha Graham, and Merce Cunningham. Following a career in sales and marketing, Laurie channeled her passion for fitness into her version of chair yoga. She initially worked with individuals and groups in the corporate world (SOS-Stretch Out Stress) and with cancer survivors at Mt. Sinai hospital. With encouragement from an Aging Life Care Professional / Care Manager, she adapted her protocol for seniors with dementia. Her sessions are private, individualized, and includes caregivers.
In collaboration with Aging Life Care Professional™ / care manager Helene Bergman, my dementia specialist mentor, I have been able to assist clients with dementia build and maintain resilience through the use of what I have come to call Chair Yogacise. Chair Yoga was developed to fill a void for those who loved Yoga but were unable to practice it for many reasons including disability, obesity, or just being unable to get on and off a mat. Adults recovering from cancer or those suffering chronic neurological disorders gravitated to it for exercise, serenity, and self-esteem. Chair yoga is a safe method for stretching, strengthening, and meditating.
Chair Yogacise is Yoga without the mat, including ballet balancing techniques without the bar, and a series of upper and lower body flexibility and strengthening exercises on and off the chair. I have developed successful approaches to work with individuals with dementia, using a variety of methods to overcome the many challenges this condition presents. Since the disease doesn’t stand still, neither can I. What might have worked in the first six months with an individual client might not work any longer. My client who always followed my movement by simply watching with some verbal cues along the way now can’t. When I say, “let’s do some shoulder rolls”, and I realize she no longer knows what the word “shoulder” means or where it is, I know to switch gears.
From the start, it has been clear that actions, and objects, speak louder than words. With that in mind, I integrated bands and balls into sessions. The bands are used by each of us holding one in each hand and as I initiate lateral movements, we stretch and flow to the music. And who doesn’t like to throw a ball? Using two size balls (soft of course), one small and one beach ball size, we throw and catch– reinforcing large and small motor skills and hand-eye coordination. Actions such as trying to pick up the ball as well as reaching for it as you bend down without falling backwards requires balance. These movements are also strengthening. They demand the quads to kick in as if one were doing squats, especially when it’s repeated several times over. Sometimes my client understands, “throw it back to me.” When she doesn’t, I can model the action desired.
Connecting with a client with dementia is integral to an effective working relationship and music opens the door. Tailoring the music list to each client’s past history and preference is imperative. Finding the right music, songs they know, that they can sing to or even dance to, is sometimes all you need to get the session up and running. Culture and ethnicity is often a guide. One of my clients, who grew up in Puerto Rico as a child, explained how she and her six sisters would dance around the living room while her mother clapped. I made a Latin play list for her and when I played it for the first time and we began, her eyes lit up, her stance straightened and she began to dance in my arms. And we both clapped!
The oldies but goodies (i.e. Take Me Out to the Ball Game, and Comin’ Around the Mountain) are real crowd pleasers with the older generation. The familiar tunes peak their memories and help the exercise become more aerobic. Clients move and sing at the same time and as this promotes breathing, more oxygen flows throughout the body and to the brain. Not all clients respond to these old standards. Some enjoy opera and classical music. Others enjoy Ella and Frank, show tunes by Cole Porter and Gershwin. It’s up to the therapist to identify what they love- what music will inspire their movement. One of my clients sings the arias in Italian along with Pavarotti. The music was so inspirational, he just moved instinctively. I let him lead the way, with arms out stretched, head back, the music filling him up with joy, with passion.
Often, clients surprise me! One very slim 92 year old with advanced Alzheimer’s moved so well, I offered her modern dance movements I learned while studying with Martha Graham. Forget overhead arm reaches, we were doing four part sequences of contract and release. I asked her if she was ever a dancer and she thought for a moment and said, “Maybe.” I later found out that she was a tap dancer in her youth and although her brain might have forgotten she had danced, her body didn’t. To my surprise, she also liked the ball but not for a simple game of catch. Buying into her competitive nature, we had a rigorous one on one, two handed basketball game from the chair, batting the ball back and forth to each other at rapid speed. Here was a woman who barely smiled, now she was laughing saying, “don’t stop, I’m not tired yet”…..though I was.
The caregiver (family or professional) should be an integral part of the process. Family and friends feel a sense of relief and joy when they observe their loved one partaking in life, laughing, smiling, and being engaged on any level they can. With family permission, I take photos or a quick video so they can see firsthand that the client is not only getting the physical and mental benefits of a workout but is truly enjoying themselves. I engage the direct caregivers as well, explaining why exercise and good diet is so important not only for the client but for them as well. Sometimes it’s as simple as the more the merrier! My goal is multi-faceted: if they are engaged and feel a part of what you are doing they might incorporate some of the exercises and activities into their daily routine, when I’m NOT there. When the caregiver is there day in and day out, having some plain fun, laughing, dancing, partaking in joy together, it is beneficial for all. It’s energizing, rejuvenating, and, I believe, builds resilience in both the client/patient and the caregiver by strengthening the bond between them.
Although each of my clients has some degree of dementia, the disease never presents itself in the same way, not physically or psychologically. Each client brings a unique personality with his/her own personal memories and psychosocial background to the present. Individuality persists despite the dementia. Understanding who one was and is now is step one; knowing how to switch gears and responding to all the constant changes is next. You do whatever is working on that particular day, with that particular client. Always showing them the respect they deserve; understanding they are a work in progress, as you are, every time you walk through that door. One size does not fit all. It never did. And how great is that!