Yoga in Voice Care Kenneth Tom, Ph'D' California State University Fullerton Department of Human Comm

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Yoga in Voice CareKenneth Tom,
Ph.D.California State University
FullertonDepartment of Human Communication
Studies
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the origins of yoga

• Yoga practices developed over thousands
  of years from their origins in the Indo-Tibetan
  regions of South Asia. Forms of Yoga have been
  integrated into most of the diverse cultural and
  spiritual traditions of the East.

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the origins of yoga

• Although similar practices evolved and were
  appropriated into the spiritual traditions of the
  West, the essential teachings of Yoga have no
  theological orientation.

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the origins of yoga

• The two main source texts for
  contemporary Yoga are the
• Yoga Sutras, collated by the Indian sage
  Patanjali (circa 180 A.D.) and
• Hatha Yoga Pradipika (circa 1350 A.D.)

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the origins of yoga

• The root of the word yoga, comes from the
  Sanskrit word yuj which means to yoke or to bind.
  
• Referring to both to a process and a state, it is
  often interpreted as
• to link , to connect, to integrate, to unite, to
  bring into relationship, or to return to oneself.

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Research on yoga as a therapeutic modality

• A literature search on PubMed using yoga as a
  keyword produced 1311 studies (10/23/09).
• No studies specifically on yoga and voice
  therapy.
• Several studies in three treatment areas relevant
  to aspects of voice care back pain,
  asthma/respiratory disease, and depression.

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Research on yoga as a therapeutic modality

• Two examples
• 1. Raub, J.A. (2002). Psychophysiologic effects
  of Hatha Yoga on musculoskeletal and
  cardiopulmonary function A literature review.
  Journal of Alternative and Complementary
  Medicine, 8(6), 797-812.
• Detailed review of studies indexed on MEDLINE,
  published from 1985 to 2002.

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Research on yoga as a therapeutic modality

• Review of approximately 120 studies selected with
  regard to focus, verity, integrity, rigor,
  utility, and clarity.
• Study topic areas included osteoarthritis of the
  hands, carpal tunnel syndrome, cardiovascular
  endurance, obstructive airway disease (e.g.,
  chronic bronchitis, asthma), cardiovascular
  disease, hypertension, and chemoreflex response
  to hypoxia (effects of controlled breathing on
  tolerance to reduced oxygenation of blood).

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Research on yoga as a therapeutic modality

• 2. Sherman, K.J., Cherkin, D.C., Erro, J.,
  Miglioretti, D.L., Deyo, R.A. (2005). Comparing
  yoga, exercise, and a self-care book for chronic
  low back pain A randomized, controlled trial.
  Annals of Internal Medicine, 143, 849-856.
• Participants 101 adults (66 women, 35 men mean
  age 44 yrs.) with chronic low back pain the
  majority had experienced pain for more than one
  year, and had experienced pain for more than 45
  of the past 90 days prior to entering the study.

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Research on yoga as a therapeutic modality

• Interventions Participants randomly assigned to
  a 12-week Yoga intervention, a 12-week exercise
  intervention, or a home study/educational book
  intervention. The 75-minute group classes and
  home practice guides for participants followed a
  gentle Viniyoga approach specifically designed
  for back pain.
• The therapeutic exercise intervention
  was designed by a physical therapist, and
  included education about biomechanics and both
  aerobic and strength-building exercise.
• The self-care book was The Back Pain
  Helpbook by J. Moore et al., an evidence-based
  book that teaches a comprehensive fitness and
  strength program, lifestyle changes, and
  guidelines for managing pain.

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Research on yoga as a therapeutic modality

• Results Participants in the Yoga group showed
  the greatest improvements in back function at 12
  weeks (the end of the intervention). At 26 weeks,
  the Yoga group also showed greater improvements
  in symptoms/less use of pain medication than the
  other two groups. At 26 weeks, the Yoga group and
  therapeutic exercise group showed similar
  improvements in back function, and both groups
  showed greater improvements than the education
  book group.

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Yoga Practices

• In the context of therapeutic applications,
  Yoga may be understood not only as a depth
  psychology, but also as
• a philosophical and practical framework
  oriented towards understanding and working with
  mind-body relationships.

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Yoga Practices

• The eight interrelated limbs (aspects) of Yoga
  are the
• yamas (ethical code of conduct)
• niyamas (ethical observances)
• asana (body postures/exercises)
• pranayama (breathing exercises)
• pratyahara (inward focus of attention)
• dharana (concentration exercises)
• dhyana (meditation work)
• samadhi (state of absorption)

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Yoga Practices

• Today, doing yoga usually refers to taking
  group yoga classes focused on performing asana,
  the physical exercises (postures) designed to
  improve physical strength, flexibility and
  stamina.

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Yoga Practices

• In a therapeutic context, however,
• Physical postures/movements and
• breath exercises,
• done with focused attention and a meditative
  or exploratory attitude can be strong techniques
  for moving towards clinical goals.

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Yoga Practices

• Two schools of Yoga with an established tradition
  of therapeutic applications
• Iyengar Yoga precise postural alignment, use of
  props, restorative postures
• (B.K.S. Iyengar )
• Viniyoga adapting form/methodology to the needs
  of the individual
• (T.K.V. Desikachar)

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Viniyoga

• As a style of practice, viniyoga refers to an
  approach to Yoga that adapts the various means
  and methods of practice to the unique condition,
  needs and interests of the individual - giving
  each practitioner the tools to individualize and
  actualize the process of self-discovery and
  personal transformation.
• Gary Kraftsow

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Posture/movement, breath work, and meditative
focus in vocal therapy

• May deepen awareness of sensory input during
  motor skill acquisition by linking focused
  attention to somatosensory aspects of
• breathing patterns,
• movement patterns,
• phonation patterns,
• emotional patterns

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Posture/movement, breath work, and meditative
focus in vocal therapy

• Focused attention
• Directing focused mental resources/energy to the
  sensory experiences of an object for a sustained
  period of time necessary for appropriate behavior
  in a given context. (Damasio)

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Posture/movement, breath work, and meditative
focus in vocal therapy

• Somatosensory subsystems
• 1. internal body milieu and visceral sensation
• 2. musculoskeletal sensation (proprioceptive,
  kinesthetic)
• 3. fine touch (texture, form, weight,
  temperature, etc.)
• (Damasio)

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Posture/movement, breath work, and meditative
focus in vocal therapy

• Emotions
• 1. Primary or universal emotions (the big six
  - happiness, sadness, fear, anger, surprise,
  disgust)
• 2. secondary or social emotions (e.g.,
  embarrassment, jealousy, guilt, pride)
• 3. background emotions (e.g., well-being or
  malaise, calm or tension)
• (Damasio)

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Posture/movement, breath work, and meditative
focus in vocal therapy

• What can we link or bring into relationship?
• Posture - Breathing,
• Breathing - Phonation,
• Breathing - Emotion/mood,
• Phonation - Emotion/mood,
• Relaxation - Emotion/ parasympathetic activation

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Increasing somatosensory awareness of breath
related thoracic-abdominal movements by directing
attention to the upper chest solar
plexus abdomen
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Specific examples of linking

• Body movements facilitating breath movement
  awareness e.g., standing - arms up on inhale
• Static yoga postures facilitating aspects of
  breath movement awareness e.g., childs pose,
  cobra, lateral stretch

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Specific examples of linking

• Movements with phonation on exhalation e.g.,
  phonation moving into forward bend
• Static yoga postures with phonation on
  exhalation e.g., chair warrior with hands on
  chair back

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Supine and standing postures
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Postures facilitating increased awareness of back
and rib movements
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Supine and restorative postures
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Chair supported postures
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Case studies

• Healthy, physically fit 35 y.o. female, married
  with three school age children, homemaker and
  soccer mom, active volunteer, regularly takes
  tap dance, swing dance, and power yoga classes,
  and private gymnastics lessons. Dx PVFM, med hx
  otherwise unremarkable. Learned pursed lip
  breathing as rescue from and reduction of PVFM
  symptoms.
• Voice Tx Goal Evoke different, more useful
  linking of slow deep inhalation/exhalation,
  easeful posture and contraction level of neck
  muscle, and self-calming non-trying attitude.

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Case studies
2. 55 y.o. male, married with two teen-aged
children, FT 5th grade teacher in public schools,
PT cantor at conservative Jewish temple. Runs 2-3
mi daily a.m. Hx of low back injury, cardiac
arrhythmia and pacemaker implantation, severe
GERD, s/p 7 yrs. Nissen fundoplication. Currently
taking Nexxium and Mucinex daily. Dx bilateral
vocal nodules, episodic severe hoarseness, loss
of singing voice. Voice Tx goals Establish
flexibility in spine and thoracic-abdominal
musculature/soft tissue, increase breath volume
decrease jaw, tongue, and neck tension.
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• Yoga provides the means to bring out the best
  in each individual. This requires an
  understanding of a person's present condition,
  personal potential, appropriate goals and the
  means available. As each person is different,
  these will vary with each individual.
• Gary Kraftsow

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• References
• Damasio, A.R. (1999). The feeling of what
  happens Body and emotion in the making of
  consciousness. New York Harcourt Brace and
  Company.
• Desikachar, T.K.V. (1999). The heart of yoga
  developing a personal practice. Rochester, VT
  Inner Traditions International.
• Feuerstein, G. (1998). The yoga tradition Its
  history, literature, philosophy, and practice.
  Prescott, AZ Hohm Press.
• Kraftsow, G. (1999). Yoga for wellness Healing
  with the timeless teachings of viniyoga. New
  York Penguin.
• Lasater, J. (1995). Relax and renew restful yoga
  for stressful times. Berkeley, CA Rodmell Press.
• McCall, T. (2007). Yoga as medicine The yogic
  prescription for health and healing. New York
  Bantam Dell.