War Related Illness and Injury Study Center Washington DC Welcome Acupuncture Presenter Jeanette Akhter MD MAc Licensed Acupuncturist JeanetteAkhtervagov Integrative Health Care Presenter ID: 190021
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Slide1
Integrative Health Care for Veterans
War Related Illness and Injury Study Center
Washington, DCSlide2
Welcome
Acupuncture Presenter
Jeanette Akhter, MD,
MAc,Licensed AcupuncturistJeanette.Akhter@va.gov
Integrative Health Care PresenterKelly McCoy, PsyDKelly.McCoy2@va.gov
Labyrinth PresenterBrenda Jasper, MEd, PA-CNational Referral Program CoordinatorBrenda.Jasper@va.gov
Yoga Presenter
Louise
Mahoney
, MS
Louise.Mahoney2@va.govSlide3Slide4
What is Integrative Health Care?
New and growing approach to health care delivery
Broader in focus than conventional care
Coordinated health careExplicitly combines conventional and complementary approaches
Complementary and alternative medicine (CAM): “A group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine.” – NCCAM definition http://nccam.nih.gov/health/whatiscam/#definingcamSlide5
Philosophy of Integrative Health Care
Mind, body, spirit, community
Tradition and innovation
Healing extends beyond cureTailored toward patient goals
Shared responsibilitySlide6
Qualities of Integrative Health Care
Holistic, broad scope
Scientifically-rigorous
Values wisdomMotivationalPatient-centeredPrevention and treatment
InterdisciplinaryHealing environments and relationshipsCross-trained providersIncorporates mind-body skillsSlide7
Who can benefit?
Individuals managing chronic illnesses
People facing acute health and life events
Individuals who want to optimize wellnessSlide8
Integrative Health Care for VeteransSlide9
The WRIISC and Post-Deployment Health Care
War Related Illness and Injury Study Center
VA Office of Public Health and Environmental Hazards
Clinical care, research, education, risk communicationNational referral programOutpatient programs (DC, NJ, CA)
Identified need for coordinated treatment approachesSlide10
Acupuncture Satisfaction Data
2010 t
otal encounters649 individual full body890 group ear acupunctureImprovement in symptoms
(n = 103) 45% yes, completely51% yes, somewhat3% no improvement<1% too early to tell
Overall quality (n = 112)70% excellent20% very good10% good<1% poor
Would recommend to other Veterans (n = 130)99% yes<1% noSlide11
Acupuncture Satisfaction Data
N = 102
Yes, Completely
Yes, SomewhatNo
Don’t Have This ProblemBack Pain22%57%
13%7%Musculoskeletal Pain25%64%5%6%Headaches
28%47%
6%19%Upset Stomach
15%22%
26%37%
Constipation/Diarrhea
8%
16%
20%
55%
Trouble Sleeping
26%
51%
18%
5%
Energy Level
32%
53%
11%
4%
Irritability/Angry Outbursts
27%
42%
18%
13%
Concentration
18%
55%
18%
10%
Depression
16%
57%
18%
8%
Anxiety
18%
61%
18%
3%
Jumpy/Easily Startled
19%
56%
18%
7%
Disturbing Memories
18%
46%
28%
8%Slide12
iRest® Yoga
Nidra
Satisfaction Data 2010 total encounters1,318 sessions
Improvement in symptoms (n = 165)10% yes, completely85% yes, somewhat4% no improvement<1% don’t have symptoms
Overall quality (n = 184)66% excellent30% very good1% good2% poorWould recommend to other Veterans (n = 184)
100% yesSlide13
Yoga Nidra
Satisfaction Data
N = 164
Yes, CompletelyYes, Somewhat
NoDon’t Have This ProblemBack Pain8%
64%19%9%Musculoskeletal Pain8%68%11%13%
Headaches10%41%
16%33%
Upset Stomach4%
18%26%
51%
Constipation/Diarrhea
4%
19%
15%
62%
Trouble Sleeping
9%
72%
13%
6%
Energy Level
12%
72%
12%
4%
Irritability/Angry Outbursts
14%
55%
16%
14%
Concentration
10%
55%
20%
15%
Depression
12%
52%
25%
11%
Anxiety
12%
66%
17%
5%
Jumpy/Easily Startled
9%
52%
22%
17%
Disturbing Memories
13%
45%
26%
16%Slide14
Labyrinth Satisfaction Data
2010 total visits
481
How was your walk on the Freedom Labyrinth Path? (n = 227)50% excellent42% very good
7% fair<1% no valueWould you walk the labyrinth again? (n = 227)
99% yes<1% noDescriptions of the labyrinth: Calming, relaxing, serene, awesome, soothing, wonderful, excellent, mellow, balanced, peaceful, meditative, rejuvenating,
surprising, inspirational, therapeutic, centering, uplifting, helpful,
purposeful, anchoring, euphoric Slide15
Yoga with Movement
Chair yoga
Mat yoga (mixed gender)
Mat yoga (women only)Satisfaction data collected following completion of 12 weekly sessions of either chair or mat yoga
Would you recommend WRIISC yoga to a friend ?
(n = 11)100% yesDo you feel better after class than before? (n = 13)100 % yesWould you participate in WRIISC yoga again? (n = 12)100% yesSlide16
Yoga with Movement Feedback
“It is one thing I look forward to because for that short amount of time I have hope”
–
Operation Iraqi Freedom Veteran“Best thing in years”
– Korean War Veteran“Wonderful for body and soul” – Gulf War I Veteran
“Great class, should meet 2x per week” – Vietnam War Veteran”Slide17
Integrative Health Care Research at the WRIISC
Yoga and Mind/Body Therapies for Treatment of War Related Illness and Injuries
PI: Louise Mahoney, MS, WRIISC-CA
The Effect of Acupuncture for PTSD-Related Insomnia PI: Michelle Prisco, MSN, ANP-C, WRIISC-DCResults anticipated May-June 2012Slide18
Integrative Health Care Research at the WRIISC
Qigong for Symptom Management and Function in Veterans with Fatiguing Illnesses
PI: Anna Rusiewicz, PhD, WRIISC-NJ
Results anticipated September 2012Acupuncture to Improve the Quality of Life in Veterans with TBI and PTSDPI: Anna Rusiewicz, PhD & Thomas Findley, MD PhD, WRIISC-NJ
Results anticipated January 2012Slide19
Integrative Modalities Throughout the VHA System
Acupuncture
Aquatic bodywork
Aromatherapy
Biofeedback
Deep-breathing exercisesGuided imagery
HypnotherapyLabyrinth
Laughter yoga
Mindfulness meditation
Massage
Progressive relaxation
Tai Chi
Qigong
Reiki
Spinal manipulation
Structural integration
Tai Chi
Therapeutic touch
Yoga with movement
Yoga
NidraSlide20
VA Integrative Health
Clinic and Program
Salt Lake City, UT VAMC
AcupunctureAquatic bodyworkStress management class: guided imagery, relaxation techniques, biofeedback, qigong, awareness and reframing of thought patterns
Medical hypnosisYoga with movementHerbal/nutritional supplement/drug interaction education
MeditationQigongTobacco cessationWeight management class: nutrition, exercise, psychotherapy, hypnosis Slide21
VA Integrative Health Clinic - Research
Chronic nonmalignant pain
Longitudinal outcome research
Chronic nonspinal-related pain group vs. chronic spinal-related pain group
Nonspinal pain group: Improved depression, anxiety, bodily pain, vitality and health transitionBenefits persisted to 24 monthsSpinal-related pain group: trend toward improvement in bodily pain Smeeding, S. J. W., Bradshaw, D. H., Kumpfer, K. L., Trevithick, S. & Stoddard, G. J. (2011). Outcome evaluation of the Veterans Affairs Salt Late City Integrative Health Clinic for chronic nonmalignant pain.
The Clinical Journal of Pain, 27, 146-155. Slide22
VA Integrative Health Clinic - Research
Depression, anxiety, and posttraumatic stress disorder
Longitudinal outcome research
Group comparisons based on levels of anxiety, depression, and PTSD symptoms
Improved depression, anxiety and health-related quality of life in all groupsGreatest improvements seen in the high anxiety, high depression, and PTSD groups
Smeeding, S. J. W., Bradshaw, D. H., Kumpfer, K., Trevithick, S., & Stoddard, G. J. (2010). Outcome evaluation of the Veterans Affairs Salt Lake City Integrative Health Clinic for chronic pain and stress-related depression, anxiety, and post-traumatic stress disorder. The Journal of Alternative and Complementary Medicine,16, 823-835. Slide23
AcupunctureSlide24
(acupuncture video 1)Slide25
Acupuncture is Over Three Thousand
Years Old
Acupuncture’s greatest contribution to the field medicine is its understanding of
qi –translated as life force, or energy.
Qi helps us maintain health. It provides the power for:GrowthDevelopmentMovementMaintaining body temperatureProtection against illnessOverall regulationSlide26
When our
Qi
is
balanced, our capacity to both heal disease and prevent future
illness is maximized. Our health is
influenced by the quality, quantity and balance of our Qi.
Symptoms of illness, whether mental, emotional or physical, are an indication of an imbalance of
Qi.
Qi
is Our Life ForceSlide27
Qi Imbalance
Qi
depletion, obstruction, disorganization
Causes of imbalanceInjury Illness Environmental exposurePoor quality nourishmentLack of physical exerciseSlide28
Rest and digest
Daytime, summer
Nighttime, winter
Awake and alert
YANG/Sympathetic Arousal
YIN/Parasympathetic Restoration
Inhale
Exhale
Balance is a constantly changing state. It exists in a dynamic and fluid interplay between our more substantial, dense
yin
aspect, and our more insubstantial, active
yang aspect.
Qi
Moves with a Rhythm, Inside a BoundarySlide29
Acupuncture heals below cognition
It helps people feel more embodied, more present, more self aware
12 main pathways – connected end to end like garden hoses
Acupuncture Helps Restore BalanceSlide30Slide31
How Does Acupuncture Work?
Local effect
Mechanical stimulation of connective tissue
Adenosine releaseIncrease local blood flow“Gate” mechanismSlide32
How does Acupuncture Work?
Increases release and binding of endogenous
opioids
Basal forebrainLimbic systemBrainstemfMRI studiesPositron emission tomography studiesSlide33Slide34Slide35
Goals of Acupuncture
Unique - focused on individual Veteran’s needs
Physical
MentalEmotionalSpiritualSlide36
Method
Ask
Listen
ObservePalpateChoose specific pointsObserve resultsSlide37
Washington, DC WRIISC Acupuncture Options
Full body, individual series of treatments
Unique design for the individual’s presentationSlide38
DC Acupuncture Options
Group Ear Acupuncture
Five points on each ear
Balance of sympathetic/parasympathetic nervous systems as well as emotional balanceCan be used for detoxificationOften affects sleep patternsMultiple venues at DC WRIISCSlide39Slide40
Acupuncture Interest at WRIISC-DC
Year 2010
649 full body acupuncture treatments
145 Gulf War Veteran treatments890 ear acupuncture treatments103 Gulf War Veteran treatmentsSlide41
Acupuncture and Integrative Health Care
Acupuncture can help:
Improve focus and attention, supporting psychotherapy clients to integrate and embody insights
Bring energy to physical injuries, supporting the work of physical therapists
Mitigate side effects of necessary medications
Help some reduce medications – for sleep or pain for exampleSlide42
Acupuncture helps
the mind find a place to rest,
the body release trauma's imprint and
the spirit come back home – safe and sound.
Acupuncture Helps Veterans Get All The Way Home - Safe and SoundSlide43
Berman, B. M.,
Langevin
, H. M., Witt, C. M.,
Dubner, R. (2010). Acupuncture for chronic low back pain
. New England Journal of Medicine, 363, 454-461. http://www.ncbi.nlm.nih.gov/pubmed/20818865
Birch, S., Hesselinm, J. K., Jonkman, F. A., &
Hekker, T. A. (2004). Clinical Research on Acupuncture: Part I. What have Reviews of the Efficacy and Safety of Acupuncture told us so far?
The Journal of Alternative and Complementary Medicine, 10.http://www.ncbi.nlm.nih.gov/pubmed?term=birch%202004%20clinical%20research%20on%20acupuncture%20part%201
Blitzer, L., Atchison-
Nevel
, D., & Kenny, M. (2004). Using acupuncture to treat
major depressive disorder:
a pilot investigation. Clinical Acupuncture and Oriental Medicine, 4, 144-147.
Chen HY, Shi Y, Ng CS, Chan SM, Yung KK, Zhang QL. Auricular acupuncture treatment for
insomnia
: A systematic review. J
Altern
Complement Med 2007; 13(6): 669-76.
http://www.ncbi.nlm.nih.gov/pubmed/17718650
Duncan A,
Liechty
JM, Miller C,
Chinoy
G,
Ricardi
, R. Employee use and perceived benefit of a CAM
wellness clinic
at a major military hospital: Evaluation of a pilot program. J
Altern
Complement Med. In Press.
Eich
, H.,
Agelink
, M.W., Lehmann, E.,
Lemmer
, W., &
Klieser
, E. (2000). Acupuncture in patients with
minor depressive episodes and generalized anxiety disorders
: Results of an experimental study.
Fortsch
Neurol
Psychiatrie
, 68, 137-144.
http://www.ncbi.nlm.nih.gov/pubmed?term=eich%202000%20acupuncture%20in%20patients%20with%20minor%20depression
Acupuncture Research – Selected BibliographySlide44
Goertz CM, Niemtzow R, Burns SM, Fritts MJ, Crawford CC, Jonas WB. Auricular acupuncture in the treatment of
acute pain syndromes:
A pilot study. Mil Med 2006; 171(10): 1010-4.
http://www.ncbi.nlm.nih.gov/pubmed/17076456
Haker, E., Egekvist, H., & Bjerring, P. (2000). Effect of sensory stimulation (acupuncture) on sympathetic and parasympathetic activities in healthy subjects. J Auton.Nerv.Syst., 79, 52-59.http://www.ncbi.nlm.nih.gov/pubmed?term=2000%20haker%20effect%20of%20acupuncture%20on%20healthy%20subjects
Hicks J, Hicks A, Mole P. Five element constitutional acupuncture. Edinburough: Elsevier, 2004.http://www.worldcat.org/title/five-element-constitutional-acupuncture/oclc/56011386&referer=brief_results
Hollifield, M., Sinclair-Lian, N., Warner, T. D., & Hammerschlag, R. (2007). Acupuncture for
Posttraumatic Stress Disorder: A Randomized Controlled Pilot Trial. J Nerv.Ment.Dis., 195, 504-513.
http://www.ncbi.nlm.nih.gov/pubmed?term=hollifield%20acupuncture%20for%20posttraumatic%20stress
Hui, K. K., Liu, J., Makris, N., Gollub, R. L., Chen, A. J., Moore, C. I. et al. (2000). Acupuncture modulates the
limbic system and subcortical gray structures
of the human brain: evidence from fMRI studies in normal subjects. Hum.Brain Mapp., 9, 13-25.
http://www.ncbi.nlm.nih.gov/pubmed/10643726
Acupuncture Research – Selected Bibliography (continued)Slide45
Kaptchuck
TJ.
The web that has no weaver: Understanding Chinese medicine,
2 ed. N.Y.: McGraw-Hill, 2000.Kim KB,
Sok SR. Auricular acupuncture for insomnia: Duration and effects in Korean older adults. J
Gerontol Nurs 2007; 33(8): 23-8; quiz 30-1.http://www.ncbi.nlm.nih.gov/pubmed/17718375Leo, R. J. &
Ligot, J. S., Jr. (2007). A systematic review of randomized controlled trials of acupuncture in the treatment of
depression. J Affect.Disord
., 97, 13-22. http://www.ncbi.nlm.nih.gov/pubmed?term=leo%202007%20acupuncture%20in%20the%20treatment%20of%20depression
Napadow
, V.,
Makris
, N., Liu, J.,
Kettner
, N. W.,
Kwong
, K. K., &
Hui
, K. K. (2005). Effects of
electroacupuncture
versus manual acupuncture
on the human brain as measured by
fMRI
.
Hum.Brain
Mapp
., 24, 193-205.
http://www.ncbi.nlm.nih.gov/pubmed?term=2005%20electroacupuncture%20versus%20manual%20acupuncture
Pilkington K, Kirkwood G,
Rampes
H, Cummings M, Richardson J. Acupuncture for
anxiety and anxiety disorders-
-a systematic literature review.
Acupunct
Med 2007; 25(1-2): 1-10.
http://www.ncbi.nlm.nih.gov/pubmed?term=2007%20pilkington%20acupuncture%20for%20anxiety
Acupuncture Research – Selected Bibliography (continued)Slide46
Plank S,
Goodard
J. The effectiveness of acupuncture for
chronic daily headache: An outcomes study. Mil Med 2009; 174(12): 1276-81.http://www.ncbi.nlm.nih.gov/pubmed/20055068
Sjoling M, Rolleri
M, Englund E. Auricular acupuncture versus sham acupuncture in the treatment of women who have insomnia. J Altern Complement Med 2008; 14(1): 39-46.http://www.ncbi.nlm.nih.gov/pubmed?term=2008%20sjoling%20acupuncture%20in%20women%20who%20have%20insomnia
Spence, D. W.,
Kayumov
, L., Chen, A., Lowe, A., Jain, U., Katzman, M. A. et al. (2004). Acupuncture increases
nocturnal melatonin secretion
and reduces
insomnia and anxiety:
a preliminary report. J Neuropsychiatry
Clin
Neurosci
., 16, 19-28.
http://www.ncbi.nlm.nih.gov/pubmed?term=2004%20spence%20acupuncture
Spira
A. Acupuncture: A useful tool for health care in an
operational medicine
environment. Mil Med 2008; 173(7): 629-34.
http://www.ncbi.nlm.nih.gov/pubmed?term=2008%20spira%20acupuncture
Van
Tulder
, M. W.,
Furlan
, A. D., &
Gagnier
, J. J. (2005). Complementary and alternative therapies for
low back pain
.
Best.Pract.Res
Clin
Rheumatol
., 19, 639-654.
http://www.ncbi.nlm.nih.gov/pubmed/15949781
Acupuncture Research – Selected Bibliography (continued)Slide47
(acupuncture video 2)Slide48
Yoga NidraSlide49
(yoga
nidra
video 1)Slide50
(yoga
nidra
video 2)Slide51
LabyrinthSlide52
(labyrinth video)Slide53
Labyrinth – Brief History
> 4,000 year history
Found in many cultures and religious traditions
Now used in health care facilities, schools, and houses of worship worldwide
Labyrinth from the Atlantic Bronze Age, Galicia (Spain)
Labyrinth carving at a temple in Halebid, India, circa 2500 BCSlide54
Labyrinth - Research
Walking meditation is shown to reduce anxiety and elicit a 'relaxation response’ associated with:
lower blood pressure and breathing rates
reduced incidents of chronic pain and insomniaAlso associated with many of the benefits seen in sitting meditation and yoga
Benson, H., "The relaxation response: therapeutic effect," Science. 1997 Dec 5;278(5344):1694-5. PMID: 9411784 Slide55
Labyrinths at VA
Veterans, staff, and volunteers can walk a labyrinth at:
Albany VAMC
Canandaigua VAMCSeattle VAMCMemphis VAMC
Washington, DC VAMCSlide56
Labyrinth Resources
Labyrinth Society
http://www.labyrinthsociety.org/
Worldwide Labyrinth Locatorhttp://labyrinthlocator.com/Slide57
Labyrinth - Practice
Not like a maze: no dead ends
Pace is up to you
Opportunity to slow down, relax, relieve stress, reflect, meditate
9/11 Memorial Labyrinth at Boston CollegeSlide58
Reasons for Walking the Labyrinth
To relax
To express intent
For physical healingAs a pilgrimageTo meditateTo ask a questionFor emotional healingTo ease griefFor inspirationTo pray
For ceremony or ritualJust for fun!Slide59
Benefits of Walking the Labyrinth
Decreases stress
Helps reconnect physical, emotional, and spiritual wellbeing
Provides opportunity for personal spaceOffers strength and hopeSlide60
Stages of Walking the Labyrinth
Releasing
Receiving
Renewal
Chartres Cathedral labyrinth in Nature’s First Pattern by Gilchrist, 1996http://www.charlesgilchrist.com/SGEO/Gal902.htmlSlide61
Preparation for Walking
Wait until there is enough room for you
Remove shoes or cover them
Quiet your mouth and body to promote a peaceful ambianceBreathe deeply, center yourself, and put other things out of your mindIf you wish, invoke the presence of a higher force for guidancePause at the entrance to bow or in some way acknowledge the labyrinthSlide62
Walking the Labyrinth
Walk at your own pace
There may be two-way traffic, cooperate
It is okay to pass others or be passedBring awareness to your experience, your body, your thoughts, and your feelingsPause in the center if you wish to meditate thereReturn by the same path you entered or, if you choose, walk directly outUpon exiting, turn and again acknowledge the labyrinthSlide63
After Leaving the Labyrinth
Continue to be aware of your labyrinth experience, even into the next day
Take a moment to sit quietly and reflect on your walk
You may wish to journal or draw to express your experienceThank yourself for the gift you have given yourselfWalk the labyrinth again, as many times as you wishUse a finger labyrinth to relax anywhereSlide64
Life is walking a labyrinth,
I cannot always know which way I will turn,
or even see far ahead, but there are no tricks.
It is not a maze, no chance of getting lost,trust in the path that has been laid for meor in the path that I have chosen.
Walk it in trust, stop when a break is necessary,and know that the center is always there. - Elizabeth H. WigginsSlide65
Yoga for VeteransSlide66
If you can breathe…..
you can do yogaSlide67
What is Yoga?
Developed from ancient East Indian religious practice
Word derived from Sanskrit root “
yuj” meaning to bindGenerally conceptualized as union of mind, body, and spiritPhilosophy outlined in the Yoga Sutras attributed to Patanjali in the 2nd century BCE
Goal of practicing yoga is to end sufferingSlide68
8 Limbs of Yoga
Yama
– moral commandments
Niyama – disciplineĀsana – postures (what most call “Yoga” in the United States – also termed “
Hatha” yoga)Pranayama – control or expansion of breath Pratyahara – freedom from domination of the senses and external objects
Dharana – concentrationDhyana – meditationSamadhi – super-consciousnessSlide69
Physical Practice of Yoga (Asana)
Most yoga we practiced today in US based on teachings of
Krishnamacharya
(November 18, 1888 – November 3, 1989)Developed active form of yoga (Ashtanga) Also practitioner of Ayurvedic medicineFather of
T.K.V. Desikachar Teacher of Iyengar (Iyengar - introduced use of props – philosteach people at any level)T.K.V Desikachar Yoga practice is adapted to fit the individual and particular situation of each student – a therapeutic approach – called it Viniyoga initiallyMentor of
Richard Miller, developer of iRestSlide70
Western Yoga
Most Yoga postures practiced today in the west developed around the turn of the 20
th
centuryInfluenced by British Physical culture – gymnastics – brought to Indian palaces during colonizationSlide71
Do we need Research on Yoga and Veterans?
PubMed search of “Yoga”
>1500 published articles
PubMed search of “Yoga” and “Veteran”19 published articles – only 2 used Veterans as subjectsThe effectiveness of Yoga to help reduce chronic low back pain (Groessl, 2008)Yoga as physical fitness in a Veteran nursing home (Hamilton-Word V, 1982)Slide72
Evidence for Yoga as Therapy
Study
Target
Population
Sample SizeResultsGroessl et al, 2008Low back pain
Veterans33Significantly less: Pain, Depression, FatigueSherman et al, 2005Chronic low back painCivilian Adults
101Both exercise and yoga reduced pain, yoga superior in medication use reduction
Da Silva et al, 2007Fibromyalgia
Civilian females33
RY & RYT improve FIQ scores & reduce VAS scores – RY continued to provide benefit after study
Vera et al, 2009
Sleep and HPA
axis
Healthy yoga
practioners
& controls
26
Long term yoga
practice improves SSQ, increase in
cortosol
Pal et al, 2009
Autonomic
funcition
Healthy volunteers
60
Practice of slow breathing for 3 months improves
autonomic function, fast breathing does notSlide73
Reviews
Literature Review
Target
ResultsYang, (review of 32 articles
Chronic diseases Weight loss, lower BP, lower blood glucose, lower cholesterolKirkwood et al, (2005)review of 8 studiesAnxiety
Positive but inconclusive resultsChou & Huffman, (2007)Chronic low back painSmall advantage of yoga over exercise in some but benefits of yoga last longer than benefits of yogaSlide74
Summary of Benefits
Reduced back pain
Lowered stress
Increased functional abilityImproved sleepIncreased cardiovascular healthLower cholesterolDecrease general pain such as experienced in fibromyalgiaImproved autonomic functionSlide75
Possible Mechanisms of Action
?
Improve structural/postural alignment
Improve muscle tone and flexibilityEnhance function and regulation of autonomic nervous system and re-setting of chronic pain responseModulation of hormonesSlide76Slide77
WRIISC-CA Yoga
January, 2010 – Program start
Mat classes – meet once/week
Mixed gender mat classWomen only mat classJuly 2010, Chair yoga class added 62 referrals to WRIISC yoga through CPRS consult38 have attended at least onceSlide78
WRIISC-CA Yoga (cont’d)
Mixed gender mat class
20 referrals, 18 have attended at least once
4 have completed post 12 week assessmentsWomen only mat class24 referrals, 9 have attended at least once, 3 have completed at least 12 weeksChair yoga15 referral, 13 have attended at least one session6 have completed at least 12 week Slide79
Barriers to Attendance?
Location not convenient
No transportation
No childcareConflicts with work scheduleClass held during high traffic commute timeNot psychiatrically or medically stableSlide80
Pilot Results, n=13
Feasibility – Will Veterans participate in yoga?
Yes, if it is convenient and consistent
SF-12 – Health and Well-BeingIncrease in energy – most significantTrend toward improvement in most others areas except depressionMcGill Pain Short FormDecrease in pain intensity Slide81
Results (cont’d)
PTSD Checklist (PCL-M)
Small trend downward
Flanders Fatigue ScaleSmall trend upwardYoga Satisfaction Questionnaire Slide82
Yoga Satisfaction – n=12
Yoga class quality: 5 item scale from poor to excellent:
All answered either “Excellent” or “Very Good”
Do you feel better after class than you did before? All answered “Yes” Would you participate in WRIISC yoga again?All answered “Yes”Would you recommend WRIISC yoga to a friend?All answered “Yes”Have your symptoms improved?3 answered “Yes, completely”
6 answered “Yes, somewhat”Slide83
Veteran Comments
“It is one thing I look forward to because for that short amount of time I have hope”
–
Female Operation Iraqi Freedom Veteran“Best thing in years”
– Male Korean War Veteran“Wonderful for body and soul” –Female Gulf War I Veteran
“Great class, should meet 2x per week” – Male Vietnam War Veteran” Slide84
Other Benefits
Provides opportunity for Veterans to bond with other Veterans in a positive space
Relief from social isolation cause by the illness
Sense of belonging to a groupLets Veterans know that the VA cares about themSlide85
NamasteSlide86
Application of Integrative Health CareSlide87
Factors to Consider
Does this approach fit with treatment goals?
Risks and benefits
Contraindications, modificationsResearch findingsLevel B evidence base or higherVeteran’s self-report
Provider qualificationsCoordination among care providersExpense and availabilitySlide88
Integrative Health in the VA System of Care
VA Office of Patient Centered Care and Cultural Transformation
Post-Deployment Integrated Care Initiative (PDICI)
PlanetreePolytrauma Service, Recreational Therapy
James A. Haley VA Chronic Pain Rehabilitation ProgramTraining standards & occupational codesSlide89
Resources
National Center for Complementary and Alternative Medicine at the National Institutes of Health
http://nccam.nih.gov/
White House Commission on Complementary and Alternative Medicine Policy http://www.whccamp.hhs.gov/Consortium of Academic Health Centers for Integrative Medicine
http://www.imconsortium.org/Slide90
VA Resources
VA
Listservs
Acupuncture Listserv, Integrative Health Care ListservVA employees may email Dr. Elizabeth Hakas to join (Elizabeth.Hakas@va.gov)Integrative health care in the VHAHCS: www.warrelatedillness.va.gov/WARRELATEDILLNESS/education/conferences/2010-sept/slides/2010_09_15_SmeedingSJW_Developing-an-Integrative.ppt
Washington, DC WRIISC: www.warrelatedillness.va.gov/dc/Clinical/cam-main.aspPalo Alto, CA WRIISC: www.warrelatedillness.va.gov/paloalto/cam.asp
East Orange, NJ WRIISC: http://vaww.newjersey.med.va.gov/planetree/complementarytherapies.htmlPlanetree: http://www.planetree.org/about.htmlSlide91
Free for Veterans
Acupuncturists Without Borders Military Stress Recovery Clinics
http://www.acuwithoutborders.org/msrpclinics.php
List of clinics nationwide that offer free acupuncture for VeteransYoga for Vets
http://www.yogaforvets.org/List of yoga studios nationwide that offer at least 4 free yoga classes for VeteransLabyrinth Society http://www.labyrinthsociety.org/
Worldwide Labyrinth Locator http://labyrinthlocator.com/Slide92
Thank you
Veterans
Bonnie Benetato, Jeanette Akhter, Cory Jecmen, Kathryn Berndtson, Alyssa Adams, Thomas Nassif, Michelle Prisco, Antoinette Lomax, Adrian Johnson, Jacqueline Cherry, Mary Lewis, Becca Handel, Susan Santos, Ron Teichman, Louise Mahoney, Florence Chau, Rita Torres, Melissa Blatt, Anna Rusiewicz, Connie Singleton, Leslie Hurd, Stephen
Ezeji-Okoye, Sandra Smeeding, An-Fu Hsiao, Stephen Hunt, Matthew Reinhard, Gudrun Lange, Wes Ashford, Michael Peterson, VA Office of Public Health and Environmental Hazards