2007 Navajeevana Clinical Activity Summary
It was a genuine pleasure to work with the staff of Navajeevana for the third year in a row. Their commitment to personal development and service to their community are a source of inspiration for me to continue with this challenging work.
In addition to conducting two workshops and two special training sessions, I provided sessions to their staff and did a clinical study on a patient I had worked with last year. I was also able to coordinate the efforts of Real Medicine and Navajeevana to provide services to Yayawatta clinic. Jen and I also provided funding for 600 meal packets for their New Year's Celebration for the Disabled.
Further, Kelly Prentice, who is writing the article for MTJ recognized a similarity between Founder Kumarini Wickramsuriya and the founders of Good Shepherd Rehabilitation Hospital in Allentown, PA, Mr. and Mr. Raker. Having been a former employee of GS, she arranged for us to have a meeting with the VP of Rehabilitation Services to discuss the potential for GS to sponsor Navajeevana as a sister hospital for as part of their upcoming 100th year anniversary. Navajeevana is celebrating their 20th year, and despite there expansion to the facilities, they are in need of immediate funding to sustain the presence of their head Physical Therapist. I'll be posting more details on this a bit later.
At the close of our time in Sri Lanka, Kumi, Jen and I had a pleasant meeting and discussed our return. The interest is high and Kumi is looking into getting support for us from Outreach International to conduct Art Therapy classes and treatment clinics for children with neuromuscular disorders. Let's see what happens.
My work in the case study below would not have been possible, without the dedicated support of Mr. Samantha Udagama who not only embodies the principles of The Trager® Approach in is daily life but through his own experience has developed a language to convey its essence clearly and effectively to his patients. All of the exercises that I shared with patients at the center where translated by Mr. Udagama. Together we modeled the movements, but it was his grasp of the approach that made it easy for patients to understand. He was the voice. Together with our touch and movement, we made a difference.
Case Study. Mr. K.A Premadasa
Background: I met Mr. Premadasa last year. He was a very pleasant man with incredible contracture throughout his torso and hips. He was locked up considerably. He had been coming to NJ since 2005 for his painful condition. During my visit, I had treated Mr. Premadasa twice and found that his tension level decreased dramatically. He was able to practice Mentastics® with notable awareness and effectiveness. He has returned to NJ numerous times over the past year for treatments of Electro Stimulation for his pain that reaches a scale of 8/9 after about 4 days after treatment.
Subjective - Pain Level – March 28th 2007 – Mid Back Pain 7 After ES treatments –pain 2/3 - 4 days pain returns 8/9.
Objective – posture – hunched
Neck – stiff very little rotation right or left without turning entire torso
Shoulders – rounded, stiff
Mid Back – most painful - Kyphosis thoracic
Low Back – very stiff, excessive tension in erectors
Hips – rotators and gluteals very tight
Legs – stands with knees locked, weight in heels
Before Session - Seated Mentastics®:
Writing Name with Nose – his neck movements were relatively fluid and dynamic. This he said he practiced from last year.
Circles with shoulders and rib cage – prior to session this movement was difficult for him to articulate. The rigidity of his trapezius and pectoralis’ prevented full articulation of this ROM.
Arm tossing – Mr. Premadasa still uses force to toss or drop the arm. (suggested what is soft) shifting weight in chair – lifting hips to mobilize rib cage
Subjective – How do you feel? When I first arrived last year I felt like stone. After treatments I feel peace and relaxed. Today I felt like tied with rope, in knots. Now I am more open. I have been doing the exercises sometimes twice a day and I am able to do my work with more comfort.
Objective/ Session Findings:
Patient needs to develop more self awareness of thoracic cavity to develop more mobility and fluidity in the articulations of the ribs and sternum. I suggested the sky hook visualization prior to our session but when he attempted this only his shoulders contracted and raised rather than his chest and sternum. Patient has developed over the past year a greater capacity for relaxing legs. There was much less hip rotator tension. However when bending knee there was strong resistance to this flexion. When I asked him to bend his knee he did so easily. There exists an unconscious pattern of resistance to this movement. Traction from WW yielded very little evidence of integration between torso and lower extremities.
Rib cage mobilization – slowly the intercostals and the pectoralis began to release, resulting more bounce and a deeper inspiration. The trapezius and subscapularis, rhomboids etc, also softened substantially (abdomen is quite soft and fluid)
Neck rolling was difficult in full range however there was noticeable release in the occipital triangle and when I incorporated shoulder bounce while rolling the neck. He fell asleep for some moments during occipital release.
After session
Before close of the session Mr. Premadasa reported a relief from tensions and the “ropes that were binding him.” After the session he began exploring with delight the mobility in his chest and rib cage that resulted from treatment. He began larger rotations of the arms with an awareness of playing with the weight and feeling the rebound or reverberation.
His walk out of the treatment room appeared more grounded and was smoother, more fluid than when he arrived. Patient is scheduled for 9am on Friday Morning, the 30th of March.
March 30th
Little pain of ribcage….mobilization set up discomfort and he didn’t continue exercises because of pain. Pain set in at night … He reported feeling fine after session.
Session went well. Very little work on ribcage lying supine. Legs, and hips released very well as did the arms. In prone position…worked shoulders and ribs….gentle rocking of the back, go away leg released visible and palpable tension in the erectors. This was confirmed by Samantha Udagama. After the session Premadasa explained that he felt like he was in a cradle and this feeling he gets from the sessions helps him through his days. He explained that
“It’s a very nice memory.”
ROM of shoulders and depth of breath substantially improved. Also explained that the changes in hips legs, etc. would occur in the rib cage over time but that the holding patterns in the chest were very deep and strong. His experience with the technique made this concept easy for him to accept and understand. He is very optimistic. I gave him 200 Rp for the two trips he’s made to NJ and for next Wednesdays visit. Each trip is 66Rp.
April 4th
Premadasa – explored walking gait. – balancing weight evenly on foot left to right and heal to toe. 25 mins. Sitting and getting up still a slight problem. He does not sit on floor. We suggested sitting on something that is closer to the ground to open his hips but not on the ground and slowly progress to the floor. Reviewed all Mentastics® as well as some yoga exercises to improve ROM in shoulders. Gomukasana with a towel and Parsvatanasana
Nalika - Ms. Nalika had visited Navajeevana 28 times, or weekly since the beginning of November, for neck, shoulder and arm pain. She was diagnosed with Perio Arthritis. I gave her two general sessions which she said provided her with a deep feeling of relaxation that decreased the pain considerably. I had Samantha review Mentastics with her. She had not returned prior to my departure three weeks later.
April 6th
NJ – Premadasa – wow…his own movement is helping him, doing Mentastics®, feeling reverberations throughout his body. His capacity to relax is increasing nicely. He reports only some low back pain and pain when sitting and then standing about level 3….showed Mentastics®, walking with rounded feet and water drip kick….great! Samantha big help on interpretation and modeling….increased Mentastics® time to focus on increasing self reliance to relieve pain, gave him 130rp for today and next Monday
April 9th
Premadasa – standing with gluteals contracted – suggested he watch his posture We softened this by shifting weight evenly towards toes and bending his knees. This relaxed his gluteals. He explained that he has always wanted to stand up straight and that is why he is using much effort. I redirected his attention to his sternum for lift here to help with the kyphosis, thoracic curvature of his spine. He then mentioned that for the first time in 7 years that he climbed a ladder and worked on his roof for about 10 minutes. As he climbed up on the table he explained that he now enjoys lying on the couch because he can get up and down without pain. During the session he asked if he was able to ride bicycle. I told him he didn’t need to ask me but rather does he trust himself to mindfully explore his movements as he did this. His last time on a bike was 7 years ago when he began suffering from pain.
While working on his ribcage and spine, he said he no longer feels pain in his mid back when I palpate the erectors. The around the clock move was easy/effortless in almost the full range of motion of his hip rotators. Finally integrated the psoas which was indicative to his level of recovery. Rib cage softened but remains focus for future treatments.
April 19, 2007
According to Mr. Indrajith, Premadasa had no pain for 6 days – (prior to this his pain level would reach 8-9 withing 4 days after treatment. Slight pain returned only after he took tractor ride in back wagon on the 15th. Because of the bouncing and jarring, he felt sore in the ribcage afterwards. He could not raise arms above shoulder height. This caused a severe pain deep in pelvis, Right side.
Performed Trager® moving his arms over head, addressed rib cage and performed cursory leg and hip work to assess hip rotators. Very relaxed. Layed him on pillows placed down center of spine to allow chest to open - had him do arm circles - without pain he was able to raise his arms over head and even rest them there with chest open…he asked if he could sleep this way as it was very comfortable for him
After session the he sat up and was able to extend his arms way over head without any discomfort…even sat back with chest wide open…..with tears in his eyes he told us of his suicidal state prior to finding Navajeevana… “I could not stand the pain any longer. I went and purchased some poison to commit suicide. My last Dr. suggested Navajeevana and I thought I would try one last time. He has made numerous visits since 2005. The relief of pain kept me from killing myself.” Then the money came for me to receive Trager® often and this helped very much.” He then asked if I would see him one last time before my departure. We scheduled for the next day.
Big changes for Mr. Premadasa. Far right picture is from second session. Look at the difference in the facial muscles, neck, trapezius, pectoralis and obviously his posture after just five session.
Open chest after 5 sessions. At second session.
April 20
Premadasa says his still sternum is free. Open. (This had been an area of unbearable pain which greatly limited his activity.) We did Mentastics® for ROM in shoulders. The increase in ROM is substantial if not maximum. He explained that since 2005 and prior to the Trager® treatments this year that he has had a 50% improvement and pain reduction of his condition. With the 7 Trager® treatments over the past 5 weeks, he has experienced an additional 25% improvement. He reported that his mid lower back was a bit painful. I addressed his legs, hamstrings and gluteals, shoulders and mid and low back, hip rotators while prone. Mobilized rib cage and shoulders while supine. Samantha also worked on his low back and instructed him in movement after the session.
At the close of the session he literally hopped of the table and surprised himself because he has always required a step to climb on and off. He was so excited he hopped onto the table again and then off again. He then squatted almost to the floor and then up again. He was extremely happy with his new capacity to move.
We reinforced the idea that he was in control of his comfort through his movement exploration (Mentastics®) and that this was the most important part of his healing. I gave him 350 rupee to cover transportation costs to continue with another five sessions with Samantha. (Note: He needs pillows for home to bolster his spine)
Recommendations:
Continue freeing sternum, upper chest with gentle compressions and rocking and working with posture to support relief of Kyphosis in thoracic spine. Provide traction to neck (length) as well to prevent compression/extension of cervical spine. Keep working with hip rotators and all of the Mentastics® we have reviewed to keep his legs soft while standing. Periodically check is walking gait.
Explore movements on the floor for increasing his ease with sitting and standing. Move incrementally with these. Not too much too fast.
Have him explore movement while in water, either the sea or nearby pond or river. Recommend a natural diet with lots of Coconut water and Gotukola.
Most importantly be yourself as you conduct your sessions. Presence and listening to the patient’s body are very important. For cases where there is a strong holding pattern, be soft, patient and just weigh and sculpt the area. Teach the body what soft is, what peace is, what lightness and being free is like. Take care of yourself in the process and most of all, have fun.
Please sign and date for verification of my activities. Thank you.
__________________________
Mr. Samantha Udagama
It was a genuine pleasure to work with the staff of Navajeevana for the third year in a row. Their commitment to personal development and service to their community are a source of inspiration for me to continue with this challenging work.In addition to conducting two workshops and two special training sessions, I provided sessions to their staff and did a clinical study on a patient I had worked with last year. I was also able to coordinate the efforts of Real Medicine and Navajeevana to provide services to Yayawatta clinic. Jen and I also provided funding for 600 meal packets for their New Year's Celebration for the Disabled.
Further, Kelly Prentice, who is writing the article for MTJ recognized a similarity between Founder Kumarini Wickramsuriya and the founders of Good Shepherd Rehabilitation Hospital in Allentown, PA, Mr. and Mr. Raker. Having been a former employee of GS, she arranged for us to have a meeting with the VP of Rehabilitation Services to discuss the potential for GS to sponsor Navajeevana as a sister hospital for as part of their upcoming 100th year anniversary. Navajeevana is celebrating their 20th year, and despite there expansion to the facilities, they are in need of immediate funding to sustain the presence of their head Physical Therapist. I'll be posting more details on this a bit later.
At the close of our time in Sri Lanka, Kumi, Jen and I had a pleasant meeting and discussed our return. The interest is high and Kumi is looking into getting support for us from Outreach International to conduct Art Therapy classes and treatment clinics for children with neuromuscular disorders. Let's see what happens.
My work in the case study below would not have been possible, without the dedicated support of Mr. Samantha Udagama who not only embodies the principles of The Trager® Approach in is daily life but through his own experience has developed a language to convey its essence clearly and effectively to his patients. All of the exercises that I shared with patients at the center where translated by Mr. Udagama. Together we modeled the movements, but it was his grasp of the approach that made it easy for patients to understand. He was the voice. Together with our touch and movement, we made a difference.
Case Study. Mr. K.A Premadasa
Background: I met Mr. Premadasa last year. He was a very pleasant man with incredible contracture throughout his torso and hips. He was locked up considerably. He had been coming to NJ since 2005 for his painful condition. During my visit, I had treated Mr. Premadasa twice and found that his tension level decreased dramatically. He was able to practice Mentastics® with notable awareness and effectiveness. He has returned to NJ numerous times over the past year for treatments of Electro Stimulation for his pain that reaches a scale of 8/9 after about 4 days after treatment. Subjective - Pain Level – March 28th 2007 – Mid Back Pain 7 After ES treatments –pain 2/3 - 4 days pain returns 8/9.
Objective – posture – hunched
Neck – stiff very little rotation right or left without turning entire torso
Shoulders – rounded, stiff
Mid Back – most painful - Kyphosis thoracic
Low Back – very stiff, excessive tension in erectors
Hips – rotators and gluteals very tight
Legs – stands with knees locked, weight in heels
Before Session - Seated Mentastics®:
Writing Name with Nose – his neck movements were relatively fluid and dynamic. This he said he practiced from last year.
Circles with shoulders and rib cage – prior to session this movement was difficult for him to articulate. The rigidity of his trapezius and pectoralis’ prevented full articulation of this ROM.
Arm tossing – Mr. Premadasa still uses force to toss or drop the arm. (suggested what is soft) shifting weight in chair – lifting hips to mobilize rib cage
Subjective – How do you feel? When I first arrived last year I felt like stone. After treatments I feel peace and relaxed. Today I felt like tied with rope, in knots. Now I am more open. I have been doing the exercises sometimes twice a day and I am able to do my work with more comfort.
Objective/ Session Findings:
Patient needs to develop more self awareness of thoracic cavity to develop more mobility and fluidity in the articulations of the ribs and sternum. I suggested the sky hook visualization prior to our session but when he attempted this only his shoulders contracted and raised rather than his chest and sternum. Patient has developed over the past year a greater capacity for relaxing legs. There was much less hip rotator tension. However when bending knee there was strong resistance to this flexion. When I asked him to bend his knee he did so easily. There exists an unconscious pattern of resistance to this movement. Traction from WW yielded very little evidence of integration between torso and lower extremities.
Rib cage mobilization – slowly the intercostals and the pectoralis began to release, resulting more bounce and a deeper inspiration. The trapezius and subscapularis, rhomboids etc, also softened substantially (abdomen is quite soft and fluid)
Neck rolling was difficult in full range however there was noticeable release in the occipital triangle and when I incorporated shoulder bounce while rolling the neck. He fell asleep for some moments during occipital release.
After session
Before close of the session Mr. Premadasa reported a relief from tensions and the “ropes that were binding him.” After the session he began exploring with delight the mobility in his chest and rib cage that resulted from treatment. He began larger rotations of the arms with an awareness of playing with the weight and feeling the rebound or reverberation.
His walk out of the treatment room appeared more grounded and was smoother, more fluid than when he arrived. Patient is scheduled for 9am on Friday Morning, the 30th of March.
March 30th
Little pain of ribcage….mobilization set up discomfort and he didn’t continue exercises because of pain. Pain set in at night … He reported feeling fine after session.Session went well. Very little work on ribcage lying supine. Legs, and hips released very well as did the arms. In prone position…worked shoulders and ribs….gentle rocking of the back, go away leg released visible and palpable tension in the erectors. This was confirmed by Samantha Udagama. After the session Premadasa explained that he felt like he was in a cradle and this feeling he gets from the sessions helps him through his days. He explained that
“It’s a very nice memory.”ROM of shoulders and depth of breath substantially improved. Also explained that the changes in hips legs, etc. would occur in the rib cage over time but that the holding patterns in the chest were very deep and strong. His experience with the technique made this concept easy for him to accept and understand. He is very optimistic. I gave him 200 Rp for the two trips he’s made to NJ and for next Wednesdays visit. Each trip is 66Rp.
April 4th
Premadasa – explored walking gait. – balancing weight evenly on foot left to right and heal to toe. 25 mins. Sitting and getting up still a slight problem. He does not sit on floor. We suggested sitting on something that is closer to the ground to open his hips but not on the ground and slowly progress to the floor. Reviewed all Mentastics® as well as some yoga exercises to improve ROM in shoulders. Gomukasana with a towel and Parsvatanasana
Nalika - Ms. Nalika had visited Navajeevana 28 times, or weekly since the beginning of November, for neck, shoulder and arm pain. She was diagnosed with Perio Arthritis. I gave her two general sessions which she said provided her with a deep feeling of relaxation that decreased the pain considerably. I had Samantha review Mentastics with her. She had not returned prior to my departure three weeks later.
April 6thNJ – Premadasa – wow…his own movement is helping him, doing Mentastics®, feeling reverberations throughout his body. His capacity to relax is increasing nicely. He reports only some low back pain and pain when sitting and then standing about level 3….showed Mentastics®, walking with rounded feet and water drip kick….great! Samantha big help on interpretation and modeling….increased Mentastics® time to focus on increasing self reliance to relieve pain, gave him 130rp for today and next Monday
April 9th
Premadasa – standing with gluteals contracted – suggested he watch his posture We softened this by shifting weight evenly towards toes and bending his knees. This relaxed his gluteals. He explained that he has always wanted to stand up straight and that is why he is using much effort. I redirected his attention to his sternum for lift here to help with the kyphosis, thoracic curvature of his spine. He then mentioned that for the first time in 7 years that he climbed a ladder and worked on his roof for about 10 minutes. As he climbed up on the table he explained that he now enjoys lying on the couch because he can get up and down without pain. During the session he asked if he was able to ride bicycle. I told him he didn’t need to ask me but rather does he trust himself to mindfully explore his movements as he did this. His last time on a bike was 7 years ago when he began suffering from pain.
While working on his ribcage and spine, he said he no longer feels pain in his mid back when I palpate the erectors. The around the clock move was easy/effortless in almost the full range of motion of his hip rotators. Finally integrated the psoas which was indicative to his level of recovery. Rib cage softened but remains focus for future treatments.
April 19, 2007
According to Mr. Indrajith, Premadasa had no pain for 6 days – (prior to this his pain level would reach 8-9 withing 4 days after treatment. Slight pain returned only after he took tractor ride in back wagon on the 15th. Because of the bouncing and jarring, he felt sore in the ribcage afterwards. He could not raise arms above shoulder height. This caused a severe pain deep in pelvis, Right side.
Performed Trager® moving his arms over head, addressed rib cage and performed cursory leg and hip work to assess hip rotators. Very relaxed. Layed him on pillows placed down center of spine to allow chest to open - had him do arm circles - without pain he was able to raise his arms over head and even rest them there with chest open…he asked if he could sleep this way as it was very comfortable for him
After session the he sat up and was able to extend his arms way over head without any discomfort…even sat back with chest wide open…..with tears in his eyes he told us of his suicidal state prior to finding Navajeevana… “I could not stand the pain any longer. I went and purchased some poison to commit suicide. My last Dr. suggested Navajeevana and I thought I would try one last time. He has made numerous visits since 2005. The relief of pain kept me from killing myself.” Then the money came for me to receive Trager® often and this helped very much.” He then asked if I would see him one last time before my departure. We scheduled for the next day.
Big changes for Mr. Premadasa. Far right picture is from second session. Look at the difference in the facial muscles, neck, trapezius, pectoralis and obviously his posture after just five session.
Open chest after 5 sessions. At second session.
April 20
Premadasa says his still sternum is free. Open. (This had been an area of unbearable pain which greatly limited his activity.) We did Mentastics® for ROM in shoulders. The increase in ROM is substantial if not maximum. He explained that since 2005 and prior to the Trager® treatments this year that he has had a 50% improvement and pain reduction of his condition. With the 7 Trager® treatments over the past 5 weeks, he has experienced an additional 25% improvement. He reported that his mid lower back was a bit painful. I addressed his legs, hamstrings and gluteals, shoulders and mid and low back, hip rotators while prone. Mobilized rib cage and shoulders while supine. Samantha also worked on his low back and instructed him in movement after the session.
At the close of the session he literally hopped of the table and surprised himself because he has always required a step to climb on and off. He was so excited he hopped onto the table again and then off again. He then squatted almost to the floor and then up again. He was extremely happy with his new capacity to move. We reinforced the idea that he was in control of his comfort through his movement exploration (Mentastics®) and that this was the most important part of his healing. I gave him 350 rupee to cover transportation costs to continue with another five sessions with Samantha. (Note: He needs pillows for home to bolster his spine)
Recommendations:
Continue freeing sternum, upper chest with gentle compressions and rocking and working with posture to support relief of Kyphosis in thoracic spine. Provide traction to neck (length) as well to prevent compression/extension of cervical spine. Keep working with hip rotators and all of the Mentastics® we have reviewed to keep his legs soft while standing. Periodically check is walking gait.
Explore movements on the floor for increasing his ease with sitting and standing. Move incrementally with these. Not too much too fast.
Have him explore movement while in water, either the sea or nearby pond or river. Recommend a natural diet with lots of Coconut water and Gotukola.
Most importantly be yourself as you conduct your sessions. Presence and listening to the patient’s body are very important. For cases where there is a strong holding pattern, be soft, patient and just weigh and sculpt the area. Teach the body what soft is, what peace is, what lightness and being free is like. Take care of yourself in the process and most of all, have fun.
Please sign and date for verification of my activities. Thank you.
__________________________
Mr. Samantha Udagama