Original Research Article EFFICACY OF PRANAYAMIC BREATHING ... · Original Research Article EFFICACY OF PRANAYAMIC BREATHING ON COGNITION AND ... [1], Tinetti Performance ... EFFICACY

Int J Physiother Res 2016;4(6):1771-79. ISSN 2321-1822 1771

Original Research Article

EFFICACY OF PRANAYAMIC BREATHING ON COGNITION ANDBALANCE IN PARKINSON’S PATIENTSNeha Singh *1, K. Senthil.Assistant Professor, Faculty of Neurosciences, Dr A. P. J. Abdul Kalam College of Physiotherapy,PIMS, Loni-413736, Maharashtra, India.Associate Professor, Thanthai Roever College of Physiotherapy, The Tamilnadu Dr. MGR MedicalUniversity, Perambalur-621212, Chennai, India.

Purpose: To investigate the effects of Pranayamic breathing on cognition and balance in Parkinson’s patients.Introduction: Recent researches have shown that pranayamic breathing shifts autonomic nervous system awayfrom sympathetic dominance. Other physical disorders that are caused by improper mental health have excel-lent cure through pranayamic breathing exercises.Materials and Methods: Twenty Parkinson’s patients between 50-80 years of age and stage 3 of Hoehn & Yahrscale were selected purposively and were randomly divided into two groups. Group A received pranayamicbreathing with conventional physiotherapy for 4 days a week for 4 weeks. Group B received conventional phys-iotherapy. Mini Mental State Examination (MMSE), Timed Get Up Go (TUG), Tinetti’s Performance Oriented Mobil-ity Assessment (POMA) were used to assess cognition and balance.Analysis: To compare values of MMSE, TUG test and POMA at the end of trial in each group, repeated measureANOVA with Bonferroni test was used. To compare those differences between two groups univariate ANOVA wasused. A level of significance was p<0.05.Results: Comparison of MMSE and POMA score was found to be statistically significant in group A (p<0.05).Comparison of TUG score at the end of trial in each group was found to be statistically insignificant (p>0.05).Comparison of MMSE, TUG and POMA score at the end of week 4 in both group was found to statisticallysignificant (p<0.05).Conclusion: This study concluded, pranayamic breathing with conventional physiotherapy has shown improve-ment in cognition and balance in Parkinson’s patients.Implications: Pranayamic breathing can be used along with conventional physiotherapy to improve cognitionand balance in Parkinson’s patients.KEY WORDS: Pranayama, Parkinson’s disease, Balance, Cognition.

ABSTRACT

INTRODUCTION

Address for correspondence: Dr Neha Singh (PT), Assistant Professor, Dr A. P. J. Abdul KalamCollege of Physiotherapy, PIMS, Loni-413736, Maharashtra, India. Phone No: +91 9420327591E-Mail: [email protected]

International Journal of Physiotherapy and Research,Int J Physiother Res 2016, Vol 4(6):1771-79. ISSN 2321-1822

DOI: http://dx.doi.org/10.16965/ijpr.2016.189

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International Journal of Physiotherapy and ResearchISSN 2321- 1822

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DOI: 10.16965/ijpr.2016.189

Received: 16-10-2016 Peer Review: 17-10-2016 Revised: None

Accepted: 08-11-2016Published (O): 11-12-2016Published (P): 11-12-2016

It is one of the commonest neurodegenerativediseases that affect more than 2 percent of popu-lation older than 65 years of age and incidenceincreases with age. The aetiology of Parkinson’sdisease remains unknown and the consensus is

Parkinson’s disease (PD) is a chronic, progres-sive disease of the nervous system character-ized by the cardinal features of rigidity, bradyki-nesia, tremor, and postural instability [1].

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Neha Singh, K. Senthil. EFFICACY OF PRANAYAMIC BREATHING ON COGNITION AND BALANCE IN PARKINSON’S PATIENTS.

that it is multifactorial [2,3].Sullivan and colleagues [4] suggested thatmemory deficits were directly related to overalldisease severity, with mildly impaired patientsshowing no decrements in memory perfor-mance, while Goldman and colleagues [5] foundincreasing memory deficit with increasingdisease severity, including deficits among thosevery mildly affected [6]. A brief screen ofcognitive function can be obtained using MiniMental Status Exam (MMSE) [1]. Cognitiveimpairment in the absence of frank dementia,typically called Mild Cognitive Impairment (MCI),occurs frequently in PD, even among those newlydiagnosed [7-11]. Joe Nocera and colleaguesgave evidence that motor function, specificallypostural control may be negatively influencedby cognitive dysfunction in PD [12].The upright postures like sitting; standing orwalking requires proper functioning of centralbalancing mechanisms. Afferent impulses ofwidespread origins, including signals from theperiphery, play important role in eliciting andguiding responses, while efferent pathwayscarry messages to the muscles for the execu-tion of the balancing act. Damage to any one ofthe central mechanisms or interruption anywherealong the sensory or motor pathway may leadto an inability to maintain body’s COG withinthe base of support, but, no one system directspecifies the position of COG as stated byBrunnstrom (1970) [13].There are a number of clinical balance tests thatexamine functional related to balance. TheTimed Up and Go Test [14] is particularlyvaluable instrument for patients with PDbecause it includes tasks that are typicallyproblematic.1 Tinetti’s Performance OrientedMobility Assessment (POMA) [15] includes bothstatic and dynamic balance items, organized intotwo subsets of balance (nine items) and gait (sixitems) [1]. Pranayamic breathing, defined as amanipulation of breath movement, has beenshown to contribute to a physiologic responsecharacterized by the presence of decreasedoxygen consumption, decreased heart rate, anddecreased blood pressure, as well as increasedtheta wave amplitude in EEG recordings,increased parasympathetic activity accompa-nied by the experience of alertness and reinvig-

oration [16]. Ravinder Jerath et al gave thehypothesis that voluntary slow deep breathingfunctionally resets the autonomic nervoussystem through stretch- induced inhibitorysignals and hyperpolarisation currentspropagated through both neural and non-neural tissue which synchronizes neuralelements in the heart, lings, limbic system andcortex.Pranayama has been researched mostly for itsbeneficial applications in treatment of cardio-vascular diseases such as hypertension [17-19],pulmonary disease such as asthma [20-22], au-tonomic nervous system imbalances [23], andpsycho logic or stress related disorders [19,24].Recent studies have shown that motor symp-toms are not influenced by dopaminergic stimu-lation, including postural instability, have beenassociated with accelerated cognitive decline[25,26]. It is possible that cognition plays a vi-tal role on enhancing balance performance.Based upon the reported findings, the primaryobjective of this study is to investigate whetherpranayamic breathing will improve the cognitionand balance in Parkinson’s. This study will alsoadd to the knowledge of physiotherapy by con-centrating on the respiratory aspect to enhancecognition as well along with motor componentto improve balance in Parkinson’s patients.

MATERIAL AND METHODSParticipants: A total of 20 subjects clinicallydiagnosed with Parkinson’s disease participatedin this study. Subjects were recruited fromParkinson’s Mitra Mandal Society, Pune. All sub-jects met the following inclusion criteria: (1)Hoehn and Yahr stage III; (2) Minimum score of24 on MMSE scale of cognition; (3) Both malesand females within the age group of 50-80 years;(4) Subjects with score of 19 and above of POMAscale. Subjects were excluded with followingexclusion criteria: (1) Subjects diagnosed withParkinson’s plus syndrome like Progressive su-pranuclear palsy, shy draggers syndrome; (2)subjects diagnosed with visual and auditoryimpairments; (3) History of any other neurologi-cal disease, musculoskeletal impairment thatwill add up to balance impairment like CVA, TIA,Vestibular disorder, joint replacement etc; (4)Subjects with uncontrolled Diabetes mellitus. All



subjects were required to sign an writteninformed consent document approved by theethical committee at Dr. D. Y. Patil Vidyapeeth,Padmashree Dr. D. Y. Patil College of Physio-therapy, Pimpri, Pune.Study Design: This study was an RCT, takingplace during a month period (fig 1). Recruitmentbegan on 20th of September 2012, and the studywas on 3rd of November 2012. Twenty subjectswere randomly allocated to two groups by theinvestigator who was involved in datacollection, treatment implication, and data analy-sis. 46 Parkinson subjects were targeted, out ofwhich 20 were included for the study purpose.Subjects in group A (experimental group)received Pranayamic breathing along withconventional physiotherapy treatment. Whilesubjects in group B (control group) receivedconventional physiotherapy. Both the groupsreceived this protocol for a period of one month,with a frequency of 4 times in a week. Baselineassessments were done after randomization, atthe start of the protocol, at the end of week 1,week 2 and week 4. For each subject, allassessment sessions were performed at thesame time of day, and all tests were performedin the same order, to control for variations inperformance because of medication cycle. Allassessments were conducted in the “on” statefor those subjects experiencing motor fluctua-tions. All subjects were required to take theirmedications at the same time of day for allassessment sessions.Fig. 1: Study design and flow of the participants througheach stages of the trial.

Assessments: Mini Mental State Examination(MMSE) [1], Tinetti Performance-OrientedMobility Assessment (POMA) [14], TimedGet-up and Go Test [15] were the outcomemeasures taken at baseline, at the end of week1, week 2 and week 4.Rehabilitation Program: The rehabilitation pro-gram consisted of 16 sessions, each 1 hour long,4 times weekly for 4 weeks. All treatment ses-sions occurred at the same time of day on thesame 4 days of the week throughout the study.Intervention was conducted individually and notin a group format. The physical therapist wasinvolved in performing the intervention as wellas conducting the assessments. Pranayamicbreathing given to the subjects was of two types,Alternate Nostril Breathing (ANB) and BrahmariPranayama of which few trial sessions weregiven before starting the treatment protocol.Subjects were given Jacobson’s relaxationtechnique to induce relaxation for 5min andcommands were given to “let go” .Then thera-pists command were given for alternate nostrilbreathing, which was continued for a period of20 minutes. Rest period of few seconds weregiven to the subjects after every 5 minutes ofalternate nostril breathing. Subjects were askedto perform Brahmari Pranayama (10min) in erectsitting posture for a repetition of 3 to 21 timesas per their comfort level while keeping theirmouth closed. Conventional therapy wasincorporated by both the groups as baselinetreatment. Conventional therapy (25 min)consisted of gentle rocking movements, gentlerange of motion for shoulder joint, thoracicmobilization, dissociated movements, prone onelbows, pelvic bridging, gentle active-assistedmovement of knee and ankle, balance exercisein standing with chair support, reaching activi-ties in sitting and standing, gentle perturbations,ground walking. There is evidence in the litera-ture to support each of the components con-tained in the intervention [27,1].Statistical analysis: Differences in Data wereanalysed using the SPSS Professional Statistics,version 15.0 software, for Windows. Repeatedmeasures ANOVA was used to compare the im-provement of MMSE, TUG and POMA score over4 weeks period in each group. If a significanteffect for cognition and balance was found, the



following post hoc analysis was done usingbonferroni test. One way analysis of variance(ANOVA) with repeated measures was used tocompare those differences between two groupsat baseline, week 1, week 2 and week 4. Anindependent t-test was used to compare the agedifference between two groups. A level of sig-nificance was taken at p<0.05.

RESULTS

In this study 20 Parkinson subjects were taken.In group A, 10 patients were treated withpranayamic breathing and conventional physio-therapy and in group B, 10 patients were treatedwith conventional therapy. At the end of 1st, 2nd

and 4th week, cognition was reassessed by MiniMental State Examination, balance was reas-sessed by Time get up and go test and Tinetti’sPerformance-Oriented Mobility Assessment. Tocompare the value of MMSE, TUG test andPOMA at the end of trial in each group, repeatedmeasure ANOVA was used. Further post hocanalysis was done using Bonferroni test to seedifferences between each level in each group.To compare those differences between twogroups univariate ANOVA was used. To comparethe age between two groups t-test was used. Alevel of significance was p<0.05. Analysis ofwithin group comparison of MMSE, TUG, POMAscore and Post hoc analysis (Bonferroni test) wasperformed (Table 1a, 1b).Comparison of MMSE score from baseline to atthe end of 4th week was found to be statisticallysignificant in group A (p<0.05). Further post hocanalysis using bonferroni test revealed that therewas insignificant difference found betweenbaseline and week 2, week 1 and week 2(p>0.05). However, there were significant dif-ferences noted between baseline and week 4,week 1 and week 4, week 2 and week4 (p<0.05).Comparison of TUG test from baseline to at theend of 4th week was found to be statistically in-significant in group A (p >0.05). Comparison ofPOMA score from baseline to at the end of 4th

week was found to be statistically significant ingroup A (p<0.05). Further post hoc analysis us-ing bonferroni test revealed that there was sig-nificant difference found between baseline andweek 2, baseline and week4, week 1 and week2, week 1 and week 4 (p<0.05). However there

was insignificant difference between week 2 andweek 4 (p>0.05).Table 1a: Within group comparison of MMSE, TUG,POMA.

Baseline Week 1 Week 2 Week 4Mean ±SD Mean ±SD Mean ±SD Mean ±SD

n= 20 n=20 n=20 n=20 F value P valueGroup A 27.90±1.19 27.90±1.19 28.90±0.73 29.90±0.31 24.75 0Group B 27.10±1.52 27.10±1.52 27.20±1.47 27.90±1.52 4.59 0.01Group A 13.47±2.16 13.47±2.16 13.58±3.73 13.04±2.54 0.225 0.801Group B 20.50±3.06 20.50±3.06 19.75±2.63 19.33±3.24 0.859 0.442Group A 20.10±0.99 20.10±0.99 21.20±1.39 22.20±0.78 32.786 0Group B 19.40±0.51 19.40±0.51 19.60±0.69 19.90±1.10 2.293 0.101

Repeated Measures ANOVA

MMSE

POMA

TUG

*Significant at < 0.05 with 95% Confidence IntervalTable 1b: Post hoc analysis (Bonferroni test).

Baseline v/s Week 2

Baseline v/s Week 4

Week 1 v/s Week 2

Week 1 v/s Week 4

Week 2 v/s Week 4

Group A 0.051 0.001 0.051 0.001 0.006Group B 1 0.221 1 0.221 0.008Group A 1 1 1 1 1Group B 1 1 1 1 1Group A 0.04 0 0.04 0 0.09Group B 1 0.829 1 0.829 0.487

MMSE

TUG

POMA

Comparison of MMSE score from baseline to atthe end of 4th week was found to be statisticallysignificant in group B (p<0.05). Further post hocanalysis using bonferroni test revealed that therewas insignificant difference found betweenbaseline and week 2,baseline and week 4,week1 and week 2, week 1 and week 4 (p>0.05).However, there was significant differences notedbetween week 2 and week 4 (p<0.05). Compari-son of TUG score from baseline to at the end of4th week was found to be statistically insignifi-cant in group B (p<0.05). Comparison of POMAscore from baseline to at the end of 4th weekwas found to be statistically insignificant ingroup B (p>0.05).In table 2, the baseline, week 1, week 2 and week4 parameters (MMSE, TUG, POMA) arepresented and between group comparisons weredone for group A and group B. Comparison ofMMSE score at baseline was found to be statis-tically insignificant between Group A and GroupB (P>0.05). It remained insignificant at the endof week 1 (p>0.05). At the end of week 2 andweek 4 it was found to be significant betweengroup A and group B (p<0.05). Comparison ofTUG score at baseline, week 1, week 2 and week4 was found to be statistically significantbetween Group A and Group B (P<0.05). Com-parison of POMA score at baseline was found



to be statistically insignificant between GroupA and Group B (P>0.05). It remained insignifi-cant at the end of week 1 (p>0.05). At the endof week 2 and week 4 it was found to be signifi-cant between group A and group B (p<0.05).Table 2: Between group comparison of MMSE, TUG, POMA.

Group A Group B

Mean ± SD n=10Mean ± SD

n=10F P

Baseline 27.90 ±1.19 27.10 ±1.52 1.704 0.208Week 1 27.90 ±1.19 27.10 ±1.52 1.704 0.208Week 2 28.90 ±0.73 27.20 ±1.47 10.616 0.004Week 4 29.90 ±0.31 27.90 ±1.52 16.514 0.001Baseline 13.47 ±2.16 20.50 ±3.06 35.116 0Week 1 13.47 ±2.16 20.50 ±3.06 35.116 0Week 2 13.58 ±3.73 19.75 ±2.63 18.228 0Week 4 13.04 ±2.54 19.33 ±3.24 23.19 0Baseline 20.10 ±0.99 19.40 ±0.51 3.903 0.064Week 1 20.10 ±0.99 19.40 ±0.51 3.903 0.064Week 2 21.20 ±1.39 19.60 ±0.69 10.473 0.005Week 4 22.20 ±0.78 19.90 ±1.10 28.855 0

One way ANOVA

MMSE

TUG

POMA

Following are the graphs representingdistribution of between group comparison ofMMSE, TUG, POMA score respectively.

DISCUSSIONAlmost all patients with PD suffer from selec-tive cognitive impairments, including difficulties with attention, concentration, problem solving, set-shifting, and memory, which are thoughtto reflect dysfunction of cortical circuits subserving frontal brain regions. These impairmentsare most frequently reported by patients in termsof the disabilities they cause, such as difficul-ties in paying attention at work, problems han-dling more than one project at a time, inabilityto sequence, plan, and organize tasks at workand home and problems completing tasks thathave been started. While dysfunction in thecortico-circuits may underlie cognitive deficitsapparent on executive and other frontal tasks,the dopaminergic system is likely not the onlyneurotransmittter disruption in this disease [6].The underlying neuropathological disturbance inPD involves selective deterioration of subcorti-cal structures, e.g. dopaminergic neurons insubstantia nigra which affects primarily thebasal ganglia structures [28].Cognitive demands associated with balance andlocomotion may contribute to the incidence offalling among older adults. The ability to recovera stable posture following an external pertur-bation is more attentionally demanding for olderadults than for younger adults. This wouldsuggest that for some older adults, an increasedrisk for loss of balance and falls may result ifsufficient attentional resources are notallocated to the task of postural recovery [29].Previous research, demonstrates that as cogni-tive scores (executive function and workingmemory) decrease Centre of Pressure (COP)sway area and thus postural instability increasessuggesting that cognitive impairment maycorrelate with motor severity [25]. For example,Levy et al. [30] found that both bradykinesia andaxial symptoms were associated with anincreased incidence of dementia. This suggeststhat the training to improve cognition andattention is beneficial. However, few studieshave explained that how cognition may play animportant role in maintaining balance in olderadults. The purpose of this study was to findout whether by giving two types of Pranayamicbreathing, does mobility and risks of fall improveby improvement in mild cognitive impairment in


PD. As, studies have also shown, Cognitiveimpairment in absence of frank dementia, typi-cally called mild cognitive impairment (MCI),occurs frequently in PD [8,9], even among thosenewly diagnosed [10,11]. And also, Cognitivedeficits are common in PD patients with “nor-mal” cognition based on MMSE performance [7].The findings of present study partially supportour main hypothesis in that gains were observedin cognitive function and mobility status of andfalls risks related to balance in individuals withPD. Our results reveal significant improvementsin Mini Mental State Examination (MMSE),Timed up and go test (TUG), and Tinetti Perfor-mance Oriented Mobility Assessment (POMA)score in the experimental group (Pranayamicbreathing and conventional physiotherapy),compared with the control group (conventionalphysiotherapy only). No significant differencesbetween groups were found for MMSE andPOMA at the baseline. The within groupanalysis did not support the between groupdifferences. Significant differences at the endof week 2 and week 4 compared with thebaseline were found for the MMSE and POMAin both the groups, along with consistentsignificance in TUG in both the groups through-out the training period, which indicates thatsome gains were maintained all the time.The efficacy of pranayamic breathing on cogni-tion in this study can be explained by changesin the autonomic balance as it has been reportedthat slow pranayamic breathing generates in-hibitory signals and hyperpolarised currentwithin neural and non–neural tissue by mechani-cally stretching tissues during breath inhalationand retention. It is likely that hyperpolarizationcurrent initiates the synchronization of neuralelements in the central nervous system, andsurrounding tissues ultimately causing shifts inthe autonomic balance towards parasympatheticdominance [16]. It has been reported that im-mediate decrease in all cardiovascular param-eters in our patients can be explained by changesin the autonomic balance as it has been previ-ously reported that sympathetic activity is lowerduring left nostril breathing.31 It has also beenstudies that exclusive left nostril breathing re-peated four times a day for a month reducedsympathetic activity [32].

As both the groups have shown statisticalimprovement in MMSE, TUG and POMA posttraining of pranayamic breathing along withconventional physiotherapy and conventionalphysiotherapy alone. Study on the relationshipbetween balance and cognition conducted byJoe Nocera et al provided evidence that motorfunction, specifically postural control may benegatively influenced by cognitive dysfunctionin PD. Cognitive impairment is common and hasdevastating implications on the quality of lifefor patients in PD [25].The memory is one of the ability of the brain tostore and retrieve information of both verbal andnon verbal nature. This retrieval process involvesgeneration of a sequence of entities in theresponse set which corresponds to the entitiesof stimulus set. This decides the nature ofrecall function. For example recall of telephonenumbers, etc. The left hemisphere (LH) lobe ofcerebral cortex is the seat for recall of numeri-cal, descriptive and analytical data. This involvestemporal lobe to register and encode the incom-ing stimulus information in the parietal lobe forinformation storage. The display of recall wouldbe a motor output such as the verbal recallinvolving speech motor pathways. This corticalaspect of retrieval function is also co-relatedwith the regional cerebral circulation [33,34].Further, few studies reveal the relation betweenthe breathing techniques such as uni-nostril(right and left nostril ) and alternate nostrilbreathing on enhanced spatial memory perfor-mance, etc. [35] An previous research concludesthat the right nostril breathing would facilitatebetter inherent digit backward and digit forwardspan memory performance of left hemisphere.However, alternate nostril breathing may onlyrefresh the left hemispheric activity duringrecall function and the associative learning isnot affected by any of such interventions [33].As discussed by Stanley John Winser [36], theresult of his experiment provided evidence that,the balance exercises dedicated to stimulate andfacilitate the peripheral proprioceptors havebeneficial effects in improving balance amongindividuals suffering from PD. Present study hasshown improvement in both the groups, furthershowing better improvement in the experimen-tal group A. This change might be due to the



rigidity in PD. Stress management techniquesare an important adjunct to relaxation training[1]. In present study, Patients were alsobenefitted from pranayamic breathing,conscious recognition and release of muscletension (Progressive Relaxation Technique/Jacobson’s Relaxation) [39].In a multidisciplinary rehabilitation program forpeople with PD, Wade et al [40] showed shortterm gains in mobility, with worsening disabil-ity at 6 months. Heterogeneity between groupsrelated to medication adjustments and activitylevel may contribute to the lack of significantfindings across outcome measures between thetraining period assessment. It is worthy to con-sider, however, that perhaps people with a longterm chronic degenerative disease need inter-vention to occur over a longer time period [41].Instead of receiving a bout of exercise andPranayamic breathing for a shorter period, theymay need to continue the program for severalmonths or more to maintain gains shown earlyon.

added intervention of pranayamic breathingincluding alternate nostril breathing andbrahmari pranayama.Analysis of present study shows that, when TUGtest scores were compared from baseline to atthe end of week 4, statistical insignificance wasfound within the groups A and B, but compari-son of TUG test scores at baseline, week 1, week2 and week 4 had shown statistical significancebetween groups A and BA deterioration of the overall therapeutic effec-tiveness of L-dopa can be expected over timewith a reported increase motor complicationsof 10 percent per year [1,37]. For many patientsthe therapeutic window is 5-7 years beforeoptimal benefit wears off. This is thought toresult from progressive nigrostriatal degenera-tion. Wearing- “off” state or endof- dose dete-rioration is a worsening of symptoms during theexpected time- frame of medication effective-ness. Freezing episodes, or sudden episodes ofimmobility, may appear. Random fluctuations inmotor performance, termed “on-off” phenom-enon, occur in about 50 percent of patientstreated for more than 2 years and can be verydisabling [1]. This may be one of the reasonbehind no significant improvement in TUG testscores taken, as it assesses the mobility statusof and fall risk for individual with PD. Timeconstraint could also be one of the factor, astraining period was of 4 weeks. If the trainingperiod had been more, much better results wouldhave been gained as present attained one. Theseverity of problems, stages of disease, age,phase and setting of rehabilitation, and otherfactors must all be taken into account in struc-turing the evaluating data [1].Additional strategies to promote relaxationincluded an emphasis on diaphragmatic breath-ing during exercise, gentle rocking to producegeneralized relaxation of excessive muscletension due to rigidity. During therapy, slow,rhythmic, rotational movements of the extremi-ties and trunk such as range of motion (ROM),stretching, functional training [1,38] Physicaltherapy also included, hook lying, lower trunkrotation, side lying rolling, upper and lower trunksegmental rotation, PNF techniques of rhythmicinitiation (RI) were designed to promoterelaxation and to help overcome the effects of

CONCLUSION

ACKNOWLEDGEMENTS

The finding of this study supports our mainhypothesis that Pranayamic breathing alongwith conventional therapy is more effective oncognition and balance in Parkinson’s patients.Subjects with clinically diagnosed PD withinstage three of Hoehn and Yahr grade benefit inshort term with regards to cognition andbalance.

We thank principal, guide and all staff ofDepartment of Physiotherapy, Padmashree Dr.D. Y. Vidyapeeth (Pimpri-Pune), members andsubjects of Parkinsons Mitra mandal, Pune,respected parent and last but not the leastalmighty for their support, suggestions,co-operation, keeping spirits high and success-ful attempt throughout the study.Conflicts of interest: NoneREFERENCES[1]. Susan B O’Sullivan, PT, EdD: Physical Rehabilita-

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How to cite this article:Neha Singh, K. Senthil. EFFICACY OF PRANAYAMIC BREATHING ONCOGNITION AND BALANCE IN PARKINSON’S PATIENTS. Int J Physiother Res2016;4(6):1771-1779. DOI: 10.16965/ijpr.2016.189


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[41]. Terry Ellis et al. Efficacy of a Physical Therapy Pro-gram In Patients with Parkinson’s Disease: A Ran-domized Controlled Trial. Arch Phys Med Rehabil2005;86:626-32.

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Original Research Article EFFICACY OF PRANAYAMIC BREATHING ... · Original Research Article EFFICACY OF PRANAYAMIC BREATHING ON COGNITION AND ... [1], Tinetti Performance ... EFFICACY