Talwadkar S, Jagannathan A, Nagarathna R. BACKGROUND Aging is associated with a gradual impairment...
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TRATAKA FOR IMPROVING MEMORY: COMMUNITY BASED INTERVENTION FOR THE ELDERLY Talwadkar S, Jagannathan A, Nagarathna R
Talwadkar S, Jagannathan A, Nagarathna R. BACKGROUND Aging is associated with a gradual impairment of cognitive functions (Curr Neurol Neurosci Rep, 2004)
BACKGROUND Aging is associated with a gradual impairment of
cognitive functions (Curr Neurol Neurosci Rep, 2004) Cognitive
functions most affected by age are Speed of processing Memory
Attention Executive function Spatial ability Reasoning (Aging
Health, 2010)
Slide 3
Treatment options for cognitive impairment- Drug Activity Diet
Cognitive interventions Tai chi Yoga (Journal of the American
Geriatrics Society, 2010; Dementia and Geriatric Cognitive
Disorders, 2010; Neurosci Biobehav Rev, 2012; Journal of the South
Carolina Medical Association, 2008)
Slide 4
Trataka is one of the Shatkarmas (six cleansing processes)
(HYP) Looking intently with an unwavering gaze at a small point
until tears are shed is known as Trataka (HYP)
Slide 5
Trataka practice makes eyes clear and bright. It improves
memory and helps to develop good concentration and strong will
power (Yoga publications trust, Munger, 2008) By practicing
trataka, all the diseases of eyes are destroyed and clairvoyance is
obtained(Gheranda Samhita) Trataka eradicates all eye diseases,
fatigue and sloth and closes the doorway creating these
problems(Hatha yoga pradipika)
Slide 6
Combination of focusing and defocusing through yoga reduces
optical illusion more than focusing alone (Indian Journal of
physiology & Pharmacology, 1997) Jyotritrataka reduces
intraocular pressure in normal subjects (Thai Journal of
Physiological Sciences, 2008) An increase in the CFF (perceptual
accuracy) is seen immediately after Trataka (The Journal of
Alternative and Complementary Medicine, 2010)
Slide 7
LITERATURE REVIEW Numerous studies looking at the effect of
yoga on cognition in healthy young subjects (Percept Mot Skills,
2007; Indian J Physiol Pharmacol, 2009; Front Integr Neurosci, 2012
) Review study-15 studies with cognitively healthy elders, 8
studies with cognitive decline-Improvement in most of the studies
(Clin J Sports Med, 2008) Review of nine studies including 3 RCTs,
6 NRCTs-yoga improved cognitive health of older adults (Int J Yoga
Therap, 2009)
Slide 8
Relaxation response training improved attention, memory in
healthy elderly (Compl Ther Clin Pract, 2006) Long term
practitioners of Vihangam yoga in the geriatric age group- better
cognition (Neuropsychol Cogn, 2012) Study in SVYASA-improvement in
semantic, primary, and working short term memory in healthy elderly
subjects (SVYASA, 2005)
Slide 9
AIM & OBJECTIVES To study the effect of Trataka in the
elderly on: Short term and working memory (digit span forward and
backward) Executive functions (Trail making test B)
Slide 10
METHODOLOGY o Age & gender:- 60 to 80 yrs., Both males and
females. o Subjects: Sample size:- n=60 Source of subjects:-
Subjects were obtained from Old age homes in Goa and from
individuals staying in and around Shantinagar and Margao areas in
Goa.
Slide 11
Inclusion Criteria: Healthy subjects Education: 5 th Std. and
above Willing to participate by giving a written informed consent.
Those knowing Konkani, Hindi, English, Marathi. Exclusion Criteria
: Those having neurological and psychiatric disorders Those who
practiced yoga for the last 3 months.
Slide 12
DESIGN Randomized block design For the convenience of
conducting the intervention, each group was not more than 10
members the groups were randomized into Trataka or wait list
control group.
Slide 13
Group A (trataka intervention) Day 30 TMT B, DS-F, DS-B
Day1(Immediately after intervention ) TMT B, DS-F, DS-B Day1 TMT B,
DS-F, DS-B
Slide 14
Group B (Wait-list control) Day 30 TMT B, DS-F, DS-B Day 1
(After quiet sitting) TMT B, DS-F, DS-B Day 1 TMT B, DS-F,
DS-B
Slide 15
ASSESSMENT Trail making test B-visual scanning, complex
attention, psychomotor speed mental exibility, executive functions,
working memory and task-switching ability. Digit Span forward and
backward- evaluates short-term memory and working memory.
Slide 16
DETAILS OF TRATAKA PRACTICE
Slide 17
Slide 18
DATA ANALYSIS Data was analyzed with the help of Statistical
Package for Social Sciences (SPSS) version 16.
Slide 19
RESULTS Shapiro-Wilk test of normality Trail Making Test Part B
(TMT B) for both groups - normally distributed (p > 0.05). Digit
span test- not normally distributed (p
Wilcoxon Signed Ranks Test showed that there was no significant
change in the digit span test scores from baseline to 1 st
follow-up (p=0.06). But significant increase in scores was seen
from baseline to 2 nd follow up (p = 0.001) and also from 1 st
follow up to 2 nd follow up (p=0.002) in the trataka group. There
was no significant changes in the digit span scores from baseline
to 1 st follow-up/2 nd follow-up (p>0.05) or from 1 st follow-up
to 2 nd follow-up in the control group.
Slide 25
Slide 26
Slide 27
SUB GROUP ANALYSIS The elderly from the old age home formed 2
blocks and those from residential localities formed 2 blocks-
randomized into any of the 2 interventions (Trtaka or wait list
control) Trataka group- 1 block-old age home 1 block- Elderly from
Localities Wait-list control group- 1 block-old age home 1 block-
Elderly from Localities
Slide 28
Trataka Group Variable Baseline 1 st follow up 2 nd follow up
Fp-value Mean (SD) Digit span Old age home 268.57 (87.042) 228.14
(64.752) 199.29 (77.706) 0.29 Locality 134.47 (65.031) 98.79
(47.989) 78.84 (31.489) TMT B Old age home 15.14 (3.024) 14.14
(1.773) 14.43 (2.070) 8.90.001 Locality 16.32 (4.137) 17.68 (4.877)
19.95 (3.979)
Slide 29
Wait-List control Group Variable Baseline 1 st follow up 2 nd
follow up Fp-value Mean (SD) Digit span Old age home 16.77 (2.555)
15.77 (3.345) 14.69 (3.011) 3.170.06 Locality 17.56 (5.126) 18.44
(4.693) 18.22 (6.667) TMT B Old age home 202.17 (81.658) 217.75
(99.649) 180.08 (85.373) 0.770.48 Locality 149.00 (60.858) 142.67
(68.440) 114.00 (58.643)
Slide 30
DISCUSSION Subjects were at a stage when cognitive decline was
a reality Have never been exposed to Tr aka or any Yog intervention
earlier Scales used in this study were sensitive enough to tap the
cognitive improvement in the elderly Prolonged duration of practice
of Yog/tr aka for desirable effects 1 day of practice was not
sufficient to produce changes in the cognitive functions, whereas
one month follow up showed significant changes
Slide 31
Tr aka- involves focusing and defocusing Focusing-Dharana
Defocusing-Dhyana Dharana or focusing improves mainly concentrative
attention, enhances the stability of attention and reduces the need
to invoke executive skills that regulate the focus of attention
from moment to moment(decreased cognitive efforts), improves the
ability to remain vigilant and monitor distractors without losing
focus. Dhyana-the regulative attentional skills are invoked less
and less frequently, and the ability to sustain focus thus becomes
progressively effortless.
Slide 32
Relaxation techniques have shown to reduce anxiety and improve
memory as well as attention. Reduced anxiety can improve the
performance on tasks requiring attention and memory.
Slide 33
CONCLUSIONS Results establish that Tr aka can be used as a
technique to enhance cognition. Tr aka if provided to a group which
is prone for cognitive decline and to those who have not been
exposed to any cognition improving interventions, it can be helpful
in improving their cognition Long term practice of tr aka
(according to this study an optimum duration of one month) is
needed to bring about the required change in cognition. Tr aka
improved memory scores of those living in residences better than
those living in old age homes shows that the place where elderly
age, has an impact on their cognition.
Slide 34
STRENGTHS & LIMITATIONS Strengths: Randomized block design
(RBD) Standardized neuropsychological tests with high reliability
and validity. Intervention was provided to the sample that needed
the intervention.
Slide 35
Limitations: Sampling was done only in 2 old age homes Sample
size was small Only three outcome variables
Slide 36
FUTURE SUGGESTIONS Study with a larger sample Combinations of
cognition enhancing Yog techniques Subjects with cognitive deficits
Combinations of Yog and other cognitive interventions Mechanism of
Tr aka practice
Slide 37
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