By: Melissa Mroz
To the naked eye the brain, as an organ, may seem unimpressive. However, this dense cluster of tens of thousands of neurons and glial cells is bound together by energy and through a microscope it looks like what telescopes can see in the cosmos. The brain fused with the energy of the mind controls every function within our physical body! Within its structure, our memories, thoughts and feelings move with the electric and chemical signaling! If this does not provoke wonder, let us take into consideration the Vedic panchamaya kosha model which observes the interconnected dimensions of life. The understanding that we are energy, matter, mind, intuition and the universe all at the same time was observed, shared and practiced thousands of years ago. The pranamaya kosha is our energy and breath. The annamaya kosha is our physical body. The manomaya kosha is our mental and emotional state. The vijnanamaya kosha is our wisdom and intuition. The anandamaya kosha is our blissful universal nature. The koshas provide a successful model to treat and educate an individual (and their support system) who has sustained a central nervous system injury because it honors the ability to grow while addressing the current energetic, physical, cognitive, emotional, intuitive and spiritual state of the person.
A central nervous system injury is most commonly refer to as a traumatic brain injury either acquired or non-traumatic. An acquired traumatic brain injury is due to external forces causing structural damage, degeneration and death to the cells by blunt force, swelling, hypoxia/lack of oxygen, and a brain bleeds. A non-traumatic brain injury is due to a stroke and other internal factors Neural damage results in axonal injury, which is damage to axon/white matter tracts or neuronal cell body death. Neural damage immediately affects the physical, cognitive, emotional, behavioral and social aspects of a person globally. Severity of symptoms and reactions/responses/resilience can be radically different from Individual to individual. Long term this has effects on society, economics and health. Statistically, young men in the US are most susceptible to acquiring a traumatic brain injuries due to recreational and occupational activities. This is only second to non-traumatic injuries, like stroke and heart attacks. Both are influenced by activities of daily living, mental resilience and allostatic load.
Neural traumas are often graded upon different scales such as the Ranchos Los Amigos scale or the Glasgow Coma scale. The scale’s grade the level of consciousness from mild to severe. They observe verbal and motoral responses to stimuli. Approaching neural damage holistically provides more accurate inferences upon a person's current condition. These scales fail to recognize the dynamic nature of the whole person and mind/body connection. The integration of the pancamaya kosha model with the modern medical model would increase the effectiveness of treatment. The panchamaya kosha model explorers and honors our existence as interconnected dimensions of the whole. It breaths acceptance while acknowledging that we are in a continual growth state. Through these sheaths imbalances become identifiable and manageable. Awareness is key to sustainable health and wellness.
The pranamaya kosha, energy of the body and breath is a link between all life. Prana by definition is our life force energy. At this is sheath, a neural trauma creates immediate energy imbalances. The body responds to brain trauma through innervating the sympathetic nervous system in order to increase blood flow and oxygenation. Essentially, the body fights to keep itself alive! This has been observed and classified as the Cushing triad syndrome. Energetically, the person may experience exhaustion, fatigue, depression, anxiety, frustration, agitation, disorientation, sensitivity, apathy and disinhibition. Their breath may also be ineffective due to lack of awareness. They also may experience cardiovascular fatigue. Metabolism may also be affected by the sympathetic response and for reasons such as the lack of sleep and a deficient diet. This leads us into the physical body.
The annamaya kosha is the physical body as includes all anatomical systems. Structural damage of axonal/white matter tract and/or neurological cell death causes electrical and chemical imbalances. Structural, chemical and electrical imbalances in the nervous system effect the entire physical body in unimaginable ways.
Damage to the motor cortex of the brain will inhibit somatic efferent and afferent tracts down the spinal cord. If this part of the brain is damaged the person will exhibit a decrease in fine and gross motor skills, coordination, ambulation, and balance. They may also experience extremity (hemi)paralysis, weakness, numbness and/or fatigue. This can also effect speech. If too fatigue, speech can begin to slur. Additionally, if language centers are effected, aphasia and verbal coherence will be present.
Damage to areas in the brain responsible to interpretation and integration of sensory information can drastically alter perception. The perception of our sense of touch, sense, taste, smell, sight and if we're going by Egyptian understanding, thought can be completely different than what they were prior to damage. The eyesight can be damaged and blurred due to detached retina or occipital lobe damage. The pupils could be blown out. Light, color, pattern and movement sensitivity can affect the brain’s electrical signaling. Fast moving and blinking light can trigger seizures. A constant ringing in the ears and headaches could emerge. All environmental sounds could be unbearably amplified, as could internal sounds. The inability to hear/focus on one voice in a crowd could be present in addition to not being able to drown our exterior sounds. Worst of all, sounds vibrations could illicit a response of wanting to crawl out of your skin, for a lack of a better way to explain this phenomenon. The interpretation of the touch in terms of pressure, temperature and pain change as well. Interestingly, the sense of smell can disappear entirely. Depending on severity, deviations in sensory perception of energy could create a state of manageable discomfort or create a complete overload which could stimulate the sympathetic nervous system. All the while, the ability to understand these changes and the ability to communicate this information to others may be greatly inhibited due to damage to language centers in the brain. These symptoms are not only immensely frustrating but they also can induce a sense of threat/fear. If experienced on a constant basis without any acknowledgement/therapeutic resilience training, stimulus overload could contribute to adrenal fatigue, as understood by fitness experts. This leads us into endocrine imbalances and nervous system imbalances.
Our mind and body are intimately connected through a dance of energy and matter and move in tandem. The sensory organs are stimulated by energy waves, the information travels up the peripheral nervous system and into the brain stem for immediate life sustaining action. From here it travels into the limbic system where the amygdala draws on memories to decide whether the stimulus is safe or dangerous. The amygdala sends a quick message to the hypothalamus and the hypothalamus signals to the pituitary gland, the master gland, in order to begin activating the appropriate hormonal response for the environmental demands. If an action response is necessary, epinephrine and norepinephrine are released immediately. While they create similar arousal responses and both stem from dopamine, they are released simultaneously as a safety net. While the body typically works toward energy conservation, this evolutionary feature ensures one of them will work in our time of need. The hormone cortisol is also released. This evolutionarily advantageous response is required for physical movement. Physical activity supports the utilization, reabsorption and excretion of cortisol in a way that is life preserving and proliferating both physically and mentally. However, chronically excessive amount of cortisol has systemic degenerative effects. It is evident that too much cortisol shortens telomere length. It also creates a demand upon the DNA to change genetic sequencing to better suit the environment, this is known as epigenetics. Unfortunately, these alterations are usually less then advantageous for sustaining life. In this imbalanced state, the neuronal cell bodies of the hippocampus and prefrontal cortex both begin to degenerate and die, while the neurons in the amygdala proliferate. The tissues of the heart incur damage as the blood vessels begin to harden and become less elastic, making oxygenating the body more strenuous and ultimately contributing to fatigue. If circulation issues continue, this could contribute to arthritis in the feet/ankles and hands/wrists. While in a sympathetic state the blood is directed into skeletal muscle for immediate action but depending on the person’s energy level there could be a significant decrease in physical activity, furthering hormonal imbalances in addition to metabolic changes. The body may begin breaking down lean muscle and storing fat in an effort to use energy efficiently in the present moment and in the future.
Cortisol also ignites systemic inflammation gravely inhibiting the immune system. Increasing cytokines in the blood and Natural Born Killer cells, T and B cells maturation, often exasperates cardiovascular, autoimmune and neural disorders. On top of all of this, injured brains have sleep problems. At first, they may sleep the majority of the day, maybe only waking to go to the bathroom and eat. However, at a point, this often turns into the inability to sleep. The sympathetic hormonal response inhibits the release and production of melatonin because the mind perceives a threat and the body stays awake to fight of the threat. This inhibits healing because it is while we sleep that the ventricles expand allowing cerebral spinal fluid to cleanse the tissue of the waste products of the day. Excretion of byproducts is imperative for tissue health. While sleeping the mind/brain has time to store memories and restore itself physically, serving to enhance our mental faculties.
After an injury, the brain is also incredibly sensitive to low glucose levels. On a regular basis, the brain use 30% of daily energy intake. Tissue repair increases energy demands. If not observed this could lead to blacking out or mood disturbances, and could also trigger a seizure. Additionally, gastrointestinal nutrient absorption and excretion can become impaired. This can proliferate into chemical and cellular issues. Reproductive organs change in function due to changes in hormonal balance, and can lead to low libido and stopped menses.
The manomaya kosha, the mental and emotional body is greatly fused with annamaya kosha, the physical body. We know because we feel. We inquire and seek understanding because we seek meaning. It is through the sensation of energy waves that we understand ourselves and our environment. Anatomically and physiologically, information from the sensory tracks of the spinal cord run through the limbic system before they reach out into the frontal cortex. We respond via the amygdala, hippocampus, hypothalamus and pituitary gland. The hippocampus is the seat of our memory and intuition, or if we were studying another species we would refer to this as instinct. It becomes apparent in brain injuries that no matter the level of impaired executive functioning, arousal control or memory, intuition and instinct drives these people forward. Responses may be deemed as socially inept, but without executive function, the person is actually responding as honestly as and as intuitively as they can respond.
The mental and emotion state of the person who has experienced a neural trauma is beyond words. In fact, this is in and of itself may be one of the most deeply root and explosive circumstances that the person faces: the inability to identify, understand, process and communicate (verbally or non-verbally) emotions and thoughts. While there is a life changing awareness that can blossom from this, it can also be unbearably frustrating and stunt development. The ability to communicate feelings using sound that we have applied meaning to is incredibly sophisticated. All animals communicate especially those who are biologically programed to be social in nature in order to thrive. When our cognition decreases, our intuition drives us forward, just as our cells do on a microscopic level, we do on a large scale. We either gravitate towards nourishment in order to grow or we protect ourselves from something that doesn't feel right.
Through the lens of societal expectations, people who have acquired a brain injury may be viewed as socially inappropriate, uninhibited, and withdrawn in how they communicate or act. This can lead to social isolation and hinders our physical, emotional or mental health. When we connect with life outside of ourselves oxytocin is released. It makes us feel connected and part of something larger than ourselves. It also binds to receptors on the heart that encourages it to heal from damage. Keeping this in mind, brain injuries can also inhibit social awareness. This can be a risk factor if they disclose too much information about themselves or trust someone whom they do not know. Due to the lack of social awareness, it is easy to be taken advantage of financially, physically etc.
All of these factors contribute to mental and emotional imbalances that are dynamic and can be volatile. A person may feel ashamed, embarrass, frustrated, inferior, judged, disoriented, confused, unable to focus, apathetic, depressed, anxious and agitated. Cognitively speaking the person could exhibit executive functioning deficits in different areas ranging from comprehension, logic, reason, judgment, concentration, attention or focused. They may express decreased motivation and purpose. Their processing speeds may be slowed and/or limited. The ability to read and write can also be directly affected by these deficits. If unresolved, these patterns of thought and feeling can also lead into secondary concerns and risk factors such as obsessive-compulsive disorder, bipolar, depression, anxiety and substance abuse.
The Vijnanamaya kosha is the wisdom and intuition of the body, it is the space where we are able to inquire discern and evaluate. It is a space beyond cause and effect. It is a space where there is universal truth and understanding. When growing through a brain injury there are great struggles and challenges but there is also a great honesty and awareness, which is what makes recovery a tango. When everything is in flow, when the environment is safe and the hormones are balanced there is incredible clarity. However, the inability to express these understandings may act as a trigger, causing frustration, confusion and socially inappropriate responses. Executive functioning may be impaired along with the ability to communicate with clarity through the use of words as society understands, but this is a man-made problem. It does not necessarily impede the wisdom and intuitive nature of our being, there may just be other influences that block the expression.
The Anandamaya kosha is the Bliss body. This is the universal energy, and awareness that we are part of the whole. Some may say it is the intuitive wisdom body that moves us forward despite structural, chemical and electrical damage. When the person feels safe, there is an increased sense of connection and awe with all life. There may also be an increased sense of faith and purpose. On the other hand, people also experience intense struggles with their sense of identity, connection and meaning of life.
Yoga as a philosophy and a practice is universal and holistic. It effectively and efficiently develops the mind/body connection by balancing the koshas. Through the use of pranayama, asana and meditation the nervous and endocrine systems balance and develop resilience. This is most apparent in how it effects the brain’s physical health through the activation of the HPA axis. Environmentally appropriate self-regulation of this center depends on regular participation in a focused practice that purposefully develops cognitive flexibility and emotional stability. In time, this serves to increase the sense of esteem, efficacy, awareness and altruism.
The yoga practice evolves with the person. While all the sheaths of a person are interconnected, when the brain sustains damage it is vital to teach the mind how to monitor the body’s physical and emotional arousals. The Pranayama practice can include different breathing exercises but the focus throughout them will be in developing the conscious motor memory of breath by engaging the diaphragm and to bring awareness to self in order to create the optimal environment for growth and healing
Engaging the parasympathetic nervous system through diaphragmic breathing regulates and balances the autonomic and endocrine systems. This practice serves to develop mental and emotional resilience which stabilizes emotions. It also increases the clarity and creativity of thought by increasing blood flow to areas of executive function and connectivity between the limbic and prefrontal cortex. This can decrease allostatic load, increase in vagal tone and balance the endocrine system. Systemically, this increases immune and cardiovascular health.
When the diaphragm is engaged fully through the breath it stimulates the vagus nerve, sending a message to the brain, and acetylcholine is swiftly released. Acetylcholine travels down the nerve and into the organs. Acetylcholine is an excitatory neurotransmitter for skeletal muscle but is an inhibitory neurotransmitter for a viscera which allows them to come to state of rest restoration and growth. Acetylcholine has been proven to enhance neuroplasticity and regeneration specifically in areas of the prefrontal cortex and hippocampus which are areas that are prone to damage with an exasperated sympathetic response.
The pranayama practice will greatly focus on self-observation. We would begin with recognizing that the body breaths. We would observe our awareness of the breath and the sensations within the body. We would also explore how the breath nourishes the body and the natural cycles of inhalation and exhalation that we are part of. We would also direct thoughts to ideas of gratitude, compassion, purpose, wonder and awe. Studies on compassion, purpose, gratitude, and aw proved to balance the mind and body through the neuroendocrine system, restoring balance and the sense on connection.
Focusing self-talk towards compassion and gratitude while learning to be present has physiological and anatomical effects. Compassion training cultivates altruistic behavior by increasing activation in neural system associated with social cognition as well as executive and emotion regulation. These areas include the inferior parietal cortex, dorsolateral prefrontal cortex and connectivity with the nucleus accumbens. Compassion training has shown to increase memory and plasticity while decreasing the sense of pain and threat. This serves to increase self-regulation of emotional reactivity. Experiencing awe, compassion and mindfulness are associated with exposure to nature, art and spirituality. However, these mental/emotional states are accessible though focused mental exercises as well. Experiencing awe and compassion increases positive affect and the sense of wellness and connection. Physiologically these experiences serve to regulate the HPA axis and decrease levels of cortisol in the body.
Recovering from a brain injury entails laying a new neural network foundation. Developing mental and emotional resilience, discipline, focus and the ability to learn to learn are paramount a long-term holistic health and wellness. The eight limbs, along with other philosophical text, will help the development of the mind/body connection. The lessons can support the acceptance of the person’s current conditions by releasing attachments to their prior sense of identity and other expectations they have internalized that may be causing distress and inhibiting growth. Self-development through the eight limbs can also help focus the mind to tune out distractions that will not aid in development. A beautiful feature of the eight limbs and ancient texts is that they understood that not everything can be taught. Sometimes, concepts can only be introduced because understanding is discovered through life experiences. These teachings can support someone in their journey to embrace who they are with acceptance and love while moving forward in their journey at their own pace.
The intuitive and inclusive nature of the eight limbs and other ancient texts can help stimulate cognitive abilities such as logical and critical thinking, problem solving and comprehension. These skills influence the development of self-awareness and social awareness. Additionally, reading these literary works (together or if the person takes the initiative independently) exercises skills such as word recognition, reading, memory, visual tracking, focus, etc. They may even serve to increase the person’s sense of empowerment and freedom of thought and self-discovery.
An asana practice may look very different depending on the person’s muscle control, balance, strength, endurance and range-of-motion and motivation. When honoring brain health, it is important to take natural development into consideration. This means working from the ground up. From the perspective of the annamaya kosha, while engaging in diaphragmic breath we would focus on fine motor skills in terms of finger touching, wrist rolls, moving the eyes, visual tracking, gentle moves the Torso as well as abdominal engagement and rotational movement of the hips and shoulders while in a seated position (either on a seat on a chair depending on their physical and emotional comfort). From here we will work through crawling movements. Simple low ambulatory movements that engage the entire body building strength and endurance and the sense of this esteem and efficacy. We would also explore balance poses like tree, warrior or triangle. These forms involve rooting into the ground holding the body up straight, and are important for proper breathing mechanics and rebuilding neural networks that engage both sides of the body. In these positions, we would also progress into raising the arms, engaging our biofeedback, to increase our sense of confidence while decreasing cortisol release. Moving at the person’s pace and embracing their current ability we incorporate mindful dance-like movements to engage dynamic balance. This could include wide legged side steps with the arms reaching out like a star and then moving the appendages back to center as we move along a straight line. I also seek to incorporate mindful movements into other recreational activities the person enjoys in order to support their sense of ability and empowerment. This could also help transfer the skills being developed into everyday life. The power of the asanas is that the person can move at their own pace space of acceptance and compassion and in gratitude.
During practice, we would also be mindful to engage as many of the senses as possible because neurons that fire together wire together. It is also important to keep the practice fun and functional so that it becomes part of their daily exercises. Ideally, I would practice with the individual outside to support the body’s natural balance and development with nature to enhance the sense of connection, compassion and awe. Otherwise if inside and engaging the senses through man made means, the person’s tolerance level must be closely monitored. Engaging in song may also help restore communication skills for someone who cannot verbally communicate. A piece of the puzzle that is often overlooked is the energy the therapist/professional brings to practice. The energy is vitally influential. People who sustain brain injuries are often incredibly sensitive to other life force’s energy which includes how they are spoken with. A safe space supports growth, as does meeting the person as equal and able while providing the “just right challenge”, which may mean going very slow and doing a little bit at a time. The brain uses 30% of all the energy we take in throughout the day. Tissue repair requires much more energy than normal so being mindful of mental fatigue is imperative. Going past patient’s comfort level could damage the therapeutic relation and most importantly, the person’s sense of ability, esteem, and motivation.
Traumatic brain injuries are traumatic for everybody involved, at least initially. The cognitive framing in which a person sees the world directly affects their internal and external interactions. The meaning a person ascribes to their life effects their cellular physiology and DNA expression. The mind shapes reality which is why a participating in a practice that restores balance to the koshas is imperative. The healing process from brain injury can take upward to 10 years and everyone's recovery is different and there are no guarantees. The ability of a person to embrace their current circumstance with compassion, gratitude and purpose is far more indicative of health and wellness that whether they have an arm or leg. The brain is always evolving and every sensory and motor input creates new synaptic connections. With focus and determination, a person will become what they practice to be, that is the beauty of plasticity.