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Professionalism-Integrative Neurology: Integrative Neurology Neurologists (and Patients) on the Move

Rukovets, Olga

doi: 10.1097/01.NT.0000547374.01863.9b
Professionalism
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ARTICLE IN BRIEF

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Two neurologists discuss their pathways to certification in dance and yoga and how they apply it in practice.

Diviya Kaul, MD, a movement disorders specialist and neurologist at Kaiser Permanente in Walnut Creek, CA, and Anne Marie Collier, MD, medical director of the epilepsy program at St. Mary's Hospital in Grand Junction, CO, are both traditionally trained neurologists. But long before they entered their medical schooling, each had spent years honing a mind-body practice — dance and yoga, respectively.

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DANCING FOR JOY

Dr. Kaul has been dancing since the age of 5 — tap, jazz, Bollywood, and classical Indian dance. She played the piano and clarinet throughout her schooling, but she said it was only dancing that gave her that unmatched sense of joy. “Anytime I was dancing, I wasn't inhibited. I had a pure sense of happiness that I wanted to share with an audience,” she recalled.

In college, Dr. Kaul joined Bhangra and South Asian dance teams and took professional dance classes. Dr. Kaul majored in neuroscience in college, but she said she did not yet know she would become a neurologist. “I was fascinated with the intricacies of the brain. I was (and still am) curious to learn on a microscopic level about the most complex organ in the human body.” In medical school, she continued to be involved in both dance performances and choreography.

Later, during her residency at Dartmouth-Hitchcock Medical Center, Dr. Kaul began to see many Parkinson's disease (PD) patients. In clinic, she noticed that patients who exercised often felt and did better overall with their disease process. Specifically, with her Parkinson's patients, she used the Unified Parkinson's Disease Rating Scale to assess patient improvement. After doing a literature search on how dance has been used to help those with movement disorders, she saw an opportunity to bridge her interests.

Dr. Kaul discovered the Mark Morris Dance Group, an internationally acclaimed dance company that collaborates with the Brooklyn Parkinson Group for a specialized Dance for PD program, in Brooklyn. She completed an interview process with the program director, David Leventhal, and thanks to her dance background, Dr. Kaul was able to attend the workshops provided through Dance for PD to become a certified dance teacher.

Bringing those skills back to Dartmouth, Dr. Kaul started a class at the medical center in December 2016. At first, only two people came, but by the time Dr. Kaul finished residency, that number had climbed to nearly 20. Now, the class continues to be taught by trained dance instructors, she said.

“It was really incredible to see dancers coming in who were rigid, but as the dance class continued, I noticed that every dancer's inner joy would take over and improve their masked faces and the fluidity of the movements. We know that studies have shown that there are improvements in balance, functional mobility, and stride length with those who dance,” she told Neurology Today. The classes also provided an element of support and community to these individuals, allowing them to see a positive side to their difficult diagnosis.

During her fellowship in movement disorders at Stanford, Dr. Kaul encouraged her patients to engage in Dance for PD classes at the wellness center — a program initiated by Helen Bronte-Stewart, MD, and Damara Ganley.

Another goal for Dr. Kaul is to create awareness of the benefit of dance for neurological disorders on a global scale. While at Stanford, she went to Haiti with Stanford movement disorders neurologist, Veronica Santini, MD, and a team of neurologists from Boston Medical Center. “I taught a dance class at St. Germaine Rehabilitation Center in Haiti for patients with all neurological issues. Dance is an art form that is universally appreciated. It is boundless.”

When Dr. Kaul gave a lecture on the benefits of dance for movement disorders at this year's AAN Annual Meeting, she ended the presentation by inviting neurologists to get up and dance with her. Research is equally as important as getting first-hand experience and feeling “the internal joy,” and she wanted her audience to learn all aspects, she said.

“A neurologist must educate, provide excellent medical care, and also compassionately motivate. I am very grateful that I have this opportunity to help patients as a physician and to teach dancers as a dance teacher in the community,” she said.

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YOGA FOR ALL

Dr. Collier started practicing yoga when she was a teenager. “We talked a lot about vagal tone and stimulating the vagus nerve with yoga, but I was light years away from becoming a neurologist at that point. All I knew was that it was a good thing to do and that it helps calm you down.”

Later, when Dr. Collier attended medical school at the University of Texas, it didn't take long for her to set her sights on neurology. She found the mind-body connection instantly appealing. “I started reading about a neurologist in Arizona who was practicing a kriya technique, which is a type of meditation and chanting, with patients with dementia and showing areas of the brain that would react using functional MRI,” she said.

She was captivated by the merging of “an antient practice such as yoga and a discipline like neurology, with modern techniques including neuroimaging,” and the ability to measure that interaction objectively. She was compelled to learn more.

This interest did cause some light teasing in residency by her professor, John E. Greenlee, MD, at the University of Utah, who would jokingly ask her, “Well, what are you going to do now, Doc, are you going to get echinacea?” Dr. Collier said, “The nice part was it made me skeptical; it made me want that evidence, so I could go toe-to-toe with ‘the old guard.’ Actually, at my residency graduation, I brought Dr. Greenlee a potted echinacea, and he carried it around grinning for the rest of the night.”

Dr. Collier completed a neurophysiology fellowship and went into practice for about a year, but she felt that something was missing. So in 2016, she enrolled in a two-year fellowship (1100 hours) with the Academy of Integrative Health & Medicine (AIHM). “It really gave me a sense of community, being able to meet with other physicians who are also looking for other things that they can offer to their patients,” she said. By this spring, Dr. Collier will be board certified in neurology, epilepsy, and integrative medicine.

As the only epileptologist between Denver and Salt Lake City, Dr. Collier primarily sees epilepsy patients. She views yoga as a practical tool for patients and a way to empower those who may feel otherwise powerless. “All of my patients with epilepsy tell me that stress makes their seizures worse. There was a point where the dogma was, if stress makes your seizures worse, they're non-epileptic, and that is definitely not the case,” she said.

She gives patients simple exercises, such as “feet up the wall — a pose where you lie on your back with your feet up the wall, practically in an L shape, and that can put you out of fight or flight mode.” The second exercise she likes to use is diaphragmatic breathing, where you breathe in for five seconds, hold for five seconds, and breathe out for five seconds. “While you are doing that, you are visualizing relaxation — you are visualizing breathing in health and you are visualizing breathing out illness.” And she directs them to visit the Epilepsy Foundation's Wellness Institute (https://www.epilepsy.com/living-epilepsy/our-programs/wellness-institute).

“One of the things that yoga really helps you do is improve proprioception, which is very important in neurology. It's something that many of our patients lose. It's probably one of the most common causes of falls — patients not being able to feel where their bodies are in space, and yoga helps.” Meditation, though not a cure-all, may offer some solace or acceptance to patients struggling with their condition, she said. “The role of integrative medicine is to integrate. I think that one of the things that makes people bristle is that they think you're throwing the baby out with the bath water,” she added. “I look at myself as a teacher; MD doesn't mean medical dictator. I'm there to serve as a guide.”

© 2018 American Academy of Neurology