I decided to write my research paper on Leukemia because my uncle who lived in Bend, OR found out that he had Leukemia. This news was devastating for our family including my uncle. His health started dropping and he started felling tired all the time. My uncle’s this condition led him to lose his job because he could not keep up with his work. In our culture sole provider of the household is man. In this situation financial condition of the family was terrible because neither my uncle nor his wife were working. Their kids school grades were dropping and they were sadden by their father’s sickness. His son had emotional breakdown, and wanted to spend all his time with his father. This commotion of the family even spilled over to my side of the family. My mom was really attached to her brother; finding out that her brother has cancer. It was very hard on my mom. My mom’s health was at its worse when she got news of my uncle’s sickness.

My uncle’s parents lived in India. Finding out their one and only son has a deadly sickness; it was very disturbing for his parents. They applied for visas to come to the United States to see their son. Even though, the family in the United States made a request to immigration services to allow my uncles parents to come to the United States to see their son. Supporting documents were submitted including a detailed letter from my uncle’s doctor describing his medical condition. However, their requests for obtaining U.S. visas were denied. My uncle’s medical condition did not allow him to travel to India to see his parents for the last time in his life.

Furthermore, my uncle did not have medical insurance. The reason for not having a medical insurance was the high cost of it. Other big factor of not having insurance was that my uncle did not have a job for a long time. Even when he had a job it did not come with medical benefits. However, few months after my uncle found out that he had a cancer, and was hospitalized a doctor from the hospital down in Bend, Oregon helped him to get a medical insurance through Oregon Health Plan. This helped my uncle and his family a lot. My uncle was able to get quality treatment from the hospital through that health plan. The doctors did chemotherapy for six months and still it didn’t cure him, and soon doctors gave up, and said sorry he won’t live for long. Just week after that my uncle passed away. This is how my family is impacted by Leukemia.

Leukemia is cancer that starts in the tissue that forms blood. To know how cancer starts it is helpful to know how normal blood cells form. Most blood cells are formed in the bone marrow called stem cells. Bone marrow is the soft material in the center of most bones. When mature it develops into different kinds of blood cells, each kind does a special job. Major kinds include the red blood cells and the white blood cells. White blood cells are helpful to fight infections. There are many kinds of white blood cells.

Red blood cells carry oxygen to the tissues throughout the body. The platelets help form blood clots to prevent bleeding. White blood cells, red blood cells, and platelets are created from stem cells when body needs them. When these cells grow old or damaged, they die, and then new cells take their place.

In a patient who has leukemia, the bone marrow makes abnormal white blood cells. Those abnormal blood cells are called leukemia cells. Normal blood cells die when they reach a certain age or when they get damaged, whereas leukemia cells do not die after aging or getting damaged. They start to crowd out normal white blood cells, red blood cells, and platelets. This situation makes it very hard for normal blood cells to do their job.

There are two types of leukemia; the types of leukemia can be grouped on the bases of how quick the disease develops and gets worse. Leukemia is either chronic which usually gets worse slowly, or theirs acute which usually gets worse quickly.

Chronic Leukemia:

In the beginning stages of the disease, the leukemia cells can still do the job for normal white blood cells. Patient may not have any sign at first; doctors often find the chronic leukemia during a routine checkup before there are any symptoms. Gradually, chronic leukemia gets worse. As the number of leukemia cells in the blood increases, patients starts to get symptoms, such as swollen lymph nodes, fevers, night sweats, weak feeling, bleeding, weight loss, swelling, pain or infections. When those symptoms do appear, they are usually mild at first and get worse slowly.

Acute Leukemia:

The leukemia cells can’t do any of the work of normal white blood cells. The number of leukemia cells increases quickly. Patients usually go to their doctor because they feel sick. If the brain is affected, they may headaches, vomiting, confusion, loss of muscle control, or seizures. Patients start to get symptoms, such as swollen lymph nodes, fevers, night sweats, weak feeling, bleeding, weight loss, swelling, pain or infections. Acute leukemia usually worsens rapidly.

Diagnosis:

Have one or more of the following tests done: physical exam, blood tests, biopsy done two ways bone marrow aspiration and bone marrow biopsy.

Prevention:

As long prevention goes, there is no way to prevent leukemia at this time. However, avoiding risk factors such as smoking, exposure to toxic chemicals, diagnostic x-rays, and exposure to radiation may help prevent some cases of leukemia. Being healthy and staying healthy plays a big role in preventing leukemia. What we put into our bodies has a lot to do with our overall health.

Cancer Fighting Foods:

I have also done some research on foods that are known to prevent different types of cancer. Eating a lot of vegetables and fruits help to prevent leukemia, list of vegetables and fruits are:

Avocados – rich in glutathione, a powerful antioxidant that attacks free radicals in body.

Black Raspberries & Blueberries – contain an antioxidant that kills leukemia cells without harming healthy cells.

Carrots – contain beta carotene, which may help reduce cancer.

Broccoli, cauliflower, Brussels sprouts, and cabbage – contains two antioxidants, lutein and zeaxanthin that may help reduce cancer.

Garlic – increases the activity of immune cells and helps break down substances that cause cancer.

Grapefruits, oranges, papayas, pomegranate – help prevent cancer

Treatment:

Leukemia treatment falls into two types of treatment to fight the cancer and treatment to relieve the symptoms of the disease and the side effects of the treatment. Chemotherapy is the widely used treatment for leukemia; it is the powerful drug to kill leukemia cells. Therapy can be administered by mouth or vein depending on the type of medication. Sometimes depending on the case chemotherapy can be given at home. In other cases patient has to hospitalize to receive the therapy. By this it kills cells or stops them from reproducing. It also kills rapidly growing healthy cells, accounting for many of the side effects of therapy. The severity of the side effects depends on the doses given and the patient’s tolerance.

Chemotherapy is usually given in cycles. Each cycle consists of severe treatment over several days followed by a few weeks without treatment for rest and recovery from side effects caused by the therapy, mostly anemia and low white blood cells. The sequence is then repeated. It may be administered for two to six cycles, depending on subtype leukemia and risk factors involved.

Bone marrow exams may be done prior to each cycle of therapy. After completion of treatment the patient is evaluated again to see the effect of the chemotherapy for leukemia.

Conclusion:

In end it is all about how we take care of our bodies, our diet plays a big role in our well being and staying healthy. As stated above leukemia cancer is a very dangerous disease. We should take proper precaution to prevent this disease. Doctors are taking several measures to prevent this cancer from spreading in human body. If leukemia cancer is not taken care in its early stages it may prove fatal to human body.

Citations:

http://www.leukemia-cure.com/leukemia-symptoms.html

http://www.lls.org/#/diseaseinformation/leukemia/

www.leukemia-lymphoma.org

http://www.emedicinehealth.com/leukemia/article_em.htm

http://www.cancer.gov/cancertopics/types/leukemia

The relation between the education and fertility of women is a topic that has received much attention in the last decades. Some scholars have found that there is an inverse relation between the education and fertility, however, it is still unknown if this relation is causal or not. But in general, across countries, when women acquire more education, this decreases the number of children. The spread of education around the world has been linked to decreases in fertility that incremented women rates of enrollment and completion of secondary education. In point of fact, women with secondary education have on average one less child (León, 2004).

When estimating the relationship between education and fertility there are unobserved characteristics that affect schooling preferences and are correlated with unobserved variables that encourage to have a child or not. To better clarify this criteria, we have to analyze the next example. When a woman has wishes to work, attend college, make a professional career, this will impact negatively the number of children that she wants to have. On the contrary, women with access to the credit market, are more likely to have more years of education and also to children. As we observe, there is no only a negative relation between fertility and education, but it also may be positive (although is not common).

In addition, when analyzing the effect of education on fertility we have to take into account the welfare policy consequences. When the total fertility rates decreases and the life expectancy increases, this may cause an ageing of the population. Therefore, the ratio of retirees to working-age adults increases and this create a serious problem on spending of governments on health care and pensions. This is the case of developed countries. By the contrary, in developing countries (specially Latin American countries), when the total fertility rate decreases, the risk of health between women and children decreases leading to a improvement in the welfare conditions. In the recent years, programs such as

the World Bank’s Female Secondary Schooling Assistance Project

seek to motivate the education of women around the world.

Given these facts, the hypothesis than education affect fertility levels of women is valid. Not only the education of women affect their fertility rate, but also the marriage, which is delayed because women desires to enter to the labor market or to increase their education.

The theoretical aspects concerning to the relation of fertility and education is very broad. In order to explain this relation with more accuracy it is important to analyze the studies of Barro and Becker (1988), Livi-Baci (1997) and Willis (1973). They agree in the fact that women with more education diminishes their fertility because of the increment in the cost of opportunity of time. Other models point out the wage of women as the main factor in explaining the cost of opportunity of childbearing. Montgomery and Trussel (1986) analyze the children as normal goods. Here and increment in the education of women produces an increment in the parent’s income, which lead to an increment in the spending of normal goods (children), dominating the wage effect. It is also important to analyze the models that explain the fertility as stochastic processes (Wolpin (1994), Newman (1988) and Hotz and Miller (1988), however, this studies have no provided any result about the empirical specification for the life cycle fertility. They just agree in the fact that the returns of more years of education are positive and that this produces an inverse relation between education and fertility in women.

Reviewing the literature between education and fertility, we have to highlight the contribution of the studies done by Becker. Becker (1960) and Becker and Lewis (1973) analyze the “child quality fertility model”, which is one of the most used model in explaining the relation between education and fertility. This model analyze the role of income of parents in the quality and quantity of children. That is to say that when the income of parents increases, the quality and quality of children also increases. Becker argues that the income elasticity of the quantity of children is small related to the income elasticity of the quality of children. Given the fact that the spending on children increases, it leads to a prevalence of the higher quality. In this case, the substitution effects subdue to the income effect.

Following this criteria, Easterlin and Crimmins (1985) formulates the theory of the demand of children, referring mainly to the desired family size of parents but taking into consideration that the knowledge of birth control instruments is general and does not imply any cost. Moreover, the supply of children refers to the quantity of children that parents would experience, without limiting the family size.

As we can observe, all the theories mentioned above deal with the negative relation between fertility and education, just with the exception of the supply theory that connects the health and the fecundity. Therefore the role of education is very important given the fact that help women to have more knowledge about contraceptive methods, and gain different perspectives of life. In addition, according to the economic theory, the relation of education and fertility has consequences for the welfare policies of the countries.

An analysis in Developing Countries

The fertility rate has decreased in Latin American countries through the years. According to Weilti (1993) the industrialization and modernization have been drivers in this reduction. On the one hand, with the industrialization the technology, communication, infrastructure and transport was improved. On the other hand, modernization has had a greater impact on fertility, improving of health care, education, urbanization.

The arguments in explaining the decrement in fertility are mainly two: gender equality and education of women. Gender equality refers to the control of women on their lives (in all aspects) and education promote all of this independence of women.

In recent years the inquiry about if educated women are selected for additional features that could be related to lower fertility such as income, earning of husband has brought lot of discussion. All of these additional features including on the analysis appears to be as indicators of a negative relation between fertility and education.

Also it is important to mention that the autonomy of women is an important aspect when decreasing their fertility (Dyson and Moore, 1983). This implies that educated women has more independence in taking decisions in their life ((Basu (1992); Morgan and Niraula (1995); Vlassoff (1996)).

The literature about the negative relation between fertility and education is very broad. Currently, there is lot of discussion about the reduction on mortality and the increasing aspirations from the women as main factors in explaining this relation. The decrease in fertility according to demographers is explained by reductions in infant and child mortality. The increasing aspirations of women is another important factor in explaining the negative relation between education and fertility. This model, that relates the decreasing in fertility levels with the increasing in aspirations of women, tries to explain mainly the resources in the market that women spend in children and in goods and this decision on how much to spend in each thing depend on preferences of women.

According to the DHS survey carried out in the 80s, one of the most powerful tools of fertility is the access to mass media in developing countries, especially when talking about contraceptive methods and family size. The access to mass media it is really important in the family planning of households. But according to some authors as (Ramesh et al. (1996, Westoff and Rodriguez (1995) the education should increase along with the increase of the material aspirations. As reductions in fertility (at macro-level) are given by increments in educational, we expect that education has a connection with rising aspirations (United Nations, 1995). In fact, in South Asia, accoring to Basu (1999), the decrease in fertility is linked to increments in dowry. As we can observe, the relation between education and fertility seems to be explained with the theory about material aspirations of women. Following this theory of the material aspirations of women, we come to the conclusion that the increment in material aspirations and more investments in the schooling of daughters can provoke a decline in fertility in the couple.

The impact on Latin American Countries

According to the International Family Planning Perspectives, 21:52-57 & 80, 1995), women that have no education have on average bigger families of 6 or 7 children, while women that have education 2 or 3 children. The knowledge about contraceptive methods is more favorable to educated women (Demographic and Health Surveys for 9 Latin American countries).

It is important to point out that the negative relation between education and fertility stopped being as an automatic progress after the World Fertility Survey in the 70s when the results gave a broader idea that the fertility reductions are explained by the development, gender stratification of the society.

The impacts of education on fertility can be explained for the following aspects. In first place, the education acts as a source of knowledge, given the fact that schooling improves the knowledge of women about different lifestyles and a major access to information about fertility elections. Secondly, education is a tool for the development of a country. The education is a cover letter to entry formally to the labor market. And finally the education acts as a transformer of attitudes, specially aspirations in life.

It is known that Latin American is the most unequal society in the world. The gap between the rich and poor people has increased in the last years and this situation seems to not come to an end. In some Latin American Countries the access to a good education is given mainly by the social origins. Not always, but in most of cases, poor people has no access to an education because of the lack of money and opportunities. But this situation has improved in the last decades with the free access to public education and improvements in the literacy rates of Latin American Countries. However, in countries such as Guatemala, 42% of women have no formal education (Indicators of female educational attainment in Latin America, by country, 1985-1989). As we observe in the table below, the 1/5 of the people in Bolivia and El Salvador has no education, which is a extremely bad indicator. In the rest of the Latin American countries the years of schooling show a better performance, reaching 10 years of education roughly. As we mentioned above, the improvements in education has been a major concern in Latin American Governments in the recent decade. As we observe in the table, countries such as Colombia, Peru, Ecuador, Dominican Republic and Mexico has showed substantial progress in the school attendance (1.4, 1.7, 1.4, 2.2. and 3.4 years respectively).

The relation between fertility and education in Latin American is considered as the most powerful in the world. This is explained by the differential in reproductive strategies inside this society. If we refer to pretransitional societies, the behavior of women with no education is similar to the one of that societies, having on average 6 or 7 children, while women with better education have on average 2 or 3 children. In table 2, there is a surprising fact in which the fertility patterns (desired family size) are almost the same among poor (educated) women and educated women, but in practice they differ a lot. Referring to the contraceptive knowledge, here we find a big difference. The difference between uneducated and educated women in Colombia and Dominic Republic is 20% and 40% in Bolivia, Ecuador, Peru and Mexico.

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The classical techniques of Yoga date back more than 5,000 years. While Yoga has been used in India for centuries to treat disease, only recently has there been scientific evidence and growing interest in the benefits of therapeutic yoga as a specialty treatment which combines postures, breathing exercises, mindfulness, and meditation. The cross-fertilization of Western science with ideas from ancient Eastern wisdom systems has been adding scientific legitimacy to the discipline of yoga over the last few decades. Medical professionals and scientists are pursuing yoga-related research, focusing on its potential to prevent, heal, or alleviate specific conditions such as heart disease, high blood pressure, carpal tunnel syndrome, asthma, diabetes, and symptoms of menopause, and its benefits as a technique for relieving stress and coping with chronic conditions or disabilities. Evidence-based publications report on clinical benefits associated with yoga, including reaction time, respiratory endurance, proprioception, and other physiological and psychological effects.

Mudras (yoga for the hands) are defined as hand gestures that are historically grounded in the ancient Indian arts and sciences. Referring to gestures or attitude, the science of yoga describes mudras as a means to control or alter the mood by reorienting or focusing the flow of prana (vital spiritual energy) in desired directions or concentrating it at specific places within the body. Modern yoga literature explains Mudras as “seals” or “circuit bypasses” for energy currents. Mudras can be used to improve hand strength and flexibility after injury because they are a simple, portable, enjoyable, and economic exercises and research shows that regular yoga practice can be used to improve overall body strength and flexibility.

Some of what is taught by yoga teachers in classes, books and journals defies modern understanding of anatomy and physiology or is grounded in metaphysics that is off-putting or virtually incomprehensible. But now, scientists are able to look at the body and brain with increasing precision, detecting subtle changes that practitioners of yoga and meditation undergo. The majority of scientific research on yoga takes place in India and is very difficult to access in the United States. Because few yoga studies were previously conducted in the West, most American scientists dismissed Indian yoga research due to methodological problems, such as a lack of control groups in the studies. The methodology has improved significantly and it can be argued that currently, many Indian yoga studies are superior to many of those conducted in the West. Given the Western allopathic model, translating the information using the language and perspective of science as much as possible is recommended to demonstrate to physicians and other health care professionals how therapeutic yoga can benefit patients.

As yoga moves deeper into the mainstream, and as research dollars for complementary and integrative health systems increase, the number of yoga practitioners and health professionals are increasing. The number of randomized clinical trials is growing as well. Improved study designs are being used both in India and the United States. In just the last few years, research has documented the efficacy of yoga for such conditions as back pain, multiple sclerosis, insomnia, cancer, heart disease, and even tuberculosis. The 2008 “Yoga in America” study shows 15.8 million people currently practice and also revealed an upward trend in the therapeutic medical use of yoga. According to the study, nearly 14 million Americans reported a doctor or therapist recommending yoga to them. Nearly half of all adults agreed that yoga would be a beneficial treatment for a medical condition. “Yoga as medicine represents the next great yoga wave,” says Kaitlin Quistgaard, editor in chief of Yoga Journal. “In the next few years, we will be seeing a lot more yoga in health care settings and more yoga recommended by the medical community as new research shows that yoga is a valuable therapeutic tool for many health conditions.”

There are 112 clinical trials utilizing yoga currently listed on the National Institutes of Health web site. These involve numerous medical conditions including arthritis, fibromyalgia, cancer, chronic neck pain, chronic back pain, asthma, kyphosis, etc. The individual trials are being conducted at medical centers across the country and involve thousands of patients. Evidence regarding the medical benefit of yoga shows mixed results. There are several reasons for this, including funding obstacles. The biggest challenge yoga studies face is that given the best intentions, it is difficult to properly ascertain the effectiveness of yoga as an exercise therapy. Yoga is not easily fit into the form of study that is most often used to prove effectiveness, the double-blind, placebo-controlled trial. While it is possible to design a placebo form of study, it would be exceedingly difficult to conceal from participants and researchers the practice of real yoga versus an inauthentic version. It is inevitable that some compromise with the research standards is required, and the compromise used in most studies is not ideal. Oftentimes, the practice of yoga is compared to no treatment. The problem with such studies is that a treatment, any treatment, frequently appears as better than no treatment due to multiple factors. A better trial design would be compare yoga practice to a generic form of exercise, such as daily walking. To date, this design has not been commonly implemented.

Hatha yoga has been studied in patients with carpal tunnel syndrome. In one study, forty-two individuals with carpal tunnel syndrome were randomly assigned to receive either yoga instruction or a wrist splint for a period of eight weeks. The results indicated that yoga was more effective than the wrist splint. The study results were soundly criticized due to a serious design flaw as participants in the control group were simply offered the wrist splint and given the choice of using it or not. Critics stated they would have preferred for subjects to have received options such as fake laser acupuncture or phony yoga postures rather than nothing. Experience from numerous studies shows that when people believe they are receiving an effective treatment, they report improvement regardless of the nature of the treatment.

The School of Medicine at the University of Pennsylvania used yoga to treat a group of patients with osteoarthritis of the hands. The treated group improved significantly more than the control group in “pain during activity, tenderness, and finger range of motion.” The randomized controlled clinical trial, published in the Journal of Rheumatology in 1994, concluded, “This yoga-derived program was effective in providing relief in hand osteoarthritis. Further studies are needed to compare this with other treatments and to examine long-term effects.”

In another small study published in the British Journal of Rheumatology, it was found that a three-month program of gentle asana and breathing techniques resulted in improved grip strength in patients with rheumatoid arthritis. As an interesting note, Robin Monro, PhD, of the London Based Yoga Biomedical Trust found that that all patients wished to continue the practice after the study was finalized.

Yoga poses called asanas work by safely stretching muscles. This releases lactic acid that builds up with muscles use and causes stiffness, tension, pain, and fatigue. In addition, yoga increases the range of motion in joints. It may also increase cellular joint lubrication. The outcome is a sense of ease and fluidity throughout the body. Yoga stretches not only muscles, but the body’s soft tissues as well, including ligaments, tendons, and the fascia sheath surrounding muscles. Vigorous exercises and precise alignment poses can provide strength and endurance benefits. Some yoga styles use specific meditation techniques to quiet the constant “mind chatter” that often underlies stress. Other yoga styles use deep breathing techniques to focus the mind on breath. Once focused, the mind settles down and becomes more calm and quiet. Yoga’s anti-stress benefits may include a reduction in catecholamines, the adrenal gland stress hormone. Another benefit of yoga is its unique way of massaging the internal glands and organs of the body in a thorough way, including those such as the prostate gland that are rarely stimulated externally. Massage and stimulation of the organs can serve to prevent and also provide early forewarning of disease. A practicing physician for over twenty years, in his book Yoga as Medicine, David Coulter, MD, says that yoga is the most powerful system of overall health and well-being he has ever seen. He describes it as a single comprehensive system that, among other things, has been shown to increase strength, flexibility, and balance, enhance immune function, lower blood sugar and cholesterol levels, facilitate weight loss, strengthen bones, prevent injuries as well as improve psychological well-being.

As the major blockages of physical and energy flows are removed through the practice of yoga asanas, pranayama and bandhas, it is believed that advanced practitioners utilize Mudras to effect extraordinary self-control of prana in the brain and the central nervous system. Swami Satyanand Saraswati observed that “Mudras provide a means to access and influence the unconscious reflexes and primal, instinctive habit patterns that originate in the primitive areas of the brain around the brain stem. They establish a subtle, non-intellectual connection with these areas. Each Mudra sets up a different link and has a correspondingly different effect on the body, mind and prana.” Echoing that concept is a recent study sponsored by the NIH National Institute on Deafness and Other Communication Disorders (NIDCD), in collaboration with the Hofstra University School of Medicine and San Diego State University, which showed sign language being largely processed in the same brain regions as spoken language, including the inferior frontal gyrus in the front left side of the brain and the posterior temporal region toward the back left side of the brain. Dr. Braun believes that developing a better understanding of brain systems supporting gestures and words may also help in the treatment of some patients with aphasia.

The palms and fingers of the hands contain an abundance of nerve endings, which continually emit bioelectric energy. Touching or pressing specific points on the fingers and the thumb folded in specific manner activates specific nerve or nerve bundles thus triggering specific signals. This is what makes certain Mudras suitable for enhancing mental and physical effects. The importance of specific points and portions of hand (and other parts of the body) can also be seen in healing effects of acupressure on the physical body. The advanced effects of yoga and of Mudras in particular are associated with mental refinement, deep meditation and spiritual conditioning. Even for beginning practitioners, Mudras utilized as physical exercises can increase manual dexterity and can be effective for stretching and maintaining hand mobility.

Exactly when and where systematized and stylized gestures originated remains a mystery, however almost all ancient cultures made use of hand signs in one way or another. Mudras, or hand gestures, were employed in early religion, rhetoric, art, social gatherings and by trade guilds. The Comacines, the builders of Europe’s finest cathedrals, and the trade guild known as the Dionysiac Artificers who were responsible for the construction of ancient buildings and structures, all made use of hand signs as a system of communication and protection of their conclaves or secret meetings against unauthorized entry. In Hinduism and Buddhism, hundreds of Mudras were used in yogic practice for ceremonies, drama, and dance. Most of these were symbolic in nature, but others had metaphysical virtues. There are literally hundreds of Mudra-gestures formed by the ancient yogis and sages. They are all based on four basic hand positions: the open palm, the hollowed palm, the closed fist, and the hand with fingertips together. Cheironomy is the term used to denote the study of ritualistic hand gestures and spontaneous movements in directing vocal music. This primarily refers to esoteric symbolism and certain forms or gestures and signs used in religious rites. The religious ceremonies of many ancient cultures considered gestures vital as they were believed to contain powers to call upon the gods, to unfold powers, and to affect surroundings. In occultism, each hand gesture embodies a particular significance and force. Ancient Egyptians regarded even the pictorial representations of their pharaohs as highly potent. Whether creating statutes or depicting pharaohs in murals, the artists were careful to represent Mudras accurately, fearing harsh consequences for misrepresentation.

Mudras also play an important role in the Indian Classical Dance. There are single hand gestures, called “Asamyukta Hastah”, which can be performed by either the right hand only or the left hand only or by both hands simultaneously without combining the two hands. The gestures formed by uniting both hands are called “Samyukta Hastah”. According to the ancient scripture “Abhinaya Darpana” (Nandikeshwara) there are twenty-eight single hand gestures and twenty-four united hand gestures. These hand gestures or Mudras are frequently used in the Indian Classical Dance known as Bharatanatyam. There are Mudras which represent all the Gods and Goddesses (Brahma, Vishnu, Shiva, Saraswati, Lakshmi, etc.), the four different castes (Brahmana, Kshatriya, etc.), different relations (Mother, daughter, etc.), the nine the nine planets (Sun, moon, etc.), rivers (Ganga, Yamuna, etc.), animals (Lion, deer, etc.) and many others.

There are numerous publications that identify the clinical benefit of yoga practice for various medical conditions, including oncology, osteoarthritis, and rheumatoid arthritis. However, these publications do not specifically report on the upper extremity sensorimotor, musculoskeletal, or neurophysiological results for hand therapy patients. As hand therapists are becoming more aware of the importance and value of respiration, core body strength, and posture to upper extremity function, the incorporation of hand Mudras could provide an integrated approach that broadens the treatment repertoire. On a tissue-specific level, differential tendon gliding, nerve gliding, and proprioception could be facilitated within a calming and holistic context using Mudras. It is well known that movement distributes lubricating synovial fluid, continually secreted into the joint by its synovial lining, over the surface of the cartilage that caps the bones. When the cartilage is well lubricated, the joint surfaces glide more easily across each other, reducing wear and tear. Joint movement also helps bring nutrients into cartilage, which lacks its own blood supply. Cartilage acts as a sponge that gets squeezed by movement. Stale synovial fluid, depleted of nutrients, is expressed thus allowing a fresh supply to soak in from the joint when the compression is released. Areas of the joint surface that are rarely used because they are outside the normal grooves of movement fail to get the nutrients they need and over time tend to degenerate. The practice of Mudras can be used to stimulate these little-used surfaces, a prime example of the “use it or lose it” theory. Mudra exercises can be individually tailored following injury to target specific muscles for the purpose of reducing stress, increasing range of motion, reducing pain, and increasing flexibility and strength. And experts in therapeutic yoga point out that individualizing a treatment approach is oftentimes vital in achieving a success outcome.

In addition to working directly with specific injuries or medical conditions, yoga therapists also emphasize the role in healing that mindfulness and awareness the body plays. It can be been argued that tension held in the body often originates in the mind and must be dealt with there first. It is common knowledge that stress contributes to the development and prolongation of many medical conditions, which in turn can delay healing. Experts have noted that while a complaint may show up, for example, as a wrist disorder, effective treatment requires consideration of the upper extremity and torso as well as the role the mind plays in the condition.

As part of medical treatment, Yogic philosophy would take into consideration posture, alignment, communication, and the effects of stress on the disorder.

There will probably never be scientific validation for each style of yoga or Mudra practice, much less all the possible combinations. As B.K.S. Iyengar says “Words fail to convey the total value of yoga. It has to be experienced.” Some of yoga’s aims, like equanimity and compassion, are difficult if not impossible to quantify. And while the current scientific evidence is not robust by Western standards, the growing body of evidence that does exist should not be ignored. We must take some of what we know about yoga on faith-not a faith based on blind acceptance of doctrine, but one grounded in everyday experience. Much more research is needed, with studies being designed to take advantage of potentially beneficial interventions. Strategies that maximize compliance among subjects at greater risk for low adherence will be important for future trials, especially complementary treatments requiring greater effort than simple pill-taking. Carefully exploring the vast universe of yogic healing can provide affordable access to compelling new models of balance and wholeness. Taking a new approach, the middle ground between uncontrolled observations and reductionist philosophy may provide overall greater value to patients. In this age of health care reform it becomes imperative to add to the body of knowledge through not only randomized controlled trials, but through studies of screening and diagnostic tools based on Eastern systems of medicine and allied health sciences, outcome studies, cost effectiveness analyses, case-control series, and surveys with high response rate.

As a therapeutic modality, yoga continues to show great potential for widespread use. The boundaries are still fluid, however provided that scientists, yoga therapists and physicians continue to communicate and learn from each other, the use of yoga practice and Mudras can expand as an noninvasive and effective means to improve strength and flexibility following injury.