E-ISSN:2456-3110

Research Article

Trataka

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 7 August
Publisherwww.maharshicharaka.in

Effect of Trataka (A Yogic Cleansing Technique) on Post-Covid Cognitive Impairments in Elders

Sahana A.1, Kumar PS V.2*
DOI: http://dx.doi.org/10.21760/jaims.7.7.8

1 AU Sahana, Clinical Psychologist, Department of Astanga Yoga, Lakulish Yoga University, “Lotus view” Opp. Nirma University, S.G. Highway, Chharodi, Ahmedabad, Gujarat, India.

2* Vijaya Kumar PS, Associate Professor, Department of Astanga Yoga, Lakulish Yoga University, “Lotus view” Opp. Nirma University, S.G. Highway, Chharodi, Ahmedabad, Gujarat, India.

Background: People who have survived COVID-19 frequently complain of cognitive dysfunction, which has been described as brain fog. Early reports describing a dysexecutive syndrome after COVID-19 and has considerable implications for occupational, psychological, and functional outcomes. It is well known that elders may be particularly susceptible to cognitive impairment after critical illness. Trāṭaka (a yogīc cleansing technique) is one of the Yogā practices which is considered to improve cognitive functions. The objective of this study was to determine whether Trāṭaka practice enhances the cognitive functions of the post covid elderly subjects. Material and Methods: Thirty elders who had enrolled in a thirty days Trāṭaka practice program. Their age ranged between 60 and 80 years (group average ±S.D., 68.5±6.3 years). Those who have any chronic illness and mental illness, and those who are not willing to participate were excluded. Trāṭaka intervention is given for 30 days, 1hour/day. At baseline and following thirty days, all participants completed DLST and SLCT. Results: Trāṭaka intervention showed significant change in DLST scores, increase (P-value< 0.000) in total attempted score, significant increase (P-value<0.000) in net score, significant reduction in wrongly attempted score (P-value<0.000). Significant change in SLCT scores, significant increase (P-value<0.000) in total attempted score, Similarly, significant increase (P-value<.000) in net score, significant reduction in wrongly attempted score (P-value<0.000). Conclusion: The thirty days Trāṭaka intervention was successful in enhancing the cognitive functions among post-covid elders.

Keywords: Cognitive function, Trāṭaka, COVID-19, SLCT, DLST

Corresponding Author How to Cite this Article To Browse
Vijaya Kumar PS, Associate Professor, Department of Astanga Yoga, Lakulish Yoga University, “Lotus view” Opp. Nirma University, S.G. Highway, Chharodi, Ahmedabad, Gujarat, India.
Email: 		AU Sahana, Vijaya Kumar PS, Effect of Trataka (A Yogic Cleansing Technique) on Post-Covid Cognitive Impairments in Elders. J Ayu Int Med Sci. 2022;7(7):58-64.
Available From
https://jaims.in/jaims/article/view/1905

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-06-25 2022-06-27 2022-07-04 2022-07-11 2022-07-18
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2022by AU Sahana, Vijaya Kumar PSand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Globally, COVID-19 has impacted several lives. People who have survived COVID-19 frequently complain of cognitive dysfunction, which has been described as brain fog. Early reports describing a dysexecutive syndrome after COVID-19[1] and has considerable implications for occupational, psychological, and functional outcomes. It is well known that elders may be particularly susceptible to cognitive impairment after critical illness.[2] It is speculated that the inflammatory status after SARS-CoV-2 infection may promote neuronal damage and accelerate the pathogenesis of neurodegenerative diseases.[3] While the exact mechanism underlying this association remains unclear, the causation of cognitive decline post-covid-19 infection is multifactorial. Acute and chronic systemic inflammation and immune dysregulation after SARS-CoV-2 infection might also cause damage to the brain and thus may lead to cognitive decline.[4] A potent mechanism underlying cognitive decline after covid-19 infection is hypoxia[2], because brain regions associated with cognitive functions, such as the hippocampus, are susceptible to hypoxia induced neuronal damage.[5,6] Oxygen deficiency at the acute disease stage and after recovery can cause damages to neurons, which are sensitive to hypoxia.[7] This mechanism might explain why older age was associated with an increased risk of cognitive impairment. A previous study demonstrated that cognitive sequelae occurred in patients who survived acute respiratory distress syndrome (ARDS), indicating that COVID-19 disease, which is commonly complicated by ARDS, might affect long-term cognitive performance.[8] Cognitive impairment following COVID-19 is a complex condition due to the cerebral micro-structural changes that have been identified in the hippocampus and multiple other brain areas.[9] These changes were correlated with deterioration in cognition, which can respond to an interprofessional approach. Its effects can be frustrating both for the patient and the care providers. In view of the multiple complications associated with brain fog, these elders present a complex mix of new and pre-existing disability, their response to rehabilitation may be diminished by frailty and cognitive impairment, and their ability to participate may be limited by environmental factors including social isolation and care dependency. A different, more integrated, approach to rehabilitation

is required; geriatric rehabilitation is very challenging. Existing facilities of rehabilitation and resource has diminished during the pandemic.[10] Yogā an age-old healing tradition of India, has proven to improve different cognitive domains. such as remote memory, mental balance, attention and concentration, delayed and immediate recall, executive functions, verbal retention and recognition tests.[11] very few studies that have looked at the effect of Yogā on cognition in the elderly subjects. Further no study has looked at the effect of Trāṭaka, on post covid cognitive dysfunction of the elders there fore, in this study we attempted to use one of the Yogā techniques (Trāṭaka) in the elderly subjects. The aim of the study was to evaluate the efficacy of Trāṭaka (a Yogīc cleansing technique) in improving cognitive functions of the post covid elderly subjects.

Materials and Methods

Thirty elders with post covid status were recruited for this study. Their ages ranged between 60 and 80 years (group average ± S.D., 68.5 ± 6.3 years). We have fully explained the potential risks and benefits in the study before written informed consent was provided by elders; the study was approved by the ethics committee of the institution, Lakulish Yoga University, located in Ahmadabad, Gujarat, India. The selection criteria included: Post covid elders Age between-60-80 yrs, Education: 5thstd and above, willing to participate by giving a written informed consent and those knowing English were included. Those having neurological and psychiatric disorders (based on case history), those who have practiced Yoga for the last 3 months and those who have major eyesight problems (in vision) were excluded from the study. In this study we adopted a purposive sampling to recruit subjects from the residential societies in Ahmedabad, thirty days Trāṭaka intervention was provided in the society premises, a single group pre-post design was used. The 30 days study was successfully completed by 30 subjects.

Design and Setting

The trial was a single group, pre-post trial. Subjects were assessed on day 1 and day 30 of the thirty days Trāṭaka practice, when the assessment was completed, respondents were appreciated for their time and cooperation. The practice was conducted in the premises of a residential society in Ahmadabad, Gujarat, India.


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Intervention: The procedure used for Trāṭaka session was adapted from the book Yogā for promotion of positive health’.[12]

Preparatory eye exercises: Trāṭaka has many steps to be followed. First are the preparatory eye exercises. For this, the first step is the up and down or vertical movement of the eyes. In all the practices one has to open the eyes and move the eyeballs gently. It has to be smooth and continuous without any jerky movement. This has to be repeated for ten rounds. After this practice, to relax the eyes, simple palming is instructed (that is, rub the palms and then make a cup of it and cover the eyeballs). The second step is right and left or horizontal movements of eyeballs. Here, after opening the eyes one has to move the eyeballs to left and right. Again, this also has to be repeated for ten rounds. Here too simple palming is provided at the end of the exercise. The next step is diagonal movement of the eyeballs. Here the eye balls have to be moved to the extreme right up and extreme left down for ten rounds. Subsequently press and release palming is provided (as one inhales press the palms around the eyes and as one exhale release the pressure). It has to be continued for 5 rounds. Fourth practice is diagonal movement in the opposite direction. The relaxation is conducted using the same press and release palming exercise as before. Next step is the rotational movement of the eyeballs that is clockwise and anticlockwise. Here after the practice for relaxation the constant pressure palming is provided (press constantly around the eyeballs with the palms with inhalation and release with exhalation).

Jyoti Trāṭaka: After the preparatory exercises, the next practice is Jyoti Trāṭaka, and it has three steps. The first is focusing, that is effortless gazing or focusing at a flame. One has to look at it for 30 seconds. At the end of the practice for relaxing the eyes, press and release palming is provided. Next step is intensive focusing at the tip of the wick of the flame. Here constant pressure palming is provided at the end of this step. The next step is de-focusing. The procedure includes first looking at the flame, then slowly widening the vision and defocusing the gaze on the flame with expansive awareness and collecting the details of the flame. After one minute again focusing on the flame followed by slowly closing the eyes and visualizing the flame between the eyebrows, collecting all the details with eyes closed is instructed.

When the image disappears, palming with chanting of Bhrāmari is instructed. The last step is silence. The participants are instructed to feel the silence and relax for a while. After sufficient relaxation, they are asked to gently drop down their hand, sit quietly for some time and feel the deep comforting effect of the practice. They are asked to be aware of the changes taking place inside, recognize that the mind has become completely calm and that the concentration, willpower and sharpness of eyesight have improved.[12] (Appendix-1)

Assessments

SLCT: Cancellation tests require visual selectivity and a repetitive motor response. A six-letter cancellation test was administered to assess functions such as selective and focused attention, visual scanning, and the activation and inhibition of rapid responses. The six letter cancellation test has been used in similar type of design on Indian population.[13] The six letter cancellation task worksheet consists of an array of random alphabets, A-Z, in 14 rows and 22 columns. Participants were asked to sit with the worksheet distributed to each one. The instructions are given asking them to cancel as many target digits as possible in the specified time. They are asked to cancel as their wish whether horizontally, vertically, or selecting a particular letter one at a time randomly in the row. Finally, after knowing the test instructions they are asked to start the test, each test was conducted for 90 seconds on a standard stopwatch.

DLST: Digit letter substitution test contains flexibility at mind level, visual scanning, attention and psychomotor speed of processing information. It is used with same type of design on Indian population.[13] DLST worksheet consists a row of random digits, 1-9, in 8 rows and 12 columns. The coding sheet contains instructions about the test with example of substituting a specific letter for specific digit 1-9, the same code is applicable to entire test. Subjects were instructed to make their choice of letter substitution process, whether horizontally, vertically, or selecting a particular digit randomly in the row one at a time. In given time of 90 seconds substitute as many target digits as possible.

Data analysis: The data taken on the last day and on the first day of the Trāṭaka were compared with t-test and Wilcoxon signed rank test for paired using SPSS version 16.0.


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Results

A total of 30 subjects were participated in the study 30 subjects completed the study, which was conducted at the end of thirty days of Trāṭaka practice; Mean values and standard deviation for total scores, wrong substitutions, and net scores of six-letter cancellation task and digit-letter substitution task.

SLCT: Six Letter Cancellation Test: After thirty days of Trāṭaka practice it showed that 37.4% significant increase (P< 0.000, paired samples t-test) in total attempted (TA) score on SLCT. Similarly, there was 53.7% significant increase (P = 0.000, paired samples t-test) in NS. However, there was 100.9% decrease in wrongly attempted (WA) score which was highly significant (P = 0.000, Wilcoxon Signed Ranks Test) [Table 1].

Table 1: SLCT Changes after 30 days Trāṭaka practice

SLCT scores Before After % increase↑ P value
TA 28.64 ±11.43 41.85 ± 7.99 37.4%↑ 0.000***
WA 5.77 ± 1.73 1.9± 0.40 100.9%↓ 0.000***
NS 22.87 ± 10.60 39.74 ±6.94 53.7%↑ 0.000***

*significant at P<0.05, ** significant at P<0.01, ***significant at P<0.00 (paired sample test and Wilcoxon Signed Ranks Test), SLCT: Six Letter Cancellation Test, TA: Total attempted, WA: Wrongly attempted, NS: Net scores.

DLST : Digit letter substitution test: After 30 days Trāṭaka practice it showed that 49.48% significant increase (P< 0.000, paired samples t-test) in total attempted (TA) score on DLST. Similarly, there was 36.3% significant increase (P = 0.000, paired samples t-test) in NS. However, there was 122.3% decrease in wrongly attempted (WA) score which was highly significant (P = 0.000, Wilcoxon Signed Ranks Test) [Table 2].

Table 2: DLST Changes after 30 days Trāṭaka practice

DLST scores Before After % increase↑ P value
TA 34.29 ± 11.74 44.32 ±8.13 49.48%↑ 0.000***
WA 8.76 ± 4.15 2.11 ±1.32 122.3%↓ 0.000**
NS 25.53 ± 7.96 42.21 ± 5.32 36.3%↑ 0.000***

*significant at P<0.05, ** significant at P<0.01, ***significant at P<0.00 (paired sample test and Wilcoxon Signed Ranks Test), DLST: Digit letter substitution test, TA: Total attempted, WA: Wrongly attempted, NS: Net scores.

Discussion

Yogā is an art of living and has various health benefits including ability to improve cognitive functions. Many scientific studies have proven that Yogā is effective to improve cognitive functions in multiple clinical conditions.[14] It is a well-established fact that aging is associated with a gradual decline of cognitive functions. But the inflammation and immune dysregulation after SARS-CoV-2 infection might also cause damage to the brain and thus may lead to accelerated cognitive decline.[4] Number of Yogā studies looking at the cognitive functions of the elderly is limited. Trāṭaka is one of the Yogā practices which are considered to improve cognitive functions. But its effect on cognitive functions in post covid status has not been studied. As this study has not been conducted earlier, the aim of this study was to test the effect of Trāṭaka on cognitive impairment in post covid elders. Completion of this practice was associated with overall significant improvement in measures of executive functions. Substitution tests are essentially speed-dependent tasks that require the subject to match particular signs – symbols, digits, or letters - to other signs within a specified time period. Substitution tasks involve visual scanning, mental flexibility, sustained attention, psychomotor speed, and speed of information processing.[15,16] Trāṭaka practice involves various steps like preparatory eye exercises, focusing, defocusing, chanting and silence during relaxation. Each component or all of them together could have been responsible for the improvement in the cognitive functions. Dharana or focusing improves concentrative attention.[17] Focused Attention (FA) is the attention which is restricted to a specific focus[18] such as the breath or the candle flame (Trāṭaka). Earlier studies have shown that Intense FA meditation effects cortical engagement, as reflected by a concomitant reduction in ERD (event related desynchronization) to target tones in the beta (13-30 Hz) frequency band. Reductions in beta ERD after practice of external tasks is due to the decreased cognitive efforts.[18] There is enhanced processing of task-related auditory inputs during FA meditation. FA meditation training is thought to improve one’s ability to remain vigilant and monitor distractors without losing focus. FA meditation which could be considered a state of dhyana, the regulative attention skills are invoked less frequently, and the ability to sustain focus


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thus be-comes progressively “effortless”.[19] Dhyana is associated with reduced sympathetic activity and increased vagal tone.[20] The defocused phase of Trāṭaka could be similar to the benefits of Dhyana phase of meditation. Multiple studies show that meditation may affect multiple pathways that could play a role in brain aging and mental fitness.[21] Meditation processes are linked to GABAergic cortical inhibition, a mechanism implicated in improved cognitive performance and enhanced emotional regulation.[22] Relaxation techniques have shown to reduce anxiety and improve memory[23] as well as attention.[24] It is already known that reduced anxiety can improve the performance on tasks requiring attention and memory.[25] So, the improved performance could also be attributed to the reduced anxiety after Trāṭaka. The findings of this study establish that Trāṭaka could be a potential tool to combat post covid cognitive impairment in elderly. The Trāṭaka intervention is easy to learn, implement and adhere. Further Trāṭaka after the initial few sessions, can be practiced independently by the elders. This study could provide a substantial base for conducting future trials to test the efficacy of Trāṭaka in controlled experiments.

Table 3: Details of Trāṭaka practice

SN Name of the Practice Duration
1. Starting Prayer 1 min
2. Preparatory eye exercises 9 mins
  Up and down or vertical movements-10 rounds 30 secs
  Simple palming 1 min
  Right and left or horizontal movements-10 rounds 30 secs
  Simple palming 1 min
  Diagonal movements -Right up-left down-10 rounds 30 secs
  Press and release palming 1 min
  Diagonal movements -Left up-right down-10 rounds 30 secs
  Press and release palming 1 min
  Rotational movements-clockwise-10 rounds 30 secs
  Constant pressure palming 1 min
  Rotational movements-Anticlockwise-10 rounds 30 secs
  Constant pressure palming 1 min
3. Jyoti Trāṭaka  
  Effortless gazing or Focusing 4 mins
  ‘A’kara chanting 1 min
  Intensive focusing 4 mins
  ‘U’kara chanting 1 min
  BREAK 1 min
  De-focussing 4 mins
  Bhramari 1 min
  Silence 4 mins
4. Closing prayer 1 min

Conclusion

The thirty days Trāṭaka practice was successful in improving sustain attention, working memory capacity among post-covid elders, a longer follow-up period will enable researchers to thoroughly examine neuro-cognitive changes. Although this was limited by small sample size, lack of heterogeneous population, these findings suggest rigorous systematic approaches and advanced imaging techniques to examine Trāṭaka practice as a means to enhance executive function among post-covid elders.

Acknowledgment: We would like to thank all the elders for participating in this research study and to complete the study successfully.

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