Article three

Yoga for people with physical limitations

“There is a wisdom which knows when to go and when to return, what is to be done and what is not to be done, what is fear and what is courage, what is bondage and what is liberation-that is pure wisdom” (Gita 18 v30)

Having spent my professional life in the area of education for the disadvantaged, I decided to undertake my yoga teacher training at the Yoga for Health Foundation in Ickwellbury England, a centre which specialises in the research and teaching for people experiencing physical limitations especially from the effects of Multiple Sclerosis. I remember during the year of my training continually asking the experienced teachers how they knew what to do with each person. They replied that it was no different to any other yoga teaching ie you get to know your student and work together so that they achieve their potential. At the time I didn’t believe them as I was impatient to know every limiting factor caused by each disease or condition a student may have.

Ten years down the track I now understand what they meant. Whilst researching the nature of a person’s illness or condition is paramount to teaching any activity, I have found that people with the same illness can move, breathe and respond quite differently, and it is indeed observation and knowledge of your student that will allow them to participate to their full potential in yoga.

The types of physical limitations I work with in teaching yoga are many and varied as the following examples will highlight.

Jessica

Although she was diagnosed with cerebral palsy with “spastic diplegia” as a two year old and told she would never walk or talk, Jessica – who attends school and is very articulate is now diagnosed as having “spastic hemiplegia” which affects the co-ordination of her left side.

I have been teaching Jessica for the past 18 months, since she was 9 years old. In the early lessons we played a lot of games with both the postures and breathing techniques, relying on the knowledge I had gained from the methods set out by RYE (Research into Yoga and Education – France and UK) and Yoga in Education (Australia). In the first year, Jessica preceded every standing posture with the words “I can’t”. We always used the wall, chairs etc to allow her to attempt and hold her postures. It was important that she gained a sense of achievement and a sense that the posture was possible.

As time has gone on the games have become less frequent as she loves flowing from one posture to another. I haven’t heard her say “I can’t” for at least the last 7 months. In fact, often if I have left out a more difficult posture from her lesson, she will ask me to do it eg Warriors 1 & 2 and the headstand.

The photo below shows the first time she did Warrior 1 unaided, we were both so excited, I ran in and got the camera.

Photo 1

Our lesson has always commenced with a visualisation and breathing technique and finished with a guided meditation – we often use ‘tratak’ techniques either with a candle or a drawing. After warming up, we then do some of the leg and hip releases of Oki yoga followed by sitting postures such as a variety of forward bends and twists. Jessica’s Salutes to the Sun have also helped her balance and co-ordination. She is now also practising Warriors 1 & 2, and Triangle. She can now balance unaided in the Tree and Garuda balances, so we are now attempting with the aid of a chair and the wall Warrior 3 and Half Moon posture (Ardha Candrasana).

She is very proficient in her prone positions, such as the Cobra and Locust postures and variations – probably as we did many of these in the beginning to improve her sense of self-confidence. We now complete each session with the inversions; full backbend , Plough, Shoulderstand, Fish and Headstand – what has impressed me with her attempt at these postures is her attitude of “let’s” rather than “I can’t”.

Photo 2

I asked Jessica to write what she thought about yoga :

“…I can now balance and do more things with my leg than before….when I can’t get to sleep I use meditation to help me relax and get to sleep….I really enjoy yoga because it’s fun and it gives me the satisfaction of being able to do things I wouldn’t normally do.”

Group of Adults with severe physical impairment brought to yoga by DARTS (Disabled Alternative Road Travel Service)

This group started about 3 years ago. All 10 members of the group are in wheelchairs and have varying degrees of severe physical impairment from different causes; cerebral palsy, cerebral ataxia, MS, Spina Bifida, spinal muscular atrophy, stroke (students asked that their separate conditions not be listed as they don’t think about themselves in the way defined by a particular disease or condition). Without the aid of council funding (Warringah Shire) and my troupe of volunteers this yoga lesson would not be possible.

This is one of those groups where the participants face life from the attitude of the yogi every minute of every day. My helpers and I feel that we learn far more about “ yoga citta vritti nirodaha” (Patanjali - yoga sutra 2 – yoga is about the stilling of the fluctuations of the mind) than do the participants. The attendance rate at this class is excellent and in fact the class has a waiting list.

Again, we always commence with breathing and centring, proceed with our postures and finish with a guided visualisation or meditation. These can be quite specific eg if it’s hot we are dangling our feet in a pool of water and we imagine ourselves in the swimming costume of our choice. Each student can now keep their eyes closed for the whole duration of these practices and this year we have proceeded onto pranayama practices of nadi shodan and ujjayi breath. We commenced with gentle postures such as the Pawanmuktasana (joint, muscle and energy block release) series from Satyananda yoga and chest opening movements to encourage positive self awareness, we have been able to progress to more physically demanding postures such as forward bends.

We have noticed the range of movement in sidebends and twists has really improved over the years. We also witness some great breakthroughs such as: Robert early 50s,being able to lift his leg with his hands ( we are now aiming for him to reach his foot); Lena no longer wears a neck brace and moves her torso more, so that she can do a Cat posture unaided in her chair, as well she is also able to lift her arm; Grace – can now hold her head up for longer and actually practices some of the postures at home; Helen is able to lean forward in her chair without fear of falling; Vanessa is able maintain total calm in her body for a whole lesson. At times, we have total “fun” lessons, ie choose a theme: Yoga for the Olympics, Animal postures, 60s yoga to name a few.

This group relies heavily on volunteer support and being creative with the use of chairs and walls but I have never heard one member of this group use any negative wording about their postures. Often if they feel we haven’t taken them far enough into the posture they will tell us how we can improve their positioning to achieve the posture more effectively. In fact Barbara’s carers (under my guidance) now put her into various postures at her home.

When I asked what the effects of yoga had been on their lives, I was surprised by some of the answers as I had expected them to mention the jolliness and social aspect of the class:

“helped me to think about breathing and helped me to think about the placement of my body:” –Barbara

“the breathing has taken me beyond the limitations of my disease” Helen

“…sometimes when something is difficult I find myself not breathing, so now I breathe….nadi shodan helps me breathe at night” Lena

“..it’s been amazing to see the ability our bodies really have..” Vanessa

“Yoga is a very peaceful and joyful activity..” Phillipa

photo 2 & 3

Sydney Academy of Sport and Recreation– developmental programs for athletes with various physical and mental impairment.

Teaching these dedicated youth has been a real joy for me. Groups vary from elite athletes to those being exposed to sport as a way of orientation for increased participation in the future. The impairments include visual, hearing, limb loss, cerebral palsy, quadriplegia, intellectual impairment etc. The yoga or relaxation and meditation programs are run for an hour or two as part of a weekend of intense training. I usually have between 20 – 25 young people in a room of varying size.

I change the postures according to the sport eg if it’s a swimming group we will do mainly lung and hip postures in prone and supine positions. For the athletics group we do more standing postures. All groups are used to challenges so they seem to really enjoy difficult balances. For example the Athletics group really enjoy the challenge of the Eagle (Garuda) These groups again enjoy some of the releases of Oki yoga, in particular the pushing rather than the stretching releases. The following photo I think reflects the focus of this group of elite swimmers in achieving this lung opening posture.

Photo 4

These groups also really enjoy finishing their sessions with a Yoga Nidra.

People with Multiple Sclerosis(MS)

Originally the MS society arranged weekly yoga lessons – with all the participants having MS. Although there are advantages to this in that students can compare what’s happening in their lives, it was again very dependent on volunteer support, which was quite difficult to procure.

About a year ago, I started integrating some of these students into my other yoga classes. We have found this to be a benefit to most students because I am able to help them physically so I don’t need to rely on volunteer support. They tell me they like being part of a “mainstream” group, and many have commented that they like it when other students ask them why some postures are difficult so that they can explain what happens with MS. Students have commented that it gives them a sense that they are helping themselves. Interestingly a few of these students had done yoga pre MS and we are able to work into quite strong postures. For those students who feel uncomfortable about integrating we still offer separate classes but are focussing more on meditative and relaxation techniques.

As the effects of MS can lead to quite a degree of variability in body movement each week, it is essential that we approach each lesson with awareness of the present to find the most effective yoga position for that day. In the early days I used to prepare lots of variations for students to achieve their posture, now I find we attempt the posture first, as often we don’t need to vary it or they can vary it in a more suitable way for them. Again, we often rely on straps, walls chairs or my body being a support eg me standing astride their bent knees to keep their knees parallel or together for a Bridge posture or using my back as a support in a sitting posture. Again students have commented that they really feel benefit from the pushing releases of Oki yoga. At the times when their limbs don’t move many of them have found benefit from visualising the movement of this limb.

Jane summarized the effects on her as follows:

As a sufferer of MS I have found yoga to be a great help in providing me with better muscular control which loosens my limbs and gives me much greater flexibility and allows me to proceed with my everyday activities with much less encumbrance. This has the added effect of reducing the pain arising from muscle spasms and helps to keep me calm – a major benefit for my family. Because of this it has given me more confidence to try more things, such as more difficult poses.

Photo 5

To conclude

Whilst I always research any condition that a student has in order to work within any necessary parameter eg being aware of the deleterious effects of heat on people with MS, the above examples illustrate the need to work mainly with the person rather than the disability or disease. The other ingredient to the success of teaching yoga for people with physical limitations can, at times, be humour. I have found that humour can often dissipate a potentially embarrassing situation.

This week I received my Yoga magazine in the mail and I enclose a quote that I feel sums up what I have observed from teaching yoga to these groups.

“Pain is a part of life, but to be a slave to pain is not a part of life. When we are slaves to our suffering, we identify with weakness and limitation, with the words ‘I can’t’, but when we identify with strength, with the words ‘ I can’, then goodness, wisdom and will power combine to become more dominant, and in pain, the infertile self becomes more dominant.” Swami Niranjan Yoga issue 1 2002

photo 1

Jessica practising Warrior 1 unaided for the first time

Photo 2

Jessica doing a headstand

Photo 3

Helen on the right being aided by Anne

Phillipa on the left being aided by Zita

I enclose this photo as it shows the joy they bring to their yoga class

Photo 4

Zita and I helping Barbara with her version of a twist

Photo 5

Swimming developmental squad at the Sydney Academy of Sport, doing a lung opening movement

Photo 6

Jane doing a Downward Dog

©Annette Loudon 2002

DRAFT - Yoga and the disabled

With a better understanding of special needs, yoga instructors can help people with any disability reap the rewards of yoga

By Annette Loudon*

“I can’t”.

These were the words I’d hear before 9-year-old Jessica attempted any yoga standing posture. Jessica has spastic hemiplegia from cerebral palsy and as a two-year-old had been told she would never walk or talk. Her mother hoped that yoga would increase her mobility.

In our early lessons we played a lot of games with both the postures and the breathing techniques. We always used the wall or chairs to allow her to attempt and hold the postures. It was important that she gain a sense of achievement and a sense that each posture was possible.

18 months after our yoga sessions began, Jessica loves flowing from one posture to another and she doesn’t say “I can’t” anymore. In fact, when I leave out a difficult posture, such as the warriors or headstand, she will ask me to include it in her lesson.

Jessica is one of the many students I have worked with over the years who have conditions including spina bifida, multiple sclerosis, limb loss, stroke and visual and hearing impairment.

Providing classes for people with physical limitations is both challenging and rewarding. Some students are quite mobile and others are in wheelchairs and have absolutely no movement. Some have had their disability from birth while others have sustained a disability from injury or disease.

People with all disabilities can do yoga and benefit from it.

My classes range from one-on-one lessons such as those with Jessica, to individuals integrated into regular classes, to the Disabled Development squads at Sydney Academy of Sport.

It is important to address the needs of the specific person or group to teach in the way that person or group feels most comfortable.

Setting up classes

Yoga teachers need to provide a suitable venue, with wheelchair access and disabled toilets.

Students need to get medical clearance and instructors need to give them a clear understanding of what is expected of them. Make sure you have indemnity forms for the students to sign.

Overall, it is important to reassure them that they can do yoga and that it is possible to adapt and modify so many wonderful yoga postures for them.

For some disabled classes, the teacher will need to rely on volunteers to assist disabled students with movement.

For example, one of my classes has been organized through the Disabled Alternative Road Travel Service (DARTS), who then advertise in the local paper for yoga students who would like to help within our classes. We have 12 students and as many volunteers.

The students of the DARTs group have been together for 5 years now, and our classes have come a long way. Now we practice more advanced meditation techniques and recently we did Kirtan – (joyous singing usually in Sanskrit) which they loved. This year we will go as a group to Mangrove Mountain yoga ashram to experience ashram life.

For my classes at the Sydney Academy of Sport, the coaches help me put students in correct postures and I always take an assistant (one of my students to demonstrate the postures). The volunteers help the students with safety under guidance from me.

The students I work with include the NSW Soccer squad for players with cerebral palsy, and the intellectually disabled basketball players. As an aside, it is interesting to note that as the disabled squads were doing so well with their yoga, now the able-bodied development teams are offered yoga at their developmental camps.

Some disabled students prefer private classes, others work best in special group classes or there is the option of integrating students into general classes. For example many of my students with Multiple Sclerosis prefer to be in regular classes. If they are in a wheelchair they have a volunteer to help them, while those not in wheelchairs use walls, props etc to help them in their postures.

Interestingly, the other able bodied students have adapted well to this situation.

* Annette Loudon has been teaching for almost 30 years. As well as her own classes in Forestville, she runs classes for the Multiple Sclerosis Society and is involved with the Sydney Academy of Sport and Recreation’s programs for developing talented athletes with a disability. She trained with Yoga for Health in England to teach people with disabilities and while in Britain she worked with street kids, teaching them yoga postures and relaxation.

Sidebar dot points:

All disabilities can be catered for

· Postures can be modified

Yoga can benefit all

©Annette Loudon

Yoga for people with disabilities

Annette Loudon-Forest Massage and Remedial Yoga

Nican conference ÓAnnette Loudon

15^th September 2002

What is yoga?

Yoga means union. In practising yoga we unite the breath with awareness of the body and mind whether we are doing postures or meditation. The postures were developed to make the body strong enough to sit and meditate in order to still the fluctuations of the mind.

What are the types of disabilities?

The types of disabilities are many and varied as are their effects. Some students are quite mobile and others are in a wheelchair with absolutely no movement. Some students have had their disability from birth while others have sustained a disability from injury or disease; many students have degenerative conditions whilst others have no worsening impairment.

The causes include:

Cerebral palsy, spinal bifida, Multiple Sclerosis(MS), limb loss, visual and hearing impairment, stroke, spinal ataxia, spinal muscular atrophy.

How are classes run?

Some students have private classes as with 11 year old Jessica who has spastic hemiplegia from cerebral palsy.

Another group of 12 students is funded by Warringah Shire. Students are brought to class by DARTS (Disabled Alternative Road Transport Service) and rely on volunteers to help move their limbs.

The Sydney Academy of Sport and Recreation includes a yoga session in its developmental squads for swimming and athletics.

Other students are integrated into general classes, as in the case of people with MS who formerly had classes run by the MS society but now attend individually in general classes.

What is included in the yoga class?

Yoga lessons consist of breathing and centering, warm up of some type, practice of postures including releases, balances, perhaps some pairwork and a relaxation or meditation or massage.

What has been useful for people with disabilities?

In their own words students have found the breathing and meditation to be of enormous help in their lives:

“helped me to think about breathing and helped me to think about the placement of my body:” –Barbara

“the breathing has taken me beyond the limitations of my disease” Helen

“…sometimes when something is difficult I find myself not breathing, so now I breathe….nadi shodan helps me breathe at night” Lena

They also comment on the effects of achieving some of the postures:

“..it’s been amazing to see the ability our bodies really have..” Vanessa

Students also commented that they really like the releases and the balances.

“.. I now use the hip release in my own training and find the balances give me a focus that I can also use in my (swimming) race preparation…” Craig

What changes are needed to accommodate the disabilities?

Knowledge of the effects from different disabilities is paramount, but should be incorporated into knowledge of the individual and their abilities as with any other class of students in teaching appropriate and safe postures.

Use of chairs, straps, the wall, another person etc to help, however necessary, to allow a student to achieve a posture. I have found the students themselves can offer the best suggestions as to how to achieve a posture. The prop or person is there to aid them not to takeover from them.

In many cases visualisation of a limb moving is used.

How are the postures chosen?

As in any other class, the postures are chosen depending on the individual and what they need. For example the yoga for swimming athletes will consist of postures in the prone or supine position, and may consist of lung and hip opening movements. The postures for track and field athletes include more upright postures or opening of the chest area.

For many of the students who are in wheelchairs it is helpful to open the chest area first to instil a sense of self-confidence. For many the yoga lesson is the only time their bodies are moved during the week, so it is necessary to try and move every joint in some way.

Co-ordination can be important so sequences including Salutes to the Sun can be taught.

As previously mentioned both releases and balances have been found helpful by students. They especially enjoy the ability to move a little more that the releases lead to and as balance is normally such a difficult proposition they also really enjoy achieving a stillness in a balancing posture.

Some examples of releases Some examples of balances

· Stretching to easy side · Tree

· Resistance · Tiger

· Leverage from difficult side · Eagle

· Corresponding points · Half Moon

A useful meditation, students focus on a dot in the middle of a word or object eg JOY, the dot would be in the O. Then lead on to candle gazing, tratak.