People with disabilities benefit from a modified version of yoga

By Beth Puliti

Physical therapist Chrys Kub, PT, e-RYT 200, and teacher of therapeutic yoga Terri Leonard, MA, CYT 200, C-CYT, know yoga doesn't just benefit the fit and flexible. As instructors of adaptive yoga, their classes are comprised of people with a full range of disabilities.

Though some of their students may not know much—if anything at all—about yoga, and may be unable to perform all poses, Kub and Leonard maintain anybody can reap yoga's benefits.

"Anyone can participate in an adaptive yoga class. The most important thing is for the instructor to be aware of the implications and precautions regarding each student's disability, and to provide modifications as appropriate," said Kub, a physical therapist at Touchstone Therapy in Pineville, NC, senior trainer at YogaFit Teacher Training Systems, Worldwide and founder of YogaFit Yoga Therapy Training.

Everyone Can Benefit

Yoga can help people with myriad disabilities, including cognitive issues, developmental issues, arthritis, multiple sclerosis, spinal cord injury, brain injury, stroke and more, explained Leonard. Children with developmental disabilities have different needs than adults, and therefore benefit from yoga in less traditional ways, she said speaking of her work with children in special education.

"A lot of the children I see have poor trunk strength and low muscle tone. We do a lot of core exercises to work on that. They also can't track very well with their eyes, so we do a lot of eye exercises. Some just can't sit still, and so we practice breathing and self-calming techniques," said Leonard.

Her adaptive yoga class at the Shepherd Center in Atlanta accepts people with a variety of disabilities, including people in wheelchairs. Even the occasional caregiver gets in on the action.

"The class could be very mixed with an able-bodied parent who is a caregiver, a teen in a wheelchair who has a spinal cord injury and a person who's just had a stroke," she said. "I try to make the class work for everybody, so people who are able-bodied can do a version of the exercise other people are doing."

Due to the amount of time spent in a seated position, people in wheelchairs are in need of activities they can perform out of their chair, and can benefit greatly from a modified version of traditional yoga, stated Kub.

"With the use of various props, supports and possibly an in-class assistant or yoga buddy, a person in a wheelchair can participate in most of the floor postures in yoga," she said. Depending on their level of impairment, some people in wheelchairs are able to perform standing postures as long as they have a stable surface to hold onto.

Kub noted that adaptive yoga classes are designed to be user friendly and have the poses fit each individual body, rather than the body having to fit the pose. "The instructor is knowledgeable about how to adapt the yoga posture to each participant with special emphasis on including specific postures that will benefit someone's condition the most," she said.

Adaptive yoga also increases self-esteem by offering instructors and peers who understand disability, Leonard said. "Some people say they wouldn't step foot in a yoga studio because they are afraid that someone wouldn't 'get it,' and would make them perform exercises that are too hard." The advantage of adaptive programs is that "everybody is there because of their disability. When they come to these classes, there's a lot of socializing and a lot of support that happens at the same time as yoga," said Leonard.

Be Creative

The difference between teaching yoga to able-bodied students as opposed to students with disabilities can be broken into three parts: possessing an open mind, obtaining specialized training and learning to be creative, stated Leonard.

"As an instructor, you need to be really open as to where everybody is. They may walk in and not know anything about yoga and they may not be able to do much, but you need to keep an open mind about what people are going to be able to do," Leonard said.

There is also different training involved in adapting yoga exercises to this population. "You need to know how to make it work, and what's a better way to make it work," she said. "If somebody is in a wheelchair, how can they stretch a particular muscle or move a joint while they're seated versus having them lie down on a mat or stand up?"

According to Leonard, the third but most important part of teaching adaptive yoga is learning to be creative. "The hardest part is working in a group where people are at a variety of levels. You need to try and give each person something they can do, while teaching one posture or movement," she said. "Some things may need to be tried a couple times in different ways, or with different props. You have to think on your feet."

People with disabilities may have to develop or re-develop the awareness in their bodies; the disability may have effectively "disembodied" them. "If it is a disability that they were born with, as is often the case in children with disabilities such as cerebral palsy or spina bifida, they need to learn awareness of their body, their sensations, breathing and movement, perhaps for the first time," said Kub. "Students with disabilities many times will need props or assistance to move into some of the postures."

Leonard uses chairs, walls, therapy tables, pillows blankets, yoga blocks, yoga straps, rolled-up yoga mats, sandbags and therapy balls to modify yoga poses. Rather than have an obese student sit on two chairs, Leonard creates a wide platform by placing aerobics risers and steps against the wall. Students who can't sit in chairs or on the floor perform stretches and adapted poses on therapy tables. If participants can't grasp, or don't have the use of their hands, they can use yoga straps to provide a handhold. "Straps can be used like a therapy band or to help lift up a leg," said Leonard.

Sandbags are used when practicing breathing techniques. "I have a lot of clients with MS and their nerves are damaged, including the muscles of respiration. Their breathing gets really shallow, and in order to exercise the diaphragm and abdominal muscles, we put a weighted bag on the belly as they breathe. This provides resistance to help strengthen and thereby deepen the breath," said Leonard.

"In adaptive yoga, it is imperative that you have props around because people simply can't do a lot of traditional postures."

Freedom From Limitations

People with disabilities can suffer from lack of body awareness and poor self esteem, noted Kub, and the practice of yoga helps them to develop increased awareness, not only of their physical body, but also of what instructors call the "subtle body."

As students move through the postures in adaptive yoga, "the increased awareness of breathing will allow them to increase their energy levels and move the energy through their bones," said Kub. "The focus in yoga of letting go of expectations and being in the present moment allows them to connect with their greater self and develop a sense of peace and wellbeing."

This can help people with disabilities deal with the fluctuating waves of emotions that come with having a disability in a calm manner. They can learn to quiet their minds, let worrisome thoughts dissipate and focus on the joy of the moment, said Kub.

At the Shepherd Center, a catastrophic care hospital, patients in the inpatient program have recently come through an accident of some kind. "There is a lot of anxiety, stress and grief about their condition. Both patients and caregivers talk about not being able to quiet their minds," disclosed Leonard. At the beginning of each class, she guides her students through a meditation where they practice breathing and body awareness.

"Whether their disability is something they are born with or something they acquired, our society many times has devalued people with disabilities. What yoga provides is a tool for people with disabilities to improve their health, and also realize that they are valuable for who they are, inside," Kub stated. "They learn to connect with their inner self, the self that transcends their physical limitations. They learn to free themselves from their perceived reality as limited beings and realize they are people of value and, despite their disability, are the same as everyone else."

For PTs interested in including the tools of yoga in their practice, YogaFit® Teacher Training Systems offers a Yoga Therapy four-day intensive workshop for yoga instructors and health care professionals. Visit www.yogafit.com for more information.

Beth Puliti is associate editor and Web editor at ADVANCE. She can be reached at epuliti@advanceweb.com