Adapted Yoga for Person with Disabilities

Jun 17, 2011
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Introduction to Yoga

The Sanskrit word, Yoga, is often translated into English as “to unite”, “to yoke” or “to control”. The term “Yoga” refers to a set of disciplines which originated in India whose goal is to assist people in attaining a state of perfect spiritual insight and tranquility. This state is brought about by a person performing specific physical and mental exercises to achieve the union of physical, mental and spiritual states. Yoga, one of the six main schools of orthodox Hinduism (darshanas), is associated with meditative practices in Hinduism, Buddhism and Jainism and for these reasons the terms used in the practice of Yoga are in Sanskrit.  One of the major types of Yoga, Hatha Yoga, and a specialized branch of Hatha Yoga known as Iyengar Yoga are most often practiced in the west.

Hatha Yoga focuses on the structural alignment of the physical body through the development of correctly performed asanas (or postures) and pranayama (breathing exercises). As a result of movement through a standardized order of postures and correct breathing exercises it is believed that the body, mind and spirit can be aligned for health and well-being.  In some settings mantras (or chanting) are also a component of the experience.

Iyengar Yoga achieves the same goal through utilization of props such as cushions, benches, blocks, straps and sandbags that allow beginners or people with disabilities to experience the asanas (or correct postures) more fully than might otherwise be possible. Postures that are based upon upright or standing positions are emphasized in Iyengar Yoga since they are believed to build strength in the legs and thereby increase circulation and balance. In this type of Yoga the instructor is highly involved in correcting misalignments as opposed to allowing a student to find their way independently through a method of trial and error.

The West has shown a great deal of interest over the past 40 years in the discipline of Yoga as a form of exercise and relaxation. As practitioners of Yoga who were also Physical Therapists and RNs have gradually noted neuro-developmental therapy has many similarities to Hatha Yoga techniques. Both require that the individual practice movements through each natural developmental posture (from laying on back/front to sitting, to hands-and–knees, and finally to upright standing). Therapists believed that the delicate skills of moving energy throughout the body, meditation, and breathing patterns are additional components that Yoga offers to the body and the mind, beyond the exercises of western neuro-developmental therapy.  Yoga has reportedly been used as one effective treatment modality in cases of Anxiety, Asthma, Cancer, Coronary Artery Disease, Depression, Diabetes, Headache, Hypertension, Lower Back Pain, Lymphoma, Multiple Sclerosis, Osteoarthritis, Pregnancy conditions and Rheumatoid Arthritis.

Yoga practice among people with disabilities has long been associated with a number of physical benefits including lowered blood pressure and reduced heart rate, reduction in inflammatory responses, and reduction of pain. The many positive effects observed among those persons with disabilities or chronic illness who practiced Yoga were thought to be brought about by the stimulation of pressure receptors under the skin (much like massage therapy) which causes an increase in vagal activity and a decrease in cortisol- a primary stress hormone. The mechanisms by which these systems operate have not yet been explored, but positive outcomes in terms of patient reported Quality of Life and reported levels of pain have been documented.

Moving from anecdotal to scientific models of study as utilization of Yoga as a treatment modality  increased over the past dozen years, a number of newer scientific studies have documented the outcomes of Yoga practice among the population of people with disabilities and chronic illness. Some of the more recent of these studies and their outcomes will be described below.

Research on Adapted Yoga for use in treatment protocols

Rheumatoid Arthritis (RA):  RA is a chronic, disabling disease that can compromise mobility, daily functioning and health-related quality of life in adolescents and young adults. Symptoms include pain, swelling, stiffness and loss of joint function. Approximately 400,000 persons have arthritis in the US. Young people with this diagnosis have reported increased depression and pain are more likely than others to use health care services and less likely to attend school leading to decreased anticipation of future employment and achieving psycho-social developmental norms. Yoga participation in this group significantly increased handgrip strength and mobility, and reduced pain as evidenced by the 90% of participants who reduced their former level of pain medication.

Chronic Lower Back Pain (CLBP): CLBP affects one percent of the US population and is associated with the lowest Quality of Life ratings among all non-malignant chronic pain surveys. Reduction in quality of life is related to sleep disturbances, fatigue, medication abuse, functional disability and stress. Psychological factors such as depression, anxiety, fear and anger are considered to have a large impact on persons with this condition. The intensive practice of Yoga by a controlled cohort of patients with CLBP in a residential program resulted in significantly reduced pain levels among 58% of participants which were thought to be related to changes in a learned pattern of response to pain and negative self talk.

Diabetes: Some 18.8 million Americans have a diagnosis of Diabetes. It has been reported that another 79 million Americans are “pre-diabetic”. A seven year study of persons with both Type I and Type II Diabetes was conducted in which participants took part in varying types of Yoga exercises and received dietary advice. Measurements of glucose levels, body composition, exercise tolerance, hypertension and cholesterol were taken regularly throughout the seven years. There was a significant drop in blood glucose levels for participants, a significant decrease in body fat and an increase in lean body mass. Blood pressure dropped, LDL decreased and HDL cholesterol increased. Many participants were able to reduce their medication levels.

For those interested in Instructor Training:

There are several locations in India, the United States, and around the world at which instructor training for disability-related Yoga instruction occurs. A few will be highlighted here, and others may be found by reviewing the websites and resources at the bottom of this article.

At its source in India, Iyengar Yoga is a highly structured traditional form of Yoga developed to utilize specific methods of teaching therapeutic yoga practices to people with health problems. In this form of Yoga the use of support props helps to assure that the correct postures can be held without putting stress on the body. Iyengar teachers study for at least seven years before being certified to work with students who have therapeutic needs. They must pass a number of certification tests before an impartial national board. The examination includes teaching, performance of poses, breathing techniques, anatomy and therapeutic sequences.  Since the training and examinations are standardized, there is a high probability that any certified teacher can accurately reproduce the methods that are related to positive patient outcomes.

In the United States a group of senior yoga teachers believed that as Yoga became more popular that standards setting forth minimum, voluntary training parameters for Yoga teachers and Yoga teacher training schools were needed. These standards were designed to allow for the diversity of the modern American yoga community. Teachers who meet these training standards are believed to have a well-rounded background in the breadth and depth of yoga. Upon demonstration of qualifications via an application process, approved teachers and schools are registered with Yoga Alliance and listed on the organization’s website.  A standard program that met the standards of the Yoga Alliance would provide a 200-hour program in Hatha Yoga to qualify participants to be recognized as a 200-hour Registered Yoga Teacher (RYT-200). An Advanced Studies Program would allow teachers to qualify for 500-hour Registered Yoga Teacher (RYT-500) status.

In addition, there are a few Yoga teacher training programs run by people with disabilities to train Yoga Instructors (including instructors with disabilities) how to provide adaptive Yoga for people with disabilities and chronic health problems. One such program, the San Francisco Integral Yoga Institute, believes that anyone, regardless of physical ability has the opportunity to complete a professional-level yoga teacher training program. The program also seeks to empower people with physical challenges by training generic instructors to utilize adaptive Yoga techniques when they would be helpful.

A three day Yoga Instructor training program (offered by Mind Body Solutions) is dedicated to transforming trauma, loss and disability into hope and potential by awakening the connection between mind and body. The founder of Mind Body Solutions- who himself has an acquired spinal cord injury- believes that the heart of yoga is “being able to work with integrity within the body you have, without attachment to the way that you think that the pose should look”. He assures others that a person who can touch the floor in a Forward Fold is not doing “better yoga” than someone who cannot. Yoga is a personal experience that can be expressed differently, depending upon the one’s body.

A seven day certification program in Yoga for children with special needs is offered by Susan Sumar, author of Yoga for the Special Child (link below).

With such a wide array of training modalities and instruction a good place to start your search for the right Yoga teacher or teacher training institute may be the International Association of Yoga Instructors (www.iayt.org). Founded by two physicians and a yoga instructor, IAYT also serves members, the media, and the general public as a comprehensive source of information about contemporary Yoga education, research, and statistics.

References and further information:

Evans, S., Cousins, L., Tsao, J., Subramanian, S., Sternlieb, B., Zeltzer, L. (2011). A randomized controlled trial examining Ivengar yoga for young adults with rheumatoid arthritis: a study protocol. Trials, 12 (19). Found at http://Academic OneFile on April 27, 2011.

Field, T. (2010). Yoga clinical research review. Complementary Therapies in Clinical Practice. Retrieved December 6, 2010 from http://www.womenswaywmc.com/wp-content/uploads/Yoga.pdf.

Kerman, I. (2008). Organization of brain somatomotor-smpathetic circuits. Exp. Brain. Res. 187: 1-16.

Kiecolt-Glaser, J., Preston, C., Houts, C., Malarkey, W., Emory, C. Glaser, R. (2010). Stress, inflammation, and yoga practice. Psychosomatic Medicine. 72; 113-121

Mason, V., Mathias, B., Skevington, S. (2008). Accepting low back pain: Is it related to a good quality of life? Clinical Journal of Pain. 24: 22-29.

Pullen, P. Nagamia, S., Mehta, P., Thompson, W. Benardot, D., Hammoud, R., Parrott, J., Sola, S., Kahn, B. (2008). Effects of yoga on inflammation and exercise capacity in patients with chronic heart failure. Journal of Cardiac Failure. 14: 407-413

Raghavendra, R., Nagendra, H., Nagarathna, R., Vinay, C., Chandrashekara, S., Gopinath, K. (2008). Influence of yoga on mood states, distress, quality of life and immune outcomes in early stage breast cancer patients undergoing surgery. International Journal of Yoga. 1: 6

Sahay, B., (2007). Role of Yoga in diabetes. JAPI, 55, 121-126.

Sumar, S. (2007). Yoga for the Special Child: A Therapeutic Approach for Infants and Children with Down Syndrome, Cerebral Palsy, Learning Disabilities. Book: ISBN-10: 9780965802406 Special Yoga Publications: amazon.com.

Tekur, P., Singphow, C., Ramarao, H. Nagarathna, R., (2010). Effect of yoga on quality of life of CLBP patients: a randomized control study. International Journal of Yoga. 3 (1). Found on http://Academic OneFile on April 27, 2011.

West, A. (2008). Mindfulness and well-being in adolescence: An exploration of four mindfulness measures with an adolescent sample. Central Michigan University.

Williams, N. (2010). Yoga Therapy for Every Special Child: Meeting Needs in a Natural Setting. Book:  ISBN: 9781848190276 Singing Dragon: London

Websites for more information:

Author: Tanya



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