Background/Aim:

Yoga is a science that has been practiced for thousands of years. It is based on ancient theories, observations and principles about the mind / body connection which is now being upheld by modern medicine. Research that has been conducted to look at the health benefits of yoga can be grouped into three categories: physiological, psychological, and biochemical.  Defined as a “skill to live your life, to manage your mind, to deal with your emotions, to be with people, to be in love and not let that love turn into hatred" ( Sri Sri Ravi Shankar) yoga is considered to be therapeutic due to awareness of body posture, alignment and patterns of movement.

There is emerging scientific evidence showing yoga helps alleviate certain medical conditions and improves overall health and well-being. However, there has been limited research regarding the benefits of yoga in people with Spinal Cord Injury (SCI) who experience significant alterations in options for exercise and leisure pursuit. No adaptive yoga course is available for people with disability in New Zealand. The aim of this pilot study was to explore whether yoga practice through adaptive yoga postures in a safe and supported environment can be beneficial for people with SCI by creating a mind and body connection, thereby creating a sense of reconnection with the parts of their bodies that are paralysed or desensitised while attaining strength and confidence. Perceived positive outcomes of improved health and increased confidence in completing poses were measured through self-report and subjective observation. The study also aimed to explore the feasibility of a more objective study assessing changes in flexibility, strength, posture, breathing, confidence and overall well-being.

 

Method:

This pilot study evolved as the course progressed through trials of different poses within the patients’ abilities. Four one-hour yoga sessions were provided to community outpatients with SCI within Auckland. Eight people with SCI ranging from C5 AIS A Tetraplegia to T11 AIS A Paraplegia attended one or more of these sessions. Two assistants with knowledge of SCI were present to assist participants. Two of the eight participants practised yoga before their SCI. Initiation of the pilot began with a preliminary evaluation exploring demographic data, participant interest and willingness for engagement with an adaptive yoga programme. Participant feedback regarding barriers to participation in leisure activities, rating of the difficulty expected or experienced in completing each yoga pose and their level of confidence was obtained through a questionnaire after the first class and at completion of the programme. Self-reported results were gathered and a post yoga programme evaluation was completed by all participants.

 

Yoga Asanas/Postures:

A restorative and adaptive style of yoga known as Yin Yoga was chosen for this pilot project. This style is practised in many studios throughout New Zealand. Yoga postures were identified, selected and developed to create a Spinal Sequence which would allow the spine to move in all four directions – forward folds, back-bends and side to side (lateral flexion).

Three breathing techniques were chosen to increase the depth of inhalation and exhalation, focus on using the breath as a tool to create a mind/body connection and in turn calm the nervous system.  At the participants request, the sequence of postures evolved as the participants progressed through trials of different poses to address specific muscle groups. The chosen poses were within the students’ abilities. Three defining characteristics of yin yoga were also incorporated, including alignment, sequencing and timing to produce maximum benefits for participants.

Participants reported the same benefits of practising Adaptive Yoga, which are also experienced by people who do not have a disability practising yoga on a regular basis. Adaptive yoga focuses on what the student can get out of each pose, not what the pose looks like. Adaptive yoga may look different than traditional yoga, but there are just as many benefits.

Participants reported the following benefits of Adaptive Yoga:

• Improved flexibility

• Increased strength

• Greater lung capacity

• Reduced levels of stress, tension and anxiety

• Improved mental clarity and focus

• Improved sense of well being

• Increased feelings of connection, less isolation

• More restful sleep

• Increased confidence - feeling better about oneself

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Results:

Data was collected through self-reporting and observations from each session. Access and lack of confidence were reported as the primary barriers to participating in group recreational activities after SCI. Improvement in confidence was reported by all participants. Also noted was a decrease in predicted and actual difficulties in completing the poses. Participants reported benefits consistent with the life enhancing benefits experienced by yoga students without disability. These include improvement in breathing/respiratory function, flexibility, posture, emotional well-being, confidence and social inclusion.

Conclusion:

Yoga is considered to be therapeutic through awareness of body posture, alignment and patterns of movement all of which are challenges experienced by people with SCI. Some participants reported less reliance on pain and sleep medication. Evidence that yoga provides significant benefits to people with SCI is scant making the findings of this pilot difficult to compare with other studies. There is little known about how yoga can be integrated into therapy sessions as a healing/therapy tool on a daily basis. The findings of this pilot study suggested that yoga is not a system of medicine; it is a way of life, the implications of which go beyond health and disease. It is employed for prevention or management of disease, some confident and highly visible elements of yoga are used selectively and their study concluded that yoga has much to offer in this modern, multitasking, sensory-overloading age, especially for individuals with SCI.

By cultivating a better presence in the entire body, yoga will cumulatively produce benefits that will greatly enhance quality of life.

A study carried out by Johnston in 2007 found that when yoga is adapted to the needs of people with physical disabilities, with appropriate assistance, yoga can be a valuable healing tool.

We need to look beyond traditional medicine to explore alternative therapies and promote a holistic care package. Yoga is a valuable therapeutic option for people with SCI due to increased awareness of body posture, alignment and patterns of movement. These are all challenges experienced by people with SCI.

According to Matthew Sanford (2006): Our body never gives up. With every ounce of energy it has, it moves toward living. It will keep pumping blood from our hearts. Your body stays faithful to living, it’s your mind that waivers … with a spinal cord injury, your mind never stops talking to your body or your body never stops talking to your mind. It just changes its voice.

Similarly BKS Iyengar (2005) stated, “Yoga teaches us to cure what need not be endured and to endure what cannot be cured”. Most people know that yoga is aimed at uniting the mind,  body and spirit. While it cannot cure SCI, regular yoga practise can assist people to accept their situation, accept where they are in life, embrace and honour their bodies, promote a better mind-body connection and ultimately improve their sense of self by increasing their confidence, letting go of negative connotations and judgement, leading to an overall sense of well-being and acceptance. More research is needed before yoga can be integrated into occupational therapy practice

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Adaptive Yoga:

Many people are intimidated to try yoga, the physical practice of yoga, because they worry that they won’t be flexible enough or strong enough.

Adaptive yoga is a style of yoga that considers all bodies and abilities. It’s accessible to everyone, and multiple variations are taught, allowing the poses to be adapted to specific needs and abilities. Accessible yoga is another name for this practice.

Adaptive yoga classes tend to be quite individualized and are often taught in smaller group settings. They also move more slowly than most traditional classes, but don’t let the pacing fool you! You will still work up a sweat.

To ensure safety and a high quality of care, the following principles from the Teacher Training Programme, Hot Yoga New Zealand are incorporated into each sequence of yoga postures designed for people with a disability:

• Treat the whole person.

• Empower the client.

• Adjust yoga asanas/postures to ensure all can do it.

• Sequence postures to enhance and build effectiveness.

• Teach sensitivity to alignment and function.

• Take maximum advantage of what's possible and envision more possibilities than are on the surface

 

According to Mind Body Solutions, which is a non-profit organisation, founded by Matthew Sanford, no physical or neurological limitation has ever stopped him from teaching yoga to someone. He has taught yoga to individuals without limitations, those in wheelchairs, and even people in comas.

Sanford began teaching adaptive yoga in 1997. At the time, he was one of the first yoga teachers living with a spinal cord injury and complete paralysis.

Some of the practical benefits from practicing yoga as outlined by Matthew Sanford include:

• Increased strength, balance and flexibility — both mental and physical

• Rhythm, an inward sense of direction and the ability to move through life in a more integrated way

• The capacity to live more fully within the body

• An enhanced ability to manage stress

• A deepened sense of connection with others

• Hope and a renewed sense of freedom

• Being more present in your body calms your mind, manages stress and helps increase energy and stamina levels

 

There are a few key benefits that are especially relevant to those with injuries, chronic conditions, physical disabilities, or age-related challenges:

• Can improve quality of life. A 2017 study among a broad range of individuals and abilities found significant improvements in their quality of life, as measured by their mental and social well-being.

• May be a safe and effective treatment option for those with Parkinson’s disease. One study found that in addition to improved physical mobility among patients with Parkinson’s disease, adaptive yoga led to a reduction in depressive and anxiety symptoms.

• Can increase self-compassion. Many disabilities present as physical impairments, but their mental effects can weigh the heaviest. One small, 6-week study found that yoga may improve the psychological effects of spinal cord injuries, including self-compassion.

• May improve balance. One study found that adapted yoga classes may improve balance ability among those living with brain injuries.

• Can improve daily function. One study found that participating in adapted yoga improved walking speed and balance among people with brain injuries.

• Can bolster a sense of community and support by attending classes with other people who are experiencing similar health concerns/issues.

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Who is Adaptive Yoga for?

Adaptive yoga is an umbrella term that can include yoga for specific conditions like multiple sclerosis, yoga for people with physical disabilities, or even yoga for older adults.

If you have a specific injury, condition, or ability level that requires some degree of modification in a traditional yoga class, you might want to give adaptive yoga a try.

In addition to general adaptive yoga classes for all bodies and abilities, Sheila offers specialized classes, such as “Yoga for Ambulatory Individuals,” which are classes for people who can walk but live with impaired mobility or balance issues, "Yoga for people with Spinal Cord Injury" and "Yoga for people with Multiple Sclerosis". 

There are also class offerings that are exclusively for people other disabilities that may affect their ability to walk or stand. No one is not suitable to practice yoga once the willingness and commitment is present.

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