Yoga techniques can be used in three specific areas of intervention: (i) educative: preventive, (ii) rehabilitative: re-integrating into society and (iii) therapeutic. The qualified yoga teacher can only operate in the first two areas – in collaboration with a doctor – by carrying out a therapeutic strategy that uses yoga practices in support of the medical-pharmacological therapies.
This article deals with the rehabilitative or re-socializing aspect, in which an attempt is made to promote the inner characteristics of an individual: their abilities, expectations and self-esteem, in order to improve their quality of life in society and their psychophysical well being.
The approach indicated by the World Health Organization in promoting the rehabilitation of disabled people is twofold: trying to reinforce functions that are healthy, thereby working on something that already exists, but at the same time using a combination of different treatments that work together on the unhealthy or injured parts in order to improve their function and render them more efficient.
Yoga techniques have proved to be efficient tools for helping disabled people develop a deeper awareness of their body, reawaken memory capacity, lengthen attention span, sharpen powers of observation, imitation and understanding, help overcome limitations, develop greater autonomy, and improve general physical health and rebalance emotions. Through yoga we can indeed both ‘educate’ and ‘rehabilitate’ a person because we can help him develop inner characteristics, express latent potential and gain the right to ‘awareness’.
The disabled people with whom I have worked, and who have experienced the benefits derived from yoga techniques, present different types of handicap to a greater or lesser degree: Down’s syndrome, cerebral palsy, mental retardation, epilepsy, etc. Others suffer from mental pathologies such as neurosis, psychosis, autism, schizophrenia and manic depression. All of these have in common a relevant psychobiological vulnerability. They are also often subject to personality disturbances and the side effects caused by intake of high dosages of drugs.
The therapist who uses yoga in rehabilitation must possess a solid foundation of training and have extensively applied and experienced the yoga practices. They are then able to effectively use the practices as therapeutic tools – adapting and modifying them from moment to moment and from subject to subject. It is also essential that the yoga teacher regularly practises his personal sadhana. These are the instruments that give the ability to maintain vital energy, refine awareness, empathetic perception, intuition and the mental flexibility that allows him ‘to put himself in a state of listening to’ the disabled person. It enables the therapist to understand the requests of the disabled person and to find a way of communicating that acknowledges their worth.
The communicative-expressive projections of a disabled person are often confused and apparently incomprehensible. Nonetheless they exist. You may notice an emotional flatness, but it is important to remember that he is always able to ‘feel’. Maybe he is unable, or does not want, to use verbal language; however, he knows how to communicate through body language what he likes or dislikes.
The resolve, sankalpa, of a yoga teacher involved in the rehabilitation of disabled people needs to be: ‘Here, where scientifically there seems to be nothing more that can be done, I must work with determination to try and reawaken this person’s latent potential in order to promote a better quality of life for him and to help to bring about a difference in the way he perceives himself and the objective world.’
If we can stand before a disabled person as if we are discovering an unknown world, then not only do we promote his evolution, but also our own. The varying situations we may find ourselves facing require us to question ourselves, overcome our limitations and find new solutions. Our qualities of concentration, fantasy, humour and patience are stretched. The therapist and the disabled person are no longer ‘therapist’ and ‘disabled’, but simply two people given the chance to learn from each other.
The relationship we establish with a person with a mental or psychological handicap is as important – maybe more important – than the methodology. Certain prerequisites are essential if we are to establish a good relationship between the yoga teacher/therapist and the disabled student/client. We need to: research and respect the times, desires, individual choices and habits; know how to create a reassuring and relaxing activity space in which they feel accepted; use simple terminology; accept physical contact which can become close and exclusive; use detached observation without judgement; have a sincere desire to help; maintain our own certainty that yoga does help.
When the yoga teacher interacts with a group of psychologically or mentally disabled people, he must totally abandon the idea of teaching a traditional lesson. The truly important thing is to promote the expression of every individual within the group, rather than sticking to a pre-arranged lesson plan. The attitude of the therapist has to oscillate between ‘motherly’ expression characterized by emotional support, listening, acceptance, empathetic understanding and ‘fatherly’ behaviour that provides security, stimulation, excitement and gratification.
You should never think that the handicapped cannot understand when you speak to them. Even if they don’t take part intellectually or actively in the practices, they are nearly always ‘attuned’ to the teacher. They pick up on our sincerity or lack of truth, and they are sensitive to the thoughts and intentions of anyone close to them. Their principal channel for communication is not verbal; it is on a subliminal level. Therefore, instead of thinking of them as human beings who lack certain skills, we need to see them as human beings who are sometimes more subtle than we are.
From our very first meetings with the disabled people with whom we are going to practice yoga, it is necessary to continually and constantly try to encourage the condition of ‘perceiving’ and of ‘being aware’ of their own body and of their own sensations – using any tool that we know can work, whether or not it is ‘yogic’.
In the beginning the practices that you propose should be very short because the students’ attention span is very short. Often it is necessary to demonstrate an exercise many times. Give clear instructions, repeated in different ways. Also use other visual methods such as drawings, pictures or slides that illustrate what you want them to do. Help them to move as you would with a puppet.
It is also important to sustain the rhythm of the activity because they have energy in abundance and this needs to be channelled in a constructive way. Establish a routine in the sequence of the practices since some of the students feel reassured by an unchanging environment and extremely repetitive actions. Maintain the same routine for some time to avoid a state of anxiety provoked by unexpected changes.
Keep in mind the fact that many mentally or psychologically disabled people often have disturbing thoughts. In severe cases they may suffer from sudden hallucinations that interfere with what they are doing, and which they then push inwards. This makes them withdraw into themselves and causes them to refuse to interact. In such cases it is better not to attempt to involve. These attitudes often precede the onset of an increase in symptoms, maybe even of a crisis in which they may lose any restraint on their emotions and in which all their perceptions and negative frame of mind become amplified.
The therapist who uses yoga should note which models of intervention are used for which handicap and in which particular situations, verifying personally once in a while how they work and assisting in the process together with the other operators of the team – educators, psychologists and social workers. They should aim to work alongside the overall strategies, by understanding and collaborating with the other activities that are prescribed for the disabled person. This helps to make his evolution more complete. But the methodology should not become ‘standardized’; this might become comfortable, but is less effective. It is essential, even if difficult at times, to create strategies that can be adapted for each individual case, bearing in mind each person’s reactions. No two disabled persons are alike. Reactions to the practices of yoga are subjective, and for some they can also be negative, regressive or hypnotic.
When you work with a group of disabled people try to ensure that the group is as homogeneous as possible, with regard to type and level of handicap and the students’ age and physical ability. Often those with Down’s syndrome are obese and have difficulty with movement. Try to ensure that the group does not exceed six people and that the teacher is helped by two assistants. These are the conditions that I consider optimal, but in reality they are rarely achievable.
I have found it useful to fill in a form in which I note the main information concerning the initial diagnosis contained in the anamnesis file, the information given from the operators, behavioural observations, formulation of intervention plans, the program, eventual modifications, verification and the final report about the activity.
Often the disabled subjects are led to practise painting/ drawing in groups. These provide an optimum source of knowledge because they relate to their psychomotor and relational development, and to their needs, inhibitions, fears and sentiments. This material – updated periodically – is useful to document the activity and also to collate a report. Writing a report creates an objective difficulty, because it is very difficult to explain in writing what has occurred mostly through subjective experiences. If those who read the report are only trying to understand it intellectually and have not ‘lived’ with the group and its growth, there is always the risk that the report could appear just as arbitrary affirmations.
It is essential to have a period of observation of the individuals who will form the group, both before starting and also during the activity, in order to prepare an effective and efficient programme. The physical attitudes of every individual in the group provide several indications about their emotional and relational areas.
All the inner disharmonies are reflected in the body and in the habitual and recurrent attitudes. For example: closing in of the shoulders, isolating oneself by curling up in a corner, trembling from a sudden noise – these all make us realize that we are in the presence of an introverted, fearful, distrustful person who has expressional blockages. Stamping the feet is a desire for attention and excitement. Walking on tiptoes means one wants to remain inconspicuous and have less contact with reality. Refusing visual contact means defending oneself from something felt as threatening, whereas accepting visual contact proves the acceptance of communication. Opening of the arms and legs means openness and trust. Oscillations of the body relate to the expression of a state of anxiety and discomfort. Muscular tone, motor coordination, rigidity or flexibility and tensions are all signals of the emotional state. Whether the voice is projected from the nose, throat or head indicates the blockages of respiration and energy in that part of the body.
A specific point needs to be made on the stereotypes of autistic people. They will make repetitive movements, almost obsessive, that seem to be attempts to come out from their state of extreme anguish. There will be ‘lallazioni’, echoing of words, continuous movement of the hands, rolling, swaying, oscillatory rotations of the head, sucking the thumb, as if searching for memories of pleasure or attempting to return to the well-being of the pre-natal world. They will surround themselves with objects, touching them, smelling them, producing sounds from them, as if this is a way to ‘feel themselves’ and to impose their presence on the environment or to try and organize movement.
Emitting screams or vocalizing sounds could represent an affective substitute with which the handicapped person tries to keep company with himself or communicate. The search for caresses and contacts can be very intimate, as if the therapist is mother or partner. Spitting, screaming, throwing themselves on the floor, trying to bang their heads, hitting out, knocking, striking – it is as if these actions are the only way to express a deep desperation.
We must not block any of these manifestations, otherwise the person becomes even more exasperated. If you can just start from that sound, noise or stereotype and build up the material at your disposal, trying to reawaken new sensations and to reorganize the energy, it can gradually be channelled into more structured and coordinated actions.
Even if you are working with disabled people, the proper sequence of yoga practices should be maintained regularly: movements and postures, asana, breathing techniques, pranayama, relaxation and meditation are proposed through game, imagination and fantasy.
The ideal arrangement of the group is in a circle, whose symmetrical form recreates the security and harmony of the mandala and allows all the members of the group to see the teacher – who is part of the circle – and the support workers who place themselves near the less autonomous students.
In the beginning a yoga class will not last more than half an hour. In time it can gradually increase up to an hour or even more. In presenting the practices you return to a childlike state yourself, suggesting analogies with objects, animals and well known things, and telling very short stories. Sometimes it is necessary to modify postures slightly, so that they resemble your analogies more closely.
With animal asanas, imitate the sound that the animal makes. Relating this sound to the posture is very useful because of the students’ short attention span, and their inability at times to understand even the simplest verbal instructions or even the teacher’s demonstration. Their lack of knowledge of their own body, with reference to space and time, creates great difficulties with communication. Furthermore, in this way, you facilitate the forming of an association of ideas.
It can happen that, besides the psychological or mental problems there are also physical problems. In such cases it is essential to find a way to involve these subjects by helping them physically, or proposing working in pairs so to favour the more disadvantaged. All members of the group must be able to participate! The instructions must be specific, simple and appropriate. Encouragement and stimuli must be continuous and different, united with praise. When the teacher presents the practices for the first time, he should try to catch the attention with physical or mental actions, even if these do not have much in common with yoga. Later on he could introduce more formal instructions. A creative imagination to invent or modify suggestions is therefore essential. It should be united with a sense of humour which is often very vivid in disabled students.
Normally the students are not able to remain steady, even less so with eyes closed. By the time they are able to follow an almost traditional yoga class, they will perhaps have also reached the ability to remain steady for five or ten minutes (possibly after one or two years). And this will be great progress. It is important that every disabled person can adopt the practices according to his own capacities, tendencies and difficulties so he develops his creativity and expression. This is more important than a perfect practice.