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Yoga, Relaxation and Massage for Learning Disabilities A creative, dynamics perspective

I have been practicing Yoga for 25 years and teaching for 20. I am trained as a nurse in both learning disabilities and mental health, and have worked as a Diploma Course Tutor for the British Wheel of Yoga. I am now a Final Class Assessor for the Wheel.

My main portfolio of work is with a further education college in Leicester working in continuing education. This is based in a hospital setting specialising in learning disabilities. I am trained too as an aroma therapist and bring this into my work with those with learning disabilities and also when working with pregnant women, another area in which I specialise. In addition, I work at a local primary school with 9 year olds an run two adult education classes a week.

The students I work with have profound and multiple learning disabilities (PMLD). This means that they have more than one disability and that one of these is a profound intellectual impairment. The World Health Organisation suggests that people with such a disability have an IQ of below 20 (WHO 1992) and function at a level equal or less than one fifth of their chronological age.

I work with an equal mix of men and women and the age range is between 20 and 60 years. Some students live at home, others in hospital or in residential care. I see 45 students a week; the sessions are very popular and the classes are always oversubscribed.

The students have complex needs. They may have physical disabilities, poor motor co-ordination and sensory impairment such as visual or hearing difficulties. There are also accompanying psychological problems with students lacking confidence, having poor self image and low self esteem. Individuals also often experience difficulties in concentration and have a high degree of tension.

Students enroll for the academic year. Sessions are on a one to one basis or in small groups. Most last about thirty minutes, although some are an hour long. I have one support worker and the student may also have his or her support worker.

The aims of the course are broad ranging: students are introduced to the concept of Yoga, massage and relaxation through a variety of techniques (explained below) which work on improving confidence, personal image and self-esteem - and to make them feel good!

Initial assessment of the student is important. I use a questionnaire and meet individually with support staff. With specific disabilities I may seek the advice of a physiotherapist or medical practitioner.

It is useful for the sessions to be structured, although it is equally important to go with the flow. I have to find ways to work in which I can communicate effectively, be aware of verbal and non-verbal cues and establish a therapeutic relationship with the students. It is also important to be aware, to listen, observe and absorb. Students need time and therefore patience is essential.

I aim to create and ambience that is safe. where an individual is able to to relax and let themselves go. Thus the environment is very important, taking into account lighting, playing appropriate soft background music and having the right amount of space for the individual. There needs to be enough room to able to walk around as well as somewhere that is cosy and comfortable to sit or lie down.

Asanas

My approach to Yoga with learning disabilities is experimental and intuitive as well as rooted in traditional Yoga teachings but adapted to the needs of the individual. The practices are gentle, safe and non competitive, students progress at their own pace. As mentioned above, simple postures are practised with or without help, as long as the student is willing. Over twenty years ago Barbara Bronson in her book 'Yoga for Handicapped People; noted that:

'The actual physical movements achieved with or without help improve the overall circulation and strengthen the heart. Consequently oxygenation is increased throughout the body and with improved oxygenation comes improvement in the whole level of functioning.'

More recently Sonia Sumar, author if 'Yoga for the Special Needs Child' says:

'Working with the body on a structural level helps align the vertebrae, increase flexibility and strengthen muscles and tendons. At the same time internal organs are toned and rejuvenated; the epidermal, digestion, lymphatic, cardiovascular and pulmonary systems are purified of toxins and waste matter; the nervous and endocrine systems are balanced and toned and the brain cells are nourished and stimulated.'

I have found a core number of asanas to be particularly useful. Movements can be passive with a support worker or myself helping to move the body, or active if students are able to practise the movements themselves. A particularly useful sequence of movements I have developed is called the 7-way stretch; this includes a sidebend, a twist, and a backward and forward bend. This set of movements can be practised sitting or standing, passively or actively, again with the concept of adapting to the needs of the individual. It is important to make teaching more accessible and more user friendly than traditional techniques. For example I have found students enjoy using animal asanas combined with sound eg the cat with hissing/meowing, the crocodile twist that includes a snap!

Individuals will understand more if practise is demonstrated and postures are broken down into stages. Photographs and line drawings of the postures are useful. The more able student can tackle more complicated practises quite quickly, but for many students the full posture many nor be possible and may have to be modified.

Massage

'Touch is a basic behavioural need; in much the same way that breathing is a basic physical need. When the need for touch remains unsatisfied abnormal behaviour will result'. (Montague. A. 1986)

Touch is key to my work with those with severe learning disabilities. Some students are very open to touch and others are tactile defensive and need to get used to being touched to reduce their hypersensitivity. It is about building up a trusting and warm relationship with an individual an respecting their needs taking into account advocacy. When I massage individuals I am working on the hands, feet, scalp face and nape of the neck. I also massage the back if their is written permission.

I use appropriate essential oils taking into account the needs of each individual student. Many of the students I work with present with a variety of symptoms including epilepsy, skin disorders, nervous disorders, heart and circulatory conditions, high blood pressure and various aches and pains. It is therefore absolutely essential that one works with the safe use of essential oils and is thoroughly aware of the contraindications of each oil. Safe practice is paramount.

Flo Longhorn (1988) suggests that for children with profound learning difficulties smelling is not a passive or isolated process:

'It is of little use to place a child near a vase of flowers and expect him to smell them. You must position the child comfortably, bring the flowers up to his nose, tell him what he is smelling and let him touch them.'

Such is the case with the individuals I work with. A little essential oil (mixed in with a carrier oil) is rubbed on to an individual's hand and they are encouraged to smell what is there, the aim being that over time individuals will be able to discriminate between smells and will be able to indicate their likes and dislikes. The use of massage fits in very well with Yoga and relaxation, the underlying ethos being to provide individuals with a variety of techniques to help them relax and find the appropriate technique. It is a learning process for both the student and myself.

Pranayama

The breath is key in yoga, it is our life force, our vital energy. How to use breath with learning difficulties depends on the individual and their breathing capacity. Many with severe difficulties suffer from poor breathing or chest problems. Thus working with breath is extremely beneficial for them.

Two main ways which both focus on the exhalation are humming/chanting and blowing out. Humming is a very good way of working with the breath, of clearing the mind of thoughts, of bringing about a sense of stillness and increasing concentration. Chanting goes one step further. Both humming and chanting are used at the end of each session to bring about that sense of stillness, to round it off and to prepare for relaxation. Humming is also used with the yoga movements where applicable. Humming and chanting have proved to be one of the most effective ways I have found of working with people with learning disabilities. Students often feel less self-conscious than most of us in this practice. Many clients with nonverbal skills will attempt to make a sound, it may not be a hum or a chant as we know it, but it is a sound.

I ask some students to blow out with the breath onto their hands out or just to blow as they work with a yoga movement. It is again another way of encouraging students to work with their breath. This involves blowing out though the mouth, the ultimate aim being to breathe out through the nose.

Guided Relaxation

To learn how to relax is a skill that takes time. Students begin to learn the art, through various techniques which then become something they can take away with them. Traditionally, relaxation forms the conclusions and culmination of every Yoga session. The regular practice of deep relaxation helps to release tension and prevent the build up of stress. So, although deep relaxation is hard to achieve, it is something we are working towards.

Relaxation sessions can last anything from two to twenty minutes. Some individuals may lie down, others may sit on a chair or a mat, some may lie down for a short period of time and then sit up or just walk around! Gradually, as individuals learn how to relax the length of relaxation is extended.

In relaxation it is not the content of the words that is important so much as the sound of the voice. Furthermore, what has happened beforehand is important so that individuals build up to the point at which relaxation is appropriate.

It is important to round off each session well. Generally we finish with the chant OM, though at times it may only be myself and the staff who practice the chant.

Putting in all in practice

We need to be able to work creatively and dynamically, to think on our feet and most importantly to adapt to the needs of the individual. Other key factors are sensitivity, flexibility and a sense of humour. It is essential to be encouraging and imaginative and to discover innovative ways of reaching students. It is important too to be aware of the unpredictable. Anything can happen, so enormous patience is important. The students we work with are not always able to communicate what they feel clearly but are aware of what is happening around them. We should therefore never underestimate them. We have much to learn from them as they have from us. Finally, as staff, we need to cultivate the concept of awareness, being aware of what we are doing as we do it, and not to get too disheartened when things don't go to plan.

To summarise

Yoga. massage and relaxation work towards improving confidence, personal image and self-esteem. This is achieved by bringing about greater body awareness, enhancing gross and fine motor co-ordination and helping individuals to work with their breath. We enhance the use of touch and smell and help individuals to learn to relax and become less anxious and tense. Finally there is more effective communication between individuals whether it is verbal and/or non-verbal as well as greater social interaction.

Working in this way is essential for the growth and development of individuals with learning disabilities. It is not a leisure pastime for them. It is vital to enable such people to become integrated within a society that is often judgmental to anyone who is different, If we can educate those with learning disabilities no matter how profound to find a place within our community, this will greatly enrich all our lives.