GW was a group yoga therapy series offered over the course of 8 weeks in person with a staff member present at the facility during class time. The group consisted of adults with Intellectual Developmental Disabilities (IDD) ranging in age from 28 to 70 years of age. Group participants vary in activity level as well as strength, stamina, and range of motion. One participant does not exercise at all, while the remaining 7 participants walk daily and one also reports that he goes to the gym. Six of the participants have practiced group chair yoga in the past prior to the pandemic and two have never taken yoga classes or yoga therapy sessions. This group has a range of personalities as well as a range of types of IDD (2 of the participants have down syndrome, one student is non verbal, and 2 have dementia). Three of the students have seizures, one has them so regularly that she wears a helmet for protection. Other conditions that participants have in addition to IDD are diabetes (2 participants), breast cancer (1 participant), hypertension (1 participant), alopecia & talipes equinovarus (TEV) (1 participant). The combined goals of the participants were to calm down (1), relax (7), and have fun (3). This group meets in the common cafeteria area in the GW headquarters where several classes and activities are offered at the center throughout the day. While the area is quiet and not generally interrupted it is in an open space rather than a closed class room. Due to this the group is set up in a circle where we can face each other to practice and share experiences.

Post Assessment Homework: Pick out a musician you would like to have on the class playlist and share it with me next week.

Each class begins with a check in and ends with a reflection. Music is played during class to enhance the experience and address the goals of the group to have fun, create calm, & relaxation. By the second group session I created a playlist based on groups or musical genres that are popular with the participants. Our chair yoga practice includes JAPA movements of the head, neck, shoulders, arms, and hands, cat/ cow, half moon, cobra, twist, twist & reach (at different heights), single leg lifts, piriformis stretch, lunge on the chair, janusirsasana, paschimottanasana (with block), & tensing and releasing. Asana that is practiced standing at the back of the chair is chair pose holding on to the back of the chair, locust, hip abduction, & tree pose. Breathwork includes cleansing breath, diaphragmatic & dirga swasam, brahmari, and shhh breath to activate the deep muscles of core support which typically can use more control with people who have lower tone and Down Syndrome. An element of improvisation is included in each class to catch student's attention, express their own creativity, and to have fun.

1) de Witte M, Lindelauf E, Moonen X, Stams GJ, van Hooren S. Music Therapy Interventions for Stress Reduction in Adults With Mild Intellectual Disabilities: Perspectives From Clinical Practice. Front Psychol. 2020 Dec 10;11:572549. doi: 10.3389/fpsyg.2020.572549. PMID: 33362637; PMCID: PMC7759728.

"Since 2006, no studies have been conducted in which the content of music therapy interventions aimed at stress reduction for adults with MID was described clearly and systematically. However, there is a growing body of neuropsychological evidence showing the positive influence of music on lowering people’s stress levels (Chanda and Levitin, 2013; Thaut and Hoemberg, 2014; Koelsch et al., 2016). Two meta-analytic studies showed positive overall effects of music listening interventions on stress reduction in different kinds of settings (Pelletier, 2004; De Witte et al., 2020b). A recent meta-analytic review of 47 studies shows medium-to-strong effects (d = 0.723) of specifically music therapy on psychological and physiological stress-related outcomes (De Witte et al., 2020a)."

2) Reina AM, Adams EV, Allison CK, Mueller KE, Crowe BM, van Puymbroeck M, Schmid AA. Yoga for Functional Fitness in Adults with Intellectual and Developmental Disabilities. Int J Yoga. 2020 May-Aug;13(2):156-159. doi: 10.4103/ijoy.IJOY_57_19. Epub 2020 May 1. PMID: 32669771; PMCID: PMC7336942.

"Functional fitness often declines for people with IDD at a faster rate than the general population; thus, these significant changes indicate that a yoga intervention may enhance functional fitness for people with IDD. Clinicians or other healthcare providers might consider yoga as a means to improve functional fitness in adults with IDDs."

3) Mullur RS, Ames D. Impact of a 10 minute Seated Yoga Practice in the Management of Diabetes. J Yoga Phys Ther. 2016 Jan 18;6(1):1000224. doi: 10.4172/2157-7595.1000224. PMID: 27774351; PMCID: PMC5070378.

"Our small pilot study reinforces the current medical evidence supporting the use of yoga, combined with standard care, to improve health outcomes in diabetes."

4) Panebianco M, Sridharan K, Ramaratnam S. Yoga for epilepsy. Cochrane Database Syst Rev. 2017 Oct 5;10(10):CD001524. doi: 10.1002/14651858.CD001524.pub3. PMID: 28982217; PMCID: PMC6485327.

This collection of studies did not have the specific information I was after in terms of exact yoga practices used in their collection of research but it was interesting to read the results of several studies on yoga and its potential effects on epilepsy, nonetheless.

• Yes

Seated in the chair: sharing, cleansing breath, brahmari, palming, self massage, chair JAPA, cat/ cow, half moon, cobra, twist & reach, janushirshasana, forward bend.
Standing behind chair: tadasana, locust, lunge.
Seated in the chair: piriformis stretch, cleansing breath (with & without arms) and dirgha swasm.
Spontaneous improvisation question: "what does this remind you of?" during several movements during class.
Reflection: Show (or tell me) about one thing we did today that you enjoyed. Share one song or artist that you would like added to our class playlist.

Try out using the cleansing breath this week anytime you feel tension or stress.

This group is positive, eager, and enthusiastic. Use of props was fun and allowed NL to reach the floor when sitting as she is petite and her feet are slightly off the floor without blocks or a blanket beneath them. I noticed that M follows along well at times and then plays lifting his arms in chin mudra saying OM (we don’t chant at this facility) and at other times. He sometimes pretends that he has a machine gun aimed at each participant and occasionally saluting. R came up to me before class and was curious why I was there prior to the class start time. I explained that I needed to set the chairs up before class time so that it could be ready for her when it was time to start. She also mentioned that we finished 2 minutes late last week. I apologized and said that I would be more careful about starting and ending on time next week.

Spontaneous improvisation question: I asked "what does this remind you of?" During several movements one was lifting and lowering the elbows. The responses were bird, butterfly, airplane, and bee. During the single shoulder rolls I asked again "what does this remind you of?" one student said “it reminds me of being on a boat in St. Johns” another participant said that it reminded them of swimming. When we did brahmari both J and N giggled quite a bit. I explained that it can tickle a little and it might seem a little funny.

During circle time I asked everyone to share how they felt that morning and we went around the circle sharing. When we got to N I realized that she was unable to express herself this way as she is non-verbal. She is, however, very expressive and wants to engage during the class following along very closely to each movement. Next time I will ask the group to show me a movement or share a word to express how they feel or what they liked will be more inclusive to all of the participants in this group instead.

This facility did not have props or a sound system the first day (during the intake/ assessment session). I reached out to the Hands to Heart Center, a local yoga non-profit that I volunteer at in Boston, and they donated and delivered 10 blankets and 10 blocks to the group for this first session. While it was in the facility the staff member that helped me set up was unsure where it was so that meant that we were distributing props once everyone arrived. Some students had a preference about which prop they wanted based on their favorite colors. Next week I will bring the props out a bit earlier and set them at each chair giving participants a chance to choose without taking up as much time. I brought a bluetooth player from home and played my own restorative playlist for this class.

The plan for the next group session is to use the new playlist with popular music/ artists that they chose. If this causes too much excitement I can always return back to the original playlist which is a bit more calming. I also plan to teach hip abduction & chair pose in standing. Prepare the props at each seat prior to class so that less time is spent choosing a color.

• Yes

Circle check in: "show me how you feel today"
Seated on the chair: cleansing breath with and without arms, JAPA from head to toe, cat/ cow, half moon, janusirshasana, forward bend, twist and reach.
Standing behind chair: tadasana, locust, chair pose, and hip abduction.
Seated on the chair: piriformis stretch, lunge seated, dirgha swasam, & body scan.
There was no spontaneous improvisation during this class.
Reflection: notice how you feel, tell or show me a movement to express your feelings.

No assignment was given this week. After class I reported to the program director to discuss my concerns about M.

Today's class started well and the group responded nicely to the music. Everyone seemed engaged and excited when their song played. Unfortunately M did not seem himself and was moving slower and was less focused than usual even when I made attempts to cue him. About half way through class he stopped moving and I called his name with no response, then went over and gently tapped his shoulder. The GW staff member also got up at this point and tapped him and he slowly came to. I am not sure if he fell asleep due to low blood sugar (he has diabetes) or if this was another type of event. I encouraged everyone to relax and take a break when we responded to M. I modified the speed of practices, stayed seated for the remainder and did not include any forward bend after this event so that M could participate with less risk.

The event when M passed out was unsettling. I did not want to alarm the group but also felt the need to give everyone direction to take a break while I responded to him. He stayed in his seat and eventually came to but I did have a moment where I felt my heart sink a bit. I noticed prior to class that he had looked older and not his cheerful and energetic self from the past 2 weeks. I made an effort to explain this to the director who informed me that this was not the first time this week someone mentioned that about M. She said she would contact his health provider. After I left GW I sat in the car and cried. While I think I handled the situation calmly and quickly I carried the stress of it till it was over. I noticed how strong my feelings were and how much care I have developed for each participant in class. If I was in this situation again I am not sure if I would have kept going or if I would take that time to reflect and ask everyone if they feel a bit different to share that with me or a staff member. I did not want him to be embarrassed and it wasn't clear if it was exhaustion, if he fainted, or if it was something else.

Plan for next week is to add on a seared tense and release and a standing tree pose behind the chair.

• Yes

Seated in the chair: sharing how we feel with a movement or word, tense & release, cleansing breath, JAPA for head, shoulders, wrists, and fingers. Cat/ cow, side bend, twist & bend (leaning forearm on lap), twist & reach (with improvisation), ankle rocks (foot circles don't work for N & J), Shhh + leg lift added on extension after a few, & janusirsasana.
Standing behind the chair: tadasana, chair pose, locust, abduction, & tree pose.
Seated on the chair: I talked about the concept of balance and feeling our body come to balance in space and gave the example of what we may have felt in tree pose. I provided a block for participant to hold in one hand or place on their head. Seated piriformis stretch, lunge on the chair, & forward bend with the block were next. We took a little time to make a lumbar roll with the blanket and practice a seated sequential muscle relaxation first with a hand on the abdomen, then hand on chest to explore dirga swasam.
Spontaneous improvisation question: during twist and reach I asked "what does this movement feel like?" Participants said picking blueberries, picking apples, picking mangoes, grapes, tomatoes, and then I added "nod if you hear someone say your favorite fruit."
Reflection: I asked the group to show me one practice we did that they would like to do again next week.

Think about other times you use balance like we did in the tree pose. Can you use the same focus and calm energy to feel your body?

The class seemed a little distracted at the start today. I did try to re-engage everyone during twist and reach asking what the movement reminded them of. V said “picking blueberries” then I asked if anyone has a favorite fruit the group started to get a bit more excited and one at a time participants called out names of fruits, one student R said “soup” and the staff member said loudly “that isn’t a fruit” I did not want R to be embarrassed for speaking up and sharing something she likes with us so I said “I like picking up cans of soup at the supermarket too.” Later on during standing work I announced that the next pose is called tree pose. R quickly put her foot against her leg and I said “R knows how to do the tree pose already. See how she is standing tall like a beautiful tree? Let's all practice like R now.” R seemed quite pleased with herself that she could teach something to her peers which made me think it might be fun for each person to lead a movement next week as an improvisational exercise. During our reflection V said that she felt her heart beat and D said that he enjoyed the forward bend. N showed me the twist and reach showing that was her favorite movement today. I learned from the GW program director that M had a decline in his health the past few weeks and he is currently in the hospital and will not be returning to class.

I need to be more mindful about movements requiring movement in the feet or toes as N cannot do this in her orthopedic shoes. J had difficulty with foot circles as well. I also noticed that if I provide a prop for one person everyone will want to use their prop too. So spending time to explain where it goes and help several students with block placement is always needed. This means I need to allow a bit more time to set up before janusirsasana (for example). Because the props take a bit more time I need to be sure to sandwich the practices that use them most together so that there is not a lot of shifting back and forth to set it up. Sometimes I forget to give myself time for this. This class might work well with the staff member assisting me with the props in the future. Today she helped with the lumbar roll for a few students which saved time. I plan to ask if she would be open to help with the block set up too next week when we get to that. In addition, despite N joining in the twist and reach exercise and enjoying that today, my group engagement question may have made her feel left out. I tried to include her by saying “if there is a fruit you like to nod when your classmate calls it out.” I realized mid way that it could exclude her.

Working with this group has been a wonderful learning experience. It was an opportunity to grow as a new yoga therapist offering my first yoga therapy group and also gaining experience working with the IDD population. There were several habits I have when I teach and cue common yoga practices that I had to break and redevelop to work more effectively with this group.

One of the ways I have had to adapt my style was simplifying my directions and cues. I cannot use language in the same elaborate ways I might in a group class or workshop with a different population. I have had to break down cues, strip them of embellishments and distill them down to their main purpose. Explain specifically what we are doing and then explain why. I also often use analogies when I teach. I had to be more thoughtful about typical analogies I give in classes as this particular group of adults do not drive, have jobs, or cell phones so they do not relate to “text neck” or the stress of being late to work. Still, they can relate to having stress and they are more likely to experience it in a world that does not center disabilities. Instead of talking about being late to work as an example, just mentioning being late is enough. Everyone in this group has experienced being late to something at one point. Teaching in this less exclusive way has helped me think more carefully about who I might be making assumptions about as a teacher or yoga therapist in other classes or sessions with other populations too.

I have also learned that I might find new ways for reflection and sharing within a group that do not single anyone out who is uncomfortable or unable to speak. I cannot ask for verbal feedback alone, so I ask students to express themselves with their body OR words. Using movement as an option to express our thoughts and feelings when words don’t come quite as readily is a tool I would like to carry into other groups and populations as well. I need to demo throughout these classes which requires a bit more energy but each person in class does much better with visual rather than verbal instruction. During bilateral movements or poses I’ve stopped using right and left. This confuses most of the participants and as we are in a big open space with no landmarks I can’t use typical geographical cues like “the window side of the room.” Instead, I just say “twist to one side and look over your shoulder, come back, now twist to the other side.” While these changes feel a bit unnatural at times it has been able to magnify my own tendencies and preferences in my approach. Being in a situation where I needed to break my own habits and preferences has been an unexpected opportunity to explore svadhyaya. This experience has been reminiscent of the shift from in-person to online during lockdown. Learning new ways to teach and cue without demoing as much or touching gave way to new insights about working with people. Working with this population has been a similar experience of needing to learn on the spot.

This particular group has been patient with me as their new teacher while I learn what works and what doesn’t. Each student has been eager to participate, patient with me, and very kind. Without generalizing about this population, I would like to say this particular group of people have been extraordinarily compassionate both to each other and myself as we navigate these classes together. Each participant has really given each class their full attention. It has been especially rewarding to work with such a kind, positive, and enthusiastic group of people.

Next class I would like to use a physical improvisation engagement tool rather than a verbal or physical one. I will ask the group to think of poses or movements we practice and ask them to demo it for us all to practice. Another practice we have not tried yet is to pass a block around the circle working on focus, balance, and coordination. I believe that netra vyayamam might be appropriate to add on as well towards the end of class when the group is a bit more centered, focused, and calm.