Entry TypeAssessment
Client/GroupIDD Group 002
Entry CategoryIntended Case Study
Select your mentorSteffany Moonaz
Intake
Assessment
Proposed number of sessions10
Location of sessionsin person
Planned time per session60 minutes
Presenting ProblemIntellectual/Developmental Disabilities, flexibility, focus, anxiety, body awareness, co-occurring mental health diagnoses
Physical

All clients are ambulatory; all appear to struggle with focus, and would benefit from balance poses, poses that support improving posture and flexibility, and grounding asanas to reduce anxiety. Physical alignment shows shoulders forward, rounded upper back, ears, shoulders and hips aren't aligned. Hips, quadriceps, and hamstrings appear to be tight. Body awareness and knowledge of R/L and some body parts is lacking.

Clients are on average 23 years of age, 6 males, 2 females, 4 Caucasians, 4 Blacks/Browns, all single. All clients consistently attended class, all but one have attended yoga for at least three years, 5 participate in other physical activities at least 5x/week, three 2-3x/week. One client has a parent with them to assist in adjustments. Three are in public school vocational programs, the remaining 5 have aged-out of the public school system and may or may not be in day programs.

Each physical practice will vary; I will use a scaffolded approach to teach Sun Salutations. All but one agree to hands-on adjustments. I will offer 1:1 work with each client during each session while practicing asanas in the teaching stage. Concrete short cues, pauses for processing, then possible adjustments.

Client/Group goalsOver ten 60-minute yoga therapy sessions clients will increase flexibility, focus, and body awareness while cultivating calmness with the intention of generalizing calming skills to self-regulate emotions.
Energetic

Clients demonstrate short, chest-centered breathing. Specific breath practices will be introduced to assist in calming the client’s mental state - Dirga Swasam, complete yogic breathing, to balance the prana thus promoting physical, spiritual and mental health; to move the chest breathing to belly breathing. Also, Bhramari with Shanmuki mudra will be introduced, as well as a mudra modification, a practice to close the gates of perception and encourage pratyahara. The intent is to aid the clients in turning the senses inward, thereby blocking some of the external input to the senses with their fingers. This may help to calm and quiet their minds. The recommendation in each session will be to practice mindful breathing on and off the mat.

Emotional

A new group affirmation is introduced each week, and throughout the practice repeated aloud together. Five clients exhibit vocalizations or verbalizations; the remaining three aren’t self-talking aloud. All appear to lack focus and the ability to locate their inner tranquility. There is stimming present in four of the clients. The need for ways to regulate stress responses, improve quality of life, socialization, and general mental health is recorded in the individual intakes.

The intent is to assist the client in reducing mental chatter and racing thoughts by applying yogic tools mindfully. Throughout the practice, I will prompt clients to repeat the affirmation set at the beginning of class as this appears to reduce self-talk, increase focus, and support self-esteem.

Spiritual orientation and needs

This is an area not asked about in the assessment, and not easily addressed in the sessions. I am unable to determine and discuss the direct conscious experience of yoga with these clients. Their experiences may improve various aspects of their spiritual well-being, inspire to a more positive outlook on life, develop happiness within, and lower levels of anxieties, and I can relay this message but in general, the group isn’t able to discuss it.

Two Sutras, and select Niyamas will be woven into the weekly sessions. Self-talk won’t go away but processing and using it consciously to alleviate anxiety is an aspiration.

Intellectual / Sense of self

Clients present as easily distractable. A sense of self-awareness appears to be lacking. Based on the clients’ apparent intellectual abilities, I believe I can support them by teaching and practicing mindfulness skills to assist in the self-regulation of anxiety.

Through Guided Meditation, imagery, progressive muscle relaxation, and restorative relaxation, I hope to assist in the integration of breath, body, and mind. Teaching witnessing may not be easy unless I can explain it in a concrete manner.

I will instruct clients in an attempt to cultivate Prana. As our essential life force, clients will be taught and encouraged to practice mindful awareness of the breath and body in daily activities.

Yoga philosophy/wisdom research reference(s)

1. Csala B, Springinsfeld CM and Köteles F (2021) The Relationship Between Yoga and Spirituality: A Systematic Review of Empirical Research. Front. Psychol. 12:695939. doi: 10.3389/fpsyg.2021.695939
a. Yoga practice is a key component for spiritual growth. I find it interesting that studies show that in the West, spiritual intentions increase over time. The reviewers suggest that hatha yoga practiced in the West can cultivate spirituality. Motivation of practice changes over time. Whereas the initial aim is often to achieve physical goals, subsequently, more profound mental and spiritual intentions appear. I like the idea that yoga may facilitate spiritual well-being and health, as well as spiritual growth. I keep this in mind as I weave yogic philosophy, chanting, and meditation into the sessions.
2. Benedek T. Tihanyi, Andrea Sági, Barbara Csala, Nóra Tolnai, Ferenc Köteles. "Body Awareness, Mindfulness and Affect". European Journal of Mental Health 01-02:97-111.https://www.ceeol.com/search/article-detail?id=319151The Central and Eastern European Online LibraryThe joined archive of hundreds of Central-, East- and South-East-European publishers, research institutes, and various content providersYou have downloaded a document from
a. The aim of this cross-sectional study is to explore expected differences in the connection between particular physical activities and positive and negative affect, body awareness or mindfulness. Advanced yoga and Pilates participants showed higher body awareness. Positive impact of PA on mental problems has also been reported. For example, in the case of depression, PA proved to be an efficient treatment. PA improves mental functioning even among healthy people. As for cognitive functioning, PA can help to avoid neurological dysfunctions and cognitive decline in old age, to improve school performance in childhood, and to improve attention.

Scientific research reference(s), why chosen, how you plan to incorporate 1-3

1. Reina, Anita M; Adams, Em V1; Allison, Claire K1; Mueller, Kaitlin E1; Crowe, Brandi M1; Puymbroeck, Marieke van1; Schmid, Arlene A2. Yoga for Functional Fitness in Adults with Intellectual and Developmental Disabilities. International Journal of Yoga 13(2):p 156-159, May–Aug 2020. | DOI: 10.4103/ijoy.IJOY_57_19
a. This paper examines the benefits that group yoga has on functional fitness of adults with IDD over 7 weeks, 2x/week. As with this Groups goal, the paper focused on lower- & upper-body strength, lower- & upper-body flexibility, agility & dynamic balance. I referred to the anatomical purposes of the asanas when designing some classes. The Yoga Therapy expanded on this to include and address all the Koshas, not only the Annamayakosha. Additionally, it’s a short paper which I will share with the caregivers.
2. Agius H, Luoto AK, Backman A, Eriksdotter C, Jayaram-Lindström N, Bölte S, Hirvikoski T. Mindfulness-based stress reduction for autistic adults: A feasibility study in an outpatient context. Autism. 2024 Feb;28(2):403-414. doi: 10.1177/13623613231172809. Epub 2023 May 16. PMID: 37190953; PMCID: PMC10851647.
a. There are few current research articles on yoga therapy and intellectual disabilities. This study’s participants were autistic and had no intellectual disability (ID). I found it interesting to read the methodology and outcomes which I believe are similar to my clients who do have ID. I plan to introduce mindfulness strategies which may be effective and sustainable when coping with stress and anxiety.

Approval Notice
Your care plan should be approved by your mentor, with any amendments they suggested, prior to your remaining Yoga Therapy sessions.
Questions for Mentor

WAG: This client now practices yoga regularly with me in person, and over a few years with another teacher on Zoom. There is on-going self-talk when practicing. The intake states that he needs to learn to be xlm and relax.
GOAL: When verbally prompted, WAG will repeat affirmations 5 times throughout the YT session as a strategy to refocus on his mind on the present moment, while quieting his voice.

GA: Client has been practicing for years but I've been informed that he doesn't move into the asanas unless directly prompted, and doesn't hold them. Most of the time in previous yoga classes, he sat or laid down.
GOAL: When verbally prompted, during YT sessions GA will move into at least 4 poses the group is practicing, and hold it for at least two rounds of breathing before releasing the asana.

EC: Quiet, seldom talks, chooses the far corner of the room, not engaging with other yogis.
GOAL: When verbally prompted, at the beginning and end of sessions, EC will participate in check-in and check-out by either gesturing or verbalizing a response.

IF: Non-verbal, non-vocal adult on the autism spectrum, responds to physical adjustments and sometimes verbal cues.
GOAL: During YT sessions, IF will slow down during at least one dynamic asana such as Cat/Cow and Low Lunge Flows, pausing at the top and bottom of the breath, holding the pose before transitioning to the next movement.

LF: Posture is poor, hamstrings appear to be tight, attention wanders, makes an effort to understand the verbal cues.
GOAL: Sitting on a prop, when verbally and/or physically prompted, the client will check-in with their posture per the cueing, inhaling and drawing the shoulders back and down, while lengthening the spine, and tucking the chin, holding the alignment for three rounds of breathing.

SH: SH is very flexible, very quiet, self-talks, transitions in and out of poses quickly, understands some sign language.
GOAL: During YT sessions, when verbally, gesturally, and/or physically prompted, SH will hold at least three asanas for 3-5 rounds of breath.

SJ: Able to following verbal cues and hold poses when she so chooses, at times vocally disruptive, often late to class due to the distance they travel to get to rec center which may throw her off.
GOAL: During YT session, SJ will follow verbal cues or modeling to transition in and out of at least 3 poses, as well as hold them, while successfully being mindful of her voice volume, especially during Savasana.

JK: First time practicing yoga, and thought it would be fun. He became agitated, the parent reported, when answering the intake questions.
GOAL: During centering while in YT sessions, JK will practice the taught yogic breathing as a strategy he can generalize to calm himself when feeling agitated.

Care PlanOutline should be a practice adapted to the needs of that client/group, including:
  • Check in, centering, balanced hatha yoga set considering contraindications, relaxation (with imagery as appropriate),
  • balanced pranayama considering contraindications, meditation/centering.
  • Please include at least one suggestion from Karma, Bhakti, Raja, or Jnana Yoga tailored for this client/group.
  • Over time, we want to see something from each branch, selected, adapted and re-framed appropriately. Tools from each module should be used (not on each client/group – but overall)
The outline should show the sequence of practices as you plan to offer them.
Your care plan proposal should be approved by the mentor before session 2 if possible, or 3 if approval is delayed by mentor.
Session
Session Instructions (Not Mentoring)Your session outline should be a practice adapted to the needs of that client, including:
  • Check in, centering, balanced hatha yoga set considering contraindications, relaxation (with imagery as appropriate),
  • Balanced pranayama considering contraindications, meditation/centering.
  • Include at least one suggestion from Karma, Bhakti, Raja, or Jnana Yoga tailored for this client.
Over time, we want to see something from each branch, selected, adapted and re-framed appropriately.
Tools from each module should be used (not on each client – but overall)
Final Client/Group ReportAfter seeing your client/group (for at least 4 sessions including interactive intake)
Please remember practicum is a learning experience. You’ll learn more from sharing what’s accurate than from what might “look good”. Things you did well, not so well, problems and questions are all valid and useful tools to teach you. We can’t serve you to become the best clinician you can be if you don’t share your challenges and mistakes. Success is anything from which you learn. You can continue to add Session entries after submitting this Final Client/Group Report.
Report briefly on each Kosha belowProgress toward wellness or worsening reported by the client/group or that you observed in the following areas
Additional Information
Personal reflection from doing client/group.
Notify Mentor?Notify Mentor of Updates/Completion