An excerpt from the Yoga for the Special Child newsletter
Sonia Sumar, Copyright © Yoga for the Special Child, reprinted with permission.

CASE STUDY OF LUISA

I first met Luisa in 1992, when she was six years old. Her mother Nair had read about my work in a local newspaper and wondered if yoga might be able to improve her daughter's condition. At that time, Luisa was diagnosed with Prader-Willi Syndrome, a congenital disorder characterized by a rounded face, almond-shaped eyes, strabismus (crossed eyes), low forehead, hypotonia, insatiable appetite, failure to thrive, and mental retardation.

In my opinion, she exhibited many of the characteristics of ADHD. When I attempted to teach her, she became easily agitated; she was also extremely hyperactive and distractible. Due to her lack of balance, she was unable to walk up and down stairs without assistance. Luisa also suffered from daily convulsions and sometimes went into multiple seizures so severe that she needed to remain in the hospital for a week at a time. To help control her seizures, she took various anti-seizure medications. None of these medications, however, was adequate in controlling her seizures, no matter how often they were adjusted.

Our first yoga sessions were spent creating a strong bond of trust and friendship between Luisa, myself, and her mother. Once this bond of trust was established, we were able to proceed with our work. When I first began to teach yoga to Luisa, her body was so tense and her mind so agitated that she couldn't keep still long enough to perform an asana (yoga pose). I discovered she was having numerous minor convulsions throughout the day.

In order to strengthen her nervous system and calm her down enough to practice yoga, I decided to focus on teaching Luisa pranayama (breathing exercises) and deep relaxation rather than asanas. For the first month of yoga therapy, she performed only rapid breathing exercises (the Skull Shining Breath and Bellows Breath) and deep relaxation. In the second month, I began to slowly introduce the asana portion of her class.

At this early stage of Luisa's yoga practice, I had to manually guide her body through the exercises because she did not possess sufficient balance, motor control, and physical strength to imitate my movements. One of the paradoxes of Luisa's condition was that she experienced stiffness in her joints and a resulting lack of flexibility, even though her muscle tone was very low. This lack of flexibility severely limited her ability to perform asanas.

I always began Luisa's yoga sessions with about five minutes of chanting and hand clapping, followed by the pranayama portion of her class. Both of these types of exercises helped to capture her attention and create a focus for the asanas that followed. The asana portion of our class was interspersed with short intervals of deep relaxation to keep her from getting too excited and speedy. In the beginning, almost all the asanas were difficult for her to perform. Even so, she persevered — a tribute to her mother's encouragement and our strong bond with one another.

After several months of yoga therapy, the intensity of Luisa's seizures began to diminish. Although her school performance was not consistent with her age level, I noticed that she was quite intelligent and had an excellent memory. This apparent contradiction was due to her extreme distractibility and impulsivity. In order to keep her attention during our yoga sessions, I found it necessary to increase the speed at which we performed asanas.

Not until I discovered her own natural rhythm, was she able to maintain her focus and to begin slowing down. The same approach applied to music and sound therapy. As with many of my other students, I learned that the only way I could reach Luisa was to go into her own world and meet her on her own terms. Only then would I be able to draw her out of her intellectual and emotional shell and establish the channels of communication so necessary for success in our work.

Once Luisa was familiar with all the asanas in her yoga routine, she began to show her great enthusiasm for yoga by beginning each new asana even before she had completed the previous one. Unable to remain still for more than a second or two, she always seemed to be one step ahead of herself in everything she did. I struggled to curb this tendency by bringing her attention to the muscle groups that were being stretched or strengthened during each pose and by encouraging her to breathe deeply.

Another aspect of Luisa's condition was her need to talk incessantly. My instructions and comments during our sessions were often met with replies on totally unrelated topics. I finally devised a way to keep her from talking during yoga. We made an agreement: Luisa could speak about anything she wanted for a period of up to ten minutes, either before or after our yoga session; but during the class, she promised to follow my instructions and to allow me to guide her without interruptions.

Another challenge I faced with Luisa was her inability to remain upright in a seated position. She would slouch over with her pelvis tilted backward and downward. In order to bring her pelvis into alignment, I gave her a variety of asanas that begin from a seated position. I also focused on poses to open her rib cage and chest area, and to relax the muscles of her back. While she held these poses, I continued to talk to her, explaining the benefits of each pose and always encouraging her to bring her awareness back to her body.

By the end of her first year of yoga therapy, Luisa had made great strides in her body awareness, motor control, and flexibility. She was now able to walk up and down stairs unaided — and even run! During yoga, she could perform pranayama and several of the asanas without my assistance. She was also able to sustain a prolonged period of deep relaxation at the end of each yoga session and learned to love this quiet time. During this phase of Luisa's development, we added Alternate Nostril Breathing to her pranayama session and worked on perfecting her standing poses.

In 1993, after a year and a half of yoga therapy, Nair asked me if Luisa could accompany her to an adult yoga class. It was during Luisa's school vacation, and Nair had been unable to arrange childcare for her daughter. Adult classes last approximately one hour and fifteen minutes, while my private yoga therapy sessions with Luisa normally lasted only forty minutes. I was not sure if she would be able to sustain her concentration for the extra thirty-five minutes.

In order to observe her reaction during this time, I seated her at the front of the class. Luisa surprised us all by completing the entire yoga routine. In fact, she did so well that I allowed her to continue attending our adult class twice a week for the remainder of her school vacation. Luisa loved this class and the other students were greatly impressed by her new-found ability to perform these more advanced asanas, as well as her overall attitude and maturity. She became the darling of our yoga class.

By 1994 Luisa was able to raise her straightened legs off the floor in both a supine and prone position. Her attention span and body awareness were both vastly improved. She could now remember the names of most asanas, about twenty-six in all, in both Portuguese and Sanskrit. In August of 1997, Luisa was finally able to join a children's yoga class, which includes children at all levels of development. During this time her ability to perform asanas and, in particular, her flexibility, improved dramatically. To give you an idea of the extent of Luisa's progress, when she first began practicing yoga in 1992, her body was so stiff that she was unable to touch her hands to her knee in the Head-to-Knee Pose. Today she can touch her head to her knee in this pose.

Although Luisa is still subject to occasional seizures, they are not as severe or frequent as they once were. Her doctors were finally forced to reevaluate their diagnosis of Prader-Willi Syndrome because she is thin and agile, and never developed the characteristic compulsive eating disorder. During yoga Luisa is usually attentive and cooperative. Throughout the majority of a forty-five minute session, she remains fully concentrated and absorbed in her yoga routine. She goes out of her way to help new yoga students and is very popular in her class. The benefits of her yoga practice have also carried over into her daily life. At school, she has learned to read and write, and to complete math exercises.

Luisa still practices yoga twice a week at our yoga center in Belo Horizonte, in a children's group class taught by my daughter, Renata; she is steadfast in her attendance. In May of 1998, during the Brazilian book signing of the first edition of Yoga for the Special Child, Luisa was the first person to receive a book from me. She showed the book to all of her friends at school, reminding everyone that the child in the painting on the cover of the book was none other than herself! I know how proud Luisa is to be on the cover of our book — and I am equally proud of her.

About the author:
Sonia Sumar teaches yoga in Brazil to special children and is the author of Yoga for the Special Child: A Therapeutic Approach for Infants and Children with Down Syndrome, Cerebral Palsy and Learning Disabilities.