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1 Research Paper Volume 2 Issue 5 January 2015 International Journal of Informative & Futuristic Research ISSN (Online): Effect Of Yogasanas In Improving Flexibility Of Hip And Knee Joint Of Children With Intellectual Disability Having Cerebral Palsy Paper ID IJIFR/ V2/ E5/ 036 Page No Subject Area Education Key Words Yogasanas, Flexibility in Hip and Knee joints, Intellectual Disability, Cerebral Palsy Dr. C. Renuga Devi 1 Assistant Professor Department of Education Mother Teresa Women's University Kodaikanal, TamilNadu Abstract Children with intellectual disability having cerebral palsy will have problem in their motor functions and requires effective treatment plan in the management of such a condition. Yoga is a strengthening discipline that uses poses, sometimes referred to as postures, which include movements that may increase the body's flexibility. A study was conducted to explore the feasibility of using Yogasanas to assist children with intellectual disability having cerebral palsy to improve their hip and knee joint flexibility. The objective of the present study is to select Yogasanas based on the need and ability level of the sample and administers it for improving flexibility of hip and knee joint of Children with intellectual disability having cerebral palsy. Single group pre and post-test design was employed for 6 children with intellectual disability having cerebral palsy in the age range of 7 to 11 years. Appropriate tools to assess the flexibility of hip and knee joint were used after establishing its reliability and validity. Intervention was administered among the selected sample for 20 sessions (each session of 1 hour per day) from Monday to Friday for 20 days. The results after appropriate analysis reveal that there is significant improvement in the improvement of flexibility in hip and knee joint of children with intellectual disability having cerebral palsy. This study substantiates the positive effect of yoga on children with intellectual disability having cerebral palsy. Copyright IJIFR

2 1. Introduction Motor development is a very important part of growing up. Motor activities help children learn how to use their bodies, gain confidence as they master skills, and prepare them for school. Normal individual differences in motor ability are common and depend in part on the child's weight and build. Atypical motor development may be an indication of developmental delays or problems such as autism or cerebral palsy. While all children grow and change at their own rate, some children can experience delays in their development. Developmental delay is a descriptive term used in reference to an assessment of delay on infants and young children in one or more of the following areas: Cognitive development, physical development (which includes fine motor and gross motor), communication development, social development, emotional development, or adaptive development. Developmental delay is recognized by the failure to meet age-appropriate expectations that are based on the typical sequence of child development. Intellectual disability is a condition in which there is delay or deficiency in all aspects of development, i.e. there is global and noticeable deficiency in the development of motor, cognitive, social, and language functions. This is the commonest form of developmental disability. Cerebral palsy is a condition where there is gross delay in the development of motor functions. Children with cerebral palsy have great difficulty in initiating and controlling their muscles and body movements. Many of these children are perfectly well in all other aspects, such as in their speech, learning ability and socialization. Even though both the conditions are independent in nature, if a child with mental retardation is associated with cerebral palsy naturally the problem becomes complex and requires effective treatment plan in the management of such a condition. Yoga is one of the six schools of ancient Indian philosophy. Interpretation of the works of Patanjali reveals that we have at our disposal an excellent management system called Yoga Sutra which advocates a method of controlling the mind and body. In fact the sutras depict a crystallized picture of what constitutes the mind, its functions and impediments. The body as a whole can be turned to fight against problematic conditions. Systematic Yogasana practice helps prevent or arrest deterioration and also brings about cures for many of the problematic conditions. It offers enormous scope to help overcome various human problems, both mental and physical. Thus Yoga answers the demands of both body and mind development. 1.1 Yoga The word Yoga comes from sanskrit root Yug meaning to join on Yoke, implying the integration of every aspect of human being from the inner most to external. The father of modern Yogashashtra, Patanjali Maharshi defines Yoga as Yogaschitta Vrutti Nirodhaha that is controlling the nature of the mind. Yoga can be defined by the following statement. (Krishnamacharya Yoga Mandiram, 1982) To bring two thing together, to meet and to unite. To cause the movement of the mind to converge To enable one to achieve his potential. To bring about focusing of attention 1.2 Asana The word asana means posture originates from the Sanskrit word as which means to be, to stay, or to remain in a particular position. Thus, the word asana refer to a posture or a particular position, which may be performed in various ways, i.e, 1298

3 i.standing. ii.supine (lying on back). iii.prone (lying on the stomach). iv.sitting. v.kneeling (Smith, 1980). Posture simply refers to a particular position. As per Desikachar (1982) there are two qualities of an asana: The individual doing an asana should experience comfort (Sukh). He should also maintain a certain amount of steadiness in a given posture without much effort or tension (Sthira). To achieve both these qualities, a long period of practice is needed. The comfort and steadiness in a posture is most often achieved through total concentration of the mind on the posture. The practice of an asana must co-ordinate with breathing. When the mind concentrates on a particular object, the body becomes fixed and somewhat relaxed. But one is unable to hold that position for long. Apparently the body was not in a relaxed natural posture, though one may have felt so for a little while. The idea behind the practice of asanas is to discipline the body to assume a posture in which greater concentration can be achieved. 1.3 Yogic view of the body Yoga is regarded as a science as well as a method that allows man to live a harmonious life while favouring his spiritual progress through the control of mind and body. The great yogis tell us that those who know how to combine yogic postures (Asanas), breathing exercises (Pranayama), and the control of the mind or concentration (Dharana) may attain a state of perfection. The object of asana and Pranayamas is the improvement of the human body from the physical point of view, while the control of mind, i.e., the constructive power of consciousness, is beneficial to the inner force, developing a positive, optimistic outlook on life. Through the practice of the physical postures, or asanas, the spinal column as the muscles and joints are maintained in a healthy and supple state. The practices of yoga not only help to keep the young body strong and supple but also incorporate mental activities, disciplines that help to develop attention and concentration, and stimulate the creative abilities that are latent within the child. Yoga is an ancient Indian tradition which through diverse physical and mental practices the practitioner strives to achieve a state of all around health. The practice of yoga has already been shown to be of therapeutic benefit in cases with psychosomatic ailments such as bronchial asthma (Nagarathna & Nagendra, 1985; Nagendra & Nagarathna, 1986). After 9 months of yogic practice, mentally retarded children also showed improvement in general mental ability, psychomotor coordination, and intelligent and social behaviour (Uma, Nagarathna, Nagendra, Vaidehi, & Seethalakshmi, 1989). 1.4 Yoga and Flexibility Yoga besides its relaxing, spiritual function is also a wonderful flexibility training program. The most important factor is that stretch has to be included as an essential part of any fitness program. Yoga is an excellent choice, because it not only stretches the muscles, but also the joints, which get the kind of gentle stretch necessary for enhanced flexibility. When the entire body is trained together, it develops a sense of harmony and balance. When opposing muscle groups are trained together, flexibility will come faster as the opposing muscle groups work together not against or without each other. The series of yoga poses called asanas work 1299

4 by safely stretching the muscles. This releases the lactic acid that builds up with muscle use and causes stiffness, tension, pain, and fatigue. In addition, yoga increases the range of motion in joints. It may also increase lubrication in the joints. The outcome is a sense of ease and fluidity throughout the body. Yoga stretches not only the muscles but all of the soft tissues of the body that includes ligaments, tendons, and the fascia sheath that surrounds your muscles. In one study, participants had up to 35% improvement in flexibility after only eight weeks of yoga. The greatest gains were in shoulder and trunk flexibility. It is widely known that the words yoga and stretching go hand in hand. Everyone should stretch regularly as part of a general fitness regime. Yoga stretches not only the muscles, but also the joints. A body which may have been quite rigid at the beginning of learning yoga will start to experience a remarkable flexibility in all parts, even those parts which have not been consciously worked upon. Yoga is good for increasing joint flexibility. Yoga and flexibility go hand in hand. While doing yoga postures, an individual may need to stretch more, which will make his / her body gain more support and get rid of any stiffness that you may have felt earlier. The asanas in yoga stretch and strengthen the muscles as well as the joints. Thus good joint flexibility is so different from the normal stretching exercise that which we do otherwise. Yoga postures are more systematic, scientific and works with joints, muscles and ligaments like no other fitness workout. 1.5 Yoga for Children with Intellectual Disability Yoga exercise has also been incorporated in manpower development and training curriculum dealing with intellectual disability and attempts are on way to make it inclusive in school curriculum. Yoga for children with intellectual disability Should help co-ordinate the activities of the mind and body. Should tend to reduce the distracted state of mind, helping the mind concentrate on the present activity. Should help improve his activities of daily living to a degree which could not be achieved before. 1.6 Postures for Persons with Intellectual Disability Initially, the asana that are taught to persons with intellectual disability should be easy to grasp and easy to perform. Hence, many of the asana and breathing techniques need suitable adaptations. While adapting them to suit needs the following principles should be kept in mind. Pre-requisite skills Developmental age Interest and needs Physical characteristics Socio cultural and other environmental factors Availability of materials and resources Availability of medical, consultation and treatment service Parental concerns and priorities Teacher strengths Future placement goals Community values and attitudes 1300

5 1.7 Asana Sequence During practice the individual must not be allowed to do single asana alone. A certain amount of preparation is necessary before the individual does that particular asana. Therefore, a sequence is built up to provide this preparation. Once the main posture is performed, counter poses are necessary to relieve the strain caused by the main asana. Sequence of asana is built by keeping the following principles in mind: Goal and purpose of asana should be clear Single asana should not be practiced Series of asana should be practiced together Relaxing the body in a posture is of vital importance. Remove all tensions in the final posture. Relax for a few minutes in between the Asanas. Do not overexert beyond the capacity to maintain the postures for long durations. Daily practice is essential for fast progress. Yoga is a strengthening discipline that uses poses, sometimes referred to as postures, which include movements that may increase the body's flexibility. Yoga poses range from very simple, such as lying completely relaxed on the floor to moderate and difficult postures that may challenge body's limits. When a person has learnt yoga and become comfortable with additional poses, body will experience better balance, flexibility, range of motion and strength. A toned and balanced body may lead to fewer injuries during routine activities. 2. Need of the Study Children with intellectual disability in addition to their low intellectual functioning will encounter with mobility difficulties if they are associated with Cerebral Palsy. When yoga is implemented regularly to children with intellectual disability associated with cerebral palsy it will help such children in: greater freedom of movement increased physical efficiency and performance increased balance and coordination decreased risk of low back pain increased relaxation and stress reduction decreased risk of injury The yoga poses helps the deep abdominals to support and hence the body awareness is increased and will help in maintaining proper posture. The increased flexibility and strength gained through yoga will help in maintaining better posture in standing and sitting poses which ultimately develops core strength. The object of yoga is to enable an individual to reach a better knowledge of ourselves. It is a method designed to reveal the sources of creative hidden inside the human psyche and thus involves the manifold expression of our being. When yoga is practiced correctly and conscientiously, it becomes a sure way of restoring balance, helping to develop determination and resistance, and above all, to find serenity and inner pace. Flexibility allows ease of movement, and increases stamina and dexterity. Other benefits include an increase in bodily awareness and a relaxation in the stretched muscle groups. Both of these benefits have positive implications for skill acquisition, recovery, and performance. Hence in order to study about the flexibility of hip and knee joint of children with intellectual disability associated with cerebral palsy the researcher has attempted to administer Yogasanas in a systematic way among the selected sample. 1301

6 3. Objectives of the Study I. To study the effect of selected Yogasanas in improving flexibility of Hip and Knee Joints of Children with Intellectual Disability having Cerebral Palsy. II. To compare the pre and posttest mean scores of the selected samples in Hip joint flexibility through selected Yogasanas. III. To compare the pre and posttest mean scores of the selected samples in Knee joint flexibility through selected Yogasanas. 4. Methodology The objective of the present study is to select yogasanas based on the need & ability level of the sample and administer it for improving flexibility of Hip and Knee Joints of Children with Intellectual Disability having Cerebral Palsy. Single group pre and post test design which is categorized under informal experimental design was employed in the study. 4.1 Sample Size Six children (both boys and girls) in the age group of 7-11 years with intellectual disability having cerebral palsy with an intelligence quotient of who can follow the position and asanas were selected as samples for the present study using purposive sampling technique under non probability sampling method. 4.2 Research Procedure A systematic procedure is applied to carry out the current study so that objective can be achieved meaningfully. Once the conceptual framework was prepared, the objectives were finalized. As per the objectives, the suitable research participants for research were identified. The researcher assessed the students to collect base line data by administrating Sit and Reach Test. A sequence of asanas was developed for the study after collecting the baseline data of the sample. Goniometer to measure the flexibility and sit and reach test to assess the flexibility of hip and knee joint was administered to study the effectiveness of asanas in flexibility of hip and knee joint. The flexibility of hip and knee joint of the identified children was measured and recorded as pretest scores. The best among the three trails was taken as the test score as prescribed in the standard measurement procedure. Selected Yogasanas was administered for the samples for 20 sessions (one hour per day for 5days - Monday to Friday in a week for 20 days). After 20 sessions of treatment the hip and knee joint flexibility of the samples was measured to find out the effectiveness of yogasans in improving the flexibility of hip and knee joint of the selected sample. 4.3 Nature of the tool The following tools are developed to study the effect of selected Yogasanas in improving flexibility of Hip and Knee Joints of Children with Intellectual Disability having Cerebral Palsy: Table 4.3.1: Tools to study the effect of selected Yogasanas S. N Tool Purpose 1 Goniometer (Equipment used in Physiotherapy) To measure the flexibility in hip and knee joint. 2 Centimeter tape or scale To measure the flexibility in hip and knee joint. 1302

7 3 Asanas 1. Ardhabathakonasanam 2. Bathakonasanam 3. Ardhapachimothanasam 4. Pachimothanasam 5. Gomugasanam (sitting) 6. Trikonasanam (sitting) Provide intervention to the samples to develop flexibility in hip and knee joint. 4 Sit and reach test To test the flexibility of muscles in hip and knee joint. 4.4 Reliability and Validity of the tool The selected asana sequence based on the need and ability level of the sample was circulated among 5 yoga therapist and 5 Physiotherapists for their opinion. Based on the opinion obtained sequence and asanas were finalized to suit the need of the sample. Since Goniometer and Sit and reach test is standardized tool to measure the flexibility opinion regarding its use in the current study was sought from the Physiotherapist. 5. Results and Discussion Paired t test on pretest and post test scores, mean and standard deviation was administered to find out the effect of selected yogasans in improving the flexibility of hip and knee joint of children with mental retardation having cerebral palsy. Individual performance analysis was also done to find out the improvement in individual hip and knee joint flexibility. 5.1 Yogasanas and Flexibility of Hip joint Performance of the selected sample on Hip joint flexibility was measured through pre and post intervention. The mean score (.00) attained by the sample at the pre intervention phase was compared with that at post intervention (118.33). This difference was found to be statistically significant ( t = 5.5, df = 5) at 1% level. This indicates that use of yogasans had positive effect on flexibility of hip joint in children with intellectual disability having cerebral palsy Hip joint-pre Hip joint-post Mean Figure: 5.1.1: Comparison of the pretest and posttest mean scores of the selected sample in hip joint flexibility through selected yogasanas 1303

8 5.2 Yogasanas and Flexibility of Knee joint Performance of the selected sample on knee joint flexibility was measured through pre and post intervention. The mean score (117.50) attained by the sample at the pre intervention phase was compared with that at post intervention (126.66). This difference was found to be statistically significant ( t = 3.84, df = 5) at 5% level. This indicates that use of Yogasanas had positive effect on flexibility of knee joint in children with intellectual disability having cerebral palsy Knee joint-pre Knee joint-post Knee joint-pre Knee joint-post Mean Figure: 5.2.1: Comparison of the pretest and posttest mean scores of the selected sample in Knee joint flexibility through selected yogasans 5.3 Individual Performance Analysis Individual performance analysis of the selected sample is also recorded to find out the effect of Yogasanas among the selected sample. The posttest performance of each sample as against their pretest performance scores shows that there exists significant improvement in the flexibility of the knee and hip joint as a result of the systematic administration of Yogasanas. Comparison of pre and post test scores of each sample is presented as below: Table 5.3.1: Case 1- Yogasanas Comparison of pre and post test scores of each sample Case 1 Name Sex Age Knee joint Hip joint S. J Male 7 years Pretest Post test 125 Pretest 80 Post test

9 Knee Joint Hip Joint Figure: 5.3.1: Comparison of Pre and Post test Scores of Case 1 in Hip and Knee Joint Flexibility through Selected Yogasanas Table 5.3.2: Case 2- Yogasanas Comparison of pre and post test scores of each sample Case 2 Name Sex Age Knee joint Hip joint I.J Male 7 years Pretest 125 Post test 135 Pretest Post test Knee Joint Hip Joint Figure: 5.3.2: Comparison of Pre and Post test Scores of Case 2 in Hip and Knee Joint Flexibility through Selected Yogasanas 1305

10 Table 5.3.3: Case 3 - Yogasanas Comparison of pre and post test scores of each sample Case 3 Name Sex Age Knee joint Hip joint R.S Male 8 years Pretest 130 Post test 135 Pretest 110 Post test Knee Joint Hip Joint Figure5.3.3: Comparison of Pre and Post test Scores of Case 3 in Hip and Knee Joint Flexibility through selected Yogasanas Table 5.3.4: Case 4 - Yogasanas Comparison of pre and post test scores of each sample Case 4 Name Sex Age Knee joint Hip joint J.J Female 11 years Pretest 130 Post test 135 Pretest Post test

11 Hip Joint 125 Knee Joint Figure: 5.3.4: Comparison of Pre and Post test Scores of Case 4 in Hip and Knee Joint Flexibility through selected Yogasanas Table 5.3.5: Case 4 - Yogasanas Comparison of pre and post test scores of each sample Case 5 Name Sex Age Knee joint Hip joint V.M Female 7 years Pretest Post test 130 Pretest Post test Hip Joint Knee Joint Figure5.3.5:Comparison of Pre and Post test scores of Case 5 in Hip and Knee Joint Flexibility through selected Yogasanas 1307

12 Table 5.3.6: Case 6 - Yogasanas Comparison of pre and post test scores of each sample Case 6 Name Sex Age Knee joint Hip joint V.K Female 9 years Pretest 80 Post test Pretest 90 Post test Knee Joint Hip Joint Figure 5.3.6: Comparison of Pre and Post test Scores of Case 6 in Hip and Knee Joint Flexibility through selected Yogasanas 6. Scope of the Study I. Sequence of asana to improve the flexibility of hip and knee joint can be identified and a flexibility training package of such sequence can be developed and standardized for implementing it to a large sample. This will enable the children to enhance their active participation in activities of daily living. II. Educational institutions enrolling children with mental retardation having cerebral palsy can be equipped with yoga administrators which will help the children to improve their flexibility in hip and knee joint. III. Apart from providing treatment to the sample, training can be provided to the class teacher in performing and developing asana sequence according to the need and ability of the child. 1308

13 7. Conclusion The researcher through this study has attempted to bring into light the effectiveness of selected asanas in improving hip and knee joint flexibility among children with intellectual disability having cerebral palsy. The findings of the study reveal that there is considerable improvement in the hip and knee joint flexibility among the selected sample.quality of life is enhanced by improving and maintaining a good range of motion in the joints. Overall flexibility should be developed with specific joint range of motion needs in mind as the individual joints vary from one to another. Loss of flexibility can be a predisposing factor for physical issues such as pain syndromes or balance disorders. The hip joints are capable of a wide range of motion, including rotation, flexion and extension. Increasing the flexibility of hip joints allows moving with less restriction and minimizes the risk of injury to the knees, hips, ankles and lower back.yoga, besides its relaxing, spiritual function, is also a wonderful flexibility training program. In addition, yoga increases the range of motion in joints. It also increase lubrication in the joints. Systematic and regular practice of yoga can make body more flexible, giving the muscles and joints a greater range of motion. This study substantiates the positive effect of yoga on children with intellectual disability having cerebral palsy. References [1] S.Chanchani & R.Chanchani, Yoga for children: A Complete Illustrated guide to Yoga, UBS Publishers Distributors, New Delhi (1997). [2] T.K.V.Desikachar, The Yoga of T. Krishnamacharya, Krihsnamacharya Yoga Mandiram, Madras (1982). [3] M.L. Gharote, Guidelines for Yogic Practices, Medha Publications, Lonawala (1982). [4] B.K.S.Iyengar, Light on Pranayama: Pranayama Dipika, Unwin Paperbacks, London (1981). [5] B.K.S.Iyengar, Yoga Sutra of Patanjali: Translation and Commentary, Ramamani Iyengar Memorial Institute, Pune (1987). [6] C.Kisner, and A.L.Colby, Therapeutic Exercise Foundation and Techniques (4th Edition), F.A.Davis Company, Philadelphia (2002). [7] Krishnamacharya Yoga Mandiram and Vijay Human Services, Teaching Yogasana to the mentally retarded persons a guide book for personnel serving the mentally retarded persons, Krihsnamacharya Yoga Mandiram, Madras (1998). [8] Madanmohan, D.P.Thombre, B.Balakumar, T.K.Nambinarayanan, S.Thakur, N.Krishnamurthy, and A.Chandrabose, Effect of Yoga Training on Reaction time, respiratory Endurance and Muscle strength, Indian j Physiol Pharmacol, 36 (4), PP (1992) visited on 24/09/13. [9] R.Nagarathna, and H.R.Nagendra, Yoga for bronchial asthma: a controlled study, British Medical Journal, 291, PP (1985) visited on 24/09/13 [10] H.R.Nagendra, and R.Nagarathna, An integrated approach of yoga therapy for bronchial asthma: a 3-54 months prospective study, Journal of Asthma, 23(3), PP (1986) on 24/09/13. [11] H.R. Nagendra, Yoga its basis and applications, Swami Vivekananda Yoga Prakashna, Bangalore (2000) [12] S.S. Sareswathi, Yoga Education for children, Bihar school of yoga pubilication Trust,Rikhia (1999). [13] K.Uma, H.R. Nagendra, R.Nagarathna, and S.Vaidehi, The integrated approach of yoga: a therapeutic tool for mentally handicapped children: a one year controlled study, Journal of Mental Deficiency Research, 33, PP (1989) visited on 24/09/