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Dr. Rex Marco is elliit danks sex videosa devoted meditator who has difficulty engaging with one of core aspect of meditation practice. When it becomes the object of focus, it helps to steady the heart and mind: the sensation of his own breath. 

In 2019, a mountain biking accident left Marco with a spinal cord injury that paralyzed him from the neck down. And as with many other people living with quadriplegia, he could barely feel his breath as it entered and exited his nose and mouth. Recently, he gained the ability to better experience these sensations, along with the feeling of his chest and belly rising and falling. But for more than a year following his accident, breath became a stranger to him.

Marco, who is trained in orthopedic surgery and is currently the chief medical ambassador of the Christopher & Dana Reeve Foundation, was crestfallen. "I had so much relaxation with my breath work," he says. "I couldn't feel, so I couldn't get present with my body sensations either." 

So when meditating, Marco began to ignore guided sessions in which he can't participate. That includes body scans that prompt the meditator to track physical sensations, and walking meditations that focus on the feeling of the foot striking the ground.

Instead, he uses sound in his environment as an anchor: paying attention to a humming ceiling fan, a revving car engine, a vibrating refrigerator. He's also deepened his self-compassion practice, which requires no movement — even when some of those guided meditations invite the listener to place their hand on their heart. 

Marco is one of 61 million adults in the U.S. who live with a cognitive or physical disability. Another 14.2 million adults have a serious mental illness, which can impair everyday functioning. For people with disabilities, standard meditation fare can seem exclusionary. Meditation resources — apps, online courses, in-person classes — often make assumptions about the person meditating. A basic set of misguided assumptions: that they can walk, see, hear, or feel. 

It may be impossible to make guided meditations and courses specific to every type of lived experience. Still, people with disabilities say they'd welcome content that caters to their needs. Not to mention more inclusive language. 

Marco is now training to become a meditation teacher, and says he plans on taking both approaches as an instructor. He aims to teach meditation to people with spinal cord injuries, offering techniques informed by his firsthand experience. He's also trying to incorporate language that reflect people's varying ability to perform traditional functions of meditation, including sitting with an erect spine.

"Even though I can't bring my hands to heart center," says Marco, "I can teach it and I can guide them through it. And I can say 'as you're able,' to be inclusive for people with [limited mobility]."

When observing thoughts won't work

For years, writer and meditation instructor Jeff Warren struggled to find practices that worked with his attention-deficit/hyperactivity disorder and bipolar disorder. Warren found that the traditional practice of trying to observe his thoughts, without becoming attached to them, sometimes backfired and put him in a "hypomanic" state, which is characterized by intense excitability, creativity, and grandiosity. Hypomania is commonly seen with bipolar disorder. 

Warren kept trying to observe his thoughts neutrally — a frequent goal in mindfulness meditation — until he decided that "enduring these spasms of energy wasn't working." Noticing thoughts remains the "backbone" of his practice, he says, but Warren now avoids being hypervigilant about his thoughts and feelings when he senses hypomania coming on. He shifts to a grounding practice, such as walking in nature, gardening, or listening to calming music. 

In Warren's own guided meditations, available on YouTube, he has spoken about his diagnoses and demonstrated techniques to work with those conditions. His goal is to be inclusive without being confusing. Warren, whose meditations also appear on the Calm and Ten Percent Happier apps, wants to see such digital platforms offer courses specific to major mental health conditions. Accommodations and suggestions, based on expert insight and people's lived experiences, should also be offered.

Instructors are typically under pressure to deliver directions in as few words as possible, Warren says. They might worry, for example, that intricate guidance will confuse or distract meditators. Perhaps mentions of different abilities could come before a guided meditation begins, Warren suggests, so that meditators can make adjustments specific to their situation or condition. 

Regardless of how it plays out, Warren insists that instructors need to be more inclusive: "There's an assumption of what the typical mediator looks like, and that really needs to be updated."  

The traditional emphasis on sitting with an erect spine, for example, comes from a belief that the body and mind can benefit from the position. Sitting tall means the breath may move through the body with more ease, and it can also keep a meditator from falling asleep. But that shouldn't come at the cost of pain, discomfort, or exclusion, says Warren. 

How to center people with disabilities 

Mashable asked the meditation apps Calm, Headspace, and Ten Percent Happier if they provide courses specific to various types of disabilities. With the exception of a two-minute Headspace video on exploring disability and movement, none of them do. A spokesperson for Ten Percent Happier said it was "an area [we] are hoping to grow in the future."

The apps, which are among the most popular in the meditation space, have varying approaches to accessibility. Headspace's audio and video content uses closed captioning for people with hearing disabilities. Additionally, Headspace is working to conform to the latest Web Content Accessibility Guidelines, a set of standards published by the Web Accessibility Initiative of the World Wide Web Consortium.

That will mean users can resize text up to 200 percent, use Apple and Android screen reader tools, and hear audio descriptions of video content, among other features.

Ten Percent Happier's accessibility featuresinclude closed captioning for most of its meditations and courses. Calm has no closed captioning nor any other accessibility features. The UCLA Mindfulness Awareness Research Center offers one of the few easily accessible collections of guided meditations in American Sign Languagein its UCLA Mindful app.

Deaf and hard-of-hearing meditators face a unique set of challenges. Online and in-person courses are largely inaccessible without an instructor who is fluent in ASL. Closed captions can helpful but have clear limitations depending on the setting. If a meditator is meant to close their eyes, captions become useless. They also don't provide cues about how long a meditative silence is meant to last, for example.

Barbara Eger-Klatt, a deaf yoga instructor, said in an email that past Google searches for accessible meditation content turned up few resources. She teaches yoga using ASL, including to deaf and hard-of-hearing students at Gallaudet University, and developed techniques to help participants know when a meditation is ending. One uses numbers to time the breath, so that everyone knows when to open their eyes.

She also makes sure that everyone can see her, and that the room is uncluttered and brightly lit. Dark rooms, common in meditation and yoga centers, make it difficult for people who are deaf or hard of hearing to use their vision to follow along.

"In my experience with yoga sessions or meditation, it was a bit stressful to keep my eyes open the whole time because they don’t know how to work with a deaf student and they talked while they closed their eyes," Eger-Klatt said. "I refused to be in that situation, and it was not very relaxing." 

Warren believes that within the next decade, the meditation field will become more accessible and inclusive with increased demand, and as instructors, apps, and institutions learn how to incorporate such approaches into their content. "If we're going to talk about this 10 years from now, it'll be a completely different conversation," he says. 

Some have already charted a more inclusive, equitable path forward. The Black Lotus Collective, a group in Boston focused on contemplative practice, was founded in 2016 with the purpose of "centering the voices of the historically oppressed," including people with disabilities. 

Black Lotus Co-founder Grant Jones says the group has made careful decisions about organizing its meditation space according to people's needs. A typical meditation center might only offer a pillow for participants to sit on; the Black Lotus Collective has adjustments and accommodations for people who may need to lay down while meditating because it is safer or more comfortable.

Guided meditations are offered at higher volumes for those who are hard of hearing. The group's webinars have featuredASL interpreters as well as closed captioning and transcripts. Instructors consider the speed and density of their directions; too much can mean a significant cognitive load for people who may be hard of hearing or have difficulty following along.

"A lot of these normative practices that we have within [Western meditation spaces and offerings] have gone unquestioned and unchallenged," says Jones, who is also a graduate student in the department of psychology at Harvard University. "But for people who come with different abilities, they might not be working at best, and at worst they might be causing certain kinds of harm."

Jones says that making meditation as accessible and inclusive as possible accomplishes critical goals. Such a setting can help a meditator bring their body to a state of ease while creating trust that will sustain their practice. He also believes that drawing attention to ableism in meditation spaces can help people confront their biases and assumptions. 

And of course, even those who consider themselves able-bodied have different physical, mental, and intellectual abilities — and may well encounter persistent pain, chronic illness, or trauma as they go through different life stages. "We are all invested, whether we recognize it or not, in this journey," says Jones. He says he's still learning about the ways in which meditation can be more inclusive and accessible. 

Meanwhile, back in Dr. Marco's teacher training, participants increasingly use broader language when guiding a meditation. They tell meditators they can sit, stand, lie down, or "relax as you're able." 

"They know that helps me," says Marco, who is most comfortable meditating when reclining in his wheelchair. His fellow students must attend breakout sessions about topics such as chronic pain and living with disability, which gives Marco hope that future instructors will be more aware of how to make meditation truly for all.

"It's trying to be more inclusive," he says.