Date Presented 4/1/2017
We used a mixed-methods design to demonstrate the benefit of a group yoga intervention for persons with chronic traumatic brain injury (TBI). Aligned with the holistic principle of occupational therapy, a yoga-based intervention combining mind and body in practice might be an ideal alternative for clients with chronic TBI.
Primary Author and Speaker: Pey-Shan Wen
Additional Authors and Speakers: Ileana Herrin
Contributing Authors: Alain Loret de Mola, Freddy Rodriguez, Brianne Maravel, Luis Benitez, Ivan Cabrera
PURPOSE: More than 5 million Americans are permanently disabled due to a traumatic brain injury (TBI). Sleep disorder, chronic pain, depression, and executive dysfunction are highly prevalent in individuals with TBI. Yoga incorporating mind and body into practice has been studied in many populations to reduce chronic pain and improve balance and sleep. The majority of studies focused on older adults and patients with arthritis, multiple sclerosis, or stroke. To our knowledge, only two studies have applied yoga to individuals with TBI. One study examined the effects of yoga on respiratory function (Silverthorne, Khalsa, Gueth, DeAvilla, & Pansini, 2012), and the other investigated the results of yoga on balance and pain (Schmid, Miller, Van Puymbroeck, & Schalk, 2015). Both studies reported positive results of yoga intervention; however, none of them investigated other important sequelae of TBI such as sleep, depression, and executive function. This study aimed to determine whether a 6-wk group yoga intervention benefited individuals with chronic TBI. Our research question was, Does a 6-wk, twice-a-week group yoga intervention improve sleep, pain, mood, and executive function in individuals with chronic TBI?
DESIGN: In this mixed-method pilot study, a 6-wk, twice-a-week group yoga intervention was implemented by a certified Hatha and Kundalini yoga instructor, an occupational therapist, and a group of occupational therapy (OT) students. Each 60- to 70-min yoga session started with breathing exercises, progressed through core strengthening and stretching poses with intermittent relaxation poses, and ended with a brief meditation.
METHOD: Two adult male participants (M age = 31) with severe TBI were recruited from a local support group. Our inclusion criteria were (1) diagnosis of chronic TBI (i.e., at least 6 mo postinjury), (2) minimal ability to stand and move with the use of a mobility device (i.e., walker or cane), (3) ability to follow a three-step command, and (4) ability to read and speak English. Patients with additional neurological conditions (e.g., bipolar disorder, attention deficit hyperactive disorder) were excluded. Quantitative outcomes were assessed using the Pittsburgh Sleep Quality Index, Neuropathy Pain Scale, and Behavior Rating Inventory of Executive Function (BRIEF) before, at midpoint, and after the yoga intervention. The Beck Depression Inventory was administered before and after the yoga intervention. We used descriptive statistics and visual graphs to summarize qualitative data. We also conducted a semistructured group interview postintervention to collect qualitative data. The interview was audio recorded and transcribed. We used a debriefing process to summarize emerging topics.
RESULTS: One participant showed a 16-point (25%) reduction in depression symptoms after the yoga intervention. Other improvements (12.5%–25.0%) were found in the Inhibition and Emotional Control scales of the BRIEF. Qualitative data also supported the benefits of yoga in improving sleep quality, pain, emotional control, and short-term memory. Participants’ statements showed alleviation of their symptoms: “I started to not . . . have to take the Benadryl [for sleep],” “I ended up going less [to the chiropractor] in the 6 weeks because of doing the neck stretching,” and “The breathing, especially . . . it seems to calm you down a lot.”
CONCLUSION: The group yoga intervention was beneficial for individuals with chronic TBI. Aligned with the holistic principle of occupational therapy, a yoga-based intervention combining mind and body in practice may be an ideal alternative for treating chronic pain, sleep disorder, depression, and emotional control. Incorporating yoga techniques such as breathing, stretching, relaxation, and meditation into OT practice shows potential to maximize intervention effects. Future studies with larger sample sizes are needed to confirm our findings.
References
National Institute of Neurological Disorder and Stroke. (2016). Traumatic brain injury: Hope through research. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Traumatic-Brain-Injury-Hope-Through
Schmid, A. A., Miller, K. K., Van Puymbroeck, M., & Schalk, N. (2015). Feasibility and results of a case study of yoga to improve physical functioning in people with chronic traumatic brain injury. Disability and Rehabilitation, 38, 914–920. https://doi.org/10.3109/09638288.2015.1062927
Silverthorne, C., Khalsa, S. B., Gueth, R., DeAvilla, N., & Pansini, J. (2012). Respiratory, physical, and psychological benefits of breath-focused yoga for adults with severe traumatic brain injury (TBI): A brief pilot study report. International Journal of Yoga Therapy, 22(1), 47–52.
