Applying a Yoga Program for Symptom Management in People With Brain Injuries in a Brain Injury Clubhouse

Annually 2.8 million traumatic brain injury (TBI) and 800,000 people have a stroke. Moderate to severe brain injuries often result in long-term disabilities. Insurance covered rehabilitation services often run out in the chronic stage, while people with brain injuries need alternative services that support their lifelong needs. OT helps implement health habits by building upon existing abilities to support a wellness lifestyle for mental health recovery. An approach that provides holistic benefits and can be incorporated into a client’s daily life for lifelong symptom management would be ideal to implement in community-based settings. Yoga practice changes gamma-aminobutyric acid levels in the brain and the change is linked to positive mood changes in healthy population [12, 13]. In diagnoses such as dementia, cancer, and chronic obstructive pulmonary disorder, the evidence suggests yoga improves depression [14-18]. However, few studies investigated the effect of yoga in people with brain injuries. The purpose of this study were to pilot an 8-week adaptive yoga program in a community based brain injury clubhouse, and examine the effect of the yoga program on mood and quality of life (QOL) in individuals with brain injury.

DESIGN: This study utilized a single group, quasi-experimental design. We collaborated with a local VA TBI clinic, a brain injury clubhouse, and support groups for recruitment. Participants were eligible if they were diagnosed with a brain injury, 18 -89 years old, able to speak English, and able to at least stand with assistive devices.

METHOD: We designed the adaptive yoga program to implement in a local clubhouse. The assessments were conducted two weeks before and after the program. A certified yoga instructor taught the 1-hour yoga session twice a week for 8 weeks. A yoga session includes tuning in, warm up, breathing exercises, exercise series, meditation, and rest. Most of the participants practiced chair yoga except for two who were on yoga mat on the floor.

MEASUREMENTS: We used the Beck Depression Inventory, a 21-item self-report assessment, to assess mood and the Short Form 36 (SF-36), a 36-item self report assessment to measure health related QOL.

DATA ANALYSIS: We used descriptive statistics to summarize demographic information. Due to the small sample size, we used the nonparametric Wilcoxon singed rank test to compare the pre and post tests.

RESULTS: 14 participants including 11 TBI and 3 stroke enrolled in the study. The mean age was 50.9 ± 10.5 years. The majority of participants were male (64 %), single or divorced (86%), unemployed (93%) and have > high school education (64%). Comparing pre and post tests, participants improved on both physical and mental composite scores of the SF-36, but only the improvement on physical composite score was statistically significant (p < 0.05). The BDI did not differ significantly; however, among 5 participants who showed depressed symptoms at the baseline, 3 people’s depression scores decreased more than 17.5% (minimal clinical difference) and the other 2 did not reach MCD.

CONCLUSION: Applying an adaptive yoga program in people with brain injuries in a community based brain injury clubhouse is feasible and potentially beneficial for manage depression and improve QOL. Modifications of movements and instructions are essential for the success of delivery this yoga program. Helpful tips include repeating instructions, avoiding abstract verbal instructions such as right/left, performing demonstrations in additional to verbal instructions, and providing positive feedback frequently. Because yoga is gentle and easy to adapt, it could be a useful tool for OTs to manage symptoms and promote health in people with chronic brain injury in the community settings.

References

Fan, J. T., & Chen, K. M. (2011). Using silver yoga exercises to promote physical and mental health of elders with dementia in long-term care facilities. Int Psychogeriatr, 23(8), 1222-1230. https://doi.org/10.1017/s1041610211000287

Streeter, C. C., Whitfield, T. H., Owen, L., Rein, T., Karri, S. K., Yakhkind, A., . . . Jensen, J. E. (2010). Effects of yoga versus walking on mood, anxiety, and brain GABA levels: a randomized controlled MRS study. J Altern Complement Med, 16(11), 1145-1152. https://doi.org/10.1089/acm.2010.0007

Thayabaranathan, T., Andrew, N. E., Immink, M. A., Hillier, S., Stevens, P., Stolwyk, R., . . . Cadilhac, D. A. (2017). Determining the potential benefits of yoga in chronic stroke care: a systematic review and meta-analysis. Top Stroke Rehabil, 24(4), 279-287. https://doi.org/10.1080/10749357.2016.1277481