Scientific Benefits of Yoga for the Stroke Population
Disclaimer: This information provided here is for educational purposes only and is not intended to treat, diagnose, or manage any specific illness or disease. It is always advisable to consult with your healthcare provider or doctor prior to beginning any yoga or exercise program. The information detailed below pertains specifically to stroke rehabilitation and its potential integration with yoga practices.
Yoga Background & Terminology
According to the World Health Organization (WHO), yoga is an integrative health approach occupational therapy practitioners may utilize to provide a holistic client-centered treatment.
Yoga, originating in India, is an ancient practice and is characterized as a mind-body discipline aimed at developing a profound sense of concentration and awareness (Curtis et al., 2017).
"The term 'yoga' comes from the Sanskrit root" "yui," which means "to yoke or join together" (Lawrence et al., 2017, p. 2).
Patanajali's Yoga Sutra outlines the eightfold path as a roadmap for living a purposeful, ethical, and meaningful life.
This path is depicted as a tree with "limbs'' representing universal ethics (Yama), physical postures (asanas), breath control (pranayama), control of the senses (pratyahara), concentration (Dharana), and meditation (dhyana) (Lawrence et al., 2017, p. 2).
Practicing each of these limbs can lead to "Samadhi," a state of spiritual bliss.
The popularity of yoga in the Western world has been growing steadily as a treatment intervention, with physical postures (asana), breath control (pranayama), and meditation (dhyana) being the most widely practiced and recommended by healthcare practitioners (Lawrence et al., 2017).
What is Asana?
Asana, also referred to as physical postures, is recognized as one of the eight limbs of yoga and is one of the most commonly practiced aspect among healthcare practitioners.
The use of physical postures for stroke rehabiliation play a significant role in developing strength, flexibility, and balance, allowing individuals to cultivate a deeper connection with their bodies and minds.
Examples of yoga asana beneficial for stroke recovery:
Weight-bearing Asana: Seated or Quadruped Cat-Cow Pose, Seated Table Top Pose.
Contralateral Movements: Seated Boat pose, Seated Extended Mountain, Tree Pose, Warrior II.
Bilateral Upper Extremity Movements: Chair Pose, Child’s Pose, Extended Mountain, Table-Top, Downward Facing Dog, Cat Cow, and Warrior I/II.
What is Pranayama?
Pranayama, also known as breath control, is frequently utilized in various occupational therapy interventions to enhance physical and mental well-being. This practice involves specific breathing techniques that can help individuals manage stress, improve focus, and promote relaxation. By integrating pranayama into therapeutic sessions, occupational therapists can support clients in achieving a greater sense of balance and overall health.
What are the benefits for stroke?
A meta-analysis by Kang et al. (2022) reported that respiratory muscle exercises enhanced muscular strength and reduced the risk of respiratory complications in patients with stroke.
Additionally, multiple studies on healthy adults have reported a positive effect on breathing exercises on cognitive functional improvements.
Breathing exercises are the synchronization of natural breathing and neuronal activity, which activates the cortex, hippocampus, and amygdala, that are related to memory performance (Kang et al., 2022). Incorporating pranayama or breath control exercises into stroke rehabilitation may contribute to improvements in cognitive function in stroke.
Breathing exercises specific for stroke recovery
Equal belly breathing
Alternate nostril breathing
Ujjayi breathing
What is Dhyana?
Dhyana, also known as meditation, is the seventh limb in the eight limbs of yoga. The National Center for Complementary and Alternative Medicine (NCCAM) defines meditation as "specific postures, focused attention, or an open attitude toward distractions." People use meditation to increase relaxation, improve psychological balance, cope with illness, or enhance general health and wellness" (Srinivasan, 2013).
Dhyana is used as a holistic occupational therapy treatment approach for individuals with cardiovascular disease, pulmonary disease, stroke, and individuals who may benefit from relaxation techniques.
Yoga Nidra encompasses various forms, such as mental imagery, motor imagery, and progressive muscle relaxation.
Scientific Benefits:
The use of dhyana as a treatment intervention for neurological conditions may alleviate stress, anxiety, activate the parasympathetic nervous system, and even alleviate symptoms of depression (Yang, 2023).
Yoga Nidra
An effective evidence-based meditation utilized in stroke rehabilitation is Yoga Nidra. According to Nayak & Verma (2023), Yoga Nidra, referred to as “yogic sleep” or “conscious sleep” is a mental practice that exists between wakefulness and sleep (Nayak & Verma, 2023).
Yoga Nidra is an effective practice for stroke patients due to eliciting neuroplasticity in the brain.
Neuroplasticity: The brain’s ability to adapt and change.
The process of neuroplasticity enables the brain to redirect damaged functions to healthier areas of the brain and can reroute functions from damaged areas to new, healthy regions (Yang, 2023).
Facts about Neuroplasticity:
The brain has a complex neurological map, called the cortical homunculus, which processes sensory and motor functions across the body.
In the cerebral gray matter, distinct centers are allocated to each body part.
The sequencing of awareness rotation in Yoga Nidra mirrors this cerebral map.
Through repetitive rotation in this prescribed order, a profound neural flow is triggered within the brain's homunculus circuitry.
This flow creates a sense of relaxation, believed to mitigate stress and anxiety, stimulate the parasympathetic nervous system, and potentially alleviate symptoms of depression.
There are many forms of Yoga Nidra including mental imagery, motor imagery, and progressive muscle relaxation (Yang, 2019).
Figure I
Image retrieved from: Nourollahimoghadam, p. 760, 2021.
Body awareness has direct affect on brain neurotransmitters, including GABA, which enhance dopamine and serotonin (Nourollahimoghadam, p. 760, 2021). Increased body awareness through meditation, breath control, and controlled physical postures, may decrease stress and increase gray matter volume in the brain. An increase of gray matter in the brain increases an individuals ability to control movement, enhance memory, and control emotions.
What the research says…
Article 1 - Kashyap et al. (2023).
A randomized control trial by Kashyap et al. (2023), reveals that early yoga intervention in stroke patients may lead to improvement in cognition.
The pilot study included a convenience sample size of 40 participants with a history of stroke (Kashyap et al., 2023). The study highlights how structures of the brain are connected by various neural fibers and may be impacted from a stroke leading to cognitive decline (Kashyap et al., 2023).
However, the brain’s ability to formulate new circuits and adapt allows for improvements in cognitive function (Kashyap et al., 2023).
The study revealed improvements in standardized cognitive assessments including MoCA scores increased by 2 points, demonstrating the positive effects of yoga as an intervention for stroke (Kashyap et al., 2023).
Article 2 - Hampson et al. (2017).
Individuals with a history of stroke may be at a higher risk for mood disorders due to changes in cognition. Adaptive yoga has been proven to have positive effects on both physical and mental health, leading to an improved quality of life.
A study by Hampson et al. (2017) explored the effects of a relaxation training program on individuals with long-term neurological conditions such as acquired brain injury, stroke, Parkinson's disease, and Multiple Sclerosis. The study consisted of a five-session relaxation training program and a follow-up session at the participant's homes.
The results showed that relaxation training is an effective treatment for anxiety and depression in individuals living with long-term neurological conditions, leading to better functional outcomes of neurorehabilitation. The study concluded that relaxation training can be offered as an effective first-line intervention in rehabilitation to treat anxiety and depression in people living with long-term neurological conditions.
These findings suggest that adaptive yoga can play a significant role in promoting holistic recovery by addressing functional factors commonly associated with stroke rehabilitation.
Article 3 - Sinha et al. (2013).
Breath control or pranayama is one of the three limbs of yoga and has been shown to enhance the autonomic control of the heart by increasing the parasympathetic modulation (Sinha et al., 2013). A comparative study by Sinha et al. (2013), following a period of six weeks, showed that participants' parasympathetic tone was enhanced through pranayama and alternate nostril breathing.
The participants participated in alternate nostril breathing for fifteen minutes per day. The results of the study demonstrate that yogic breathing exercises improved participants' mood and emotional well-being.
Alternate nostril breathing not only decreased sympathetic activity but improved the participants cardiovascular and respiratory functions as well (Sinha et al., 2013). These findings suggest that adaptive yoga can significantly promote holistic recovery by addressing functional factors commonly associated with stroke rehabilitation.
References:
The American Journal of Occupational Therapy. (2023). Complementary health approaches and integrative health in occupational therapy. The American Journal of Occupational Therapy. 77(3). https://research.aota.org/ajot/article/77/Supplement%203/7713410200/25025/Complementary-Health-Approaches-and-Integrative
Harris, A., Austin, M., Blake, T. M., & Bird, M. L. (2019). Perceived benefits and barriers to yoga participation after stroke: A focus group approach. Complementary therapies in clinical practice, 34, 153–156. https://doi.org/10.1016/j.ctcp.2018.11.015
Lawrence, M., Celestino Junior, F. T., Matozinho, H. H., Govan, L., Booth, J., & Beecher, J. (2017). Yoga for stroke rehabilitation. The Cochrane database of systematic reviews, 12(12), CD011483. https://doi.org/10.1002/14651858.CD011483.pub2
Schmid, A., Van Puymbroeck. (2019). Yoga therapy for stroke. A handbook for yoga therapists and healthcare professionals. Singing Dragon.
Schmid, A. A., Van Puymbroeck, M., Altenburger, P. A., Schalk, N. L., Dierks, T. A., Miller, K. K., Damush, T. M., Bravata, D. M., & Williams, L. S. (2012). Poststroke balance improves with yoga: a pilot study. Stroke, 43(9), 2402–2407. https://doi.org/10.1161/STROKEAHA.112.658211