I recently received an email from a recent graduate of a yoga teacher-training program who is looking for more guidance in how to work with her students who have suffered a stroke and are attempting to recover some of their lost function. She happened upon a piece I did for Yoga Journal Magazine a number of years back (see here) and found it useful, but wanted any additional advice I could provide. Seemed like a good topic to share with all of our readers here, so let’s start by defining stroke.
According to the Mayo Clinic: “A stroke occurs when the blood supply to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and food. Within minutes, brain cells begin to die.” Stroke is considered a medical emergency that can result is severe disability and death, so it is one of those conditions that need immediate attention. And in the span of time since I began practicing medicine, some significant changes have taken place in the acute treatment of stroke that have gone a long way in improving one’s chances of a better outcome. In fact, in the last 15 years the risk of dying from a stroke has dropped significantly. Better care of the risk factors associated with stroke, such as high blood pressure and cholesterol and diabetes, may be playing a role in these improvements, too. However, getting to a hospital immediately if you suspect stroke is the number one thing to do once symptoms show up.
Once a person has had a stroke, there are innumerable changes that can occur, including trouble walking or even balancing easily on two feet, trouble speaking or understanding what others are saying, paralysis or numbness of the face, arm or leg on one side of the body, or trouble seeing in one or both eyes. There can be mild, moderate or severe mixes of these various deficits in stroke survivors.
Despite the huge changes that can arise for someone who has suffered a stroke, new understanding of how the brain works provide encouragement that what was once considered a largely unchangeable thing (the brain) is now known to be highly changeable. This concept is known as “neuroplasticity.” According to well-known writer and neurologist Oliver Sacks, M.D., neuroplasticity is “the brain’s capacity to create new pathways.” There are now NIH studies looking at the brain’s ability to learn and grow new neural pathways after damage that are quite encouraging. And since physical therapy is considered an essential treatment for post–stroke recovery, yoga asana can supplement this quite nicely. And yoga may work because someone new to yoga is “learning” new patterns of movement, new skills of observation, as well as learning a new language, Sanskrit, and new verbal patterns, via memorizing yoga sutras and learning chants. So the brain is being maximally stimulated to lay down new neurons in many if not all of the areas that have been negatively impacted by the stroke.
|Flowers in a Rock Crevice by Michele Macartney-Filgate|
As I have previously recommended, modifying asana practice via doing reclining pose variations either in a bed or on the floor if the patient can easily transfer up and down is quite helpful in situations of extreme weakness or balance problems. Another way to work if standing is still dicey is to do a chair-based practice, with one or more chairs available. A huge variety of poses can be done safely in this way, including clever modifications of sun salutations. I’d direct you to several books for more ideas, including Nischala Joy Devi’s The Healing Path of Yoga, and Sam Dworkis’ Recovery Yoga. Although not specifically written for stroke recovery, many of the ideas presented could be nicely adapted for this setting. And for those with more ability to do standing work, the use of the wall for supporting various body parts while doing any number of standing poses could be the next step in progressing students towards more normal physical functioning.
In addition, as way of working with the cognitive loses that can result from stroke, working with mantra, chant and pranayama could be quite helpful for most students. Always start off with simple variations of these things. Encourage regular, repeated practice outside of class once the student has learned the new “pattern.” It is really the participating in a discipline that may ultimately lead to the positive changes we would hope for our students who have had a stroke. Another modality that may help is certain “eye exercises” that have made their way into modern yoga classes. And although I don’t have a lot of personal experience with these, you could seek out a teacher well versed in such techniques to learn and share with your students.
In addition, due to the fatigue associated with stroke, as well as the mental-emotional stresses that arise, restorative practices and yoga nidra can play a wonderful role in supporting the work of the other tools of yoga you have already introduced to your students. And for teachers just starting out, you often have been given very limited exposure to working with students with special needs, such as stroke survivors. So, I highly encourage you to look for workshops and post-graduate therapeutic training opportunities to increase your skills and competence in working with these special folks. I may return to this topic in the future, but for now, this should give you some ideas to start working with right away. All the best in this very worthwhile endeavor!