Introduction and Overview
Again, I am surrounded by yoga in Colorado which is a really exciting place to do my research. We have 3 objectives as listed above that we will talk about today. One is talking about impairment after a stroke, specifically things like balance and balance self-efficacy, and why we think those things are important, and then, to the part that we are excited about, why yoga might work for different people, particularly people with stroke, and why it might make sense for OTs to use yoga. Then, additionally, I have done a couple of research studies specifically about yoga for people with chronic stroke. We will really dive into those methodologies and the results of that study, and then talk more throughout the presentation about what some yoga practices or postures are, and how can we bring this to our client with chronic stroke.
We have a few slides here about stroke but we will not go as far into depth as we might need to if it was a different population or a different group of people here with us today.
Stroke
Stroke is bad and that is because there are so many people in our country that have had strokes. About 800,000 new strokes happen per year and there are a lot of physical, cognitive and emotional disabilities that arises from this condition as seen in Figure 1.
Figure 1. Stroke stats.
The big takeaway from this slide is that it is the primary rehab diagnosis that we work with as OTs in the United States. While there are many, many things that happen after a stroke, we are going to focus on some of the physical aspects. We are even going to talk a little bit about gait and the idea of mobility. Mobility is certainly very important, but as OTs, we do not always necessarily think about that. We are going to touch on gait speed and endurance, and then balance and falls, fear of falling, pain and strength, and range of motion. One of the big things that we will talk about today is balance self-efficacy.
Common Post-Stroke Impairments
Again, as OTs, we do not necessarily always talk about or think about gait speed and endurance, but I think it's really important for us to consider. There are a lot of people out there who actually think that gait speed is very important and that it might even be considered the sixth vital sign.
Figure 2. Post-stroke impairments.
Gait Speed
Figure 3. Gait speed and endurance.
When we think of vital signs, blood pressure and things like that, we need to add gait speed (Figure 3) to that. There is a whole another camp though that thinks pain is really the sixth vital sign and is very important to function and quality of life in those big outcomes. I think as OTs, it is important for us to think about gait speed being important as it is related to ADLs and IADLs. Can you make it across the street before the hand on the sign goes away?
Gait Endurance
The other piece of gait that we will talk about is endurance (also noted in Figure 3). Endurance is measured by how many feet can you walk in 6 minutes, or the 6 Minute Walk Test. I really like this test because it really gets to the idea of, "Can I walk around the whole grocery store? Can I walk outside, down the street, and get to the bus stop?" That really is related to OT and what we want as outcomes for our clients. Some people and therapists think that gait speed is the most important thing to address in therapy. However, when we ask the clients, which is what we should be doing, they actually say that it is endurance that is important. I think that is really important for us to think about as OTs who are thinking about doing yoga. We will talk about that more, but I just want to get everybody on the same page.
Balance Impairment
The next thing we will talk about is balance. Balance is very important after a stroke (Figure 4).
Figure 4. Balance after stroke.
For those of you in the audience working with people with stroke, you know that it's very often impaired. It could be sitting or a standing balance and it's really complex because there's actually primary damage or damage that happens to the primary central cores of the brain with the stroke. Then there's all of these other secondary effects of the stroke, responses, musculature, the nervous system, mobility, sensory. Balance is very complex to try and help make it better for people with stroke. Really interestingly, we know that balance is related to quality of life. If you have better balance, in general, your quality of life is balanced after stroke.
