Depression and Fatigue

(ACABCHUCK ET AL.,L 2020)

This first-ever meta-analysis on meditation, yoga, and mindfulness-based interventions for chronic symptoms of mTBI offers hope but highlights the need for rigorous new trials to advance clinical applications and to explore mechanistic pathways. Twenty studies (N = 539) were included. Results revealed significant improvement of overall symptoms compared to controls (d = 0.41; 95% CI [0.04, 0.77]; τ2 = 0.06), with significant within-group improvements in mental health (d = 0.39), physical health (d = 0.39), cognitive performance (d = 0.24), quality of life (d = 0.39), and self-related processing (d = 0.38). Symptoms showing greatest improvement were fatigue (d = 0.96) and depression (d = 0.40). Findings were homogeneous across studies. Study quality concerns include lack of randomiZation, blinding, and recording of adverse events.

 

Memory, Self-Efficacy, and Quality of Life

(AZULAY ET AL., 2013)

This pre-post study evaluated the effectiveness of a 10-week Mindfulness-Based Stress Reduction (MBSR) program tailored for mild TBI.  The MBSR program included a series of mind-body practices, specifically body scan (i.e., systematically scanning the body with awareness), walking meditation, sitting meditation, and yoga. Participants included 22 individuals (11 men, 11 women) who were within 7 months post-injury and ranged in age from 18 to 62 years. The MBSR program involved enhancement of attentional skills, in addition to increased awareness of internal and external experiences with an attitude of acceptance and non-judgment.

Clinically meaningful improvements were noted on measures of quality of life (Cohen's d = 0.43) and perceived self-efficacy (Cohen d = 0.50) with smaller but still significant effects on measures of central executive aspects of working memory and regulation of attention.

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Best practices for adapting and delivering community-based yoga for people with traumatic brain injury in the United States

(CHAUHAN ET AL. 2020)

This cross-sectional, mixed methods study used an online survey among 175 yoga teachers trained to teach yoga to people with TBI through the LoveYourBrain Yoga program. Responses were analyzed using descriptive statistics and qualitative content analysis. 86 teachers (n=50%) responded. Best practices for adapting yoga for TBI revealed six themes: simple, slow, and repeated, creating a safe space, position of the head and neck, demonstration, importance of props, and special considerations for yoga studios, and three themes for yoga program delivery: structured yet flexible, acceptability of compensation, and time management. 89% of teachers reported using the manual to guide their classes was either very/extremely helpful, yet nearly half (49%) adapted the manual content often/always. To deliver accessible, community-based yoga services to the TBI population, we recommend using a manual that allows for flexibility and an environment that has low light and noise, props, and sufficient space. We also recommend ensuring yoga teachers have skills in offering physical modifications for the head and neck; slow, simple, and repeated cueing to facilitate cognitive processing; managing challenging behaviors through redirection techniques; and promoting safety through inclusivity, compassion, and personal agency. Training yoga teachers in best practices for TBI-specific yoga may be a strategic approach to meeting the gap for accessible community-based services among this population.

 

Strength, Balance, and Endurance

(SCHMID ET AL., 2015)

In this study, 3 TBI survivors participated in an 8-week one-on-one yoga program. Participants were on average about 19 years postinjury. Each yoga class was 1-hour in length and offered twice a week, and became progressively more challenging. All yoga sessions included breathing, yoga postures (seated, standing, and floor), and 10 minutes of guided meditation/relaxation.

Participants experienced more strength, balance, endurance, and flexibility. All participants reported that yoga had a positive impact on their life and improved their recovery.   

 

Mental Fatigue and Information Processing

(JOHANSSON ET AL., 2012)

In this study, 19 individuals with TBI or stroke were randomized to participate in an 8-week Mindfulness-Based Stress Reduction (MBSR) program or as no-treatment controls. The MBSR program included weekly 2.5-hour long group sessions and home practice for 45 minutes of gentle yoga, body scan (systematically scanning the body with awareness), and sitting meditation.

Participants experienced significant improvements in mental fatigue (MFS) and in neuropsychological tests (i.e., Digit Symbol-Coding and Trail Making Test), with specific focus on information processing and attention.

 

Attention

(COLE ET AL., 2015)

In this pre-post pilot study, 9 Veterans with post-traumatic stress disorder (PTSD) and a history of mild TBI with chronic cognitive complaints participated in an 8-week Mindfulness-Based Stress Reduction (MBSR) program.

There were significant improvements in participants’ attention control immediately following MBSR and largely sustained improvements 3 months after completion. There were also significant reductions in PTSD symptoms immediately after MBSR, which were also sustained 3 months following completion.

 

Physical and Emotional Well-being

(SILVERTHORNE ET AL., 2012)

This study investigated the respiratory, physical, and psychological functioning of 10 individuals with severe TBI (6 men, 4 women) who attended weekly chair-yoga classes as compared to 4 no-treatment controls (3 men, 1 woman).

The yoga group experienced improvements in several measures of respiratory functioning and physical and emotional well-being over 9 months. The control group also had positive trends in physical functioning and general health, but they did not experience improvements in as many outcomes as the yoga group.

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A qualitative study of LoveYourBrain Yoga: a group-based yoga with psychoeducation intervention to facilitate community integration for people with traumatic brain injury and their caregivers

(DONNELLY ET AL. 2019)

Researchers interviewed 13 people with TBI and 3 caregivers who had participated in LYB Yoga. Participants reported improvements in strength, balance, flexibility, and attention control, and a greater sense of belonging, community connection, and ability to move forward with their lives. Participants reported ongoing use of tools (e.g., breathing exercises) to cope with negative emotions and stress. About half of participants sustained relationships built during LoveYourBrain Yoga and felt more capable of accessing other activities in their community. Our results show that LoveYourBrain Yoga led to diverse and meaningful physical, psychological, and social health benefits, which suggest that it may be an effective mode of community-based rehabilitation.

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Feasibility of a Combined Neuromodulation and Yoga Intervention for Mild Traumatic Brain Injury and Chronic Pain: Protocol for an Open-label Pilot Trial

(KRESE ET AL. 2021) 

The aim of this study is to (1) develop a combined iTBS+yoga intervention (based on LoveYourBrain Yoga) for mTBI and chronic pain, (2) assess the intervention's feasibility and acceptability, and (3) gather preliminary clinical outcome data on quality of life, function, and pain that will guide future studies. 

 

Quality of Life

(BEDARD ET AL., 2009)

This pre-post pilot study examined a mindfulness-based stress reduction approach to improve quality of life among individuals affected by TBI. The intervention comprised 12-weekly group sessions including insight meditation, breathing exercises, guided visualization, and group discussion. The intention was to encourage a new way of thinking about disability and life to bring a sense of acceptance, allowing participants to move beyond limiting beliefs.

They found significant improvements in quality of life among the 10 people who participated in the intervention, while no improvements were found among the 3 people in the control group. 

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The feasibility and impact of a yoga pilot program on the quality-of-life of adults with acquired brain injury

(Donnelly et al., 2017)

Alongside Dartmouth College, LYB conducted a pre-post evaluation of an 8-week gentle yoga program for people with acquired brain injury.  This study included 31 adults with ABI who were allocated to yoga (n = 16) or control (n = 15) groups. People who participated in the yoga program experienced significant improvements in their overall quality of life (measured by the valid and reliable TBI-specific Quality of Life after Brain Injury scale), as well as a more positive sense of themselves and their capabilities and their ability to manage negative emotions. We used the results of this study to inform the design of our current yoga program curriculum, which is based on the science of resilience. 

 

A crossover pilot trial of the feasibility, acceptability, and effectiveness of LoveYourBrain Yoga for community-dwelling adults with multiple sclerosis

(Donnelly et al., 2022)

Although yoga is among the top most popular forms of complementary and alternative medicine used for multiple sclerosis (MS) symptom management, yoga services that are safe and specific to the MS community are largely inaccessible. This crossover pilot trial compared LoveYourBrain Yoga to a control among 15 people with MS living in rural Vermont or New Hampshire. Significant improvements were found in fatigue, positive affect and wellbeing, and anxiety after LoveYourBrain Yoga compared to the control. The results suggest LoveYourBrain Yoga may improve a range of MS symptoms and offer a means for acquiring new skills for stress reduction, anxiety management, and overall wellbeing. Participants also reported high satisfaction and over 92% would ‘definitely, yes’ recommend LoveYourBain Yoga to a friend or family. Our results show that LoveYourBrain Yoga improved a range of health benefits, which suggest that it may be an effective mode of community-based rehabilitation for MS. 

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Cognitive Function

(MCMILLIAN ET AL., 2010)

This randomized controlled trial offered a brief (4-week) mindfulness intervention for individuals affected by TBI. This study found no differences on objective or self-report measures of cognitive function, mood or symptom reporting. Researchers postulate that the brevity of the intervention may explain the lack of effect.