A stroke, also know as a cerebral vascular accident (CVA), occurs when there is interrupted blood flow to the brain resulting in brain cell death. It is commonly caused by a thrombosis (stationary clot), embolism (floating clot), or hemorrhage (bleeding) in the brain. Recent data from the American Heart Association estimates that about 33 million individuals per year suffers a new or recurrent stroke. Stroke occurs more often in women than men and currently is the second leading cause of death behind heart disease world wide. Of the 795,000 individuals diagnosed with stroke in the United States, about 66% will survive the incident. Stroke is the leading cause of long term disability in the US and it is the leading cause of PREVENTABLE disability.

It has been estimated that Americans spent $65.5 billion dollars in medical care cost related to disability from stroke in 2008. Additionally, about 30% of all stroke cases diagnosed in the United States, each year, have had a history of previous stroke. Several risk factors for stroke have been identified and often fall into 2 categories, those are uncontrollable factors which include family history, age, gender, medical history of clotting disorders and race. Preventable, which include, unhealthy diet, heart disease, alcoholism, sedentary lifestyle, smoking, high cholesterol, high blood sugars, and obesity.

The American Heart Association has goal is to increase the cardiovascular health of Americans by 20% by the year 2020. Their goal is to improve the “ Life’s Simple 7” or the preventable risk factors of heart disease and stroke. Neurologic impairment in the individual survivor depends on the size and location of the stroke. A stroke survivor may present with impaired motor and/or sensory function, loss of balance and coordination, visual deficits, hearing loss, impaired cognitive functioning, disruption of speech as well as emotional issues. The typical course of treatment in the United States for a stroke survivor starts with admission to an acute care hospital. Once the patient is medically stable, the rehabilitation process begins. Rehabilitation is critical to stroke recovery. The goal of rehabilitation is to return the survivor to their optimal daily activities after a stroke. Physical, Occupational, Speech Therapist, along with other health care specialist work with a stroke survivor in the acute care setting prior to rehabilitation placement. The stroke survivor may be transferred to an inpatient setting for an intense period of rehabilitation, followed by discharge to home with outpatient therapies continued in the home and/or clinic setting.

In the United States, eighty percent of all stroke survivors will return to their home and families following rehabilitation. Recovery guidelines tend to be general, since each stroke survivor presents with different needs. According to the National Stroke Association, 10% of all survivors recover completely, 25% recover with minor impairments, 40% experience moderate to severe impairments requiring special care, 10% require long term care and 15% will die shortly after stroke. Length of recovery and lasting impairments are different for each stroke survivor but studies, show that stroke survivors can continue to improve their sensorimotor function, and aerobic capacity many months after having a stroke. Despite continued recovery post- rehabilitation, stroke survivors face the risk of stroke recurrence, complications from inactivity from a decrease in their motor skills, depression, social isolation, and the reduction of their risk factors that may have lead to their stroke in the first place. Yoga can be an extremely powerful adjunct therapy in the treatment of the stroke survivor. While the stroke often affects the individual’s physical body, it also affects the social, emotional and spiritual “bodies” of the survivor. The impact of stroke affects the family and friends of the the survivors as well. Yoga’s multifaceted approach allows for work in several areas including breathing, movement, reduction of stress, anxiety and depression, as well as diet and lifestyle management. Small group yoga classes are beneficial in reducing the social isolation that many survivors face.

Additionally yoga allows for the Survivor to be in charge of their journey. They are an active participant instead of a passive recipient. Yoga can be utilized in conjunction with traditional standards of care for stroke survivors as well as an excellent self management tool and long term care approach post rehabilitation. While yoga studies looking specifically as stroke to date have been small in scale and warrant further research, but has shown to benefit the stroke survivor. A review of the most recent research shows:

• Yoga provides a general benefit to the stroke survivor

• Yoga is a useful adjunct to formal rehabilitation post stroke

• Improvements in quality of life measures and improvements in mental health were seen following yoga intervention for the stroke survivor

• Yoga and mindfulness could be clinically valuable for intervention for the stroke survivor

• Therapeutic yoga my improve multiple aspect of the physical function after stroke and maybe a complement to traditional medicine

• Group yoga maybe complimentary to rehabilitation in both medical based and community based settings

• Yoga is cost effective treatment

• Yoga may be a promising intervention in the management of fear of falling and improve balance there by reduce the the fall risk in older individuals Strokes impair each person differently.

The saying goes, when you have met one person with a stroke you truly have met one person with a stroke. Below are some of the short and long term impairments and issues that may happen with a stroke:

• Seizures

• Orthopedic issues

• Loss of sensation

• Hearing loss or heightened

• Visual disturbances

• Neglect of the affected side

• PTSD

• Depression and Social Isolation

• Fatigue

• Loss of Mobility

• Loss of ROM

• Obesity/Sedentary life style

• Risk of secondary stroke

• Need adaptive equipment, braces and slings

• Vestibular impairments

• Impaired judgement

• Aggression

• Irritability

• Emotional difficulty

• Abnormal muscle tone

• Gait disturbance

• Balance impairments

• Coordination and proprioception issues

• Other issues which may have been the cause of the stroke in the first place such as heart disease, diabetes, obesity, carotid stenosis

Yoga’s multifaceted approach can be beneficial in addressing these and other issues that arise post stroke and helping the yoga student to develop a long term, self care practice. In looking specifically at the poses (asana) or the movement component of yoga. The American Heart Association published in 2004 (and subsequent revision in 2014), “Physical Activity and Exercise Recommendations for Stroke Survivors”. This document provides a scientific statement the accepted standards of care for stroke survivors and movement. Some of the key points of this scientific statement as it relates to yoga and include: Stroke survivors benefit from counseling on participation in physical activity and exercise training. Aggressive rehabilitation beyond the usual 6 month period increases aerobic capacity and sensorimotor function. Stroke risk can be reduced with regular leisure-time physical activity in individuals of all ages, sexes and ethnicities This scientific statement further emphasizes that “physical activity remains a corner stone in the current armamentarium of risk-reduction therapies for the prevention and treatment of stroke.”

The American Heart Association recommends that stroke survivors participate in a program which includes resistance training, flexibility and neuromuscular training, at an intensity, frequency and duration that is appropriate for each individual survivor’s level of fitness. The statement also points out that each “survivor will require an individual approach”; and additionally, it recommends that to increase compliance, the issues of family support and social isolation need to be addressed and resolved. In addition physical therapy literature has shown exercises specific to balance can help reduce falls. Yoga asana can address all of these needs. While research into specific pranayama (breathwork) practices has not looked at the benefit to those who have had a stroke,the known general benefits of a practice does have benefit to the survivor.

Pranayama practices help to maintain normal alignment in the spine and chest wall and strengthen muscles around the lungs including the diaphragm and the intercostal muscles. Yoga practitioners learn to identify inefficient breath patterns and through regular practice often learn to adopt a more efficient pattern. For the stroke survivor, it is important to choose breath practices that stimulate the parasympathetic nervous system which has been shown to help lower stress, anxiety, depression and improve mental concentration.

Studies in mindfulness practices while not looking specifically at stroke have shown increase gray matter concentration in the brain in the area of learning, memory, and emotional regulation. People who meditate sense more tactile feeling in their body, and studies have demonstrated consistent attention to focus, enhance sensory awareness and sensory experiences. Meditators also have shown an increase parasympathetic activity which is important for the stroke survivor. Studies have also shown meditators show decreases in rumination, stress emotional reactivity and better relationship satisfaction. Strokes unfortunately do not happen in isolation. Stroke survivors are left with the residual affects of the stroke.

Some yoga practices are contraindicated for stroke survivors as well as their underlying medical issues. So it is imperative that prior to beginning yoga that a stroke survivor have clearance from a physician and the stroke survivor work with a yoga therapist experienced in neurologic issues, or a licensed health care practitioner who integrated yoga into their practice.

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