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Internationa Journal of Complementary & Alternative Medicine
Yoga after Traumatic Brain Injury: Changes in Emotional
Regulation and Health-Related Quality of Life in a Case-
Study
Submit Manuscript | http://medcraveonline.com
Volume 8 Issue 1 - 2017
1Department of Occupational Therapy, Colorado State
University, USA
2Department of Parks, Clemson University, USA
3Department of Physical Therapy, Indiana University School of
Health and Rehabilitation Sciences, USA
4Vera Z. Dwyer College of Health Sciences, Indiana University
South Bend, USA of Health and Rehabilitation Sciences, USA
*Corresponding author: Laura Grimm, 1Colorado
State University, College of Health and Human Sciences,
Department of Occupational Therapy, Fort Collins, CO, Tel:
315-373-9168; Fax: 970-491-6290;
Email:
Received: May 19, 2017 | Published: July 24, 2017
Research Article
Int J Complement Alt Med 2017, 8(1): 00247
Abstract
Purpose: The purpose of this study was to analyze changes in emotional regulation
and health-related quality of life (HRQOL) following a yoga intervention for three
participants with traumatic brain injury (TBI). Yoga was utilized as a modality to
improve HRQOL and emotional regulation.
Methods: A mixed method design was used to analyze changes in emotional regulation
and HRQOL. Participants completed an eight-week yoga intervention and assessments
were completed before and after the intervention. Outcome measures included the
Scale (QOLIBRI, both are reliable and valid after TBI. The Change in score (percent
change) were calculated for data from both assessments. Semi-structured interviews
were completed, data were transcribed, and qualitative data were analyzed with a
focus on emotional regulation and HRQOL.
Results: On average, the three participants had a 16% improvement in DERS scores
and 6% improvement in QOLIBRI scores following the yoga intervention. Analysis
to emotional regulation in the mind-body connection, peaceful and calm feelings,
concentration and focus, and self-control. In relation to HRQOL participants noted
self-development.
Conclusion: Yoga is a potential intervention to address emotional regulation and
HRQOL for individuals with chronic TBI. Emotional regulation and HRQOL are two
important factors affected post-TBI that through this study were impacted by yoga as
a focused mind-body intervention.
Keywords
Emotional Regulation; Health-related Quality of Life; Traumatic Brain Injury; Yoga;
Mind-Body Interventions
Abbreviations: TBI: Traumatic Brain Injury; HRQOL: Health-
Related Quality of Life; MMSE: Mini Mental Status Exam; DERS:
Therapist
Introduction
A traumatic brain injury (TBI) is a form of acquired brain
injury, resulting from damage caused by an external force to
the head [1]. The injury can be penetrating or non-penetrating,
creating an open or closed head injury. In 2010, it was estimated
that 2.2 million emergency room visits in the United States
resulted in a TBI diagnosis [2]. Over three million Americans are
living with a residual disability because of a TBI [3,4]. The effects
of TBI permeate the individual’s lifespan, potentially creating low
60% had either died or experienced functional decline [6]. Due
to alterations in brain function, a TBI can result in residual
impairments in physical, emotional, cognitive, social, and daily
functioning across the lifespan [7].
The impact of a health condition impairment on an individual’s
perception of function is known as health-related quality of
life (HRQOL) [8]. TBI is associated with multiple long-term
impairments in HRQOL [9], potentially affecting functioning
in physical, emotional, cognitive, and social domains [10].
Individuals with TBI often develop poor coping strategies
following the injury, which also negatively impacts HRQOL [11].
When HRQOL domains and coping are interrupted by a TBI, the
ability to understand limitations and adjust behaviors, known as
emotional regulation, may decline.
This ability to regulate emotions by managing behaviors and
making adaptations in social contexts [12,13] is important to
Yoga after Traumatic Brain Injury: Changes in Emotional Regulation and Health-
Related Quality of Life in a Case-Study 2/9
Copyright:
©2017 Laura et al.
Citation: Grimm LA, Van Puymbroeck M, Miller KK, Fisher T, Schmid AA (2017) Yoga after Traumatic Brain Injury: Changes in Emotional Regulation
and Health-Related Quality of Life in a Case-Study. Int J Complement Alt Med 8(1): 00247. DOI: 10.15406/ijcam.2017.08.00247
both psychological (cognitive) and social HRQOL domains,
that directly address emotional regulation [14]. Additionally,
emotional regulation can act as a predictor of HRQOL outcomes.
Regarding individuals affected by TBI, Henry et al. [15] found that
function [16]. Emotions, such as hope and optimism, have been
linked to higher scores in HRQOL [17]. In general, the ability to
cultivate positive emotions may be fundamental to well-being
[18], and may be particularly important following a TBI if an
individual’s emotional regulation capabilities are disrupted [13].
Negative changes in post-TBI HRQOL and emotional regulation
indicate a need for interventional research that can address these
important outcomes [13,7]. TBI creates a perceived mind-body
disconnect for many individuals [19]. A study by Fernros and
Furnhoff (2008) analyzed HRQOL changes following one week of
subsets of general health perception, and emotional well-being
[20]. Therefore, interventions focused on connecting the mind
and body may improve the emotional domain of HRQOL and
should be further studied for individuals with TBI in conjunction
with emotional regulation. Participants with stroke, another
neuropathology, reported an increased sense of connection
and emotional domains following a yoga intervention [21]. As
a mind-body practice focused on physical postures and mental
awareness, yoga can lend itself to a neurological population when
implemented by trained practitioners [22]. Currently, there are a
none targeting emotional regulation. Silverthorne et al, completed
improvements in physical functioning and emotional well-being
from baseline to nine months following the intervention [23].
In another related population, researchers evaluated an 8-week
yoga program for acquired brain injury [24]. They found that the
and participants reported high satisfaction ratings indicating that
yoga is potentially feasible for individuals with brain injuries.
Other studies examined the effects of mindfulness-based stress
reduction (MBSR) for individuals after TBI [25,26], and MBSR
programs contain a Hatha yoga element but are not designed
to be yoga interventions [27]. There is however more yoga-
to yoga interventions have been demonstrated in other clinical
neurological populations [28], such as: multiple sclerosis [29];
Parkinson disease [30-32]; and stroke [33,21]. Yet, there is
emotional regulation and HRQOL after yoga for individuals
with TBI. Many studies recommend that future research should
examine the role of yoga, or other non-pharmaceutical treatment,
for individuals with TBI [34,35]. The purpose of this study was
to analyze the participant reported outcomes of emotional
regulation and HRQOL, along with their perceptions of an eight-
week yoga intervention.
Methods
Design
This was a multi-methods case-study including three par-
ticipants and was focused on changes in HRQOL and emotional
regulation following a yoga intervention. Each participant
completed 16 sessions of yoga, twice a week for eight weeks, and
outcome data were collected before and after the eight-week yoga
intervention.
Participants
All participants were adults, 18 years of age or older, and
consented to the study following Institutional Review Board
TBI (greater than six months post injury). All participants
received occupational therapy or physical therapy services post-
TBI, but had completed all TBI rehabilitation prior to enrollment
in this study. In order to qualify for the study, individuals had to
score >4/6 on the Short Mini Mental Status Exam (MMSE)[36], be
able to speak, read, and understand English and be able to stand
with or without an assistive device.
Data collection
Demographic data, patient reported outcome data, and
qualitative data were collected by a trained research assistant.
Age, race, gender, marital/partnership status, and education were
all included as demographic data. Date of TBI, years since TBI,
and corresponding hemiparesis were also collected. Quantitative
assessments occurred before and after the yoga intervention
through use of the DERS and QOLIBRI.
Regulation Scale (DERS)
The DERS is a 36-item questionnaire, consisting of options 1
“almost never” to 5 “almost always” [37]. Six subscales are included:
lack of emotional awareness; lack of emotional clarity; non-
acceptance of negative emotions; lack of strategy building; lack
of control of impulsive behaviors; and inability to behave during
goal-directed emotions while experiencing negative emotions.
There are no established cut-off scores for TBI participants
when using the DERS. In this study, items were reverse scored
which made a higher total DERS score indicate higher emotional
regulation abilities.
Quantitative data collection-Quality of Life after Brain
Injury (QOLIBRI)
The QOLIBRI is a 37-item questionnaire that includes a 5-point
Likert scale with scoring from 1 “not at all very
cognition, feelings and emotions, autonomy and daily life, and
social relationships. Part two focuses on impact, in regard to
negative feelings and restrictions. The total score 0-100 acts as a
HRQOL measurement for individuals following TBI, with higher
scores indicating better HRQOL [39].
Yoga after Traumatic Brain Injury: Changes in Emotional Regulation and Health-
Related Quality of Life in a Case-Study 3/9
Copyright:
©2017 Laura et al.
Citation: Grimm LA, Van Puymbroeck M, Miller KK, Fisher T, Schmid AA (2017) Yoga after Traumatic Brain Injury: Changes in Emotional Regulation
and Health-Related Quality of Life in a Case-Study. Int J Complement Alt Med 8(1): 00247. DOI: 10.15406/ijcam.2017.08.00247
Qualitative data collection
Qualitative data were collected post intervention using an
18 question face-to-face semi-structured interview format. All
interviews were audio recorded for verbatim transcription.
Primary questions included, “What has been your overall
experience in the therapy program?” and “What did you expect the
yoga program to be like before it started?” Further questions were
developed as the interview progressed, and when appropriate
participants were probed for further information with phrases
like, “expand on that thought.”
Intervention
The intervention consisted of one-hour yoga sessions,
provided by a registered yoga therapist (RYT), bi-weekly for
eight weeks. Yoga was delivered in a 1:1 fashion and a research
assistant was available if needed to assist with postures or
advancing from seated, to standing, then supine, or quadruped on
and safety needs. Sessions began with breathing techniques to
enable awareness. Adjustments throughout the session included
support and ideal biomechanical alignment. Sessions ended with
ten minutes of progressive muscle relaxation alongside guided
meditation, with the RYT providing eye pillows while participants
were supine on their yoga mats. See Table 1 for a full description
of yoga postures and progression. Additionally, information on the
protocol has been previously published focusing on the physical
and balance outcomes [40].
Table 1: Yoga intervention.
Position (Week
Estimate) Description Yoga Practice:
Select Examples
Seated (Weeks 1-8)
Opening breathing
Breathing Practices:
i. Breath with sound
ii. Natural rate breathing
iii. Prolonged exhale breathing
iv. Alternate nostril breathing
Eye Movements, eyes opened or closed:
i. Diagonal
ii. Horizontal
iii. Circles
iv. Hourglass
Cervical Movements:
i. Rotations
ii.
Head Movements:
i.
Shoulder Movements:
i. Shoulder shrugs
ii. Shoulder forward rolls
iii. Shoulder backward rolls
iv. Rotations with shoulders in abducted position
v. Scapular protraction and retraction
Torso Movements:
i.
ii. Rotation
Breathing:
a. Ujjayi
b. Pranayama
c. Nadi Shodhana
Eye Movements:
a. Drishti Bheda
b. Pralokita, Saachi, Alokita
Head/Neck/Torso Movements:
i. Adapted Ardha Chandrasana
ii. Adapted Simhasana
iii. Ardha Matsyendrasana
Standing
(Weeks 3-8)
Using the wall or chair for support:
i. Calf stretch/hip extension
ii. Supported Toe Balancing
iii. Supported One leg balance
Standing Movements:
i. Tadasana
ii. Virasan
iii. Utkatasana
iv. Vrksasana
Yoga after Traumatic Brain Injury: Changes in Emotional Regulation and Health-
Related Quality of Life in a Case-Study 4/9
Copyright:
©2017 Laura et al.
Citation: Grimm LA, Van Puymbroeck M, Miller KK, Fisher T, Schmid AA (2017) Yoga after Traumatic Brain Injury: Changes in Emotional Regulation
and Health-Related Quality of Life in a Case-Study. Int J Complement Alt Med 8(1): 00247. DOI: 10.15406/ijcam.2017.08.00247
Floor
(Weeks 3-8)
Quadruped:
i.
ii. Opposing hip and shoulder extension
Prone:
i. Thoracic extension
ii. Tricep extension
iii. Hip extension
a. Full body extension
Supine
a. Holding knees to chest
b.
c. Pelvic tilts and holds with guided isometric
contractions
Relaxation
a. Guided relaxation
b. Targeting certain muscles and areas with breath
Movements on all Fours:
i. Purvottanasana
ii. Marjaryasana
iii. Bitilasana
iv. Ardha Pincha Mayurasana
Movements on Stomach:
i. Chakravakasana
ii. Bhujangasana
iii. Salambhasana
Movements on Back:
a. Pawanmuktasana
b. Ananda Balasana
c. Setu Bandha Sarvangasana
d. Savasana
Relaxation:
a. Samadhi
Data Analysis
Quantitative data
Quantitative data were analyzed using SPSS 20.0 (Chicago, IL).
Demographic data were described using descriptive statistics:
means and standard deviations or frequencies and proportions.
Pre and posttest means and standard deviations are included for
the DERS and QOLIBRI scores. With the case study format of three
participants, researchers calculated a percent change for each
outcome measure (Posttest—Pretest/Pretest x100).
Qualitative data
Transcripts were transcribed verbatim by a trained research
assistant into a word processing document and then were
imported into NVivo for analyses (NVivo 10 QSR International,
Victoria, Australia). Transcripts for qualitative data were
analyzed and coded by two trained researchers. Two primary
analyses and therefore focused on the variables of interest:
HRQOL and emotional regulation. Secondary themes then
evolved with multiple researchers through an iterative consensus
building process. Through this process, researchers agreed upon
reoccurring subthemes which emerged during analysis of semi-
structured interviews (Figure 1). Researchers then used NVivo
and comparison. Qualitative comments that best illustrate each
code or theme are included in the results.
Figure 1: Primary and Secondary Themes derived from Participant Interviews.
Results
Demographics
Three individuals enrolled and completed the yoga
intervention. Two were female, two were more than ten years post
TBI, and one was married. See Table 2 for additional demographic
and TBI characteristics.
Yoga after Traumatic Brain Injury: Changes in Emotional Regulation and Health-
Related Quality of Life in a Case-Study 5/9
Copyright:
©2017 Laura et al.
Citation: Grimm LA, Van Puymbroeck M, Miller KK, Fisher T, Schmid AA (2017) Yoga after Traumatic Brain Injury: Changes in Emotional Regulation
and Health-Related Quality of Life in a Case-Study. Int J Complement Alt Med 8(1): 00247. DOI: 10.15406/ijcam.2017.08.00247
Table 2: Demographic Information.
Variable Participant One Participant Two Participant Three Mean
n=3
Age 42 48 43 44.33±3.22
Gender Female Female Male Two female (67%)
Race White ‘Other’ White Two white (67%)
Years since TBI 21 28 9 19.33±9.6
Corresponding hemiparesis Yes Yes Yes Hemiparetic (100%)
Age at time of injury (years) 22 21 35 26±7.81
Medication for anxiety (current) No No Yes No
Medication for depression
(current) Yes No Ye s Ye s
Partner Single Widowed Married
Education (any college) Post-graduate Some college Some college Some college (100%)
Quantitative data
DERS scores indicated overall improvements, the mean DERS
score improved from 94.67 to 109.67, a 16% improvement. Two
out of three participants presented higher scores indicating
improved emotional regulation capabilities (Table 3). Participant
three showed the largest change, with an increase of 36%
following the yoga intervention.
QOLIBRI scores improved for all three participants following
the intervention (Table 3). Individually, scores increased from
between 5% and 8%, showing an improved perceived HRQOL.
The overall mean score increased from 108.33 to 115.33, which
is a 6% positive change. Further analysis was then obtained using
semi-structured interviews.
Table 3: Emotional Regulation and Health-Related Quality of Life Changes.
Outcome Measure n=3 Baseline
Score
8 weeks
Score % Change
Participant 1 82 80 -2%
Participant 2 118 135 14%
Participant 3 84 114 36%
Mean (SD) 94.67 ± 20.23 109.67 ± 27.75 16%
Quality of Life After Brain Injury
Participant 1 133 144 8%
Participant 2 84 89 6%
Participant 3 108 113 5%
Mean (SD) 108.33 ± 24.50 115.33 ± 27.57 6%
Emotional regulation qualitative data
Driven by the research questions, two primary themes were
examination and analysis of the semi-structured interviews.
Secondary themes within emotional regulation included: Mind-
Body Connection; Peaceful & Calm; Concentration & Focus; and
Self-Control (Figure 1). The data showed an improvement in
overall self-perceived ability to regulate or manage emotions.
Certain quotes from the data have been previously published in
a manuscript on the physical effects of yoga for chronic TBI [40].
A few of these quotes bear repeating due to the powerful nature
questions.
Mind-body connection
Two participants acknowledged how yoga practice facilitated a
stronger relationship between the mind and body. Participant One
TBI, he stated “I mean mine’s what? 19 years, 20 years after, and
I’m noticing different things that…are improving. I mean I think
that it would be incredibly valuable to someone with [a] brain
injury that was just because of the connection.” Participant Two
Yoga after Traumatic Brain Injury: Changes in Emotional Regulation and Health-
Related Quality of Life in a Case-Study 6/9
Copyright:
©2017 Laura et al.
Citation: Grimm LA, Van Puymbroeck M, Miller KK, Fisher T, Schmid AA (2017) Yoga after Traumatic Brain Injury: Changes in Emotional Regulation
and Health-Related Quality of Life in a Case-Study. Int J Complement Alt Med 8(1): 00247. DOI: 10.15406/ijcam.2017.08.00247
also noted the connection and simply stated, “I am more mindful”.
others with chronic TBI, an increased connection between mind
and body surfaced from the interviews.
Peaceful & calm
to emotional regulation. One participant commented on how
increased peacefulness during or after yoga had led to calmer
feelings throughout daily activities, “It’s more real now…I feel
participant stated, “it was very peaceful.” Another participant
noted his control in the way of revving up or relaxing: “The
breathing techniques were huge… [In] how to calm myself down
or how to ram [rev] myself up.” Attention to breath had provided
an opportunity to elicit a peaceful awareness.
Concentration & focus
Cognition may be impacted post-TBI, in this study concentration
and focus emerged as a noted improvement from yoga by two of the
participants. For example, Participant Three compared previous
addressed the ability to “now be able to concentrate,” in a way that
he had not previously seen improvements, despite specialized TBI
interventions. Expanding on the concentration piece, he noted
that his attention was more focused on his kids at tee ball and he
did “not constantly scan the crowds or you know all the people
around it’s just there’s so many things that just made my life
better.” Contextually, his statement was in regard to not needing to
scan the crowds for terrorists or harm, given he is a veteran with a
brain injury, post-traumatic stress, and multiple physical injuries.
Self-control
Another theme which emerged under emotional regulation was
self-control. Participant Two did not experience an improvement
in DERS scores but described her overall improvement in self-
control, stating that for her the yoga intervention was “more
mental” with a focus on “getting more self-control.” Participant
Three, the veteran, discussed using the breathing techniques
and eye movements learned in the program as a method of self-
control “to ground you in the here and now,” and as an escape
from continuing to perceive the threats of Iraq in his home,
while driving, and elsewhere in his day to day life. He discussed
these improvements through daily activities, as well as within an
overarching sense of self-control that he received from the yoga
intervention.
Health-related quality of life qualitative data
HRQOL was a qualitative primary theme and included the
following secondary themes: Social Changes; Physical Changes
Development (Figure 1).
Social changes
Relating to HRQOL, all participants described an increase in
social engagement as the result of this yoga intervention. One
impacted in the form of “wanting to go out more and to have that
and engagement due to the yoga intervention emerged as a theme
from all three participants.
Physical changes leading to life changes
from yoga practice became a vehicle to complete their chosen
meaningful activities. Participant One expressed that halfway
through the intervention he was engaging in an occupation he
had been missing, “I started playing golf…last September - and
this year. It was only the second time I’d ever played a full-size
course [since my injury].” Participant Two similarly discussed the
impact of physical improvements and stated: “I learned…that I
could make my body move and accomplish feats that I didn’t think
were possible.” Due to the yoga intervention Participant Three
highlighted the daily improvements related to strength, “I’ve got
more strength in my legs and I’ve got more stamina now…to be
able to go out.”
People who have experienced TBI often report dissatisfaction
performance in life [41]. Two out of three participants indicated
yoga intervention. This improvement allowed them to complete
more desired activities. For example, one participant noted the
go back to school and start and complete my degree.”
Self-development
The semi-structured interview revealed statements from all
three participants regarding personal growth. One participant
noted yoga as a form of self-development, and indicated “I used it
more…to…develop myself, that’s what I appreciate more, the self-
development.” While another participant stated, “I’m not quite as
hard on myself,” in response to how life was different following
the program.
Interaction of multiple HRQOL themes
relationship in HRQOL: “I mean it’s rocked my world. It’s changed
my life. I mean all the different aspects.” For him, all the HRQOL
changes culminated in perceived new capability in his role as a
father: “this has changed my world and given me a new life back,
because I’ve got a new opportunity now with my two youngest
sons to be the Dad that I couldn’t be, in my eyes, to my older kids.”
He further commented on several HRQOL domains “physically,
emotionally, mentally…it’s given me, you know, my life back. It’s
opened up so many doors for me.”
Discussion
These data indicated that an eight-week yoga intervention for
Yoga after Traumatic Brain Injury: Changes in Emotional Regulation and Health-
Related Quality of Life in a Case-Study 7/9
Copyright:
©2017 Laura et al.
Citation: Grimm LA, Van Puymbroeck M, Miller KK, Fisher T, Schmid AA (2017) Yoga after Traumatic Brain Injury: Changes in Emotional Regulation
and Health-Related Quality of Life in a Case-Study. Int J Complement Alt Med 8(1): 00247. DOI: 10.15406/ijcam.2017.08.00247
people with TBI is potentially an impactful modality to address
HRQOL and emotional regulation. The three individuals included
in this multi-methods study showed an overall improvement in
QOLIBRI and DERS scores, as well as perceived improvements
as evidenced by the semi-structured interviews. The QOLIBRI
provided a foundation for HRQOL domain analysis, and the
data from the DERS elaborated on the “emotions” domain
the QOLIBRI assesses emotions, but also includes the additional
domains: cognition, general “self”, daily life and autonomy, social
relationships, and physical problems [14]. Emotion was then
further explored with the DERS through six subsets assessing
emotional regulation: “(a) lack of awareness of emotional
responses; (b) lack of clarity of emotional responses; (c) non-
acceptance of emotional responses, (d) limited access to emotion
controlling impulses when experiencing negative emotions,
experiencing negative emotions” [37]. This three-person format
then allowed for in-depth discussion and understanding of
each domain through analyses of semi-structured interviews.
Researchers focused on the participants’ perspectives and
regulation for the three participants.
Emotional regulation
Emotional regulation can be viewed as the constant situational
adaptation of behaviors to meet social expectations. This study
separated four subsets of emotional regulation that emerged in
qualitative interviews: mind-body connection, peaceful & calm,
concentration & focus, and self-control. Yoga interventions
frequently include attention to mindfulness, or moment-to-
moment awareness through the development of adaptive
emotional regulation. Azulay and Mott (2016) implemented
improvements in DERS scores for individuals with mixed brain
injuries [43]. Mindfulness programs may target the disconnect
between the mind and body, which is a common theme for
individuals with neurological impairments [44,19]. The current
study presented qualitative data which described an increased
mind-body connection for three participants following a yoga
intervention.
Further, previous research indicates that yoga can trigger the
ability to implement a relaxation response [45,46], this supports
the presented qualitative results regarding increased peaceful
and calm feelings. A study done with individuals diagnosed with
multiple sclerosis assessed emotional regulation and found that
higher emotional regulation correlated to improved scores in
psychological and environmental QOL domains [47]. Participants
in the current study highlighted HRQOL domains that were affected
in conjunction with emotional regulation changes. In a different
study, researchers used the DERS measure and found that, in 50
participants with TBI, global distress strongly related to lower
DERS scores [48]. High negative correlation between emotional
addressing emotional regulation. Furthermore, continuous
emotional regulation can lead to higher life satisfaction [49],
reasoning that emotional regulation and quality of life cannot
be disentangled, and measurement together is cornerstone to
future treatment planning for individuals with neurological
impairments. Collectively, these data represent preliminary
case study evidence for an individualized yoga intervention and
support further exploration of yoga as a treatment intervention
post-TBI.
Health-related quality of life
to decreased ability to sustain meaningful relationships, which
leads to a reduction in overall quality of life [15]. This study
divided HRQOL into four subsets that emerged during qualitative
analysis of the interviews: social change, physical changes leading
by Hawthorne, Gruen, & Kaye (2009) found that lower HRQOL is
associated with decreased social interactions [50]. Individuals with
TBI generally report lower HRQOL [50]. All three participants in
this study discussed their increased social participation following
the yoga intervention, which was supported by increased HRQOL
yoga study for healthy older adults; those who participated in
than the control or exercise groups [51]. Improvements in social
engagement may potentially be related to increase varying
following a yoga intervention.
Regular yoga practice has been connected to increased
they had avoided since their TBI. In a mindfulness study for
a population with mixed (ex. anoxic, traumatic) brain injury,
and well-being through mindfulness [43]. Another part of
self-reported physical improvements, which allowed for a return
to participation. The relationship between physical changes,
eight-week yoga intervention study, which revealed increased
with chronic stroke [53]. The results can be interpreted to show
a relationship between the physical component of balance, the
improvements. All three participants in this current study
discussed how physical changes had promoted increased life
involvement. Participant One, for example, returned to his
the yoga intervention. Silverthorne et al. (2012) implemented
breath-focused yoga, for individuals with severe TBI, and found
being, and overall health [23]. Tying together the important
factors included in emotional regulation helps to perhaps explain
some of the improvements seen throughout HRQOL in this study.
Yoga after Traumatic Brain Injury: Changes in Emotional Regulation and Health-
Related Quality of Life in a Case-Study 8/9
Copyright:
©2017 Laura et al.
Citation: Grimm LA, Van Puymbroeck M, Miller KK, Fisher T, Schmid AA (2017) Yoga after Traumatic Brain Injury: Changes in Emotional Regulation
and Health-Related Quality of Life in a Case-Study. Int J Complement Alt Med 8(1): 00247. DOI: 10.15406/ijcam.2017.08.00247
Limitations
Limitations in this study include that there was no control
group and a small sample size, which is common in emerging
mind-body intervention research and continues to be a limitation
especially in neurological populations [22]. The size makes it
this line of research. In addition, severity of impairment (mild,
moderate, severe) and the location of the injury were not included
in the demographic data. Therefore, researchers analyzing these
data cannot discuss changes following yoga as they relate to
Strengths and implications for future research
for yoga interventions. This study highlights an intervention
strategy that improved emotional regulation and HRQOL scores
for individuals with TBI. To generalize the results and prove
important to consider the strengths of a small yoga group. In this
study, participants were provided individualized adaptations and
adjustments throughout yoga sessions, tailoring each session to
meet the participants’ needs. Hands-on adaptation and attention
to each participant could have been a reason for the positive
results seen in HRQOL and emotional regulation. However, a
group yoga intervention for people with TBI should be tested to
meet social and economic needs.
Conclusion
This study provides preliminary evidence that an eight-week
emotional regulation and HRQOL for individuals with chronic
TBI. Improvements were seen with this sample, and this study
highlights the importance of assessing emotional regulation
along with HRQOL for individuals with TBI. However, further
research is warranted because this study was not large enough to
be generalizable.
Acknowledgments
Dr. Schmid and this study were supported by a Veterans
Administration Career Development Award (VA RR&D CDA
D6174W). We thank Nancy Schalk, a yoga therapist, for
developing and teaching the yoga intervention to each of the study
participants. We also thank the Indiana University Occupational
Therapy students involved with this research: Erin Debaun-
Sprague, MS OTR; Elizabeth Short, MS OTR; Jenna Mitchell, MS
OTR; Laura Montgomery, MS OTR; and Tiffani Davis, MS OTR.
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