Guide to Yoga Sequencing for Individuals Diagnosed with a Stroke

Disclaimer

This is for educational purposes only and is not intended to treat, diagnose, or cure any illness of disease. Although yoga may have benefits for individuals with stroke, yoga should be used as a tool and not as the sole intervention in a patient’s rehabilitation plan.

Background

Yoga is an ancient practice that originated in India and is characterized as a mind-body discipline aimed at developing concentration and awareness. The word "yoga" is derived from the Sanskrit root "yui," which means "to yoke” or join together.

The Eight Limbs of Yoga

• Patanjali’s Yoga Sutra outlines the eightfold path, also called the eight limbs of yoga, serves as a roadmap for living a purposeful, ethical, and meaningful life.

• The 8 limbs of yoga are the values of yoga.

• Yama (restraint)

• Niyama (observances)

• Asana (posture)

• Pranayama (breath)

• Pratyahara (turning inward)

• Dharana (concentration)

• Dhyana (meditation)

• Samadhi (Oneness with all living things)

• The 3 limbs that are the most used in healthcare include:

• Pranayama (breath control), Asana (posture), and Dhyana (meditation)

Yoga Sequencing

Most yoga sequences involve breathing exercises, physical postures, and meditation. Listed below is a general sequence I follow when planning my yoga sessions for individuals with a history of stroke.

1. First set the focus of the treatment session to provide a goal.

2. Choose one breathing exercise to implement into the session.

   1. Examples include: equal belly breathing, alternative nostril breathing, and ujjayi breath.

      1. For breathing scripts refer our scripts here

3. Proximal Movements: Most individuals benefit from participating in 4 proximal warm-up exercises prior to starting an exercise.

   1. Examples include:

      1. Neck movements (neck flexion/extension/ lateral flexion)

      2. Shoulder shrugs (shoulder elevation/depression)

      3. Unilateral scapular elevation and depression

      4. Self-range of motion (shoulder flexion ~90 degrees; shoulder abduction/adduction; etc).

4. Incorporate the upper and lower extremities: Select one or more yoga poses from these four categories: (See template for examples of each category).

   1. Weight-Shifting

   2. Weight-Bearing

   3. Contralateral upper extremity (UE) / lower extremity (LE) Movements

   4. Functional reach

5. (optional) Lastly, select a meditation to close out the session.

   1. Examples include:

      1. Yoga Nidra

      2. Progressive Muscle Relaxation

      3. Mental Imagery

   2.  Refer to our scripts here

Click here to download a free yoga sequencing template

Note: Not all elements of the protocol have to be completed together. You can use one element that may benefit your patient’s specific goals in the plan of care.

Protocol developed by Julianne Madeline OTD, OTR/L, RYT-200