Yoga Poses to Improve Balance Following a Stroke

• Asana is one of the eight limbs of yoga and means “physical posture” or “pose.” Asana is one of the most common types of yoga in health care and research shows asana may improve strength, flexibility, and motor control in patients recovering from a stroke. 

• Following a stroke, many individuals experience paresis (weakness) leading to significant limitations in motor control and activities of daily living (ADLs).

• Research indicates engaging in yoga improves balance, coordination and encourages neuromuscular reeducation, thereby leading to improved outcomes in motor function (Yang & Fahey, 2021).

Link to the article

• This pilot study utilized a non-controlled pretest-posttest method to explore the feasibility and impact of integrating occupational therapy (OT) and yoga to enhance balance, balance self-efficacy, and management of fall risk factors in individuals who have experienced chronic stroke.

• Over an 8-week intervention period, participants engaged in sessions twice a week, each lasting one hour. The results indicated a significant improvement in the Berg Balance Scores, with an increase of 30%.

• These findings suggest that yoga serves as an effective intervention for improving balance among individuals with stroke (Schmid et al., 2016).

Exercises to Improve Balance:

Improving sitting balance is essential for individuals with neurological conditions. The following exercises can help enhance stability and control while seated.

1. Seated Marching | Boat Pose

Benefits:

• Strengthens the hip flexors, knee extensors, dorsiflexors, and hip abductors.

• Improves the alignment of the spine and improves digestion.

Functional carryover:

• Improved balance and strength can make it easier to complete transfers from sitting to standing position. 

Contraindications:

• Individuals with asthma, headache, heart problems, and low blood pressure.

• Individuals with an injury at the neck, shoulders, spine, hips, or who have undergone any recent abdominal surgery should avoid this pose.

Modifications

• Option to keep hands on the sides of the chair or on thighs for additional support.

• Use of yoga strap to lift the affected lower extremity.

Directions:

• Sit in a sturdy chair with your back straight.

• Lift one knee toward your chest, then lower it back down.

• Alternate legs, marching for 1-2 minutes.

• Option to lean back in chair, engaging core muscles, raising one or both legs off the ground. Hold for 5 seconds.

• Focus on maintaining an upright posture throughout the exercise.

Seated Boat Pose using strap to increase lower extremity range of motion.

2. Weight Shifting | Seated Table Top

Benefits:

• Strengthens the scapular stabilizers, muscles of the shoulder, elbow, and wrist, and stretches the wrist and elbow flexors.

• Facilitates proprioceptive input to affected shoulder.

Functional carry over:

• Increased upper extremity strength and proprioception may increase independence in upper body dressing. 

Contraindications

• Contraindicated for carpal tunnel syndrome and injury to the wrists or knees.

Props

• Place yoga block under affected elbow for greater support.

Directions:

• Sit with your feet flat on the floor.

• Shift your weight to the right side, lifting the left hip slightly off the chair.

• Hold for a few seconds, then return to the center and repeat on the left side.

• Perform 5-10 repetitions on each side.

• Shift your weight forward, hold for a few seconds, then return to center and shift your weight backward.

3. Seated Side Bends | Seated Triangle Pose

• While sitting, place your feet flat on the floor and arms at your sides.

• Lean to the right side, reaching your right arm down towards the floor.

• Hold for a few seconds and return to the starting position.

• Repeat on the left side. Complete 5 reps on each side.

4. Ankle Pumps

• Sit with your feet flat and knees bent at a 90-degree angle.

• Lift your toes while keeping your heels on the floor and then point your toes down.

• Repeat this movement for 1-2 minutes to enhance lower limb stability.

5. Ball Toss | Seated Extended Mountain

• Sit upright in a chair and hold a lightweight ball (or a soft object).

• Toss the ball gently from hand to hand without losing balance.

• Gradually increase the distance between your hands to challenge your stability.

Reference:

Schmid, Arlene., Marieke Van Puymbroeck, Jennifer D. Portz, Karen E. Atler, Christine A. Fruhauf. (2016). Merging Yoga and Occupational Therapy (MY-OT): A feasibility and pilot study. Complementary Therapies in Medicine. Vol. 28, pgs 44-49. ISSN 0965-2299. https://doi.org/10.1016/j.ctim.2016.08.003.

4 Exercises for Shoulder Weakness Following a Stroke

Disclaimer: All information presented in this blog post is intended solely for educational purposes only and should not be considered medical advice. It is highly recommended that you consult with your doctor or healthcare provider before starting any new exercise program.

Individuals often experience upper and/or extremity weakness, also called hemiparesis, following a stroke. The following include 4 active-assist and self-range of motion exercises for upper extremity weakness.

Tips:

• Complete these exercises slowly and with control.

• Avoid holding your breath. Often this leads to an increase in blood pressure.

• Make sure you are sitting up tall and keeping your spine straight.

If you have any pain or feel dizzy, stop immediately. Make sure to monitor how you are feeling throughout.

1. Table Glides: 15-20 reps

   • Benefit: Encourage shoulder range of motion, strength, and sitting balance.

   • Directions:

     • Sit in a comfortable chair at a table.

     • Clasp hands together.

     • Slowly and gently stretch your arms forward on the table. (I often put a cone or an object to use as a “target.”)

1. Table Circles: 20 each side

   • Benefit: Encourage shoulder range of motion, tolerance to upright position, and strengthens the shoulder muscles.

   • Directions

     • Place both hands on a small hand towel, placing one hand on top of the other and make medium circles to the right and then medium circles to the left. (Typically 15 each direction).
       

2. Shoulder Abduction and Adduction: 10 each side

   • Benefit: Stretches the shoulder muscles and increases upper extremity strength.

   • Directions:

     • Either sitting or standing.

     • Cradle your affected arm with your unaffected arm.

     • Lift both arms to chest level, then move both elbows (without moving trunk or gaze), to the unaffected side.

     • Hold for 5 seconds and then return to neutral. Repeat 10 times.

     • Repeat on opposite side.

3. Shoulder Flexion: 10 reps

   • Benefit: Increases shoulder range of motion and movement efficiency.

   • Directions:

     • Either sitting or standing.

     • Clasp your hands together and slowly raise your arms as high as you can and hold for 5 seconds.

     • With hands clasped, lower your hands down.

     • Repeat 10 times.

Yoga Postures for Arm Weakness (Hemiparesis) Following a Stroke

Asana is one of the eight limbs of yoga and means “physical posture” or “pose.” Asana is one of the most common types of yoga in health care and research shows asana may improve strength, flexibility, and motor control in patients recovering from a stroke. 

Following a stroke, most patients experience paresis, or weakness, in their upper or lower extremities, leading to significant limitations in motor control and activities of daily living (ADLs). Research indicates that engaging in yoga improves flexibility, strength, coordination and encourages neuromuscular reeducation, thereby leading to improved outcomes in motor function. Research suggests asana increases flexibility, balance, strength, and range of motion (Yang & Fahey, 2021).

The following poses encourage neuromuscular re-education, focusing on weight-bearing and weight-shifting to promote body awareness, reduce pain, improve posture, and increase upper extremity strength.

Seated cat cow 

Benefits

• Encourages tolerance to an upright position.

• Stabilizes the shoulders, elbows, and wrists. 

• Stretches the wrist flexors and elbow flexors. 

• Strengthens the core. 

• Encourages weight-bearing.

Functional carry over

• A strong core supports various functional movements, such as reaching, bending, and lifting. 

Contraindications

• Individuals with an injury at the neck, shoulders, spine, hips, or who have undergone any recent abdominal surgery should avoid this pose.

Seated Forward Fold 

Benefits

• Encourages bimanual upper extremity range of motion and coordination. 

• Strengthens the hip flexors at the front of the body.

Functional carryover

• Increased core stability increases ability to pick objects off the floor during chore participation. 

Contraindications

• Individuals should avoid this pose if they have a spinal injury or recent abdominal surgery.

Seated extended side angle 

• Facilitates proprioceptive input and weight bearing in affected upper extremity. 

• Strengthens the shoulder girdle, abdominal muscles, and hip flexors. 

Child’s pose

• Relives stress and tension in the back, shoulders and hips. 

• Increases strength in the upper extremity for carry over in functional reach tasks.