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

Best Practices for Adapting and Delivering Community-Based Yoga for People with Traumatic Brain Injury in the United States and Canada

“…Not only does a manual enhance fidelity 38 and more reliable investigation of impact, 39 but it also facilitates repetition and a gradual progression of challenge, which people with TBI have reported as valuable in yoga programming. 14 Furthermore, a manual coupled with ongoing technical support (e.g., mentorship calls) may also lower barriers to teachers feeling confident enough to teach the TBI population. We also recommend additional training for yoga teachers in behavior management skills (e.g., redirection, 40 identifying antecedents to the problem, and developing collaborative strategies 41 ).…”

“…Finally, there is opportunity to explore the application of best practices for remotely delivering community-based, TBI-specific yoga, 48 given that fear of leaving home 49 and lack of transportation 14 are barriers for people with TBI to access programs at the community level. Researchers have demonstrated high satisfaction and feasibility of yoga delivered through telehealth in veterans 50 and cancer patients, 51 suggesting this topic as an important area of future research among the TBI population.…”

“…The LoveYourBrain Foundation has sought to address the lack of holistic community-based services by offering a free, 6-week yoga and psychoeducation program for groups of people with TBI and caregivers in yoga studios across the United States and Canada. 14 Yoga, which encompasses physical movement (asana), breathing exercises (pranayama), meditation practices, and moral principles, 15,16 has been shown to improve outcomes for people with TBI, including physical functioning, 17 emotional regulation, 18 psychological well-being, 19 and quality of life. 20 Each weekly class in the LoveYourBrain Yoga program is designed to include multiple components: 10 minutes of pranayama to enhance nervous system regulation and attention control; 45 minutes of gentle yoga to improve strength, flexibility, and balance; 15 minutes of guided meditation to enhance attention control, mood, and nervous system regulation; and 20 minutes of facilitated discussion with psychoeducation to build community connection and skills in resilience.…”

“…The few studies that have identified important TBIspecific modifications for yoga (e.g., avoiding forward folds, minimizing movement of the head, using landmark s instead of "left" and "right" direction cues, slow and repeated instruction, ignoring/reorienting misbehavior, using props for transitions) 14,17,25 and community-based yoga programming (e.g., travel distance, psychosocial environment, scheduling, free of cost) 14 have focused on clinicians' and patients' perspectives, which likely differ from the perspective of yoga teachers with specific training and expertise in how to effectively offer yoga for TBI in community settings. Thus, there is opportunity to leverage the large network of yoga teachers implementing the LoveYourBrain Yoga program to better understand their perceptions of best practices for safely adapting yoga for TBI and the barriers and facili-tators to implementing a large-scale community-based yoga intervention for this underserved population.…”

“…More information about the development and content of the LoveYourBrain Yoga program curriculum has been published elsewhere. 14,21…”