5 Mindfulness Brain Injury Exercises After TBI or Stroke

After an acquired brain injury, many people experience anxiety, depression, and emotional distress.

Mindfulness exercises can help this population improve pain, mental health, and cognitive and physical recovery (Saban et al, 2022).

As a speech-language pathologist, you can recommend mindfulness exercises to help your patients cope and eventually thrive. 

In this article, you’ll learn:

• How mindfulness can help after a stroke or TBI
• 5 mindfulness brain injury exercises, with free PDFs
• Mindfulness resources to improve your quality of life!

Mindfulness In Speech Therapy

First, what is mindfulness?

Mindfulness is the intentional act of paying attention to what’s happening in the present moment with openness, acceptance, and nonjudgment.

By accepting and relaxing into what they’re experiencing, people feel calmer and cope better with their symptoms.

After a brain injury, patients often experience mental health difficulties that decrease quality of life and inhibit recovery (Chemerinski & Robinson, 2000).

Research shows that practicing mindfulness can improve outcomes for these patients:

• Lower anxiety and depression
• Better stress response
• Decreased pain and fatigue 
• Decreased mental fatigue
• Improved cognition, particularly attention
• Improved sleep

(Lovette et al, 2022; Saban et al, 2022; Rusch et al., 2019)

The benefits of mindfulness are not limited to acquired brain injuries. It can also improve mental health and functional outcomes in people with cancer, stuttering, multiple sclerosis, and many other conditions (Beilby et al, 2012; Saban et al, 2022)

Just as you offer patient education about a stroke or TBI, you can also provide information on the benefits of mindfulness. Keep scrolling to learn exactly what those benefits are.

Mindfulness And Stroke Rehabilitation

The consequences of having a stroke can be devastating.

Our patients can no longer think, talk, eat, or do other daily activities as well as before. All of this hardship and loss can lead to depression, anxiety, pain, fatigue, and decreased quality of life (Chemerinski & Robinson, 2000; Saban et al, 2022).

A review of 16 quantitative studies of mindfulness-based interventions in stroke survivors found that practicing mindfulness may:

• Improve emotional well-being
• Improve depression
• Improve anxiety
• Decrease mental fatigue
• Improve pain
• Improve stress management
• Help reach rehabilitation goals, including language fluency
• Improve attention, information processing speeds, and executive functioning
• Improve motor function and spasticity (Saban et al, 2022)

Mindfulness and TBI

Mindfulness-based interventions can also facilitate recovery in people who’ve had a traumatic brain injury. 

A review of 29 studies on the effects of mindfulness-based interventions on individuals post-TBI found that mindfulness improves:

• Stress response
• Cognition, particularly attention
• Emotional regulation
• Coping (Lovette, 2022)
• Mental fatigue 
• Mental processing speed (Saban et al, 2022)

Mindfulness and Chronic Pain

Mindfulness may also improve chronic pain.

After practicing mindfulness, study participants with chronic pain experienced less pain intensity, less pain unpleasantness, less depression, and improved quality of life (Hilton et al, 2017; Ziedan et al, 2011).

Read Mindfulness For Pain Management In Speech Therapy to learn more.

5 Mindfulness Brain Injury Exercises

Mindfulness-Based Stress Reduction (MBSR) is the current gold-standard mindfulness program in the United States.

Dr. John Kabat-Zinn developed MBSR to help patients with chronic illnesses manage their pain and reduce stress.

MBSR is a secular, 8-week program that includes mental body scans, mindful movement, meditation, and other strategies.

Many organizations offer MBSR classes, including online options.

Lori Gray, an MBSR instructor who had a stroke, created an adapted MBSR program for stroke survivors (Gray, 2020). Gray recommends giving plenty of breaks and keeping mindfulness exercises short.

Below are 5 mindfulness exercises that draw from MBSR that have been adapted for your speech therapy patients. You’ll also find printable PDFs.

1. The Body Scan

The body scan is a practice that focuses on the sensations in different parts of your body. If possible, lie on your back or sit up comfortably.  

Below is a printable body scan script from the Veteran’s Health Administration:

How To Do A Body Scan

Start with slow, deep breaths. Then shift your attention from outside your body to the sensations inside your body.

Notice the sensations in your feet. Try not to think about your feet and instead focus on the sensations that are already there.

What are the feelings, temperatures and sensations in your feet right now? Observe these things and any emotions or thoughts that come up.

From there, you’ll systematically scan up your entire body (feet to ankles to legs to pelvis, etc.) with this same gentle, non-judgemental attention.

Keep the body scan short, around 3 minutes, then gradually increase the time as appropriate.

Click for an audio library of Guided Body Scans by Mindfulness Northwest.

2. Mindful Movement

Mindful movement is focusing your attention on the movements of your body. This can be done with a gentle exercise, like yoga or Tai Chi, or during a slow walk.

The goal of mindful movement is to practice non-judgemental awareness of the sensations in your body plus any thoughts and emotions that come up as you move.

To avoid overdoing it, patients should move within their comfort zones and then gradually expand that comfort zone. Take breaks as needed and modify for fatigue and physical limitations as appropriate.

Mindful Movement with Gentle Yoga

Below are printable PDFs created by Mindfulness Northwest. One is chair yoga and the other is gentle yoga.

Visit their website for Guided Mindful Movement Audio to go along with the PDFs.

3. Awareness Of Breathing

Awareness of breath is the mindfulness exercise of paying attention to your breathing.

It gives your mind and body a break from worrying about the future or ruminating about the past. Evidence shows that deep breathing can improve pain and stress (Busch et al, 2012).

Take a slow, deep breath. 

On your next breath, observe where it’s easiest to feel the breath in your body. The nostrils, the back of the mouth, the throat, the chest, or the stomach? Continue feeling the breath in your body as you practice deep breathing.

Your mind will wander. When it does, gently return your attention to your breath. Do this exercises for 3 minutes. Gradually increase the time as appropriate.

4. 2 Feet 1 Breath

This quick mindfulness exercise can keep you grounded throughout the day.

It can also help you feel more calm before or during a stressful situation, like a medical procedure.

• Stop what you’re doing. Pause.
• Feel both feet on the floor. Focus all of your attention on your feet. What do you feel in your feet?
• Next, feel one breath in and then out.
• Continue with your day.

5. STOP

S: Stop

Stop and pause. If you can, sit down and relax with your hands in your lap.

T: Take A Deep Breath

Take a few deep breaths. Focus on the sensation of air moving in and out your nostrils or the rise and fall of your chest or stomach.

Focus your attention on your breath.

O: Observe

Notice the thoughts, emotions, and physical sensations in your body.

Remind yourself you are not your thoughts or your feelings. They are ever-flowing and will move through you.

P: Proceed

Proceed with the rest of your day.

Mindfulness For You

Mindfulness might also help you! 

In a 2017 experiment, speech-language pathology students who had 8 weeks of mindfulness training showed less stress, more self-compassion, and fewer negative aspects of perfectionism compared to peers who didn’t do the training (Beck et al, 2017).

Read 2 Quick Ways To Reduce Stress, Even When You’re Really Busy for mindfulness exercises curated for you.

To try MBSR for yourself, Mindfulness Northwest offers an online course for healthcare providers.

For more options, look up “Mindfulness-Based Stress Reduction” in your local area.

More ABI Materials

References

• Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
• Beck, A. R., Verticchio, H., Seeman, S., Milliken, E., & Schaab, H. (2017). A Mindfulness Practice for Communication Sciences and Disorders Undergraduate and Speech-Language Pathology Graduate Students: Effects on Stress, Self-Compassion, and Perfectionism. American journal of speech-language pathology, 26(3), 893–907. https://doi.org/10.1044/2017_AJSLP-16-0172
• Beilby, J. M., Byrnes, M. L., & Yaruss, J. S. (2012). Acceptance and Commitment Therapy for adults who stutter: psychosocial adjustment and speech fluency. Journal of fluency disorders, 37(4), 289–299. https://doi.org/10.1016/j.jfludis.2012.05.003
• Busch, V., Magerl, W., Kern, U., et al. (2012). The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing-an experimental study. Pain Med, 13(2), 215-228.
• Chemerinski, E., & Robinson, R. G. (2000). The neuropsychiatry of stroke. Psychosomatics, 41(1), 5–14. https://doi.org/10.1016/S0033-3182(00)71168-6
• Gray L. A. (2020). Living the Full Catastrophe: A Mindfulness-Based Program to Support Recovery from Stroke. Healthcare (Basel, Switzerland), 8(4), 498. https://doi.org/10.3390/healthcare8040498
• Han, A. (2021). Mindfulness- and Acceptance-Based Interventions for Stroke Survivors: A Systematic Review and Meta-Analysis. Rehabilitation Counseling Bulletin. https://doi.org/10.1177/00343552211043257
• Hilton, L., Hempel, S., Ewing, B. A., Apaydin, E., Xenakis, L., Newberry, S., Colaiaco, B., Maher, A. R., Shanman, R. M., Sorbero, M. E., & Maglione, M. A. (2017). Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 51(2), 199–213. https://doi.org/10.1007/s12160-016-9844-2
• Lovette, B. C., Kanaya, M. R., Bannon, S. M., Vranceanu, A. M., & Greenberg, J. (2022). “Hidden gains”? Measuring the impact of mindfulness-based interventions for people with mild traumatic brain injury: a scoping review. Brain injury, 36(9), 1059–1070. https://doi.org/10.1080/02699052.2022.2109745
• Rusch, H.L., Rosario, M., Levison, L. M., Olivera, A., Livingston, W. S., Wu, T., & Gill, J. M. (2019). The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. Annals of the New York Academy of Sciences, 1445(1), 5–16. https://doi.org/10.1111/nyas.13996
• Saban, K. L., Tell, D., & De La Pena, P. (2022). Nursing Implications of Mindfulness-Informed Interventions for Stroke Survivors and Their Families. Stroke, 53(11), 3485–3493. https://doi.org/10.1161/STROKEAHA.122.038457
• Zeidan, F., Martucci, K. T., Kraft, R. A., Gordon, N. S., McHaffie, J. G., & Coghill, R. C. (2011). Brain mechanisms supporting the modulation of pain by mindfulness meditation. The Journal of neuroscience : the official journal of the Society for Neuroscience, 31(14), 5540–5548. https://doi.org/10.1523/JNEUROSCI.5791-10.2011