Ten years ago, while training in Park City, UT, for the Vancouver Winter Olympics, professional snowboarder Kevin Pearce was attempting a tricky aerial move called a cab double cork. He mistimed his landing and smashed face-first into a snowbank.
Luckily Kevin survived, but he sustained a traumatic brain injury (TBI). After two months in intensive care and three months at a rehabilitation center in Denver, he returned to Vermont to continue his recovery at home. At some point in his healing journey, Kevin discovered yoga, which allowed him to connect with his body and relax instead of focusing on how much his symptoms—headaches, double vision, memory loss, and impaired executive functioning—needed to improve.
Kevin says yoga gives him the same sense of accomplishment he used to get from snowboarding. He says he finds it both empowering and calming. It also encourages him to listen to his body and respond with compassion rather than push his limits, says his sister-in-law Kyla Pearce, a yoga instructor from Hanover, NH.
Kevin's injury ended his promising snowboarding career but paved the way for a new venture, Love Your Brain. A nonprofit foundation established in 2013 by Kevin and his brother Adam (Kyla's husband), it aims to improve the quality of life for people with TBI—and offers yoga retreats geared specifically for people with brain injuries. Kyla, a postdoctoral researcher at Dartmouth College, developed the yoga program for Love Your Brain and conducts workshops across the country on TBI-friendly yoga curricula.
Yoga poses, pace, and instruction are adjusted for people with TBI. Instructors modify the position and movement of the head to help prevent the dizziness and nausea common after injury. They also limit up and down movements and complicated positions. Instead, classes involve light stretching and slow, repetitive pacing, designed to accommodate fatigue, attention, concentration, and memory problems. Because bright lighting and noise can be overstimulating and painful for people with TBI, instructors dim the lights, keep noise to a minimum, and try to maintain an uncrowded space.
"It's important to provide a safe setting for people with TBI," says Heidi Fusco, MD, clinical assistant professor of rehabilitation medicine at NYU Langone Medical Center/Rusk Rehabilitation. "I like to get patients moving in general, and I find yoga's mindfulness healing. Yoga also helps with balance, muscle pain, breathing, conditioning, and core strength."
Balance is one of the biggest challenges for somebody who's had a TBI, according to Arlene Schmid, PhD, associate professor at Colorado State University, who has conducted studies on the benefits of yoga for rehabilitation. Balance involves a complex set of sensorimotor control systems, including vision, touch, and the vestibular system, says Dr. Schmid, who's also an occupational therapist and specializes in stroke rehabilitation and neurorehabilitation. "Yoga may help these systems talk to each other, something they haven't been able to do in a while."
Yoga can also improve the mind-body connection. "People with TBI often can't use a limb the way they used to," says Dr. Schmid, "and sometimes they may ignore the limb or get angry at it."
Dr. Schmid's research includes a March 2017 study published in the British Journal of Occupational Therapy that used yoga to help 13 stroke patients overcome a fear of falling, and a July 2017 case study of three patients with TBI in the International Journal of Complementary & Alternative Medicine that assessed whether yoga could improve quality of life. Over the course of a study—usually six to eight weeks—people often feel gentler or more patient with their bodies, she has found. "Mantras that we use, such as 'I love myself' and 'I am enough,' help stop the rumination and change the pattern of thinking about how they hate their bodies or how their brain doesn't work," says Dr. Schmid, who says yoga is most helpful when paired with occupational or physical therapy.
For her high-functioning patients with brain injuries, Monica Verduzco-Gutierrez, MD, recommends traditional yoga classes, but she advises lower-functioning patients to get one-on-one instruction. She also tells patients to do meditation and breathing exercises, two components of many yoga classes. "I encourage my patients to download meditation apps, try specific stretches, and do deep breathing exercises," says Dr. Verduzco-Gutierrez, associate professor of physical medicine and rehabilitation at McGovern Medical School at UTHealth and chief of the Brain Injury and Stroke program at TIRR Memorial Hermann in Houston.
Yoga also may help people with communication problems due to TBI or stroke, says Katherine Noyes, a speech pathologist and certified brain injury specialist in Portland, ME, who taught a six-week program through the Love Your Brain foundation in 2018. "Many patients with TBI work with a speech pathologist to improve attention, memory, and focus," she says. Coordinating breath and movement to produce speech is also challenging but can be improved by yoga's focus on deep breathing and movement. Even using mantras, like the simple "om," helps with diaphragmatic breathing and coordination, she says.
"There's a big benefit to slowing down, quieting your mind, and focusing on coordinating different systems of your body," Noyes says. "With yoga you have to coordinate your breathing with basic movements, which can be hard for a person with TBI." At the end of each Love Your Brain class, Noyes says, participants gathered for a 15-minute debriefing to discuss the class and their recovery and offer one another support. It's a safe environment for people to practice expressing themselves, she says.
Kyla Pearce designed a study to determine the benefits of the Love Your Brain classes: In semi-structured interviews, 13 participants reported improvements in strength, balance, flexibility, and attention control, and a greater sense of belonging, community connection, and ability to move forward with their lives. The results were published in the April 2018 issue of Disability and Rehabilitation.
"Participants say they're having better relationships because they're more able to emotionally self-regulate," says Kyla. "Others say the program has helped them reframe the TBI experience. They're excited to see what's possible rather than reflecting on all the things they've lost."
Recovery from TBI is different for everyone, says Kyla, who warns that defining it as "returning to where you were originally might not be realistic." In Love Your Brain and other TBI-adaptive yoga classes, participants learn about resilience. "Resilience," Kyla says, "is about meeting yourself where you are, understanding your weaknesses, and cultivating your strengths to move forward."
How to Find a TBI-Friendly Yoga Class
If you're interested in a yoga class for people with traumatic brain injuries (TBI), inquire at YMCAs, community centers, and yoga studios about adaptive classes (sometimes marketed as "restorative yoga") that include meditation, gentle flow, and beginner-level positioning. Classes where lighting is dimmed and the number of students is limited are especially suitable for people with TBI. For TBI-specific sessions, check loveyourbrain.com for a directory of classes across the country. Your neurologist or physical therapist may be able to recommend classes or specific yoga-type stretches and breathing exercises.