International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571

Original Research Article

To Study Effects of Yoga Therapy on Balance in Post Stroke Hemiplegic Patients

Dr. Anupama Anant Paranjape1, Dr. Archana Gore2

1Physiotherapist at Small Steps Child Development Centre &Morris Autism Centre, Deenanath Mangeshkar Hospital, Near Mhatre bridge, Erandwane, Pune 411004 2Assistant Professor at Physiotherapy Department, Seth GSMC & KEMH, 402, PT department, Dhrumal Bajaj Orthopaedic Centre, Opposite TATA Hospital, Seth GSMC & KEMH, Borges road, Parel, Mumbai 400012

Corresponding Author: Dr. Archana Gore

ABSTRACT

Introduction: Stroke is the common cause of chronic disability and it leads to balance impairments, frequent falls, improper gait and poor quality of life. The complexity of balance control and the need to be independent in functions with confidence and reduced falls lead to the need for studying effects of other approaches to the conventional rehabilitation for enhancing the balance control after stroke. Yoga has originated in ancient India and recent evidences show positive effects of yoga for people with range of other neurological disorders. So purpose of the study was to see effects of yoga therapy on balance in post stroke hemiplegic patients. Objectives: To compare post therapy balance between conventional and yoga group and to assess pre and post therapy balance in both groups using Bergs balance scale (BBS) and Fullerton advanced balance scale (FAB) Method: 30 post stroke hemiplegic subjects were randomly assigned into two groups, 15 in each group. Conventional group received six conventional balance exercises and yoga group received six yoga asanas for 40 minutes, 4 times a week for 3 weeks. Results: Intra group pre and post therapy scores of BBS and FAB improved significantly in both groups (p>0.001) however intergroup post therapy BBS (p=0.436) and FAB (p=0.512) scores comparison did not show statistical significance. Conclusion: Both conventional therapy and yoga therapy improve balance in post stroke patients.

Key words: Stroke, BBS, FAB, Yoga therapy.

INTRODUCTION improper ambulation. (2) Balance is an A stroke or brain attack is the integral component of daily functional sudden loss of neurological function activities, and there are many factors such caused by an interruption of the blood as sensory, neuro-motor, and flow to the brain. Hemiplegia is severe or musculoskeletal which lead to balance complete loss of motor function on one impairment, frequent falls, and add to side of body. Stroke can be caused due to disability and poor quality of life in these thrombotic or embolic infarction or due to patients. (3) Hence post stroke balance haemorrhage, and it is the most common rehabilitation is essential. For balance cause of chronic disability. (1) Main rehabilitation numbers of interventions difficulties associated with hemiplegia are have been published evaluating the effects alteration in tone, loss of selective of newer rehabilitation methods other than movements and balance reactions and conventional therapy. Many studies used

International Journal of Health Sciences & Research (www.ijhsr.org) 135 Vol.9; Issue: 7; July 2019 Anupama Anant Paranjape et.al. To Study Effects of Yoga Therapy on Balance in Post Stroke Hemiplegic Patients new methods such as biofeedback therapy, in balance in stroke. (12) Fullerton Advanced short-form tai chi, kinaesthetic ability Balance Scale (FAB) is another scale used training device, virtual reality treadmill to assess static and dynamic balance under training for balance rehabilitation in stroke varying sensory conditions. Some population. (4-7) As newer methods are components of FAB are more challenging being used in balance rehabilitation it has to perform than BBS.FAB has been been proposed that yoga therapy which is determined to be valid and reliable in less expensive and simple; can be used to stroke. (13) improve balance in post stroke patients. (8) There are several studies showing Recent non Cochrane review suggested effects of yoga therapy on individuals that yoga can be used as a self- without any pathology and there are studies administered practice in stroke which have showed effects of yoga therapy rehabilitation. (9) in other neurological disorders. (14, 15) Yoga Commonly, Yoga is translated to is originated in India but very few imply the union of body, mind, and spirit. Physiotherapy centers offer yoga therapy Hatha yoga is one of the most well-known for stroke patients. Very few studies have branches of yoga and which uses a been done to see effects of yoga in stroke combination of postures (asanas), and in the published research; study breathing, and meditation. (10) According to sample sizes are small, biased and non- International Association of Yoga, Yoga randomized. (16) Thus well-designed therapeutics is defined as the application of studies may provide some important yoga for health benefits. (8) Yoga therapy guidelines. Hence aim of this study was to consists of the application of yogic know effects of yoga therapy on balance in principles, methods, and techniques to post stroke hemiplegic patients. Objectives specific human ailments. In yoga, the mind were to compare post therapy balance is encouraged to focus specifically on what between conventional and yoga group and is occurring in the body and where the assess pre and post therapy balance in body is in space, thus increasing conventional and yoga group using BBS and awareness. On the physical level, yoga FAB. postures, called asana, which can be done alone, as the limbs of the body provide MATERIALS AND METHODS necessary weight and counterweight. Yoga Approval for the study was taken therapy employs simple postural, from the Institutional ethics committee of breathing, relaxation and meditation Seth GSMC & KEMH and the approval practices, taking into account medical committee of Maharashtra University of diagnoses and holistic factors. (11) There Health Sciences Nasik.54 post stroke are several asanas in yoga therapy which hemiplegic subjects from physiotherapy can be used for improving balance. OPD of GSMC & KEMH hospital were Measurement of recovery after screened according to inclusion criterion in stroke is important with the advent of new period of January 2014- August 2015. treatment options under investigation in Inclusion criterion was patients with onset stroke rehabilitation and research. Bergs of stroke 3 months to 1 year period, Balance Scale (BBS) is a 14 item objective ambulatory with or without aid and with measure designed to assess static and BBS score less than 45, FAB score less than dynamic balance in stroke patients. 30. An informed consent form was signed Excellent interrater and intrarater reliability by subjects who were ready to participate and construct validity have been and were randomly assigned using computer demonstrated for BBS. Thus the BBS is generated table into two groups, 15 in highly recommended as a clinical and conventional group and 15 in yoga group. research tool for evaluating improvement All subjects were assessed for outcome

International Journal of Health Sciences & Research (www.ijhsr.org) 136 Vol.9; Issue: 7; July 2019 Anupama Anant Paranjape et.al. To Study Effects of Yoga Therapy on Balance in Post Stroke Hemiplegic Patients measures BBS and FAB scales by principal 1. Ekpadahastasna is a hand to one foot investigator (PI). Both scales have been pose. This started by individual standing determined to be valid and reliable to use erect and keeping one foot forward. Upper for assessment of balance in stroke patients. limbs were raised above the head, and Conventional group received conventional keeping the knee straight they started to therapy and yoga group received yoga bend forward slowly through trunk. They therapy for 40 minutes a day, 4 days a week tried to touch fingers to toes. Normal for 3 weeks. Reassessment was done after 3 breathing was maintained while maintaining weeks of intervention. this posture for 15- 30 seconds. While coming back to starting position individuals Intervention: were asked to raise the body gradually by Conventional therapy included taking up the trunk, the neck and the head. routine exercises like Sit to stand from a Same procedure was asked to be repeated chair, Half kneeling (floor/mat) to standing, with other leg ahead. In this asana posture is Forward lunges, Tandem stance, Heel raises asymmetrical with narrow base. Hands and One leg standing postures and being raised the centre of mass also is movements. (1,17,18) First week subjects were higher. Bending requires eccentric control given minimal assistance by PI if required of back extensors and concentric work of and asked to maintain each position for 10 oblique abdominals. Muscles of lower sec and repeated5 times. Constant verbal extremity are also put under static work to feedback was given by PI for postural maintain stance. Coming up requires correction and motivation. Whenever concentric work of back extensors, hip required, tactile cues were also given to extensors and static work of foot intrinsic. make their performance better. Gradually, in PI constantly supervised the subject for second week subjects were asked to maintaining shoulders square, pelvis maintain each position for 15 sec and obliquity, knee extension, and toes firmly on repeated 5 times. Then in third week ground especially of affected limb and subjects were asked to do all exercises breath control. Individual was also given independently and maintain each position cues to maintain adequate weight bearing on for 20 seconds and repeated 5 times. each limb rather than more on non-affected Constant supervision was given for each side. session. For some subjects, one leg standing was difficult to maintain on affected leg 2. Utkatasana resembles a chair pose. independently, so it was allowed to perform Individual stood with feet shoulder width with minimal support. Subjects were apart and hands placed ahead in forward supervised and advised against breath flexion. He /she slowly squatted down as if holding. sitting on a chair, maintained this position In Yoga therapy; the asanas were for 15 - 30seconds and then slowly came up explained to the subjects of this group by to standing position with hands slowly demonstration and showing images by PI. moving down. Performing this asana Asanas involving muscle work similar to required static work of back extensors and muscle work required for improving balance foot intrinsics. Hip extensors, quadriceps were selected. They were selected in view and plantar flexors eccentrically contract to of ease of understanding, performing and lower the body to chair pose. Maintaining ability to challenge balance in an individual this posture required good coordination with stroke. Following asanas were included between these muscles along with co for yoga therapy group: Ekpadahastasana, contraction of back extensors and Utkatasana, Veerasana, Trikonasana, abdominals. Rising up is brought by Tadasana and Vrukshasana. (19-21) concentric work of hip extensors, quadriceps and plantar flexors. The

International Journal of Health Sciences & Research (www.ijhsr.org) 137 Vol.9; Issue: 7; July 2019 Anupama Anant Paranjape et.al. To Study Effects of Yoga Therapy on Balance in Post Stroke Hemiplegic Patients individuals were supervised for symmetry contraction of hip abductors, abdominal of posture, synchrony of movement, breath obliques and quadriceps. Weight bearing on control and maintenance of balance. affected side creates better body awareness Constant motivation was provided to and positive schema. increase the time of holding this asana. 5. Tadasana resembles palm tree pose. The 3. Veerasana resembles warrior pose. individuals stood with feet apart, raised Individuals in standing position took one leg hands together above head and raised body as ahead as possible bending the anterior upwards standing on toes. They were asked knee. The posterior leg was extended at to feel stretch in the body from toes to knee. Both hands were taken together finger tips. They maintained this posture for overhead and they extended their trunk and 15- 30 seconds and then released it slowly, the neck to look up. They maintained this taking heels and hands down posture for 15 – 30 seconds. While releasing simultaneously. This asana brings about a the asana, trunk and head returned to neutral greater challenge to balance in an individual position followed by hands and leg. They with stroke due to postural control repeated the same asana taking other leg maintained on toes only. Maintaining trunk forward. erect with upper limbs in elevation also This asana involves asymmetrical creates greater co contraction in various standing with narrow base of support and muscles of entire body along with better higher center of mass bringing about more postural awareness. PI supervised the muscle work. It causes spinal stretch along individual for creating optimal plantar with challenge to balance causing greater flexor concentric work, neutral pelvis postural awareness. Breathing normally in obliquity and synchronous breathing. Gentle this posture brings about a better mind body touch was provided to reduce fear of fall as connect. Looking upwards in challenged and when required. Also they were coaxed posture caused reduced visual reliance for to maintain balance in this posture for balance to allow better integration of longer than 15 seconds. proprioception, vestibular and tactile senses. The PI supervised the individual for 6. Vrukshasana is a pose that resembles a maintenance of trunk extension without tree. The subjects stood with feet apart, one increased lumbar lordosis, assisting affected foot over the opposite leg’s thigh, in upper limb elevation and prevented them abducted and externally rotated position. from closing eyes. Both hands were placed overhead together. They maintained this position for 15-30 4. Trikonasana resembles triangle pose. seconds on both sides alternately. This Individual stood with feet apart. They raised position had to be held with high center of their upper limbs to horizontal position, bent mass over one foot thus challenging through trunk laterally as much as possible balance. PI supervised the subjects for so as to touch the ground with that side preventing hyperextension especially of hand. Individuals were asked to breathe out affected leg and also gave verbal feedback while bending to the side. Other hand was to ascertain elevation of upper extremities elevated and touched the head laterally. The and maintenance of posture for longer time. posture was maintained for 15-30 sec. The The posture had to be maintained on one same activity is repeated on other side. The foot causing intrinsic muscle work of both individuals were supervised for adequate sides, concentric work of abductors, weight bearing equally on both lower limbs, elevators of arm and co contraction of trunk to prevent knee hyperextension and prevent muscles especially on affected side. breath hold. This asana causes body weight Progression-In second week, to be distributed asymmetrically causing co- subjects were instructed to do asanas

International Journal of Health Sciences & Research (www.ijhsr.org) 138 Vol.9; Issue: 7; July 2019 Anupama Anant Paranjape et.al. To Study Effects of Yoga Therapy on Balance in Post Stroke Hemiplegic Patients independently, with 2 repetitions and hold group (inter group) analysis of the post time was 60 seconds. Third week all asanas intervention scores of BBS and FAB, Mann- were maintained for 120 seconds and Whitney U test was used. repeated twice. Few subjects could not All the tests were carried out at 5% maintain Vrukshasana for long time on significance affected side, so minimal support was given to maintain correct posture. RESULTS The baseline characteristics of the Statistical Analysis: conventional group and yoga group are Statistical analysis was performed using shown in Table 1. SPSS (Statistical Package for Social There were no significant Sciences) for windows, version 17. Baseline differences between the two groups with characteristics of the two treatment groups’ respect to demographics (age, gender) p namely conventional group and yoga group value > 0.005, stroke characteristics i.e. time were compared to evaluate the success of since stroke, type of lesion, side of randomization. Depending on the results of paralysis) p value > 0.005, baseline score the Kolmogorov- Smirnov test for for BBS p value =0.683, and baseline score normality; if the data was found to be for FAB p value =0.838. normally distributed, baseline characteristics Table 2 & 3 show BBS and FAB were compared by unpaired t test, if found scores pre and post intervention in not normally distributed then Mann- conventional group and yoga group. In both Whitney U test was used and Fisher exact groups post therapy scores improved test was used for categorical data. Median significantly (p<0.001) (range) was calculated to summarize the Table 4 shows comparison of BBS and FAB scores of BBS and FAB for balance scores post intervention between assessment. conventional and yoga group. Comparison For within group (intra group) of scores between the groups was not analysis of pre and post intervention scores statistically significant (p value of BBS- of BBS and FAB, Wilcoxon matched- pairs 0.436 and FAB- 0.512) signed rank test was used. For between-

Table1. Baseline characteristics of conventional and yoga groups. Variable Conventional group Yoga group Statistical Test P value (n=15) (n=15) Age (years) 53.06 ( 6.922) 52.3 ( 4.287) Unpaired t test 0.730(ns) Gender Male (%) 10 (66.7%) 9 (60%) Fisher’s Exact test 1.0000(ns) Female (%) 5 (33.3%) 6 (40%) Time since stroke (months) 10 (8,18) 10 (8,18) Mann Whitney U test 0.269(ns) Type of injury Ischemic (%) 10 (66.7%) 11 (73.3%) Fischer’s Exact test 1.0000(ns) Haemorrhagic (%) 5 (33.3%) 4 (26.7%) Paretic side Right (%) 10 (66.7%) 9 (60%) Fisher’s Exact test 1.0000(ns) Left (%) 5 (33.3 %) 6 (40%) BBS 40(21,45) 41(26,45) Mann Whitney U test 0.683(ns) FAB 22(8,30) 20(12,30) Mann Whitney U test 0.838 Note : Values are mean (_+Standard deviation), number of subjects (%), or median (range), (ns) = not significant

Table2. BBS and FAB scores in conventional group pre and post intervention Conventional Pre Intervention Post Intervention Wilcoxon matched pairs signed rank group test Median 95% Median 95% (range) Confidence (range) Confidence p value Remark Interval Interval BBS 40(21,45) [32.46-41.28] 49(27,52) [39.00-47.93] <0.001 Significant FAB 22(8,30) ]17.06-24.27] 25(14,36) [21.72-28.27] <0.001 Significant

International Journal of Health Sciences & Research (www.ijhsr.org) 139 Vol.9; Issue: 7; July 2019 Anupama Anant Paranjape et.al. To Study Effects of Yoga Therapy on Balance in Post Stroke Hemiplegic Patients

Table3. BBS and FAB scores in yoga group pre and post intervention Yoga group Pre Intervention Post Intervention Wilcoxon matched pairs signed rank test Median (range) 95% Median (range) 95% Confidence Interval Confidence p value Remark Interval BBS 41 [33.83-41.36] 50 [41.35-49.58] <0.001 Significant (26,45) (34,55) FAB 20 [17.60-23.59] 26 [23.19-29.74] <0.001 Significant (12,30) (18,36)

Table4. BBS and FAB score in conventional and yoga group post intervention Conventional group Yoga group Mann Whitney U test Median (range) 95% Median (range) 95% Confidence Interval Confidence p value Remark Interval BBS 49 [39.00-47.93] 50 [41.35-49.58] 0.436 Not Significant (27,52) (34,55) FAB 25 [21.72-28.27] 26 [23.19-29.74] 0.512 Not (14,36) (18,36) Significant

DISCUSSION like sit to stand, forward or lateral step-ups, Stroke results in significant changes heel raises which challenge balance and in balance and patients typically exhibit improve lower limb muscle strength. (18) delayed, varied or absent balance responses Another correlation study related to sit to with impairments in latency, amplitude and stand movement and its correlation to timing of muscle activity. (1) Lower limb falling in stroke patients, showed that rate of muscle weakness and slowed force build up rise force and greater postural sway while are associated with functional disability, rising or sitting down, and asymmetric immobility, poor standing balance and high weight distribution may be useful in anticipatory, on-going, and responsive identifying stroke patients who are at risk of postural adjustments and risks of falls. (3) falling. (23) Lord and Colleagues(2007), summarizing Balance improvement in the current evidence from 44 randomized conventional group in all patients could be controlled trials, point out that effective attributed to, increase in strength of weak exercise programs for preventing falls muscles concentrically and eccentrically and comprised of challenging and progressive improving segmental limb control, creating balance exercises performed in weight a loading response and activating extensors bearing positions which minimize the use of activity, improving symmetrical weight upper limb support. (22) There is an increase shifts, increasing flexibility and lower limb in evidence that challenging balance range of motion, eventually enhancing exercises in standing with feet close motor activity, functional mobility and together and practicing controlled walking. (17,18,22,23) movements of centre of mass, is an optimal In yoga therapy group also, BBS and way to improvebalance during performance FAB scores showed significant of everyday actions when performed with improvement. Leslie Kaminoff sufficient dosage and without reliance on internationally recognized specialist in upper limbs. (22) Sherrington et al in their fields of yoga and breathe anatomy, studied study showed exercises like sit to stand yoga anatomy under the team of Human activity, lunges, heel raises, one leg stance, Kinetics. He analysed asanas and proposed and tandem stance can be used to improve effects of asanas on muscular system. coordination, strength, and endurance and According to his analysis standing asans balance in older adults. (17) For stroke like Ekpadahastasana, Utkatasana, patients exercise intervention to prevent Veerasana, Trikonasana, Tadasana and falls, enhance mobility and improve Vrukshasna increase activity of lower limb physical activity in community dwellers, muscles such as gluteus medius and which involves weight bearing exercises minimus, adductor group, quadriceps,

International Journal of Health Sciences & Research (www.ijhsr.org) 140 Vol.9; Issue: 7; July 2019 Anupama Anant Paranjape et.al. To Study Effects of Yoga Therapy on Balance in Post Stroke Hemiplegic Patients tibialis anterior and soleus, and intrinsic of connective tissue due to property of muscles of the feet. (21) George Saleman plastic elongation and muscle tissue length studied physical demand profiles of hatha due to addition of sarcomere to the ends of yoga postures performed by older adults by muscle fibres. (26) Mark D Tran et al found quantifying biomechanically using 3D out in a study that with stretching there is motion analysis, force platforms and decrease in neuromuscular activity in electromyography (EMG). Surface antagonist muscles and increase efficiency electromyography signals (EMG) were in agonist group of muscles and stretching is collected from lower limb muscles like associated with increase in capillarization gluteus medius, hamstrings, vastuslateralis and oxidative enzymes. (27) and gastrocnemius. Results showed that A study done by Julie Bastilleto see there was appreciable increase in core effects of yoga therapy in chronic post activity in all postures, increase in stroke hemiparesis, in which4 subjects quadriceps activity in Utakastasana, participated in 8 week yoga program, Veerasana and Trikonasna. Increase in outcome measures being BBS and Timed activity occurred in gluteusmedius, Movement Battery (TMB), results showed 3 minimusand maximus muscles in subjects improved in TBM and 2 subjects Vrukshasana. (24) improved in BBS score. (8) Another RCT Increase in isometric muscular done by Arlene A, post stroke balance endurance could be attributed to holding improved with yoga, in which between poses for prolonged period of time with group comparison showed no significant controlled breathing implies the mind and difference in BBS score, but within group body to focus on active muscles responsible comparison showed significant difference in for stabilizing the body in the various poses BBS score in yoga group. In this study and alternating recruitment of different mean BBS score in yoga group improved by motor units to execute the specific task. 6, which means clinical meaningful Repetitive stretching and force resistance improvement and according to authors this movements of yoga postures increase blood improvement is larger than what is found in circulation to muscles and connective the older adult yoga literature. (28) In our tissues and also improve proprioception by study, in yoga therapy group; mean increase stimulating intrafusal and golgi tendon in BBS score was 8 which indicates, organ feedback mechanism. (24) clinically meaningful improvement. Hip abductors are important There are similarities between stabilizers of pelvis and their muscular asanas and some rehabilitation exercises performance is correlated with balance and that are intended to correct faulty motor fall risks in seniors. Hip flexors are patterns for example movement and important in pulling the limb forward during instructions for performing Utakatasa and the swing phase of the gait and their rehabilitation exercise like rising from chair performance is related to walking speed and pose are essentially the same. There are fall recovery in older adults. (25) Core similarities between Veerasana and forward stability is important because it influences lunges, Vrukshasana and one leg stance trunk orientation which in turn affects hip, pose. But main difference is; rehabilitation knee and ankle position during yoga exercises require multiple repetitions to practice and joint kinematics during learn and develop a motor pattern whereas ambulation. Traditionally important aspect in yoga, a pose has to be achieved slowly of yoga practice is increase in flexibility of and held for a longer duration. Holding upper and lower limb muscles. Increase in poses for prolonged period of time along flexibility can be attributed to static with controlled breathing is one of the stretching nature of the asanas. Increase in important aspects of yoga. (11) Latest studies range of motion is due to increase in length suggest that along with increase in balance

International Journal of Health Sciences & Research (www.ijhsr.org) 141 Vol.9; Issue: 7; July 2019 Anupama Anant Paranjape et.al. To Study Effects of Yoga Therapy on Balance in Post Stroke Hemiplegic Patients which ultimately reduces the risk for falls; stroke. Cochrane Database Syst Rev. yoga is also beneficial in reducing state of Oct18;(4):CD004129. anxiety, depression and asanas may possess 5. Au-Yeung SS, Hui-Chan CW, and Tank JC. depressive symptoms reduction benefits Short-form tai chi improves standing particularly as life stressors increase. (29-31) balance of people with chronic stroke. NeurrehabilNeural Repair. 2009; 23(5): So improvement in balance in yoga group 515-22. could be attributed to increase in strength 6. Gok H, Geler-Kulcu D, Alptekin N et al. and endurance of abdominals, back Efficacy of treatment with a kinaesthetic extensors, hip abductors, hip flexors, ability training device on balance and quadriceps, ankle plantar flexors, lower mobility after stroke: A randomized limb range of motion, spine flexibility, controlled study. Clinical Rehabilitation. increase in concentration and awareness of 2008; 22: 922-30. oneself and surroundings. (21, 24-28) 7. Yang S, Hwang WH, Tsai YC et al. In this study both conventional and Improving balance skills in patients who yoga therapy group showed significant had stroke through virtual reality treadmill improvement. That means both training. American Journal of Physical Medicine & Rehabilitation.2011; 90: 969- interventions seem to have an equal 978. potential for an intervention period of 3 8. Julie V Bastille and Kathleen M Gill-Body. weeks. Both groups showed significant A yoga based exercise program for people results which could be because of with chronic poststroke hemiparesis. similarities in postures attained in both Physical Therapy. 2004; 84: 33-48. groups. 9. Lawrence M, Celestino Junior FT, Matozinho HH et al. Yoga for stroke CONCLUSION rehabilitation. Cochrane Database Syst This study suggests that both Rev.2017 Dec 8;12:CD011483. conventional therapy and yoga therapy 10. Lee Lipton. Yoga to treat diseases. enhance balance in post stroke patients at ReviewArticle.2008; 21(2). 11. Robin Manro. Yoga therapy. Journal of the end of3 weeks of treatment. However, body work and movement therapies.1997; there was no statistically significant 1(4): 215-28. difference between conventional group and 12. Lisa Blum and NicolKorner-Bitensky. yoga group on the outcome measures at the Usefulness of the Bergs balance scale in end of 3 weeks treatment. Yoga therapy can stroke rehabilitation: A Systematic Review. be used as an alternative approach to Physical Therapy. 2008; 88(5): 559-566. conventional training in stroke patients in 13. Arlene A. Schmid, Marieke Van sub-acute and chronic stages of recovery. Puymbroeck,Peter A. Altenburgeret al. Balance and balance self-efficacy are REFERENCES associated with activity and participation 1. O’Sullivan SB, Schmitz TJ. Physical after stroke: A cross-sectional study in rehabilitation assessment and treatment. people with chronic stroke. Archives of Stroke. 5th ed. India: Jaypee Brothers; 2007. Physical Medicine and Rehabilitation. 2012 p. 705-775. June;93(6):1101-1107. 2. Darcy A. Umphred. Neurological 14. Hall E, Verheyden G, Ashburn A. Effect of rehabilitation. 5th ed. Mosby Elsevier; 2007. a yoga programme on an individual with p. 865- 858. Parkinson's disease: a single-subject design. 3. Carr JH, Shepherd RB, Stroke rehabilitation DisabilRehabil. 2011 Nov; 33(15-16):1483- guidelines for exercise and training to 9. optimize motor skill. 1st ed. London: 15. Mooventhan A, Nivethitha L. Evidence Butterworth Heinemann; 2003. P- 36-75. based effects of yoga in neurological 4. R.Barclay-Goddard. Force platform disorders. J ClinNeurosci. 2017 Sep;43:61- feedback for standing balance training after 67. 16. Holly Lynton, Benjamin Kligler, and Samuel Shiflett. Yoga in stroke

International Journal of Health Sciences & Research (www.ijhsr.org) 142 Vol.9; Issue: 7; July 2019 Anupama Anant Paranjape et.al. To Study Effects of Yoga Therapy on Balance in Post Stroke Hemiplegic Patients

rehabilitation: A systematic review and 25. Zettergren KK, Lubeski JM, Viverito JM. results of pilot study. Top Stroke Rehabil. Effects of a yoga program on postural 2007;14(4):1-8 control, mobility, and gait speed in 17. Dr. Catherine Sherrington, Dr. Colleen community-living older adults. Journal of Canning, Dr Catherine Dean et al. Weight Geriatric Physical Therapy 2011 April- bearing exercises for better balance. A June;34(2):88-94. challenging, safe, evidence-based 26. Bal, B.S,Kaur, P.J. Effects of selected physiotherapy program for older people. asanas in hatha yoga on agility and DRAFT 19, 1 September 2008. Available flexibility level. Journal of Sport and Health from: www.webb.org.au Research. 2009;1(2): 75-87. 18. Catherine M Dean, Chris Rissel, Michele 27. Tran MD, Holly RG, Lashbrook J et al. Sharkey etal. Exercise intervention to Effects of Hatha Yoga Practice on the prevent falls and enhance mobility in Health-Related Aspects of Physical Fitness. community dwellers after stroke: a protocol Preventive Cardiology. for randomised controlled trial. BMC 2001.Autunm;4(4):165-170. Neurol.2009;9:38. 28. Altenburger, Nancy L. Schalk, Tracy A. 19. VishwasMandlik. Yogapravesh. 11th Dierks et al. Post stroke balance improves edition. Nashik:YogaChaitanya; with Yoga: A prospective, randomized, pilot 2004.p.174-180 study. American Heart Association. 20. SadashivNimbalakar. Yoga for health and 2012;43: 2402-2407. peace.3rd Edition. Mumbai: Yoga Vidya 29. Green E, Huynh A, Broussard L et al. Niketan;1999.p.122-170 Systematic review of Yoga and Balance: 21. Leslie Kaminoff. Yoga Anatomy. 1st Effects on Adults with neuromuscular edition.US: Human Kinetics; 2007. impairment. Am J OccupTher. 2019. 22. Janet Carr and Roberta Shepherd. Jan/Feb;73(1):1-11. Neurological Rehabilitation, Optimizing 30. Thayabaranathan T, Andrew NE, Immink motor performance.2nd edition. Churchill MA et al. Determining potential benefits of Livingstone: Elsevier, 2010. p.77-18. yoga in chronic stroke care: a systematic 23. Cheng PT, Liaw MY, Wong MK et al. The review and meta-analysis. Top Stroke sit-to-stand movement in stroke patients and Rehabil. 2017 May;24(4):279-287. its correlation with falling. Arch Phys Med 31. Franklin RA, Butler MP, Bentley JA. The Rehabil. 1998 Sep;79(9):1043-6. physical postures of yoga practices may 24. GeorgeJ.Salem, Yu SS, Wang MY et al. protect against depression symptoms, even Physical demand profiles of hatha yoga as life stressors increase: a moderation postures performed by older adults. analysis. Psychol Health Med. 2018 Evidence-Based Complementary and Aug;23(7):870-879. Alternative Medicine. 2013;2013: 165763.

How to cite this article: Paranjape AA, Gore A. To study effects of yoga therapy on balance in post stroke hemiplegic patients. Int J Health Sci Res. 2019; 9(7):135-143.

******

International Journal of Health Sciences & Research (www.ijhsr.org) 143 Vol.9; Issue: 7; July 2019