Brain injury mindfulness strategies to incorproate into brain injury rehabilitation
Hi everyone. Welcome. Thank you all for being here, and I’m honored to be a speaker. So my lecture is gonna be on mindfulness and the brain injured population, and this is actually something that I do with my patients every single week. So instead of sit here for the next 50 minutes and lecture to you about the benefits of mindfulness, we’re gonna do a little bit of that for about 10 minutes. And the rest of the session is actually gonna be what I do with patients every single week, which is teach them breath work to help them get calm and centered and then followed by an actual meditative practice, which I’ll guide you through. So the purpose of this is for you guys to have an experience of what our patients have every single week. So first, these are the objectives. One, what is mindfulness? Two, how do you actually practice it? Three, what are the benefits of mindfulness? And four, how do we incorporate this practice into our brain injured population? So first, what is mindfulness? So it’s a state of consciousness where we’re paying attention to our present moment. And this can happen in any experience that you have throughout the day, and you can cultivate it through many practices such as meditation, tai chi, walking in nature, et cetera. And as you learn these principles and techniques of mindfulness, you can utilize them in any moment of your day, whether you’re eating, driving, showering, or even sending emails.
What is meditation and how can mindfulness help brain injury recovery?
So meditation is considered a general term, and that covers a wide range of practices to help you with your awareness. There are hundreds of kinds of meditation practices out there, including but not limited to, relaxation, concentration, visual imagery, which we’ll do today, breath work and religious chanting, and even prayer. So what is the history behind this? So mindfulness based practices have been around for over 5,000 years. They date back to the Hindu Vedas, but they were also seen later on in history with the Greeks, the ta, TAUs, the Native Americans and other various religious traditions, as well as poets, philosophers, and scientists throughout history. And this practice can be done by anyone regardless of age, background, religion, or diagnosis. So mindfulness is a state of being. And there’s a large body of research coming out right now showing that it actually changes our physiological state. It increases your parasympathetic system, which is your rest or digest system, and it decreases the sympathetic or the fight or flight response system in our bodies. And research is also showing that it could be a powerful way to actually affect neuroplasticity. So our brain’s ability to form new neural connections in response to the environment after trauma.
What are the benefits of mindfulness-based brain injury treatment?
So these are some, but not all of the benefits of having a mindfulness-based practice. One, it can help reduce stress, it helps reduce chronic physical pain, it helps boost your body’s immune system to fight disease. It helps you cope with painful life events such as death of a loved one or even major illness. It helps reduce your blood pressure. It helps deal with negative emotions like anger, fear, or greed. It helps increase your self-awareness to detect harmful reactive patterns of thought, feeling, or action. It helps improve your attention and your concentration. It also helps enhance positive emotions, whether that’s happiness or compassion or joy. It helps increase your interpersonal skills and your relationships. In addition, it helps reduce addictive behaviors like eating disorders, alcoholism, and smoking. And it helps in enhance your performance, whether that be in work, academics or sports. And it helps stimulate and release creativity.
The benefits of aerobic exercise and mindfulness after brain injury
So we’re briefly gonna look at three articles, specifically looking at mindfulness based practices in the brain injured population, and then we’ll dive right into a practice. The first article I want to discuss is the effects of guided aerobic exercise and mindfulness after acquired brain injury. So the purpose of this study was to examine whether a specific guided program of aerobic exercise together with mindfulness could have an effect on estimated health status and occupational performance and individuals with acquired brain injury. And as secondary outcomes, the researchers looked at the effects on health related quality of life, cognition and mental fatigue. So what were the methods of this study? They included individuals with mild to moderate brain injury with residual cognitive impairments. The actual intervention was a combination of outdoor walking and mindfulness sessions three times a week for a total of 12 weeks. Each session started off with 40 minutes of walking, followed by training sessions and mindfulness.
And the walking was beautiful. It was carried out in a forest or pathways with surrounding trees. And the participants were told not to talk during the final 30 minutes, but to just focus on nature. And the exercises in mindfulness were carried out indoors, sitting on a chair and lying on a yoga mat. The training and mindfulness included body scanning, meditation, breathing, and yoga, followed by discussions about attitudes to life and the participants’ experiences with mindfulness exercises and neuropsychological and physical tests as well as patient reported outcome measures were used as outcomes. And the results of this study showed a statistically significant improvement in cognitive function, processing speed, attention, et cetera, and also mental fatigue was reduced. The second research article I wanted to bring up was mindfulness-based stress reduction, otherwise known as MBS R, improving long-term mental fatigue after stroke or traumatic brain injury. So the objective of this study was to look at patients who suffer from mental fatigue after a stroke or tbi.
They have a drastically reduced capacity for work and for participating in social activities. And since there really is no effective therapy for this, the aim was to implement a novel non-pharmacological strategy aimed at improving the condition of these patients. So what were the methods of this study? It tested a treatment with mindfulness based reduction MBS R, and the results were evaluated using a different scale, a self-assessment scale for mental fatigue and a variety of neuropsychological tests. They had 18 stroke patients and 11 traumatic brain injury patients. And just in general, what is MBS R? You might have heard of it before, but it’s designed for a heterogeneous population. It’s an educational program, not about training to remove something unwanted, but learning rather to live fully live life to the fullest. It’s clinically effective for a wide range of conditions as stress, depression, pain, fatigue, and even cancer with the potential of helping individuals to cope better with their difficulties.
So the results of this study showed a statistically significant improvement achieved in the primary endpoint, which was the self-assessment for mental fatigue and the secondary endpoint, which was neuropsychological tests. And concluding from this study, they show that MBSR may be a promising non-pharmacological treatment for mental fatigue after a stroke or traumatic brain injury. And the last research article I wanna go to before we dive into practice is stimulus oversell activity and temporal brain injury mindfulness as a potential intervention. So the objective of this study was aimed to investigate the impact of brief mindfulness training on the performance of a sample of patients with traumatic brain injury in an overs selectivity task. So basically what is that? So stimulus over selectivity occurs when one aspect of your environment exerts a disproportionate influence over your behavior. So at the expense of other equally important events going on in your environment at the same time.
And as we all know, a lot of traumatic brain injury patients do have this problem. And it’s been suggested that individuals who display over selectivity may suffer attention control deficits that impair their ability to attend to their environment in an appropriate manner. So what was the method of this study? It was a study. It was a study was a between subjects to design. So they used mindfulness intervention versus a control group with the difference between the number of most and least chosen stimulus selections during an over selectivity task. And they used a variety of tests to test this, and the results showed that over selectivity was significantly reduced by a mindfulness induction when compared to a non intervention control group.
Let’s practice mindfulness and meditation
Now that you have a background about the benefits of meditation and mindfulness and these practices, let’s go ahead and go into practice. So again, this is what I do with my patients every single week, and it’s structured very similarly to this. For about the first 10 minutes, I talk about research behind mindfulness and why we do this practice. The second portion is teaching them how to do prana or deep breathing work, which helps them set in into a good head space to start meditation, which they lead them through. So what is pram? It’s a Sanskrit word, and it’s made up of two different parts. Prana meaning your life force, otherwise known in traditional Chinese medicine is chi, you’ve probably heard of that before. And Yama is the direction of, so together their breathing exercises that can either increase, decrease, or stabilize your energy. And the purpose of these exercises is to help stabilize them. The three breathing exercises that I’ll actually do with you right now is one alternate nostril breathing, two, three stepwise breathing, and three, a sahaja four part equal breath. So this is where it becomes fun. All you have to do is listen and follow along. It doesn’t have to be perfect. And as long as you focus on your breath, you’re doing everything right. So the first breath we’re gonna do is alternate nostril breathing.
So what we’re gonna do is take your right hand and with the two fingers right over here, you’re gonna place them right in between your eyebrows and then it’s alternate nostrils. So either your thumb will hold down your right nostril or your fourth ring finger will hold down your left nostril. So you’re gonna place your two fingers right here between your eyes. You’re gonna close your right nostril and take a deep breath in through the left nostril, hold it, close the left nostril, breathe out through the right, breathe in through the right nostril. Close the right nostril. Breathe out through the left. And that’s one round. We’re gonna do a few more of these. Okay, so close your right nostril, breathe in through the left, close the left, breathe out through the right, breathe in through the right, close the right breathe out through the left. And we’ll repeat. Breathe in through the left close. Breathe out through the right, breathe in through the right close. Breathe out through the left. We’ll repeat, breathe in through the left close. Breathe out through the right, breathe in through the right close. Breathe out through the left.
And we’ll do it one more time. Breathe in through the left close, breathe out through the right, breathe in through the right close. Breathe out through the left. And just put your hand down and open your eyes. How do you guys feel?
A little different, maybe a little bit more common centered. So that’s actually my favorite pram technique. And the second one we’re gonna do is called three stepwise breathing. And this is also very simple. And all of these are things that you can utilize on your own or do safely with patients. And so for three stepwise breathing, you’re gonna exhale all the way out. And then you’re gonna take a breath in and hold it. Take a breath in and hold it, take a breath in and then hold it at the top. You’re gonna take a breath out, hold it a breath out, hold it a breath out, and hold it at the bottom. So three breaths into the top and three breaths out to the bottom. And you wanna kind of space your breathing. And this one takes a little bit longer to get used to. And some of these are easier than others, but all of these have wonderful benefits. So, and what you can do with your hands is place them on your lap with your palms facing up. So we’ll start off with just taking a cleansing breath in through the nose and then out.
And then we’ll start. Take a breath in, hold it, breath in, hold it, breath in and hold it. Breathe out, hold it, breathe out. Hold it, breathe out and hold it really good. Take a cleansing breath in and then out. Breath in and hold it. Breath in and hold it, breath in. And then hold it at the top. Breathe out, hold it, breathe out. Hold it, breathe out. Hold it good. Take a cleansing breath in and then release whatever you don’t need out. And we’ll do it one more time. Breathe in, hold it, breathe in, hold it, breathe in. Hold it at the top. Breathe out, hold it, breathe out. Hold it. Breathe out and hold it. Good. Take a deep breath in and then let everything out.
Good. And the last breath that we’re gonna do is called a sahaja four part equal breath. And when you think about doing this specific type of pram, you wanna think about air expanding from the bottom of your lungs all the way to the top, and every rib expanding, and even your clavicles. And the more air that you get, the more oxygen that you’re able to put into your lungs, the more that gets to your brain and the better the benefit. And it’s just four part equal breath. So you’re gonna breathe all the way out, and then you’re gonna breathe in and hold it at the very top. And then you’re gonna breathe out and hold it at the very bottom. And we’ll do a couple of rounds of this. Okay? And again, you can have your palms on your lap just facing up. And just everyone close their eyes. And we’ll just take a deep breath in and take a cleansing breath out and then we’ll begin. Breathe in. Hold. Breathe out. Hold. Breathe in.
Hold. Breathe in. Hold. Breathe in. Hold. Breathe in. Hold. Breathe in. Hold. Breathe in. Hold. One last time, breathe in. Hold. Breathe out and hold. And just relax and open your eyes. How do you guys feel?
Mindfulness preparing you for meditation and brain injury rehabilitation
So this is supposed to help relax you and get you a state of meditation to be prepared for it. And how many of you noticed it was hard to think about other things when you were doing these exercises? When you focus on your breath, it helps center you. And then you’re able to move forward in a more peaceful state. And these are things that you can do and that you can have patience do at any moment of the day. Um, at any time. They’re wonderful and they’re very relaxing. So the second thing that we’re gonna do for our practice is do a heart-centered meditation. And this was actually something that got me back into my practice of meditation when I was in medical school with Dr. Anne Maia, liaison at the University of Arizona and their integrative medicine center. And to do this guided meditation, you’ll place your right palm over your chest, and then on top of that you’ll place your left palm with your thumbs touching. And all you have to do is just close your eyes and just relax and just listen to her words. It’s incredibly calming. So we’ll go ahead and get started. Thank you.
What is the “heart center” and how does it contribute to brain injury rehabilitation?
Now we’ll move into the heart center. Many people think that the heart center is a personal love and a place of compassion, yet I find it’s much more. The heart center for me is a transpersonal state of consciousness. It’s not in our ordinary everyday awareness. For me, this is the wellspring of healing. It’s actually the source of divine healing located within the body. So when I do healing work, I always start with the heart center. We’ll begin now by an exploration of the heart center. Before we begin, I’d like to show you the mudra that I use during the heart-centered meditation. Start with your right hand placed mid chest. Place your left hand over the right hand and let your thumbs touch gently rest your hands on your chest. If it requires any effort, then push a little more deeply into your chest and relax. The heart center has four aspects. The the first is compassion, the second innate harmony, the third healing presence, and the fourth unconditioned, unconditional love. Close your eyes and take a few deep breaths while I bring you into this center. With your eyes closed, slow your breath. The first aspect of the heart center,
Compassion, oceanic compassion. Bring up an image of something that makes you feel compassionate. Breathe compassion. Be compassion. With each breath deepen into oceanic compassion. Allow it to flow through your entire body. Compassion now gently shift your awareness to the second aspect of the heart center. Innate harmony. It’s the calm. In the midst of chaos, it’s the eye in the center of the hurricane. It’s the still point. Finding the place inside that knows innate harmony. No matter what’s happening around you that still place innate harmony, breathe it in and breathe it out. Become innate harmony. Calm In the midst of chaos, let it perfuse your whole body. Innate harmony. Now shift your focus to the third aspect of the heart center healing, presence, the longing and desire to move toward healing. Healing presence. With each breath, allow yourself to feel the longing for healing. Desire turned into service, healing presence. Allow it to radiate through your whole body, into your hands, and back into your own heart healing presence. Take a deep breath in and allow your focus to shift again to the fourth aspect of the heart center. Unconditional, unconditional love, allowing each thing to be exactly as it is.
Take a few deep breaths in the quietness of unconditional, unconditional love, unconditioned, unconditional love. It’s not personal love, it’s divine love with the ability to love everything and anything that comes into its focus. No judgment, unconditioned, unconditional love. Breathe it in and breathe it out. Allow yourself to be unconditional love. Now we’ll prepare for heart centering before healing with your hands on your chest. Again, right hand over your mid chest, left hand over that thumbs touching. Take a deep breath and let’s begin. Use the aspects of the heart center as an internal mantra as we moved into the heart center space. Compassion, innate harmony, healing, presence, unconditioned, unconditional love. As you internally repeat these, allow yourself to activate so your whole body becomes the heart center before you move into healing, compassion, innate harmony, healing, presence, unconditioned, unconditional love with each breath, repeating the mantra that calls you, allowing your whole body to experience the heart center. Now, asking to go one level, deeper compassion, innate harmony, healing, presence, unconditional love with each breath, dropping in deeper compassion, innate harmony, healing, presence, unconditional love. Allowing the healing work inside your own body. To start with this simple meditation,
Asking for any healing that you’re seeking from the source. Compassion, innate harmony, healing, presence, unconditional love, breathing deeply, feeling it throughout your whole body. Noticing how you feel and opening your eyes.
Loving kindness meditation also helps with brain injury recovery
How is that? That felt good.
Wonderful. That’s exactly what I wanted you to guys, what I wanted you guys to feel and experience, um, and the reason why I didn’t want to lecture this entire 50 minutes, but we’re not over yet. The last thing I do with my patients is a loving kindness meditation. And I have a lot of these resources online that I’ll share with you at the very end so you can utilize them for yourself, your friends, your family, or your patients. And again, all you have to do is close your eyes and this will be short, it’ll be about eight minutes. Close your eyes and relax. To begin this practice, let yourself be in a relaxed and comfortable position. We’re going to do the practice of cultivating positive emotion. In this case, loving kindness, which is the desire for someone to be happy or yourself to be happy. It’s not dependent on something, it’s not conditional. It’s just a natural opening of the heart to someone else or to yourself. So you can check in into your body and notice how you’re feeling right now, letting whatever is here be here. Now let yourself bring to mind someone whom the moment you think of them, you feel happy.
See if you can bring to mind. It could be a relative or a close friend, someone with not too complicated a relationship, just a general sense that when you think of them, you feel happy. You can pick a child or you can always choose a pet, a dog or a cat, a creature that’s fairly easy to feel love for. So let them come to mind. Have them have a sense of them being right in front of you. You can feel them, you can sense them, you can see them. And as you imagine them, notice how you’re feeling inside. Maybe you feel some warmth or there’s some heat to your face, a smile or a sense of expansiveness. This is loving kindness. This is a natural feeling that’s accessible to all of us at any given moment. So now having this loved one right in front of you, begin to wish them well. May you be safe and protected from danger. May you be happy and peaceful. May you be healthy and strong. May you have ease and wellbeing. And as I say these words, you can use my words or your own words and have a sense of letting this loving kindness come from within you
And begin to touch this loved one. Reaching out
Far out.
You might think in images, you might have a sense of color or even light. You might just have a feeling. The words may continue to bring on more of this feeling. And I encourage you to say whatever feels meaningful to you. May you be free from stress and anxiety. May you be free from all fear. And so as you’re feeling and sending out these words and these feelings of loving kindness, also check into yourself and see how you’re feeling inside. And now imagine that this loved one turns around and begins to send it right back to you. So see if you can receive the loving kindness, take it in, take it all in, and they’re wishing you well. May you be happy, meaning you. May you be peaceful and at ease. May you be safe and protected from all danger. May you have joy and wellbeing, letting yourself take it all in. Now, if you’re not feeling anything at this point or before in the meditation, it’s not a problem. This as a practice that plants seed. And if you’re feeling something other than loving kindness, just check into that. What is it I’m feeling in this present moment? There may be something to learn here. Now if it’s possible. And it’s not always easy to do this, but see if you can send loving kindness to yourself.
You can imagine it coming down your body from your heart. You can have a sense of it. May I be safe and protected from danger? May I be healthy and strong? May I be happy and peaceful? May I accept myself just as I am. And as you ask yourself the question, what do I need to be happy? See what arises and offer that to yourself. May I have meaningful work, a joyful life? May I have close friends and family? And now checking into yourself and noticing what it is you feel as you do this. And now let yourself bring to mind one person or a group of people that you wish to send the loving kindness to. Imagine them right in front of you. Sense them. Feel them. May you be happy and peaceful. May you be free from all stress and anxiety and fear. May you be free from worry. May you be free from grief. May you have all the joy and happiness this life has to offer. May you have wellbeing And now let this loving kindness expand out, spreading far out, touching anyone that you want to touch right now in all directions. People you know, people you dunno, people you have difficulty with, people you love. Just imagine expanding and touching. And each person or animal, whoever is touched by this loving kindness, each person is forever changed. You can imagine that. So may everyone, everywhere be happy and peaceful and at ease. May we all experience great joy. And you can slowly open your eyes. You guys feel relaxed?
Good. Ready to fall asleep? When you first start practicing this, that’s pretty normal. If you feel tired, maybe a little bit lightheaded, all of that’s completely normal. And the more that you practice this, the less you’ll feel that. And you’re gonna feel more energized, especially with the breathing work. I think it’s so incredibly powerful. Even if you did that for 30 seconds a day, you’re gonna notice a change. So here are some of my resources that I’ve used over my presentation and I just wanted to dedicate this lecture and this talk to my mother, Sava three Balala, who is a neonatologist practicing in uh, private practice in Clear Lake for over 30 years. She lost her battle to cancer at MD Anderson December 14th. And is the reason why I became a physician and is the reason why I’m up here talking to you guys today.
Resources to continue learning about mindfulness, meditation, and brain injury rehabilitation
Here are two really amazing resources where I’ve gathered a lot of information from one being the UCLA Health Mark Center and they have a bunch of resources, both guided and non guided meditations that you can download from online transcripts that I’ve actually used for today’s lecture and also music that you can do. And they have podcasts that you can, um, assign to and get weekly meditations from them. Apart from that, there’s also Palouse Mindfulness. And this is a Harvard based researcher who actually developed mindfulness based stress reduction, M B S R that we talked about earlier in one of the, um, trials that I talked about. And it’s a free eight week course where you actually can get certified in mindfulness based stress reduction. You do different workshops throughout the week, send in different um, worksheets and look at different videos and you’ll actually be certified. And this is completely free. And those are two wonderful resources. And that concludes my presentation. Does anyone have any questions? Wonderful. Well, you guys have lunch right now and it’s right next door. I believe so. I hope you all enjoy it. And thank you so much for this opportunity.
