Open Access Open Access  Restricted Access Subscription or Fee Access

Yoga and self-management for people with chronic stroke: Effect on community reintegration and perceived activity constraints

Ruby A. Bolster, MS, OTR, Marieke Van Puymbroeck, PhD, CTRS, FDRT, Karen E. Atler, PhD, OTR, Jennifer Dickman Portz, PhD, MSW, Katie M. Hinsey, MS, OTR, Arlene A. Schmid, PhD, OTR, RYT-200


After a stroke, it is common for individuals to experience challenges in both perceived activity constraints and community reintegration. Few interventions have addressed these two important variables that are related to post-stroke life and recovery. The objective was to assess the impact of an 8-week intervention on perceived activity constraints and community reintegration among individuals with chronic stroke. This noncontrolled pilot study with pre- and post-test design included 13 people with chronic stroke who completed group yoga and self-management intervention. Assessments were completed at baseline and at the completion of the 8-week intervention. Data were analyzed using Wilcoxon Signed-Rank tests to compare baseline and 8-week scores. Additionally, the correlation between activity constraints and community reintegration scores among this sample was analyzed. The average age of the 13 participants was 73.23 years, and 77 percent of the participants sustained a stroke >5 years ago. Perceived activity constraint scores improved significantly (76.82 ± 10.97 vs. 87.08 ± 9.5, p = 0.005; 13 percent change), as did community reintegration scores (79.25 ± 15.45 vs. 97.92 ± 11.46, p = 0.004; or a 24 percent improvement). Perceived activity constraint and Reintegration to Normal Living  Index (RNLI) scores demonstrated an excellent and significant correlation (rs = 0.864, p = 0.001). When working with people with chronic stroke, rehabilitation therapists may consider self-management combined with yoga. Due to the correlation between community reintegration and perceived activity constraints, potentially rehabilitation therapists, including recreational therapists, may target perceived activity constraints to improve community reintegration.


activity constraints, community reintegration, group therapy, self-management, stroke, yoga

Full Text:



Centers for Disease Control and Prevention: Prevalence and most common causes of disability among adults—United States, 2005. MMWR. 2009; 58(16): 421-426.

Mozaffarian D, Benjamin EJ, Go AS, et al.: Heart disease and stroke statistics—2016 update: A report from the American Heart Association. Circulation. 2015; 133: e38-e360.

Gauggel S, Peleska B, Bode RK: Relationship between cognitive impairments and rated activity restrictions in stroke patients. J Head Trauma Rehabil. 2000; 15(1): 710-723.

Hartman-Maeir A, Soroker N, Ring H, et al.: Activities, participation and satisfaction one-year post stroke. Disabil Rehabil. 2007; 29(7): 559-566.

Go AS, Mozaffarian D, Roger VL, et al.: Heart disease and stroke statistics—2014 update: A report from the American Heart Association. Circulation. 2014; 129(3): e28.

Forster A, Young J: Incidence and consequences offalls due to stroke: A systematic inquiry. BMJ. 1995; 311(6997): 83-86.

Schmid AA, Van Puymbroeck M, Altenburger PA, et al.: Balance and balance self-efficacy are associated with activity and participation after stroke: A cross-sectional study in people with chronic stroke. Arch Phys Med Rehabil. 2012; 93(6): 1101-1107.

Schmid AA, Yaggi HK, Burrus N, et al.: Circumstances and consequences of falls among people with chronic stroke. J Rehabil Res Dev. 2013; 50(9): 1277-1286.

Schmid AA, Rittman M: Consequences of poststroke falls: Activity limitation, increased dependence, and the development of fear of falling. Am J Occup Ther. 2009; 63(3): 310-316.

Egan M, Davis CG, Dubouloz C-J, et al.: Participation and well-being poststroke: Evidence of reciprocal effects. Arch Phys Med Rehabil. 2014; 95(2): 262-268.

Wood-Dauphinee SL, Williams JI: Reintegration to normal living as a proxy to quality of life. J Chronic Dis. 1987; 40(6): 491-499.

Robison J, Wiles R, Ellis-Hill C, et al.: Resuming previously valued activities post-stroke: Who or what helps? Disabil Rehabil. 2009; 31(19): 1555-1566.

Walsh ME, Galvin R, Loughnane C, et al.: Factors associated with community reintegration in the first year after stroke: A qualitative meta-synthesis. Disab Rehabil. 2015; 37(18): 1599-1608.

Crawford DW, Jackson EL, Godbey G: A hierarchical model of leisure constraints. Leisure Sci. 1991; 13(4): 309-320.

Jackson EL: Leisure constraints: A survey of past research. Leisure Sci. 1988; 10(3): 203-215.

Jackson EL, Crawford DW, Godbey G: Negotiation of leisure constraints. Leisure Sci. 1993; 15(1): 1-11.

Winstein CJ, Stein J, Arena R, et al.: Guidelines for adult stroke rehabilitation and recovery. Stroke. 2016; 47(6): e98-e169.

Mayo NE, Anderson S, Barclay R, et al.: Getting on with the rest of your life following stroke: A randomized trial of a complex intervention aimed at enhancing life participation post stroke. Clin Rehabil. 2015; 29(15): 1198-1211.

Huijbregts MP, Myers AM, Streiner D, et al.: Implementation, process, and preliminary outcome evaluation of two community programs for persons with stroke and their care partners. Top Stroke Rehabil. 2008; 15(5): 503-520.

Field T: Yoga clinical research review. Complement Ther Clin Pract. 2011; 17(1): 1-8.

Gard T, Noggle JJ, Park CL, et al.: Potential self-regulatory mechanisms of yoga for psychological health. Front Hum Neurosci. 2014; 8: 770.

Schmid AA, Miller KK, Van Puymbroeck M, et al.: Yoga leads to multiple physical improvements after stroke: A pilot study. Complement Ther Med. 2014; 22(6): 994-1000.

Immink MA, Hillier S, Petkov J: Randomized controlled trial of yoga for chronic poststroke hemiparesis: Motor function, mental health, and quality of life outcomes. Top Stroke Rehabil. 2014; 21(3): 256-271.

Van Puymbroeck M, Smith R, Schmid A: Yoga as a means to negotiate physical activity constraints in middle-aged and older adults. Int J Disabil Hum Develop. 2011; 10(2): 117-121.

Lorig KR, Holman H: Self-management education: History, definition, outcomes, and mechanisms. Ann Behav Med. 2003; 26(1): 1-7.

Ng SS, Chan DY, Chan MK, et al.: Long-term efficacy of Occupational Lifestyle Redesign Programme for strokes. Hong Kong J Occup Ther. 2013; 23(2): 46-53.

Schmid AA, Miller KK, Van Puymbroeck M, et al.: Feasibility and results of a pilot study of group occupational therapy for fall risk management after stroke. Br J Occup Ther. 2015; 78(10): 653-660.

Lund A, Michelet M, Sandvik L, et al.: A lifestyle intervention as supplement to a physical activity programme in rehabilitation after stroke: A randomized controlled trial. Clin Rehabil. 2012; 26(6): 502-512.

Wolf TJ, Baum CM, Lee D, et al.: The development of the Improving Participation after Stroke Self-Management Program (IPASS): An exploratory randomized clinical study. Top Stroke Rehabil. 2016; 23(4): 284-292.

Schmid AA, Van Puymbroeck M, Portz JD, et al.: Merging yoga and occupational therapy (MY-OT): A feasibility and pilot study. Complement Ther Med. 2016; 28: 44-49.

Callahan CM, Unverzagt FW, Hui SL, et al.: Six-item screener to identify cognitive impairment among potential subjects for clinical research. Med Care. 2002; 40(9): 771-781.

Wood-Dauphinee SL, Opzoomer MA, Williams JI, et al.: Assessment of global function: The Reintegration to Normal Living Index. Arch Phys Med Rehabil. 1988; 69(8): 583-590.

Eng JJ, Chu KS, Kim CM, et al.: A community-based group exercise program for persons with chronic stroke. Med Sci Sports Exerc. 2003; 35(8): 1271.

Kessler D, Egan M: A review of measures to evaluate participation outcomes post-stroke. Br J Occup Ther. 2012; 75(9): 403-411.

Bluvol A, Ford-Gilboe M: Hope, health work and quality of life in families of stroke survivors. J Adv Nurs. 2004; 48(4): 322-332.

Shinew KJ, Floyd MF, Parry D: Understanding the relationship between race and leisure activities and constraints: Exploring an alternative framework. Leisure Sci. 2004; 26(2): 181-199.

Portney LG, Watkins MP: Foundations of Clinical Research: Applications to Practice. Vol 2. Upper Saddle River, NJ: Prentice Hall, 2000.

Schmid AA, Van Puymbroeck M, Altenburger PA, et al.: Poststroke balance improves with yoga: A pilot study. Stroke. 2012; 43(9): 2402-2407.

Lorig KR, Holman HR: Self-management education: History, definition, outcomes, and mechanisms. An Behav Med. 2003; 26(1): 1-7.

Cole MB: Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention. 4 ed. New York, NY: Slack Incorporated, 2011.

Falk-Kessler J, Momich C, Perel S: Therapeutic factors in occupational therapy groups. Am J Occup Ther. 1991; 45(1): 59-66.

Murtezani A, Hundozi H, Gashi S, et al.: Factors associated with reintegration to normal living after stroke. Med Arch. 2009; 63(4): 216-219.

Atler K: The experiences of everyday activities post-stroke. Disabil Rehabil. 2016; 38(8): 781-788.

Wood JP, Connelly DM, Maly MR: Getting back to real living: A qualitative study of the process of community reintegration after stroke. Clin Rehabil. 2010; 24: 1045-1056.



  • There are currently no refbacks.