Sensorimotor Changes in Stroke Following Mindfulness

Thirty percent of stroke survivors experience spasticity, a velocity dependent increase in
stretch reflexes, which negatively affects quality of life and activities of daily living
(Thibaut et al. 2013). Spasticity is a secondary neurological symptom induced by neurological
hyperreflexia seen in stroke and other neurological disorders (Bose et al. 2015). If left
untreated, stroke survivors may develop contractures which can further impede motor recovery
and participation in activities of daily life (Thibaut et al. 2013). Spasticity is typically
treated with medications, botox injections, baclofen intrathecal pumps, occupational therapy,
and physical therapy, but current treatment options are often expensive and effectiveness is
generally unsatisfactory (Kheder and Nair 2012). Thus, there is a need to find low-cost,
effective, and accessible methods that have the potential to help reduce spasticity and
promote recovery.

Increased spasticity has been linked to emotion-based stress, such as anxiety (Bhimani and
Anderson 2014). Previous research has anecdotally linked meditation, a technique that has
been used to reduce anxiety, to decreased post-stroke spasticity (Bhimani and Anderson 2014).
In this pilot study, the researchers aimed to test whether two weeks of mindfulness
meditation could lead to reduced anxiety and reduced post-stroke spasticity. Briefly,
mindfulness meditation is a type of meditation that trains awareness and acceptance of the
current inner and outer reality, and is often taught through Jon Kabat-Zinn's 8-week
Mindfulness Based Stress Reduction (MBSR) course (Kabat-Zinn 1996). Importantly, while it is
typically taught by an experienced teacher over a series of sessions, studies have also shown
successful mindfulness practice via audio/video recording (Potter 2017), allowing for greater
accessibility to mindfulness training for broader audiences, including those with mobility
limitations.

Although studies have found that mindfulness meditation may be linked to mood, anxiety, and
pain reduction, it has not been directly connected to motor function or spasticity (Creswell
et al. 2014; Moustgaard et al. 2007; Zeidan et al. 2010). Specifically, mindfulness
intervention studies have reported decreased mental fatigue in people with TBI or stroke
(Johansson et al. 2012) and a reduction in psychological stress and improvement in cognitive
function in patients with multiple sclerosis (Blankespoor et al. 2017). One systematic review
showed that mindfulness meditation helped patients cope with their chronic illnesses,
including cancer, depression and general anxiety disorder, by improving their mood and
anxiety symptoms (Hofmann et al. 2010). In stroke and transient ischemic attack survivors,
there is small but growing evidence that mindfulness promotes positive results for
psychological and psychosocial health (Lawrence et al. 2013). A pilot study with individuals
after stroke used an 8-week Mindfulness-Based Cognitive Therapy (MBCT) intervention, which is
a combination of MBSR with some insights from cognitive behavioral therapy, and found a
reduction in anxiety and depression and an increase in quality of life, including physical
functioning. (Moustgaard et al. 2007).

Because of the anecdotal evidence linking stress to increased spasticity and the clinical
evidence linking meditation to decreased stress, the researchers conducted a pilot study to
explore whether two weeks of guided mindfulness meditation—a low-cost, home-based
intervention—could improve spasticity, along with quality of life, stress and anxiety, in
individuals after stroke.

Inclusion Criteria:

- Chronic stroke (greater than 1 year post stroke)

- Over 18 years old

- Moderate to severe motor deficits with self-reported spasticity

- No prior mindfulness meditation experience

Exclusion Criteria: