Mindfulness based therapy on group of rehabilitative ABI (Acquired Brain Injury) patients: a pilot study

Introduction Mindfulness means maintaining a moment-by-moment awareness of our thoughts, feelings, bodily sensations, and surrounding environment. In the last twenty years the diffusion of Mindfulness-based intervention for rehabilitation purpose in in- and out-patient has been rapidly increasing and the research interest growing up attempting to give scientific rigor in this area. The use of this method is considering a variety of medical and psychiatric conditions (e.g chronic pain, depression etc) as reported in Didonna (2012), futhermore the group intervention has been recently proposed to obtain maximum therapeutic effect (Grossman et al 2004). So far there have been few studies describing Mindfulness-based approach for neurological and orthopedic patients (Azulay et al 2013), especially those under Rehabilitation Units assistance . These kinds of patients are frequently showing anxiety, depression and attention dysfunction as well as problem of adaptation to new situations such as hospitalization or outcome acceptance (Azulay et al 2013) As recently reported by Bédard and colleagues (2012), the symptoms above may benefit from Mindfulness-based therapy. Aim The aim of the present pilot study is to verify if the Mindfulness-based group Therapy could be usefully introduced for rehabilitative purpose with acquired brain injuries patients (e.g stroke, hemorrhagic or traumatic brain injury patients) attending the Rehabilitation Units of the Hospital of Parma. Methods Design: Observational Prospective Study Subjects: 10 individuals (5 males and 5 females) with mild to moderate brain injuries (6 patients) and stroke (4 patients), at least 1 year post-injury were recruited. The sample median age was 39,5 (SD 11,8) years while 8 to 17 years in education. Each member of the reported sample had at least one of the symptoms related to the Cognitive (attention deficits and executive dysfunctions), Physical (headache and fatigue), Psychological (anxiety, depression and post-traumatic syndrome) or Emotional-behavioural domain. Inclusion Criteria: 1) Age: 18-60; 2)education ≥ 8 years; 3) individual on-going rehabilitation program, followed by the Rehabilitation Unit of the Parma Hospital, for the presence of neuro-motor and/or neuro-psychological disabilities; 4) First ABI episode ; 5) at least 3 months from acute ABI episode; 6) Stabilization of clinical pictures; 7) Absence of significative deficits in language production and comprehension; 8) Absence of significative deficits in mnemonic functions; 9) Adequate motivation and compliance Program of intervention: group session, 90 minutes lasts, for 8 weeks. each one relied on breathing exercises, according to Trascendental Meditation Technique (Benson,1976) and was preceded by an adapted postural exercises session to improve breathing observation and environmental and body awareness. Main Outcome Measures: Mindfulness Attention Awareness Scale (MAAS), Hospital Anxiety and Depression Scale (HADS); Modified-Neurobehavioral Rating Scale, SF 12 Standard Italian Version 1.0. Results Patients have generally improved their intentional attention, a better attitude toward living in the present moment and focusing attention on required task. The pre and post Mindfulness-based therapy influence, reported into MAAS scale data, graphically represented in figure 1, showed statistically significant results (X p<0.05) in items 3 (“I find it difficult to stay focused on what is happening at present”), 10 (“I carry out work and tasks automatically without realizing what I’m doing”.) and 13 (I’m concerned about past and future). Summing up, the results indicate the effectiveness of Mindfulness-based group Therapy for rehabilitative ABI patients. This procedure may provide an alternative approach to integrate classical rehabilitation therapy in reducing post-traumatic symptoms. No relevant statistical results are been reported about the other administered scales. Conclusions The Mindfulness-based group Therapy provide a useful instrument for ABI patients, to add to the individual rehabilitation program. The particular responsiveness recorded into “attention” and “awareness” domain could suggest an increasing patient’s compliance also during the classical rehabilitation activities (e.g. physiotherapy, speech therapy etc.).