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Relaxation and Mindfulness Techniques in O.T. Practice

The Importance of Mental Health

Recovering from a stroke, spinal cord injury, or brain injury can be stressful on the road to recovery. One area that can often be overlooked in a hospital stay is mental health and appropriate coping strategies for discharging home.  

According to a scientific statement from AHA in 2016, depression affects around 1/3 of stroke survivors. 1 A systematic review and meta-analysis from 2017 cites that anxiety affects 25% of people that have experienced a stroke. 2 A meta-analysis on anxiety prevalence following spinal cord injury from 2016 examined 18 independent studies, finding that 5% of participants met the criteria for Panic Disorder or Generalized Anxiety Disorder (GAD).3  

Education on coping strategies in relation to mental health are within occupational therapy’s area of practice. Occupational therapists and other rehabilitation professionals can assist patients by providing them with mental health resources that may include a referral to a psychiatrist or psychologist, mental health counselor or therapist.

One unique treatment area in occupational therapy is educating on coping strategies such as relaxation techniques, meditation, mindfulness and positive mental imagery. This post will provide resources for relaxation and mindfulness techniques as well as ideas to integrate some of these techniques into OT practice. 

Mental health written tiles

The Research – Stroke

Two sequential studies examined techniques for relaxation and mindfulness with stroke survivors in the community. 4 The first study, with a group of 13 Participants, was divided into four different focus groups. The group of 13 included five individuals with communication problems (such as aphasia). In this primary study, they presented participants with a DVD video with seven frequently used relaxation and meditation techniques and asked participants for feedback on the activities, how they could be improved, and other preferences.

Techniques were ranked by participants, leading to four out of seven techniques being selected for the second study based on participant feedback. Counting, body movement, and word repetition were ranked the lowest in preference by participants and seen as inappropriate for participants, especially those with speech deficits. 4

With the assistance of a Speech-Language Pathologist (SLP) the four chosen techniques based on participant feedback were modified for those with speech deficits and aphasia and a new DVD was produced. 

The four techniques chosen for the second study4 

  • Positive emotion 
  • Body relaxation 
  • Thinking of a nice place
  • Breath watch  

    Task Modifications used for Aphasia in the study4 

    • Breath watch – the integration of hand gestures for breathing in and out above the chest. 
    • Positive emotions – the addition of yellow ball in thought bubble on screen, gesturing ‘Rays’ while saying “with rays of love and happiness”. 
    • Thinking of a nice place – using visual images with an example, and pictures in thought bubbles on the screen. 
    • Body relaxation – integration of term “you don’t need to move that part of the body, just focusing on it.” Repetition slowly of single words, using visual arrows on screen. 

      The second sequential study had 38 participants. It used the Barthel Index, Daily Living Self-efficacy Scale (DLSES), and the Hospital Anxiety and Depression Scale Anxiety Subscale (HADS-A) measures. A self-report practice diary was used to measure engagement. Participants were asked to practice the techniques twice daily, five days a week.

      The study found that these techniques were found to be generally feasible and acceptable for use with this population. 4 

      Interested in reading this study? Find it here. 4 

      What is Mindfulness?

      Merriam Webster defines mindfulness as “the practice of maintaining a nonjudgmental state of heightened or complete awareness of one’s thoughts, emotions, or experiences on a moment-to-moment basis5. Simply put, mindfulness is concentrating on the present moment, leaving behind distracting thoughts and anxieties. Occupational therapists can combine mindfulness techniques with ADLs and task performance as well as other treatments. Mindfulness interventions in healthcare have been shown to help reduce pain severity and anxiety and enhance well-being. 6

      In a scoping review in 2016 by the American Journal of Occupational Therapy (AJOT), evidence was found to suggest that mindfulness was helpful for patients with chronic pain disorders and musculoskeletal disorders. Trends moving towards improvements in outcomes were seen for neurocognitive and neuromotor disorders. 7  

      Mindfulness written in sand

      What are Relaxation Techniques?

      Physiopedia defines relaxation techniques as “therapeutic exercises designed to assist individuals by decreasing tension and anxiety.”8 Practicing relaxation techniques can come with a variety of health benefits such as lowering blood pressure, slowing down heart rate, reducing chronic pain, reducing stress hormones and more.

      You can learn more about the benefits of relaxation techniques at Mayo Clinic 9. 

      Types of Relaxation Techniques

      • Meditation  
      • Autogenic training 
      • Breathing techniques 
      • Progressive muscle relaxation 
      • Guided imagery

      Check out these techniques and more online from Mt. Sinai 10  

      Meditation Apps

      • According to Wirecutter rankings, the top three meditation applications are Headspace, Calm, and hm (Healthy Minds Program). 11  
      • The top five free meditation apps from mindful.org are healthy minds program, UCLA mindful, MyLife meditation, smiling mind, and insight timer.12  
      • The Plum Village App13 (created by Thich Nhat Hanh) is also a wonderful free meditation application. It provides free Buddhist meditations. 

      Colorado State University’s Occupational Therapy Department has some wonderful resources on its website, 14 such as app recommendations and the center for mindfulness!  

      Ideas for OT Practice

      1. Create a weekly coping skills group in your practice setting where you can integrate mindfulness and relaxation techniques. Ideas might include stretching, mindfulness, progressive muscle relaxation, visualization and more! 
      2. Use mindfulness practice as a 5 minute intro to your therapy group.
      3. Add a few minutes of mindfulness in with, before, or after your mental visualization exercises 
      4. Direct patients to practice basic mindfulness during ADL practice or task practice in therapy  
      5. Work together with social work to provide recommendations for community resources for classes in the community or other community resources. 
      6. Train patients and caregivers in the concept of mindfulness and basic relaxation techniques such as breathing techniques or progressive muscle relaxation.  
      7. Have patients create a mindfulness journal in therapy group or individually. 
      8. Create a packet with community resources and exercises that patients can take with them when they go back into the community.  
      9. Get certified as a yoga instructor and get certified to teach chair yoga for seniors or children’s yoga (depending on your area of practice).  
      10. Take a meditation course to learn helpful relaxation techniques that you can apply to your practice.  
      11. Take a class in Tai Chi. Tai Chi is a popular relaxation technique that has been shown to have benefits including improving balance 15and fall prevention 16 as well!

      The Importance of Mental Health

      The importance of mental health cannot be understated. Oftentimes, as therapists, we may get caught up assessing and treating only physical impairments, but as mentioned earlier in the article, mental health disorders like depression and anxiety are common.

      A holistic approach in treatment and evaluation has never been more important. There are great free assessments available including the Hospital Anxiety and Depression Scale (HADS), Depression, Anxiety, and Stress Scale (DASS), and Beck Depression Inventory (BDI), amongst many others.

      Looking for a list of free occupational therapy assessments in general? Check out this link 17 

      BIONIK is dedicated to improving the lives of patients that suffer from stroke and other neurological conditions. Rehabilitation Robots can assist therapists in achieving the high-intensity motor repetitions required for neuroplasticity in a fraction of the time that it takes in traditional therapy – so you can spend more time on your holistic treatment plan! Visit our post Rehabilitation Robotics: An Unofficial Guide to learn more about robot-assisted therapy. 


      1. Towfighi, A., Amytis et al. Poststroke depression: A scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. Retrieved June 21, 2022, from https://www.ahajournals.org/doi/10.1161/STR.0000000000000113#:~:text=Depression%20is%20common%20after%20stroke,a%20cumulative%20incidence%20of%2055%25. 
      2. Wright, F., Wu, S., Chun, H.-Y. Y., & Mead, G. (2017, February 22). Factors associated with Poststroke Anxiety: A systematic review and meta-analysis. Stroke Research and Treatment. Retrieved June 21, 2022, from https://www.hindawi.com/journals/srt/2017/2124743/ 
      3. Le, J., & Dorstyn, D. (2016, March 8). Anxiety prevalence following spinal cord injury: A meta-analysis. Nature News. Retrieved June 21, 2022, from https://www.nature.com/articles/sc201615 
      4. Wang, X., Smith, C., Ashley, L., & Hyland, M. E. (2019). Tailoring Self-Help Mindfulness and Relaxation Techniques for Stroke Survivors: Examining Preferences, Feasibility and Acceptability. Frontiers in psychology10, 391. https://doi.org/10.3389/fpsyg.2019.00391 
      5. Merriam-Webster. (n.d.). Mindfulness definition & meaning. Merriam-Webster. Retrieved June 21, 2022, from https://www.merriam-webster.com/dictionary/mindfulness 
      6. Hardison, M. E., & Roll, S. C. (2016). Mindfulness interventions in physical rehabilitation: A scoping review. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. Retrieved June 21, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834757/  
      7. Hardison, M. E., & Roll, S. C. (2016). Mindfulness interventions in physical rehabilitation: A scoping review. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. Retrieved June 21, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834757/ 
      8. Relaxation techniques. Physiopedia. (n.d.). Retrieved June 21, 2022, from https://www.physio-pedia.com/RelaxationTechniques 
      9. Mayo Foundation for Medical Education and Research. (2022, April 28). Relaxation techniques: Try these steps to reduce stress. Mayo Clinic. Retrieved June 21, 2022, from https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/relaxation-technique/art-20045368 
      10. Relaxation techniques. Mount Sinai Health System. (n.d.). Retrieved June 21, 2022, from https://www.mountsinai.org/health-library/treatment/relaxation-techniques
      11. The New York Times. (2018, June 14). The best meditation apps. The New York Times. Retrieved June 21, 2022, from https://www.nytimes.com/wirecutter/reviews/best-meditation-apps/ 
      12. Kira M. Newman and Janet Ho, Staff, M., & Reicherzer, S. (2022, January 26). Five free mindfulness apps worthy of your attention. Mindful. Retrieved June 21, 2022, from https://www.mindful.org/free-mindfulness-apps-worthy-of-your-attention/ 
      13. Plum Village Mobile App. (2021, November 5). Retrieved June 21, 2022, from https://plumvillage.app/  
      14. Mindfulness. Occupational Therapy. (2021, July 13). Retrieved June 21, 2022, from https://www.chhs.colostate.edu/ot/research/restoring-effective-sleep-tranquility/resources/mindfulness/ 
      15. Watson, S. (2012, August 23). Try Tai Chi to improve balance, avoid falls. Harvard Health. Retrieved June 21, 2022, from https://www.health.harvard.edu/blog/try-tai-chi-to-improve-balance-avoid-falls-201208235198#:~:text=Tai%20chi%20helps%20improve%20balance,’t%20physical%E2%80%94but%20emotional. 
      16. Huber, A. J., Hansen, A. A. J., Hite, A. E., MacCormick, A. H., & Leggett, A. H. (2018, September 14). Tai Chi may help prevent older adults from falling, a study finds. Scope. Retrieved June 21, 2022, from https://scopeblog.stanford.edu/2018/09/13/tai-chi-may-help-prevent-older-adults-from-falling-a-study-finds/#:~:text=A%20new%20study%20finds%20tai,a%20high%20risk%20for%20falling. 
      17. Sarah Lyon, Cindysays: Lyon, S., scottsays:, K., Laurasays: Walkersays:, B. A., McMahonsays:, M., Author, P., & *, N. (2022, May 31). Occupational therapy assessments (2022) • OT potential. OT Potential • Occupational Therapy Resources. Retrieved June 21, 2022, from https://otpotential.com/blog/occupational-therapy-assessments 
      Want to learn about robot-assisted therapy?
      Visit us at www.bioniklabs.com.


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