Adaptations to mindfulness-based interventions for neurological impairment: The SMALL PROMPTS approach.

Abstract

Purpose/Objective: Standardized mindfulness-based interventions (MBIs), used for the management of physical and psychological symptoms associated with neurological impairment/injury (NI), have been problematized as lacking accessibility due to their focus on sensory presence and mindful walking. Research is needed to generate formalized recommendations regarding how MBIs may be best adapted to enhance their suitability for people with NI. Research Method/Design: A two-phase qualitative study was completed. First, semistructured interviews were undertaken with eight accredited mindfulness teachers with NI. Interviews reviewed the adaptations participants made in their personal and teaching practice, using thematic analysis, and generated recommendations for adaptations to MBIs specific to people with NI. Second, using the DELPHI method, the adapted practice recommendations were reviewed and revised via three rounds, following cognitive interviews with an expert panel (N = 5 trained mindfulness teachers with NI). Results: Ten core areas for adaptation are proposed and validated, acting as SMALL PROMPTS which can be used to adapt mindfulness-based teaching techniques to the specific requirements of people with NI: (a) Skin/bladder/bowel management; (b) mindful Movement; (c) Accessible training; (d) Language Leadership; (e) Permissive pRactice; (f) Optimizing timelines; (g) Management of posture; (h) inclusion of Pacing; (i) Teaching from experience; and (j) bodyScanning. Conclusion/Implications: Mindfulness is a highly applicable approach for people with sensory loss, however significant, specific adaptations are required to improve inclusivity and accessibility. The SMALL PROMPTS adaptations increase the accessibility, applicability, and utility of MBIs for populations living with NI, enhancing effective management of physical and psychological wellbeing, and optimizing MBI delivery. Impact and ImplicationsMindfulness-based practices can and should be effectively adapted for people with neurological injury or impairment using the SMALL PROMPTS guidelines. Specific adjustments need to be made to mindfulness teaching practices and session timing to allow for skin/bladder/bowel management and postural adjustment during mindfulness teaching. Mindfulness teachers need to adapt sensation-focused language so that teaching is inclusive, presenting sensory presence and sensory absence as equally valid and observable experiences.

Quality of Life in Multiple Sclerosis: The Predictive Roles of Positive Body Image and Meaning in Life

“…Regarding body responsiveness, participants could have been at a stage in which this body facet was still preserved. However, it should be noted that the absence or reduced perception of physical sensations is not a limiting factor for the positive effects on body responsiveness of mindfulness practices [61]. Adapting exercises to the bodily needs of MS patients through imagery exercises-creating mental representations of the body-is related to increased sensory awareness.…”