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Year : 2022  |  Volume : 10  |  Issue : 1  |  Page : 77-83

Effect of structured yoga program on functional balance, flexibility, and emotional status in students with bilateral sensorineural hearing impairment

Department of Yoga Studies, School of Medicine and Public Health, Central University of Kerala, Kasaragod, Kerala, India

Date of Submission24-Oct-2021
Date of Acceptance24-Feb-2022
Date of Web Publication26-Apr-2022

Correspondence Address:
Dr. Pailoor Subramanya
Department of Yoga Studies, School of Medicine and Public Health, Central University of Kerala, Tejaswini Hills, Periye, Kasaragod - 671 316, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijoyppp.ijoyppp_31_21

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Background: Children with bilateral sensorineural hearing impairment (SNHI) face various physiological, psychological, and sociological complications that require attention. The objective of the current study was to analyze the effect of a 1-month structured yoga program on functional balance, flexibility, and emotional status of the students with bilateral SNHI. Materials and Methods: The study was conducted as a controlled pre–post experimental method. Forty (n = 40) bilateral sensorineural hearing-impaired students (moderate–profound range) of ages 8–16 years were randomly divided into two equal groups, i.e., experimental and control. A one-hour structured yoga module was provided to the experimental group as an intervention for 30 days, while the control group followed a routine lifestyle. Outcome Measures: Static balance (SB) was assessed by single-leg stance test, dynamic balance (DB) by functional reach test, flexibility by sit and reach test, emotional status by Positive Affect and Negative Affect Scale (PANAS), and Self-Esteem recorded by Rosenberg Self-Esteem Scale. Results: The results revealed a significant improvement (P < 0.001) in physical parameters such as SB on the right leg, SB on the left leg, DB, and lumbar flexibility in the experimental group. Additionally, psychosocial parameters such as positive emotions, negative emotions, and self-esteem showed significant improvement in the experimental group. However, no significant change in any of the study parameters was observed in the control group (P > 0.05). Conclusion: These findings provide substantial evidence that a 1-month structured yoga program was an efficient method to improve the functional balance, flexibility, and emotional status in the students with bilateral SNHI.

Keywords: Hearing impairment, lumbar flexibility, postural balance, self-esteem, structured yoga

How to cite this article:
Naduvanthody S, Subramanya P, Shitha P, Sayana P S. Effect of structured yoga program on functional balance, flexibility, and emotional status in students with bilateral sensorineural hearing impairment. J Appl Conscious Stud 2022;10:77-83

How to cite this URL:
Naduvanthody S, Subramanya P, Shitha P, Sayana P S. Effect of structured yoga program on functional balance, flexibility, and emotional status in students with bilateral sensorineural hearing impairment. J Appl Conscious Stud [serial online] 2022 [cited 2023 Dec 9];10:77-83. Available from: http://www.jacsonline.in/text.asp?2022/10/1/77/343856

  Introduction Top

Hearing impairment (HI) is a public health problem, which negatively affects the quality of life by altering psycho-sociological behavior, emotional health, and participation in physical activities (Wroblewska-Seniuk et al., 2017; Kurkova, 2020). Sensorineural hearing impairment (SNHI) is the most prevalent form of HI occurring due to the damage in the inner ear or the nerve pathway with an incidence of 1–3 in every 1000 healthy term births, 10% of whom suffer from profound HI (Banda et al., 2018; Korver et al., 2017).

Students with bilateral SNHI demonstrate a greater quantum of changes in static and dynamic balance (DB) as compared to normal hearing students of the peer group (Melo et al., 2017). Vestibular end organs and cochlea strongly contribute to the sensory integration which is essential for kinesthetic sense. Therefore, damage to the vestibular system causes functional balancing impairments due to the lack of sensory-motor coordination (Sibley et al., 2017; Rajendran & Roy, 2011). Corollary delay in postural development and physical inactivity can hinder physical growth, immunity, and overall development (De Kegel et al., 2011).

Furthermore, children and adolescents with HI tend to show higher rates of emotional and behavioral difficulties compared to normally hearing children, which complicates social interactions and can lower self-esteem (SE) (Stevenson et al., 2015). Due to limited communication, these subjects are at a greater emotional pressure of exclusion and rejection than others (Kobosko et al., 2018; Warner-Czyz et al., 2015; Theunissen et al., 2014a).

Therefore, providing a suitable environment that brings forth confidence in physical activities, ensuring emotional stability, and improving SE, etc., play a significant role in the rehabilitation of children with SNHI (Kurkova, 2020). Several studies have observed that yoga improves the physical agility, functional balance, strength, and flexibility of the body while simultaneously enhancing emotional stability and mental health (Sengupta, 2012; Prado et al., 2014; Polsgrove et al., 2016). However, none have expounded its impact on children with bilateral SNHI. Hence, the present study was focused on assessing the effect of a structured yoga program on functional balance, flexibility, and emotional status in the students with bilateral SNHI.

  Materials and Methods Top

Selection of subjects

Forty subjects (n = 40) who belong to classes III to IX were selected from Jyothibhavana high school for the hearing impaired in Kasaragod district, Kerala, India, for the present study. Approval from the Institutional Ethics Committee and informed consent of the parents were acquired prior to initiation of the study. Detailed case history about physical condition and emotional condition was recorded before starting yogic intervention to understand the condition of the subjects. Considering the availability of the subjects, purposive sampling method was opted. Students of age between 8 and 16 years and diagnosed with bilateral SNHI were included, whereas students outside this age range and having conductive and mixed HI or mild HI and unilateral HI were excluded from the study.

Study design

This interventional research adopted a controlled pre–post study design [Figure 1]. Purposively selected 40 samples were randomly assigned into two equally sized experimental group and control group (EG age mean 12.65, standard deviation 1.69±, CG 11.2 and 2.36±, respectively). The experimental group was provided a 30-day (5 weeks) structured yoga program for approximately 1 h per day, weekly 6 days. The control group continued their routine life activity.
Figure 1: Schematic diagram of the study

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Outcome measures

Static balance (SB), DB, lumbar flexibility (LF), positive affects (PA), negative affects (NA), and SE were assessed to understand the impact of yoga intervention among the children.

Modified single leg stance test (SLST) by incorporating Vrikshasana (tree pose) was used to test SB (Springer et al. 2007). Subjects were instructed to do the procedure after a demonstration prior to the assessment and allowed three attempts in each side. The best reading out of three tries on both sides was recorded. DB was measured in centimeters using the functional reach test (FRT) (Duncan et al. 1990). Flexibility was measured using the sit and reach test (Jackson & Langford, 1989). The best attempt out of three was recorded in centimeters. Emotional status was assessed by the differentiated Positive and Negative Affect Schedule (PANAS PA, NA) scale (Watson et al. 1988). The questions were communicated clearly to the hearing-impaired students with the help of a teaching staff. Students were allowed to discuss the question to avoid ambiguity. No time limit was fixed for answering the questions.

Self-Esteem was assessed by the Rosenberg Self-Esteem (RSE) scale (Rosenberg, 1965). All subjects were assessed using the abovementioned scales on a one-to-one basis, with the help of a sign language expert to facilitate communication.

Structured yoga intervention

A structured yoga module was framed and validated by experts in the field of yoga therapy [Table 1]. The module comprised Yoga Sukshma Vyayamas (loosening practices) for warming up the body, selected asanas to improve the balancing ability, flexibility and physical strength, simple breathing techniques, and relaxation techniques (Amaranath et al. 2016; Narasimhan et al. 2011). The practices were conducted as a group session with sufficient space arrangements. The structured yoga program was applied progressively to each subject of the experimental group. Since all the yogasanas could not introduce in the 1st day, the selected asanas were grouped into primary level, secondary level, and tertiary level for the purpose of progressive intervention in the HI subjects. The intervention started with the primary level practices, and after 5 days, the secondary level practices were taught. Tenth day onwards, all the practices were introduced and practiced including primary and secondary levels of asanas. Nadishuddhi Pranayama and Shavasana also applied in all the days of intervention. Sitkari Pranayama introduced along with a tertiary group of asanas. All the asanas applied single-round basis. Every practice was taught through demonstration by a trained person in yoga and instructions to the subjects were given in sign language with the help of a teaching staff in the same institution. Yoga instruction and data collection were done by different people.
Table 1: Yoga intervention schedule

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Statistical analysis

Data were tabulated and the statistical analysis was performed by R × version. The effect of yoga intervention was measured by paired two-tailed t-test at α level of 5%.

  Results Top

The mean age of subjects was 12.6, ± 1.69 years in the experimental group and 11.1, ±2.46 years in the control group. Male:female (M: F) ratio was 11:9 and 9:11, respectively, in the experimental group and control group.

SLST results revealed that the mean difference in SB recorded among the experimental group subjects was 55.25 s in the right leg and 46.9 s in the left leg. The mean difference in SB was statistically significant in both the right (P < 0.001) and left legs (P < 0.001) showing notable improvement postintervention.

In the control group, however, the mean difference in the right leg was 0.5 s, and in the left leg, the mean difference was 0.75 s. But the difference in SB among the control group participants was not found to be statistically significant (P > 0.05) in either of the legs.

DB assessed by FRT recorded in the experimental group demonstrated a mean difference of 7.95s between the pre- and post-intervention values observed. The comparative results indicated a significant improvement in DB of experimental group participants (P < 0.001) mean difference in FRT pre- and postintervention was 7.95 cm. however, in the control group, it was 0.65 and no statistical significance could be established (P > 0.05). Assessment of flexibility by the sit and reach test demonstrated a mean difference of 7.1 cm in the experimental group and was found to be statistically significant (P < 0.001). Whereas in the control group, it was 0.15, the study could not observe any statistically significant improvements (P > 0.05).

In a differential analysis of PANAS P and PANAS N shows a significant improvement in the emotional stability in the experimental group. The change in positive affects (PANAS P) among the experimental group was recorded to be 5.05 revealing a statistically significant association between the yoga module intervention and positive emotional status (P < 0.001). Contrastingly in the control group, the mean difference between pre- and posttest scores was 0.4 which was deduced to be statistically insignificant (P > 0.05). In regards to the negative affects (PANAS N) experienced, the subjects of the experimental group showed a mean difference of 9.95, revealing a significant decline postintervention (P < 0.001). In the control group a smaller decline of 0.3 was recorded, which, however, did not prove to be statistically significant (P > 0.05).

Using the RSE scale, the experimental group was found to show a significant improvement in SE by a mean difference of 8.55 between pre- and postintervention values (P < 0.00). The mean difference in SE of subjects in the control group was 0.5, which was inferred to be insignificant (P > 0.05) [Table 2]. On completion of the 1-month yoga intervention conducted at primary secondary and tertiary levels, a significant improvement in all the variables was observed in the experimental group. The control group, however, did not show any significant improvement.
Table 2: Comparative analysis of study population

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  Discussion Top

The present study assessed the effect of selected yogic techniques on functional balance, flexibility, positive and negative affects, and SE in the students with bilateral SNHI. Analysis of the observation made pre- and postintervention provides clear evidence of yoga as a system of improving balance, physical flexibility, and improving emotional status.

In the baseline assessment, the control group and experimental group showed a similar tendency in all the parameters. Such as SB 21–24 s, DB 28–33 cm, LF 15–18 cm, PANAS P 33–34, PANAS N 28-20, and SE 19–20, respectively. After 1 month of structured yoga intervention, the experimental group showed a statistically significant improvement in all the parameters, whereas such an improvement could not observe in the control group.

Functional balance is important for safe mobility and for performing functional tasks in the daily activities (Sibley et al., 2017). Balance is static when the body is at rest and is dynamic when the body is in a steady-state motion (Hemmati et al., 2017). In the present steady SB was measured using a modified SLST by incorporating the technique of Vrikshasana. The studies have reported that the significance of training the balancing exercise to the hearing impaired children for the sake of improving the sensory motor skill and improving motor performance (Soori et al., 2019). As falls represent a major balancing problem and the fear of falls is the major deterrent to the normal mobility (Li & Prevatt, 2010). The improved functional balance will give confidence to these hearing impaired subjects to perform their daily activities independently and confidently. Several studies reported the ability of yoga to improve the balancing ability of the body (Cooper et al., 2018). Nonetheless, there is a lack of sufficient studies related to the efficacy of yoga in the balancing ability of hearing-impaired children. The present study attempted to assess the effect of yoga on balance in the area concerned. The study observed a statistically significant improvement in the mean difference of the experimental group (+55.25 right + 46.95 left). There was not much difference in the control group as compared to baseline assessment (+0.5 right and 0.49 left), which shows the efficacy of yoga to improve the ability of postural stability that influence the SB which is an important factor in the subjects with HI. The DB assessed by FRT also showed a significant improvement in the experimental group. The mean difference in the study group was + 7.95 cm, same time in the control group it was-0.65. The improvement in the abovementioned variables shows 1-month yoga intervention improved the static and DB in the experimental group.

The flexibility of the body is an important measure of physical fitness. Delayed postural and motor development contributes to physical inactiveness of patients, consequently decreasing the flexibility of joints. Stretching increases the range of motion of the joints and is effective for the enhancement of flexibility (Choi et al., 2016). The significant improvement in the experimental group on the flexibility shows the efficacy of yoga to provide the elasticity of the muscles, and improve the strength. Several studies have observed the importance of physical fitness to maintain mental health (Alexandratos et al., 2012). Physical fitness also enhances cognitive ability. The study observed a significant improvement in the experimental group (+7.1) and control group not showed much improvement. The improved flexibility shows improved muscular resistance in the experimental group. Physical fitness also improves the immunity of the children. The improved Functional balance and flexibility is an indicator of improvement in the somatosensory perception as well as neuromuscular control in the subjects with HI.

Emotional status

Psychological wellness is another concern in HI children. Numerous studies have observed various psychological issues are prevalent among the children with HI (Stevenson et al., 2015; Theunissen et al., 2014b). The positive and negative emotional quotient provides a glance about mental health. The present study assessed the emotional status by applying the PANAS scale and RSE scale. PA is related to the level of enthusiasm, activeness, and alertness of a person. High PA indicates high energy, ability to concentrate, happiness, etc., whereas low PA indicates sadness and lethargy. NA indicates unhappiness in the activities, aversive mood states, etc., Low NA indicates a state of mind with calmness and serenity (Watson et al., 1988). The mean difference of the PA and NA in the study group was +5.05 and 9.95 and in the control group −0.4 and −0.3, respectively. In the posttest the experimental group showed more NA compared to baseline assessment of the control group. But after the intervention, the significant decrease was observed in the experimental group. The significant improvement observed PA and NA indicates that 1 month of yoga program benefitted the hearing impaired children to improve the positive affect and decrease the negative affect.

As SE refers to one's general evaluation or appraisal of the self, the improvement in SE will help these subjects to cope with stressful life events (Patil & Pujar, 2019). The ability of the physical exercise to improve positive mood, SE, concentration alertness as well as the quality of life is the evident factor (Alexandratos et al., 2012; Scully et al., 1998). Several studies have also observed that yoga intervention is important for improving the SE (Bazzano et al., 2018). The data obtained in the present study also validate the efficacy of yoga to improve the SE in children with hearing impaired. The mean difference in the study group was + 8.55, and in the control group, it was + 0.5. The improved SE scale shows that 1 month of structured yoga program improves the self-confidence level in the subjects with HI.

Yogasana has multidimensional techniques that are characterized by balancing postures, strengthening postures, dynamic movements, stretching postures, polymetric techniques, etc., and it also positively controls breathing and self-awareness. A proper combination of yogic techniques is helpful to improve the physical development as well as to enhance the mental health. The 1-month yoga intervention made a significant improvement in the functional balance, flexibility, and bring positive changes in the emotional status of the bilateral sensorineural hearing-impaired children in the experimental group.

  Conclusion Top

The rehabilitation trajectory among sensorineural hearing-impaired students is augmented by incorporating routine such as Yoga. The findings of this study suggest that a structured yoga program has tremendous potential as an efficient training module that fosters improvement of functional balance, flexibility, and emotional status in bilateral sensorineural hearing-impaired students. More large-scale multicentric studies and extended follow-up periods can add further salience to the therapeutic potential of yoga on hearing impaired children.

However, this study has its limitations such as a small sample size, lack of short-term and long-term follow-up postintervention with the yoga module, and consideration of other posture-independent sensorimotor assessments. Future studies can take cue from the encouraging results of this study to further validate the findings on a large and diverse population by conduction multicentric studies of a longer duration.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Table 1], [Table 2]


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