Baxter Bell's reply:
I agree that a very slow pace is a good idea, especially if you are working with recent stroke survivors who are still hospitalized or are in a rehab unit. It's challenging to work with a group of students with stroke, as their difficulties can vary so widely. Two common problems that arise after a stroke are difficulty with balance, and one-sided weakness affecting an arm or leg or both.
If the student is able to transfer easily from chair to floor, consider starting out with the students on their backs. If a student gets dizzy lying flat, prop the head slightly to see if the dizziness resolves promptly. You'll be able to recreate almost all of the standing poses in this position, often placing the feet against the baseboard of the wall and propping limbs as needed.
The next option is to work with students on folding metal chairs. You can modify standing poses, such as Virabhadrasana I (Warrior I) and Virabhadrasana II (Warrior Poses II), Utthita Parsvakonasana (Extended Side Angle Pose), and High Lunges by having them hold onto the backs of the chairs. Chairs are also a great help with simple hip openers and chest, shoulder, and arm variations. Remember that stroke patients will likely have serious underlying medical problems, such as high blood pressure, heart disease, or glaucoma, so any variation of an inversion may be contraindicated. With that in mind, avoid all poses where the head drops below the waist. Modify standing forward bends by having students come no further than parallel to the floor, and teach them to practice Ardha Adho Mukha Svanasana (Half Downward-Facing Dog Pose) at the wall.
As strength and balance improve, you can begin to work standing poses against a wall. Keep the back to the wall for such poses as Utthita Trikonasana (Extended Triangle) and Utthita Parsvakonasana (Extended Side Angle). For extra support, students can rest the bottom hand on the back of a chair in these poses.
There are several different types of stroke, and one kind requires special attention. This type is a result of plaque that develops in the carotid artery, which supplies the brain with blood. A stroke results when a piece of this plaque breaks off and heads up to the brain. Since you may not have this information about your students, assume that they all could have had this type of stroke and modify twists by keeping the head in a neutral position—that is, don't take the twist all the way into the neck. Let the belly and the chest create the movement of the twist instead. Focus on lengthening the back of the neck and keeping the front of the throat soft and receptive.
Stroke almost inevitably brings up a host of issues, including fear, anxiety, grief at lost ability, and uncertainty about recovery. The breathwork should focus on letting go of this worried mental state and return again and again to the experience of the present moment. Begin with simple breath observation and gradually introduce simple belly breathing, focusing on even expansion of the belly and chest into both the right and left sides of the body.
Baxter Bell, MD, teaches in the San Francisco Bay Area and internationally, and is director of the Piedmont Yoga Studio's teacher-training program in Oakland, California. He is a contributing writer for Yoga Journal website and magazine and for the International Journal of Yoga Therapy.