Adaptations to Mindfulness-Based Interventions for Neurological Impairment: The SMALL PROMPTS Approach

Katherine A. Finlay*, Jasmine H. Hearn, Jenna L. Gillett, Priyanjali Ratwatte, Joanne Morton-Bye, Angel M. Chater

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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. ResearchMethod/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) body Scanning. 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 ofMBIs for populations living with NI, enhancing effectivemanagement of physical and psychological wellbeing, and optimizingMBI delivery.

Original languageEnglish
Pages (from-to)391-404
Number of pages14
JournalRehabilitation Psychology
Issue number3
Publication statusPublished - 2022
Externally publishedYes

Bibliographical note

Funding Information:
This research was approved by the University of Buckingham School of Psychology and Wellbeing ethics committee and was conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Publisher Copyright:
© 2022. American Psychological Association


  • Mindfulness
  • Multiple sclerosis
  • Neurological rehabilitation
  • Qualitative research
  • Spinal cord injuries


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