Background: Tai chi (TC) has been reported as being beneficial for improving balance post stroke, yet its utility in upper limb rehabilitation remains unknown. Methods: Twelve chronic stroke survivors with persistent paresis of an upper limb underwent 60 minutes of adapted TC twice a week for eight weeks, with a 4-week follow up. A 10-min TC home program was recommended for the days without sessions. TC level of performance, attendance to the sessions, duration of self-practice at home, and adapted TC movements used were recorded. Results: Eleven participants completed the study. A clinical reasoning algorithm underlying the adaptation of TC was elaborated throughout the trial. Participants with varying profiles including a severely impaired upper limb, poor balance, shoulder pain, and severe spasticity were not only capable of practicing the adapted TC, but attended all 16 sessions and practiced TC at home for a total of 16.51 ± 9.21 h. The degree of self-practice for subgroups with low upper limb function, shoulder pain, or moderate-to-severe spasticity was similar to that of subgroups with greater upper limb function, no shoulder pain, and minimal-to-no spasticity. Conclusion: Adapted TC seems feasible for upper limb rehabilitation post stroke. Although the study was based on a small sample size and requires confirmation, low upper limb function, insufficient balance, spasticity, and shoulder pain do not appear to hinder the practice of TC.
Stroke is a leading cause of serious, long-term disability among middle-aged and older adults worldwide . Functional impairment of an upper limb is reported in approximately 85% of stroke survivors . The effects of current treatments for arm weakness are shown to be suboptimal . Though upper limb recovery has been found to continue even in the chronic stage , long-term rehabilitation services are limited for a large proportion of chronic stroke patients after returning home [5,6]. Therefore, novel and effective approaches are needed to provide timely and ongoing upper limb rehabilitation.
Tai chi is an ancient martial art originating from Chinese healing traditions. Typified by slow and gentle movements, tai chi is an “internal” martial art that cultivates the flow and balance of qi, which is translated as vital energy . The relaxation of body and mind is a main feature which is said to facilitate the flow of qi . Also, tai chi requires well-coordinated sequencing of segments to make the body move as a whole unit to help the flow of qi . Thus, tai chi is a moving form of qigong, which is a practice focusing on cultivation, circulation, and harmonization of qi. To date, tai chi is accepted as a suitable, low impact, home-based exercise option for aged and patients with chronic diseases [10,11,12]. Since tai chi emphasizes slow and continuous weight transfer between the two feet, it has been widely shown as beneficial for improving balance and for fall prevention in the aged [13,14,15].
In recent years, some studies have also reported the benefits of tai chi in improving balance in chronic stroke patients [16,17,18]. However, the use of tai chi in upper limb rehabilitation post stroke remains unknown. Tai chi is not only an exercise of lower limb, but a whole-body exercise. Upper limb muscle strength and flexibility have been shown to improve in the aged following the practice of tai chi [19,20,21]. Tai chi practitioners have also demonstrated better arm movement control and eye–hand coordination in older adults [21,22,23,24]. Furthermore, the relaxation component of tai chi may have the potential to improve the motor function of the paretic upper limb. Therefore, tai chi may be a promising upper limb rehabilitation method.
However, the presence of hemiplegia may be an important barrier to using tai chi for upper limb rehabilitation post stroke, potentially limiting the ability to actually perform upper limb tai chi movements. Similarly, shoulder pain and severe spasticity of the affected arm may impact on the ability to perform tai chi movements. Furthermore, the standing position used in traditional tai chi styles poses difficulties for persons with poor balance. Adapting tai chi to take into account these limitations may need to be included in post-stroke rehabilitation. Although sitting tai chi has been reported to be used in persons with spinal cord injuries to improve muscle strength of the upper limbs , little is known about how to adapt tai chi with respect to paretic upper limbs. Moreover, the feasibility of using adapted tai chi movements for upper limb rehabilitation remains unknown.
Therefore, this study aimed to explore the use of adapted tai chi movements for upper limb rehabilitation. More specifically, the objective was to evaluate the feasibility of using adapted tai chi for upper limb rehabilitation post stroke, including: (1) whether the adapted tai chi was performable and acceptable by participants; and (2) whether the potential influencing factors such as impairment level of an upper limb, insufficient balance, shoulder pain, and spasticity constrained the practice of the adapted tai chi. A second objective was to document the clinical reasoning underlying the adaptations made to tai chi based on the participants’ characteristics when used for upper limb rehabilitation post stroke. The efficacy of adapted tai chi has been reported elsewhere . […]