Posts Tagged Tai Chi

[ARTICLE] Adapting Tai Chi for Upper Limb Rehabilitation Post Stroke: A Feasibility Study

Abstract: 

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.

1. Introduction

Stroke is a leading cause of serious, long-term disability among middle-aged and older adults worldwide [1]. Functional impairment of an upper limb is reported in approximately 85% of stroke survivors [2]. The effects of current treatments for arm weakness are shown to be suboptimal [3]. Though upper limb recovery has been found to continue even in the chronic stage [4], 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 [7]. The relaxation of body and mind is a main feature which is said to facilitate the flow of qi [8]. Also, tai chi requires well-coordinated sequencing of segments to make the body move as a whole unit to help the flow of qi [9]. 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 [25], 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 [26]. […]

Continue —>  Medicines | Free Full-Text | Adapting Tai Chi for Upper Limb Rehabilitation Post Stroke: A Feasibility Study | HTML

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Figure 1. Individual self-practice hours per month of participants.

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[Systematic Review] Does Tai Chi relieve fatigue? A systematic review and meta-analysis of randomized controlled trials – Full Text

Abstract

Background

Fatigue is not only a familiar symptom in our daily lives, but also a common ailment that affects all of our bodily systems. Several randomized controlled trials (RCTs) have proven Tai Chi to be beneficial for patients suffering from fatigue, however conclusive evidence is still lacking. A systematic review and meta-analysis was performed on all RCTs reporting the effects of Tai Chi for fatigue.

Methods

In the end of April 2016, seven electronic databases were searched for RCTs involving Tai Chi for fatigue. The search terms mainly included Tai Chi, Tai-ji, Taiji, fatigue, tiredness, weary, weak, and the search was conducted without language restrictions. Methodological quality was assessed using the Cochrane Risk of Bias tool. RevMan 5.3 software was used for meta-analysis. Publication bias was estimated with a funnel plot and Egger’s test. We also assessed the quality of evidence with the GRADE system.

Results

Ten trials (n = 689) were included, and there was a high risk of bias in the blinding. Two trials were determined to have had low methodological quality. Tai Chi was found to have improved fatigue more than conventional therapy (standardized mean difference (SMD): -0.45, 95% confidence interval (CI): -0.70, -0.20) overall, and have positive effects in cancer-related fatigue (SMD:-0.38, 95% CI: -0.65, -0.11). Tai Chi was also more effective on vitality (SMD: 0.63, 95% CI: 0.20, 1.07), sleep (SMD: -0.32, 95% CI: -0.61, -0.04) and depression (SMD: -0.58, 95% CI: -1.04, -0.11). However, no significant difference was found in multiple sclerosis-related fatigue (SMD: -0.77, 95% CI: -1.76, 0.22) and age-related fatigue (SMD: -0.77, 95% CI: -1.78, 0.24). No adverse events were reported among the included studies. The quality of evidence was moderate in the GRADE system.

Conclusions

The results suggest that Tai Chi could be an effective alternative and /or complementary approach to existing therapies for people with fatigue. However, the quality of the evidence was only moderate and may have the potential for bias. There is still absence of adverse events data to evaluate the safety of Tai Chi. Further multi-center RCTs with large sample sizes and high methodological quality, especially carefully blinded design, should be conducted in future research.

Background

Although no one can exactly quantify or document fatigue [1], fatigue is a common symptom not only deeply related to most acute and chronic diseases, but also to everyday life. It is not only common, but problematic, for people with conditions such as cancer, multiple sclerosis, and rheumatoid arthritis [2]. The National Comprehensive Cancer Network (NCCN) defined cancer related fatigue as ‘an persistent, unusual, subjective feeling of tiredness correlated with cancer or cancer treatment that obstruct to normal functioning’ [3]. Definition of fatigue was also described as “a subjective feeling of lacking mental and/or physical energy, which was perceived by the caregiver or individuals interfering with usual and desired activities” [4]. Because of its subjective nature, fatigue can only be gauged by self-reported or caregiver-reported questionnaires [5]. Fatigue generally lasts longer than somnolence [6]. Tiredness is a state of temporary decreasing in strength and energy, which may be experienced as a partial of fatigue [7]. Some authors simply divided fatigue into acute and chronic fatigue [2]. Acute fatigue occurs in healthy populations, with a rapid onset and short duration. After a period of rest and exercise, it is generally relieved. Chronic fatigue mainly affects clinically disordered individuals and is onset gradually, persists and develops over time. It usually can’t be alleviated by usual recovery techniques [6]. As a symptom, fatigue is a common complaint among most people, and many ailments are accompanied by fatigue. However, it is often ignored, under-diagnosed, and seen as a natural result of physical deterioration [8].

A previous study had shown that 10.6% of women and 10.2% of men complained of fatigue for ≥ 1 month in the South London general practice attenders [9]. The prevalence rate of chronic fatigue was 10.7% in general Chinese population [10]. Among older adults with myocardial infarction, fatigue is frequently reported to be one of the most serious barriers to physical activity [11]. Fatigue occurs in 50%-83% of patients with multiple sclerosis [12]. Among breast cancer patients 58%-94% undergoing treatment and 56%-95% who are post-chemotherapy experience fatigue [13]. Although the methods, standards, and results of these studies are not always consistent, it is undeniable that fatigue is a common symptom from which many patients suffer.

The mechanisms behind fatigue are unclear [5], however they may be related to a patient’s physical condition. There is no panacea for fatigue other than treating the symptoms [5]. Evidence has shown that exercise including walking, running, jogging, swimming, resistance (strengthening) training, stretching, aerobic exercise can counter fatigue among sufferers of chronic fatigue syndrome [14], multiple sclerosis [15], fibromyalgia [16] and among cancer survivors [17,18]. So we supposes that Tai Chi, a traditional Chinese martial art, may be an effective treatment for patients suffering from fatigue.

Tai Chi has popular in China for several centuries. Many different types of Tai Chi exist, but most consist of movement, meditation and breathing, while concentrating on the mind and maintaining low intensity [1920], and further modulate various aspects of the body including the physical, the psychological, mood and spirit [21]. In the theory of Chinese medicine (CM), Tai Chi can maintain the harmony between qi and the blood, keep yin and yang in balance and also enhance immunity [2223]. These properties are both important in relieving fatigue and maintaining energy. Qi, the energy which promotes the body’s movement, can circulate around the entire body freely if yin and yang are kept in balance [23].

Tai Chi may relieve fatigue via different mechanisms of action. Firstly, through slow movement and weight shifting, Tai Chi may relieve stress, make people more happy [24] and promote relaxation [25]. Secondly, the proven efficacy of Tai Chi to enhance aerobic capacity and immune function [26] and to improve pain [27], depression and psychological well-being [28] may be beneficial to relieve fatigue.

An advantage of Tai Chi is that it is easy to learn, teach, and popularize, and more reports on evidence of its effects should lead to it becoming even more popular. As a low impact exercise, Tai Chi may be ideal for people with fatigue, lack of exercise or who do not have active lifestyles [19]. Several studies have reported that Tai Chi plays a critical role in fighting fatigue [2932]. However, there not been explicit studies to reach a conclusion on Tai Chi’s effects on fatigue. Others have shown no difference between Tai Chi groups and control groups [33,34]. In addition, most of the studies focus on only one ailment [32,35,36]. As far as we know, the majority of the literature on Tai Chi intervention for fatigue is empirical, and uses small sample sizes. Few of the existing studies have explored fatigue as the primary outcome. To date, there have been no systematic reviews nor meta-analyses to evaluate the effects of Tai Chi for fatigue, but single RCTs based on a specific population in a certain place. This systematic review evaluates the effects and safety of Tai Chi for fatigue, and provides an overall understanding of the current situation, as well as problems in this field.

Continue —> Does Tai Chi relieve fatigue? A systematic review and meta-analysis of randomized controlled trials

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[VIDEO] Tai Chi for Rehabilitation – Introduction and Free Lesson 1 – YouTube

Tai Chi for Rehabilitation is infinitely modifiable. It can be used to aid recovery, facilitate relaxation or simply as a quick wind down after a busy day. It leads seamlessly into Tai Chi for Energy. After Tai Chi for Energy there is the more demanding Tai Chi for Energy 2. The trilogy begins with a Health form, moves to a Beginners Form, and ends with an intermediate form. It guides the beginner through a series of moves which subtly build into a sophisticated sequence which will satisfy the needs of every practitioner.

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[Abstract] Tai chi for upper limb rehabilitation in stroke patients: the patient’s perspective.

Abstract

Introduction: This study aimed at exploring the perceived benefits and drawbacks of practicing tai chi, an alternative therapy that can be implemented in the community, as part of upper-limb rehabilitation following stroke.
Methodology: Semistructured interviews were carried out with participants with chronic stroke (>6 months). The participants took part in 16 tai chi sessions over 8 weeks. Interviews were conducted in person using an interview guide based on the theory of planned behavior (TPB), and a thematic analysis was conducted.
Results: Eight interviews were carried out with participants at various stages of motor recovery. Participants perceived a number of physical, functional, and psychological benefits. They found tai chi to be a global exercise, including both physical and mental aspects, and suggested that it can be included as part of rehabilitation for stroke patients. Many participants expressed a desire to continue practicing tai chi after completion of the study because it exceeded their expectations, among other reasons.
Conclusion: This study can serve to guide future tai chi interventions and research on tai chi for rehabilitation in terms of the characteristics of the intervention and the various areas to assess in order to measure the overall benefits.

  • IMPLICATIONS FOR REHABILITATION

  • Tai chi was perceived as a good way of integrating various skills learned during rehabilitation.

  • Despite having different functional abilities, all the participants noted various physical, functional, and psychological benefits from participating in the tai chi sessions.

  • Tai chi seems to be a form of exercise that stroke patients would perform more long-term since all the participants in this study expressed the desire to continue practicing tai chi.

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Source: Tai chi for upper limb rehabilitation in stroke patients: the patient’s perspective – Disability and Rehabilitation –

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[ARTICLE] Tai Chi for stroke rehabilitation: protocol for a systematic review – BMJ Open – Full Text

Abstract

Introduction Stroke is a major cause of death and disability, and imposes a huge burden and significant workload for patients, their families and society. As a special form of physical activity, Tai Chi is may be useful for stroke rehabilitation. The objective of this review is to systematically evaluate the efficacy and safety of Tai Chi for rehabilitation in stroke patients.

Methods and analysis We will conduct a systematic search of the following electronic databases from their inception to 31 October 2015: MEDLINE, EMBASE, the Cochrane Library, the Chinese BioMedical Literature Database (CBM), the Chinese National Knowledge Infrastructure (CNKI), the Chinese Science and Technology Periodical Database (VIP), Wanfang and the Chinese Dissertation Database. All relevant randomised controlled trials (RCTs) in English and Chinese will be included. The main outcomes will be changes in the neurological function of patients and in independence in activities of daily living. Adverse events, adherence, costs and the cost effectiveness of Tai Chi will also be assessed. Two independent reviewers will select studies, extract data and assess quality. Review Manager 5.3 will be used for assessment of risk of bias, data synthesis and subgroup analysis.

Ethics and dissemination This systematic review does not require formal ethical approval because all data will be analysed anonymously. Results will provide a general overview and evidence concerning the efficacy and safety of Tai Chi for stroke rehabilitation. Findings will be disseminated through peer-reviewed publications.

Continue —> Tai Chi for stroke rehabilitation: protocol for a systematic review — Zhang et al. 6 (6) — BMJ Open

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[ARTICLE] Applying Tai Chi as a rehabilitation program for stroke patients in the recovery phase Full Text PDF

Abstract (provisional)

Background: As the second commonest cause of death and a major cause of disability worldwide, stroke has greatly influenced patients’ quality of life and created a huge public health burden. As a special form of physical activity that has been widely practiced in China, and even throughout the world, Tai Chi may be favorable for the rehabilitation of stroke patients. Several studies have been conducted to investigate the rehabilitative effects of Tai Chi for stroke patients, but none of them have been focused on the recovery phase (2 to 24 weeks) of stroke.

Methods: This study is an assessor-blinded randomized controlled trial. A total of 50 eligible participants will be randomly assigned to either a control group or a Tai Chi group. Patients in the control group will receive standard, conventional rehabilitation therapies, and a combination of Tai Chi and conventional rehabilitation programs will be applied in the Tai Chi group. The recovery of motor impairment, functional activity and balance abilities as measured with the Fugl-Meyer Assessment, Barthel Index and Berg Balance Scale will be assessed as primary outcome measures. The secondary outcome measures to be used are the scores on the Stroke-Specific Quality of Life Scale, the National Institutes of Health Stroke Scale and the objective parameters of the RSscan footscan gait system. All assessments will be conducted at baseline, 4 weeks after the rehabilitation course and at the end of 3-month follow-up.

Discussion: The results of this study will provide preliminary evidence regarding the efficacy and feasibility of Tai Chi as an additional rehabilitative program for stroke patients in the recovery phase.

Trial registration: Chinese Clinical Trial Register ID: ChiCTR-TRC-13003661 (7 October 2013)

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

via Trials | Abstract | Applying Tai Chi as a rehabilitation program for stroke patients in the recovery phase: study protocol for a randomized controlled trial.

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[ARTICLE] What Do We Really Know About the Safety of Tai Chi?:

…TC is unlikely to result in serious AEs, but it may be associated with minor musculoskeletal aches and pains. However, poor and inconsistent reporting of AEs greatly limits the conclusions that can be drawn regarding the safety of TC…

http://www.archives-pmr.org/article/S0003-9993(14)00392-X/abstract?rss=yes

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[VIDEO] Tai Chi for Rehabilitation – Introduction and Free Lesson 1 – YouTube

via Tai Chi for Rehabilitation – Introduction and Free Lesson 1 – YouTube.

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