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Can Tai Chi Improve Vestibulopathic Postural Control?
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Short Description: review the evidence that Tai Chi improves postural control and .... cluded that Tai Chi does not improve static postural stability, ...
Content Inside: 142 REVIEW ARTICLE Can Tai Chi Improve Vestibulopathic Postural Control? Peter M. Wayne, PhD, David E. Krebs, DPT, PhD, Steven L. Wolf, PhD, PT, FAPTA, Kathleen M. Gill-Body, DPT, MS, NCS, Donna M. Scarborough, PT, MS, Chris A. McGibbon, PhD, Ted J. Kaptchuk, OMD, Stephen W. Parker, MD ABSTRACT. Wayne PM, Krebs DE, Wolf SL, Gill-Body are studies that integrate measures of balance relevant to ADLs KM, Scarborough DM, McGibbon CA, Kaptchuk TJ, Parker with other psychologic and cognitive measures; these might SW. Can Tai Chi improve vestibulopathic postural control? help identify specific mechanisms whereby Tai Chi can remedy Arch Phys Med Rehabil 2004;85:142-52. balance disorders. Objectives: To evaluate the rationale and scientific support Key Words: Balance; Posture; Rehabilitation; Tai Chi. for Tai Chi as an intervention for vestibulopathy and to offer © 2004 by the American Congress of Rehabilitation Medi- recommendations for future studies. cine and the American Academy of Physical Medicine and Data Sources: A computer-aided search, including MED- Rehabilitation LINE and Science Citation Index, to identify original Tai Chi studies published in English; relevant references cited in the retrieved articles were also included. VESTIBULOPATHY, OR INNER EAR disease causes whole body dynamic postural control impairments, func- Study Selection: A preliminary screening selected all ran- tional limitations in locomotor activities, disability in typical domized controlled trials (RCTs), non-RCTs, case-control role activities, and decreased quality of life1-3 (QOL). Patients studies, and case series that included Tai Chi as an interven- with vestibulopathy experience a constellation of problems for tion and had at least 1 outcome variable relevant to postural which they are often referred to rehabilitation, including un- stability. steady standing and gait and difficulty stabilizing the visual Data Extraction: Authors critically reviewed studies and environment during head movement.4,5 Findings from research summarized study designs and outcomes in a summary table. on vestibular rehabilitation provide an understanding about the Data Synthesis: Twenty-four Tai Chi studies met screening benefits and limitations of vestibular rehabilitation for this criteria. No studies specifically studying Tai Chi for vestibu- patient population.6 Tai Chi, which purports to improve overall lopathy were found. Collectively, the 24 studies provide some- body control, mind-body focus, and psychologic well-being, times contradictory but generally supportive evidence that Tai Chi may have beneficial effects for balance and postural im- may offer an alternative or complementary approach to treating pairments, especially those associated with aging. Ten RCTs vestibulopathy-induced balance dysfunction, but, to date, little were found, of which 8 provide support that Tai Chi practiced such evidence exists to support Tai Chi as an effective inter- alone, or in combination with other therapies, can reduce risk vention for this population. of falls, and/or impact factors associated with postural control, Tai Chi, also referred to as Tai Chi Chuan and Taijiquan, has including improved balance and dynamic stability, increased its roots in the martial arts; yet, for centuries millions of musculoskeletal strength and flexibility, improved performance Chinese have practiced Tai Chi's flowing, meditative move- of activities of daily living (ADLs), reduced fear of falling, and ments to cultivate and maintain health and well-being. Numer- general improvement in psychologic well-being. Studies using ous anecdotal reports of past and present practitioners claim other designs support the results observed in RCTs. that Tai Chi exercise has helped cure a diversity of health Conclusions: At present, few data exist to support the con- disorders.7,8 Considered a treasure of Chinese medicine, Tai tention that Tai Chi specifically targets the impairments, func- Chi is based on the same core principles that underlie acupunc- tional limitations, disability, and quality of life associated with ture and Chinese herbal therapies.9-11 Although acupuncture peripheral vestibulopathy. There are, however, compelling rea- relies on needle insertion and herbal medicine on phytochem- sons to further investigate Tai Chi for vestibulopathy, in part ical pharmacology, Tai Chi uses detailed regimens of physical because Tai Chi appears useful for a variety of nonvestibulopa- movement, breathing techniques, and cognitive tools (both thy etiologic balance disorders, and is safe. Especially needed visualization and focused internal awareness) to strengthen the body, to relax the mind, and to "balance the flow of chi" (life force).12-14 Falls and unsteady gait are critical problems in older From the Research Department, New England School of Acupuncture, Watertown, adults.15 Tai Chi has been used extensively among older adults, MA (Wayne); Biomotion Laboratory (Krebs, Scarborough, McGibbon) and Neurol- ogy Department (Parker), Massachusetts General Hospital, Boston, MA; MGH Insti- but the benefits of Tai Chi for vestibulopathy are largely tute of Health Professions, Boston, MA (Wayne, Krebs, Gill-Body Scarborough, unknown. Tai Chi's reputed health benefits, apparent safety, McGibbon, Kaptchuk); Department of Rehabilitation Medicine, Emory University low cost, and growing recognition have resulted in this exercise School of Medicine, Atlanta, GA (Wolf); and Harvard Medical School, Boston, MA becoming more prominent as a preventive and rehabilitative (Krebs, McGibbon, Kaptchuk, Parker). Supported by the National Center for Complementary and Alternative Medicine therapeutic tool by the Western, allopathic medical community. (NCCAM), National Institutes of Health (grant nos. R21AT0(0)0553, 5R25AT00714- Recent studies have begun to address the safety and efficacy of 02). The content of this review is solely the responsibility of the authors and do not Tai Chi as a therapeutic intervention for various health con- necessarily represent the official views of NCCAM. cerns, including postmyocardial infraction,16 coronary artery No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any bypass surgery cardiac rehabilitation,17 hypertension,18 general organization with which the author(s) is/are associated. cardiorespiratory function,19-23 multiple sclerosis,24 rheumatoid Reprint requests to Peter Wayne, PhD, New England School of Acupuncture, 40 arthritis,25 osteoarthritis,26 microcirculation and endothelial Belmont St, Watertown, MA, 02472, e-mail: pwayne@nesa.edu. function,27,28 immune function,29 dementia,30 and general stress 0003-9993/04/8501-7993$30.00/0 doi:10.1016/S0003-9993(03)00652-X management.31-33 These and other Tai Chi uses have been Arch Phys Med Rehabil Vol 85, January 2004 Document OutlineCan Tai Chi Improve Vestibulopathic Postural Control?Vestibulopathy and Vestibular RehabilitationTai Chi for Whole Body Postural Control and Balance ImpairmentMETHODSLiterature Review ResultsRCTs with outcomes relevant to postural controlPsychologic Responses to Tai ChiDISCUSSIONRelevance of Tai Chi Studies to Date for Patients With VestibulopathyDesign Limitations of Studies to Date and Considerations for Future Tai Chi…Vestibulopathy StudiesElements of Tai Chi That May Improve Vestibulopathy PatientsCONCLUSIONReferences
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