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  • New in the Literature: Tai Chi in Patients With Parkinson Disease (N Engl J Med 2012; 366:511-519.)

    Tai chi training appears to reduce balance impairments in patients with mild-to-moderate Parkinson disease, with additional benefits of improved functional capacity and reduced falls, say authors of an article published this month in NEJM 

    For this trial, researchers randomly assigned 195 patients with stage 1 to 4 disease on the Hoehn and Yahr staging scale (which ranges from 1 to 5, with higher stages indicating more severe disease) to 1 of 3 groups: tai chi, resistance training, or stretching. The patients participated in 60-minute exercise sessions twice weekly for 24 weeks. The primary outcomes were changes from baseline in the limits-of-stability test (maximum excursion and directional control; range, 0 to 100%). Secondary outcomes included measures of gait and strength, scores on functional-reach and timed up-and-go tests, motor scores on the Unified Parkinson Disease Rating Scale, and number of falls.

    The tai chi group performed consistently better than the resistance-training and stretching groups in maximum excursion (between-group difference in the change from baseline were 5.55 percentage points and 11.98 percentage points, respectively) and in directional control (10.45 percentage points and 11.38 percentage points, respectively). The tai chi group also performed better than the stretching group in all secondary outcomes and outperformed the resistance-training group in stride length and functional reach. Tai chi lowered the incidence of falls more than stretching did, but not more than resistance training did. The effects of tai chi training were maintained at 3 months after the intervention. No serious adverse events were observed.

    APTA member Johnny Galver, PT, coauthored the article.

    Comments

    • Would like to know which type/ style of Tai Chi was used? Also, did the participants learn isolated therapeutic type motions, or they did practice a specific part of a specific "form". For instance, many classic "forms" incorporate 100 or more specific motions. Thanks!

      Posted by Gail, PT on 2/17/2012 3:58 PM

    • I applaud the study, thank you group. I use Tai Chi principles consistently in my rehab work, with positive response. All of my work is one to one, it's good to see another study w/ numbers. Gail PT - look at Appendix for form sequences.

      Posted by Peter Kay PTA on 2/17/2012 4:44 PM

    • Your willingness to devote the time and energy to do research are commendable. However, I do not understand the rationale for comparing Tai Chi to resistance training and stretching as neither are intervention techniques specifically related to improving balance. In other words, it seems the positive results of Tai Chi compared to the other groups for addressing balance and fall risk would be expected by physical therapy professionals. Why research to support what we already know? Research comparing Tai Chi to traditional balance training makes more sense.

      Posted by Laura Miele, PTA on 2/17/2012 5:08 PM

    • But Tai Chi was not more effective at reducing fall risks. It would seem that this is would be of primary concern.

      Posted by John Stapleton on 2/19/2012 10:11 PM

    • In response to John, Tai Chi did reduce fall risks moreso than stretching but not more than resistance training. The implications are great for supporting active stretching and posture that takes place in Tai Chi versus traditional muscle stretching techniques.

      Posted by Kelly King, PT on 2/23/2012 10:27 AM

    • Dr. Fuzhong Li at ORI is currently to my knowledge the only individual who is using the most OBJECTIVE research to prove that tai chi is extremely effective to reduce falls especially in the elderly. Dr. Paul Lamb teaches Tai Chi and is very good but it is Dr. Li who has succeeded in achieving validation for Tai Chi by the CDC as effective fall prevention for the elderly. Tai Chi is NOT derived from the martial arts. "If Tai Chi is taught this way it is a dance, it is a series of movements and exercise but not true Tai Chi" These are the words of one of my master Dr. Yang Jwing Ming. Unfortunately most of the individuals performing Dr. Fuzhong Li's Moving for Better Balance TM program are teaching it like a dance or exercise. For this reason and the expense associated with Dr. Li's program I chose to study instead with Dr. Yang Jwing Ming and Master Sam Tam. It does not matter what style you choose...Yang, Chen, Sun Wu but what is important is the grasp of the fundamentals...the basics. No one should be certified to teach Tai Chi as real Tai Chi unless they have successfully competed push hands with a master such as Sam Tam or Dr. Yang Jwing Ming. Then you will know why the Tai Chi classics are not myth. "Two fingers can move 1000 pounds and the young can defeat the old." As a long time black belt and student of MMA Tai chi suddenly opened my eyes that there is something here that is real but seems impossible. How is it my 74 year old teacher can mop the floor with people twice his size and yet he uses no force? This is Tai Chi. Unfortunately what we have today is the equivalent of a physical therapy aide teaching exercises but having no idea why or the reason behind what they are doing. This is only causing the waters to become more murky in that people believe Tai Chi is just an exercise, a dance or related to martial arts. It is so simple I teach it to 95 year old patients, yet it is so difficult even a teenager would have difficulty grasping it. What is amazing is to see a 95 year old grow enthusiastic, excited and begin to laugh as they suddenly find their equilibrium and how this relates to their center of gravity and BOS. It is truly incredible to teach a 95 year old to achieve static standing balance unsupported when they have not been able to perform this since their 80's and in less than an hour. It appears to be magic. This is Tai Chi.

      Posted by Noah M Fox on 1/7/2016 2:42 PM

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