Effects of Tai Chi training on postural control and cognitive performance while dual tasking - a randomized clinical trial.

BACKGROUND: This single-blinded, randomized controlled study investigated the effects of practicing Tai Chi on the postural control and cognitive performance of older women while dual tasking. METHODS: Community-dwelling older women (n=31) were recruited from community centers. They were randomized to Tai Chi group (n=15, 12-form Yang style Tai Chi training) or a control group (n=16, general interest classes) for 16 weeks. Balance was tested in single leg stance after stepping down from a step, with and without a concurrent auditory response task (auditory Stroop test). Balance was measured by total sway path and sway area of subject's center of pressure (COP). The reaction time and the correctness of the auditory Stroop test were also measured. RESULTS: Tai Chi subjects made fewer errors in auditory Stroop test under dual-task condition after Tai Chi training (p=0.01). They also showed significant decreases in the COP path (p<0.05) and the COP area (p<0.05) in their postural control after training in both single- and dual-task conditions. The subjects in the control group did not show any significant improvement in dual-task condition after the intervention. CONCLUSIONS: Tai Chi training improves the cognitive and postural control performance of older women when dual tasking.

Reliability and validity of the sequential weight-shifting test: a new functional approach to the assessment of the sitting balance of older adults.

[Purpose] The evaluation of sitting balance is important for the prevention of falls in older adults, especially those who have a disability involving the lower extremities. However, no studies have been designed to assess a patient's dynamic sitting balance using a sequential protocol. The objective of this study was to investigate the psychometric properties of the sequential weight-shifting (SWS) test. [Subjects and Methods] Twenty-three older adults who were physically dependent with regard to ambulation were recruited by convenience sampling. In study 1, 10 participants performed the SWS test and repeated the procedure 1 week later. In study 2, 23 participants were assessed using the SWS test, forward and lateral reach tests in a sitting position, tests of shoulder flexor and hand grip strength, an eye-hand coordination test, mobility tests, and pulmonary function tests. The test-retest reliability of the SWS test and its correlations with the different physical dimensions were examined. [Results] The intraclass correlation coefficient (3,1) of the SWS test was 0.67. The results of the SWS test correlated significantly with forward reach in the sitting position, arm muscle strength, eye-hand coordination, mobility, and pulmonary function (all p<0.05). [Conclusion] The SWS test demonstrated satisfactory psychometric properties and can be considered a useful functional approach for the measurement of sitting balance.

Reduced Cognitive-Motor Interference on Voluntary Balance Control in Older Tai Chi Practitioners.

BACKGROUND AND PURPOSE: Recent dual-task studies suggest that Tai Chi practitioners displayed better control of standing posture and maintained a quicker response time of postural muscle activation during a stepping down activity. Whether this effect extends to voluntary balance control, specifically the limits of excursion of the center of pressure, remains to be examined. The purpose of this study was to evaluate the cognitive-motor interference pattern by examining the effects of a concurrently performed cognitive task on attention of voluntary balance control in older adults who are long-term practitioners of Tai Chi. METHODS: Ten older Tai Chi practitioners and 10 age-matched nonpractitioners performed a voluntary balance task that required them to shift their weight to reach a preset target in the forward and backward directions, with (single task, ST) and without (dual task, DT) a secondary cognitive task, which was the counting backward task. The counting backward task required the individual to compute and verbalize a series of arithmetic differences between a given pair of randomly generated numbers. The cognitive task was also performed independently (cognitive-ST). All trials were performed in a random order. Balance outcomes included reaction time, movement velocity, and maximal excursion of the center of pressure provided by the NeuroCom system. Cognitive outcome was the number of correct responses generated within the 8-second trial during the ST and DT conditions. Outcome variables were analyzed using a 2-factor, group by task, analysis of variance. DT costs for the variables were calculated as the relative difference between ST and DT conditions and were compared between the 2 groups using independent t tests. RESULTS: Tai Chi practitioners displayed shorter reaction times (P < .001) and faster movement velocities (P < .05) of their center of pressure than older nonpractitioners for both directions; however, no difference was found between the maximal excursions of the 2 groups. Cost analyses revealed that reaction time and cognitive costs were significantly lower in the Tai Chi practitioners for both forward and backward directions (P < .05); however, similar findings for movement velocity costs were significant only in the backward direction (P < .05). DISCUSSION AND CONCLUSIONS: Our results suggest that Tai Chi practitioners expended fewer motor and cognitive resources than older nonpractitioners during a fairly complex (dynamic) postural equilibrium task while performing a verbal working memory task. They exhibited lesser cognitive-motor interference and thus better allocation of attentional resources toward the voluntary balance control task. Given that dynamic balance is a crucial prerequisite for walking and dual-tasking ability is considered to be a significant predictor of falls in older adults, our results might point at the possible long-term benefits of Tai Chi practice to counteract age-related decline in dual-tasking ability. Findings present preliminary data for further investigation, especially related to potential benefits in fall prevention.

The effects of practicing sitting Tai Chi on balance control and eye-hand coordination in the older adults: a randomized controlled trial.

PURPOSE: The purpose of this study was to examine the effects of 3 months of sitting Tai Chi training on the sitting balance control and eye-hand coordination of older adults subjects. METHODS: We randomly assigned 59 older adults from four residential care facilities to either sitting Tai Chi group or mobilizing exercises group as control. The sitting Tai Chi group underwent 3 months of training with a total of 36 sessions (1 hour/session, 3 sessions/week). The outcome measures included sitting balance tests (testing sequential weight shifting and forward reaching in a sitting position) and eye-hand coordination tests (reaction time, movement time and accuracy in finger pointing task). RESULTS: The Tai Chi practitioners showed significant improvement in their sequential weight shifting while sitting (improved by 29.0%, p ≤ 0.05) and in their maximum reaching distance from a sitting position (improved by 21.2%, p ≤ 0.05). No such improvements were found in the control group. In the eye-hand coordination test, the sitting Tai Chi practitioners had significant improvements in accuracy (improved by 17.3%, p ≤ 0.05). Also, no improvement was found in the control group. CONCLUSIONS: The results demonstrate 3-months of sitting Tai Chi training can improve sitting balance and accuracy in finger pointing task in the older adults. IMPLICATIONS FOR REHABILITATION: Traditional Tai Chi poses difficulties for older adults with poor standing balance. This pilot study showed that a 3 months sitting Tai Chi training can improve sitting balance and accuracy in the finger pointing task in the older adults. Sitting Tai Chi can be a therapy option for older adults with poor standing balance.

Internal consistency and test-retest reliability of an instrumented functional reaching task using wireless electromyographic sensors.

The purpose of this study was to establish the internal consistency and test-retest reliability of the electromyographic and accelerometric data sampled from the prime movers of the dominant arm during an antigravity, within-arm's length stand-reaching task without trunk restraint. Ten healthy young adults participated in two experimental sessions, approximately 7-10days apart. During each session, subjects performed 15 trials of both a flexion- and an abduction-reaching task. Surface EMG and acceleration using wireless sensors were sampled from the anterior and middle deltoid. Reliability was established using Cronbach's alpha, intraclass correlation coefficients (ICC 2, k) and standard error of measurements (SEM) for electromyographic reaction time, burst duration and normalized amplitude along with peak acceleration. Results indicated high degrees of inter-trial and test-retest reliability for flexion (Cronbach's α range=0.92-0.99; ICC range=0.82-0.92) as well as abduction (Cronbach's α range=0.94-0.99; ICC range=0.81-0.94) reaching. The SEM associated with response variables for flexion and abduction ranged from 1.55-3.26% and 3.33-3.95% of means, respectively. Findings from this study revealed that electromyographic and accelerometric data collected from prime movers of the arm during the relatively functional stand-reaching task were highly reproducible. Given its high reliability and portability, the proposed test could have applications in clinical and laboratory settings to quantify upper limb function.

Electrical acupoint stimulation of the affected arm in acute stroke: a placebo-controlled randomized clinical trial.

OBJECTIVES: To determine whether adding electrical stimulation of upper limb acupoints to conventional rehabilitation during acute stroke could produce greater and longer lasting motor improvements of the arm. DESIGN: Double-blind, randomized, placebo-controlled trial. SETTING: Acute stroke wards, followed by rehabilitation hospitals and subjects' residences. PARTICIPANTS: Seventy-three patients ≤ 46 hours post stroke onset with moderate to severe weakness in the arm contralateral to the side of stroke. INTERVENTION: All subjects received conventional rehabilitation. Twenty-nine received additional electrical stimulation, 21 received additional placebo-electrical stimulation and 23 received conventional rehabilitation only, as control. Electrical stimulation or placebo-electrical stimulation was applied to acupoints GB20, LI15, LI11, LI10 and LI4, 60 minutes a day, five days a week, for four weeks. MEASUREMENTS: Primary outcome measures were hand grip and pinch strength, with Action Research Arm Test (ARAT) as secondary outcome measure. These were assessed on the affected arm at recruitment, then 4 (W4), 12 (W12) and 24 weeks (W24) afterwards. RESULTS: Post-hoc analysis showed that the electrical stimulation group had greater improvements than the control group in hand grip (P = 0.015) and pinch strength (P = 0.007) at W4, with the gains maintained at W12 and W24. In contrast, the placebo-electrical stimulation group did not differ from either the control or the electrical stimulation group. Between-group improvements in ARAT scores from baseline to W24 (by 16.8 in control, 27.6 in placebo-electrical stimulation group and 26.3 in electrical stimulation group) were not significant. CONCLUSIONS: Adding four weeks of electrical stimulation during acute stroke appears to produce greater and longer lasting hand grip and pinch strength improvements than administering conventional rehabilitation alone.

Tai Chi practitioners have better postural control and selective attention in stepping down with and without a concurrent auditory response task.

To compare the performance of older experienced Tai Chi practitioners and healthy controls in dual-task versus single-task paradigms, namely stepping down with and without performing an auditory response task, a cross-sectional study was conducted in the Center for East-meets-West in Rehabilitation Sciences at The Hong Kong Polytechnic University, Hong Kong. Twenty-eight Tai Chi practitioners (73.6 ± 4.2 years) and 30 healthy control subjects (72.4 ± 6.1 years) were recruited. Participants were asked to step down from a 19-cm-high platform and maintain a single-leg stance for 10 s with and without a concurrent cognitive task. The cognitive task was an auditory Stroop test in which the participants were required to respond to different tones of voices regardless of their word meanings. Postural stability after stepping down under single- and dual-task paradigms, in terms of excursion of the subject's center of pressure (COP) and cognitive performance, was measured for comparison between the two groups. Our findings demonstrated significant between-group differences in more outcome measures during dual-task than single-task performance. Thus, the auditory Stroop test showed that Tai Chi practitioners achieved not only significantly less error rate in single-task, but also significantly faster reaction time in dual-task, when compared with healthy controls similar in age and other relevant demographics. Similarly, the stepping-down task showed that Tai Chi practitioners not only displayed significantly less COP sway area in single-task, but also significantly less COP sway path than healthy controls in dual-task. These results showed that Tai Chi practitioners achieved better postural stability after stepping down as well as better performance in auditory response task than healthy controls. The improved performance that was magnified by dual motor-cognitive task performance may point to the benefits of Tai Chi being a mind-and-body exercise.

Effects of aging and tai chi on a finger-pointing task with a choice paradigm.

Background. This cross-sectional study examined the effect of aging on performing finger-pointing tasks involving choices and whether experienced older Tai Chi practitioners perform better than healthy older controls in such tasks. Methods. Thirty students and 30 healthy older controls were compared with 31 Tai Chi practitioners. All the subjects performed a rapid index finger-pointing task. The visual signal appeared randomly under 3 conditions: (1) to touch a black ball as quickly and as accurately as possible, (2) not to touch a white ball, (3) to touch only the white ball when a black and a white ball appeared simultaneously. Reaction time (RT) of anterior deltoid electromyogram, movement time (MT) from electromyogram onset to touching of the target, end-point accuracy from the center of the target, and the number of wrong movements were recorded. Results. Young students displayed significantly faster RT and MT, achieving significantly greater end-point accuracy and fewer wrong movements than older controls. Older Tai Chi practitioners had significantly faster MT than older controls. Conclusion. Finger-pointing tasks with a choice paradigm became slower and less accurate with age. Positive findings suggest that Tai Chi may slow down the aging effect on eye-hand coordination tasks involving choices that require more cognitive progressing.

Effects of Tai Chi training on arterial compliance and muscle strength in female seniors: a randomized clinical trial.

BACKGROUND: Exercise which can improve muscle strength while not compromising arterial compliance is especially needed for older adults. Tai Chi practitioners are known to have better than average arterial compliance and muscle strength. This study was designed to establish a cause and effect relationship between Tai Chi training and both increased arterial compliance and increased muscle strength. DESIGN: In a single blind randomized clinical trial, 31 elderly women were randomly assigned to receive either Tai Chi training or an education programme, three sessions per week for 16 weeks. RESULTS: After training, the subjects in the Tai Chi group showed significant improvements in arterial compliance and eccentric knee extensor strength. The subjects in the control group showed no significant improvement. CONCLUSION: Practising Tai Chi can improve the eccentric knee extensor strength and arterial compliance of elderly women. Tai Chi maybe a good exercise choice to improve the cardiovascular health and muscle strength of the elderly.

Tai Chi, arterial compliance, and muscle strength in older adults.

BACKGROUND: Aerobic exercise can alleviate the declines in arterial compliance common in older adults. However, when combined with strength training, aerobic exercise may not reduce arterial compliance. Tai Chi practice has been found to improve muscle strength and cardiopulmonary function in older subjects, but whether or not it improves arterial compliance is not known. The primary aim of this study was to investigate whether Tai Chi practitioners have better arterial compliance and muscle strength. DESIGN: Twenty-nine older Tai Chi practitioners (73.7 ± 4.5 years) and 36 healthy control subjects (71.4 ± 6.6 years) participated in this cross-sectional study. METHODS: The participants were independent in their daily living activities. They were screened for apparent cardiovascular disease and underwent arterial compliance testing and isokinetic knee muscle strength testing at 30°/s. RESULTS: Tai Chi practitioners showed significantly better haemodynamic parameters than the controls as indexed by larger and small artery compliance. They also demonstrated greater eccentric muscle strength in both knee extensors and flexors. CONCLUSION: The findings of better muscle strength without jeopardizing arterial compliance suggests that Tai Chi could be a suitable exercise for older persons to improve both cardiovascular function and muscle strength.

An adjunct intervention for management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

OBJECTIVES: Application of transcutaneous electrical nerve stimulation over acupuncture points (Acu-TENS) is a noninvasive intervention that has recently been shown to alleviate dyspnea in patients with stable chronic obstructive pulmonary disease (COPD). This case report aims to explore the role of Acu-TENS in patients diagnosed with COPD during the acute exacerbation. STUDY DESIGN: The study design was a case report. SETTING: The study was conducted in an inpatient setting. SUBJECT: The subject was a 74-year-old man admitted to the hospital due to acute exacerbation of COPD (AECOPD). INTERVENTION: Treatment consisted of application of TENS on EX-B1 (Dingchuan) for 45 minutes. OUTCOME MEASURES: Oxygen saturation, heart rate, and dyspnea score were measured before, immediately after, and 45 minutes after Acu-TENS intervention. Other than the physiologic measures, 10 mL of venous blood was taken from the cubital vein for assessment of ß-endorphin level, white blood cell count, tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) level before and immediately postintervention. RESULTS: Postintervention, improved oxygen saturation, and reduction in heart rate and dyspneic sensation were observed accompanied by a raised blood ß-endorphin level but the level of white blood cell count, TNF-α, and CRP remain unchanged. CONCLUSIONS: Application of 45 minutes Acu-TENS appeared to alleviate symptoms in a patient with AECOPD. The role of adjunctive Acu-TENS therapy during acute exacerbation warrants further investigation.

Effect of externally cued training on dynamic stability control during the sit-to-stand task in people with Parkinson disease.

BACKGROUND: Previous studies have shown that people with Parkinson disease (PD) have difficulty performing the sit-to-stand task because of mobility and stability-related impairments. Despite its importance, literature on the quantification of dynamic stability control in people with PD during this task is limited. OBJECTIVE: The study objective was to examine differences in dynamic stability control between people with PD and people who were healthy and the extent to which externally cued training could improve such control during the sit-to-stand task in people with PD. DESIGN: This was a quasi-experimental controlled trial. METHODS: The performance of 21 people with PD was compared with that of 12 older adults who dwelled in the community. People with PD were randomly assigned to 2 groups: a group that did not receive training and a group that received audiovisually cued training (3 times per week for 4 weeks) for speeding up performance on the sit-to-stand task. Outcome measures recorded at baseline and after 4 weeks included center-of-mass position, center-of-mass velocity, and stability against either backward or forward balance loss (backward or forward stability) at seat-off and movement termination. RESULTS: Compared with people who were healthy, people with PD had greater backward stability resulting from a more anterior center-of-mass position at seat-off. This feature, combined with decreased forward stability at movement termination, increased their risk of forward balance loss at movement termination. After training, people with PD achieved greater backward stability through increased forward center-of-mass velocity at seat-off and reduced the likelihood of forward balance loss at movement termination through a posterior shift in the center-of-mass position. LIMITATIONS: The study applied stability limits derived from adults who were healthy to people with PD, and the suggested impact on the risk of balance loss and falling is based on these theoretical stability limits. CONCLUSIONS: For people with PD, postural stability against backward balance loss at task initiation was increased at the expense of possible forward balance loss at task termination. Task-specific training with preparatory audiovisual cues resulted in improved overall dynamic stability against both forward and backward balance loss.

Effects of Tai Chi on pre-landing muscle response latency during stepping down while performing a concurrent mental task in older adults.

To investigate whether elderly Tai Chi practitioners are better able to descend a step while performing a concurrent mental task than non-practitioners. The design includes cross-sectional study. The setting includes university-based rehabilitation center. The subjects were 16 young women, 29 elderly women, and 31 elderly women who had been practicing Tai Chi regularly for at least half a year. Pre-landing muscle response latencies in their tibialis anterior (TA) and medial gastrocnemius (MG) muscles were measured during stepping down (single task) and stepping down while performing a concurrent mental activity (dual tasking). The non-practitioners had earlier onset of muscle activity in the TA in preparation for landing than the other subjects. The response latency of the Tai Chi practitioners was not significantly different from that of the young controls. When the cognitive task was added, the pre-landing response in the TA was significantly altered in both elderly groups. Response was significantly delayed among the non-practitioners, but significantly earlier among the Tai Chi subjects. The average change in response latency was significantly greater in the non-Tai Chi group compared with the young subjects and the Tai Chi practitioners (p = 0.006). Such findings suggest that practicing Tai Chi helps the elderly maintain the same strategy as much as younger subjects during stepping down. Tai Chi practitioners seem to have a greater capacity to shift attention between mental and physical tasks than other elderly women.

Golfers have better balance control and confidence than healthy controls.

In a well-executed golf swing, golfers must maintain good balance and precise control of posture. Golfing also requires prolonged walking over uneven ground such as a hilly course. Therefore, repeated golf practice may enhance balance control and confidence in the golfers. The objective is to investigate whether older golfers had better balance control and confidence than non-golfing older, healthy adults. This is a cross-sectional study, conducted at a University-based rehabilitation center. Eleven golfers and 12 control subjects (all male; mean age: 66.2 ± 6.8 and 71.3 ± 6.6 years, respectively) were recruited. Two balance control tests were administered: (1) functional reach test which measured subjects' maximum forward distance in standing; (2) sensory organization test (SOT) which examined subjects' abilities to use somatosensory, visual, and vestibular inputs to control body sway during stance. The modified Activities-specific Balance Confidence (ABC) determined subject's balance confidence in daily activities. The golfers were found to achieve significantly longer distance in the functional reach test than controls. They manifested significantly better balance than controls in the visual ratio and vestibular ratio, but not the somatosensory ratio of the SOT. The golfers also reported significantly higher balance confidence score ratios. Furthermore, older adults' modified ABC score ratios showed positive correlations with functional reach, visual and vestibular ratios, but not with somatosensory ratio. Golfing is an activity which may enhance both the physical and psychological aspects of balance control. Significant correlations between these measures reveal the importance of the balance control under reduced or conflicting sensory conditions in older adults' balance confidence in their daily activities. Since cause-and-effect could not be established in the present cross-sectional study, further prospective intervention design is warranted.

Acu-TENS and Postexercise Expiratory Flow Volume in Healthy Subjects.

Transcutaneous Electrical Nerve Stimulation over acupoints (Acu-TENS) facilitates recovery of resting heart rate after treadmill exercise in healthy subjects. Its effect on postexercise respiratory indices has not been reported. This study investigates the effect of Acu-TENS on forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) in healthy subjects after a submaximal exercise. Eleven male subjects were invited to the laboratory twice, two weeks apart, to receive in random order either Acu-TENS or Placebo-TENS (no electrical output from the TENS unit) over bilateral Lieque (LU7) and Dingchuan (EX-B1) for 45 minutes, before undergoing exercise following the Bruce protocol. Exercise duration, rate of perceived exertion (RPE), and peak heart rate (PHR) were recorded. Between-group FEV1 and FVC, before, immediately after, at 15, 30, and 45minutes postexercise, were compared. While no between-group differences in PHR, RPE, and FVC were found, Acu-TENS was associated with a longer exercise duration (0.9 min (P = .026)) and a higher percentage increase in FEV1 at 15 and 45 minutes postexercise (3.3 ± 3.7% (P = .013) and 5.1 ± 7.5% (P = .047), resp.) compared to Placebo-TENS. We concluded that Acu-TENS was associated with a higher postexercise FEV1 and a prolongation of submaximal exercise.

Acute Effects of Acu-TENS on FEV1 and Blood Β-endorphin Level in Chronic Obstructive Pulmonary Disease.

Background Pharmacotherapy is the mainstay of dyspnea management in patients with chronic obstructive pulmonary disease (COPD). Undesirable side effects have led to the application of alternative treatment strategies such as acupuncture. Our previous study showed that transcutaneous electrical nerve stimulation over acupuncture points (Acu-TENS), a noninvasive modality, can reduce dyspnea symptoms in patients with COPD, but the underlying mechanism is unknown. Primary Study Objective This study investigated the effect of acu-TENS on forced expiratory volume in one second (FEV1), dyspnea, and Β-endorphin levels in patients with COPD. Design A double-blinded randomized controlled trial Setting: Hospital outpatient clinic Participants Forty-four subjects diagnosed with COPD Intervention Participants were randomly assigned to receive either acu-TENS or placebo-TENS on Dingchuan (EX-B1) for 45 minutes. Outcome Measures FEV1, forced vital capacity (FVC), dyspnea visual analogue score (DVAS), respiratory rate (RR), and blood Β-endorphin levels were measured before and after therapeutic intervention. Results Our findings showed that the increase in FEV1 was 24.2% greater in the acu-TENS group than the placebo group (P < .0001). The decrease in RR and DVAS was also more in the acu-TENS group by 14.2% (P < .0001) and 20.7% (P = .006), respectively. The postintervention increase in Β-endorphin was significantly higher in the acu-TENS than the placebo group (18.3%) (P = .027). Furthermore, the percentage reduction in RR correlated with the increase in Β-endorphin (R = -0.477, P = .033). Conclusion An improvement in FEV1 and dyspnea score at the end of Acu-TENS treatment was associated with a concurrent increase in b-endorphin level in patients with COPD.

Do older t'ai chi practitioners have better attention and memory function?

OBJECTIVES: Cognitive declines are common in older people and can be a major health issue in an aging world. One type of body-mind exercises, t'ai chi, can be a possible means to help maintaining older adults' cognitive abilities, in addition to beneficial effects of physical exercises. The purpose of this study was to investigate whether t'ai chi practitioners had better attention and memory functions than older people with or without regular exercises. METHODS: A cross-sectional study examining the relationship between t'ai chi practice and age-, gender- and education-similar older peoples' attention and memory functions. Forty-two (42) community-dwelling elderly subjects, aged 60 or older, recruited from t'ai chi clubs in Hong Kong formed the t'ai chi group. Another 49 elderly having regular exercise habits were recruited from community centers for inclusion in the exercise group. A nonexercise group (normal healthy control) consisting of 44 subjects were also recruited by random selection and through contacting local elderly centers. They were also screened by the Modified Barthel Index, Chinese Mini-mental Status Examination, Geriatric Depression Scale, and evaluated by attention tests (Color Trail Form A-1 and 2) and memory tests (including Rivermead Behavioral Memory Test and The Hong Kong List Learning Test). RESULTS: The main finding was that the three groups differed in attention and memory functions, and the t'ai chi group had demonstrated better performance than the other two groups in most subtests. CONCLUSIONS: As a causal relationship cannot be assumed in the present cross-sectional study, future research is required to examine how t'ai chi can improve cognitive function using a randomized control trial as well as determining whether t'ai chi practice can lead to better health status among elderly people.

Transcutaneous electrical stimulation on acupoints combined with task-related training to improve motor function and walking performance in an individual 7 years poststroke: a case study.

BACKGROUND AND PURPOSE: Impaired walking function and spasticity are common sequelae of stroke. Prior studies have shown that a rehabilitation program combining transcutaneous electrical stimulation (TES) with task-related training (TRT) improves motor function in individuals with stroke. However, it is unclear if this approach is beneficial for individuals with long-standing stroke. CASE DESCRIPTION: The subject of this case study was a 61-year-old man who was 7 years poststroke. He exhibited limitations of walking function, impaired strength of the ankle muscles, and severe plantarflexor spasticity. INTERVENTIONS: For 4 weeks, the patient performed a 5-day/wk home program consisting of 60 minutes of TES (below motor threshold) to the acupoints in the affected lower leg, followed by 60 minutes of TRT. He documented his daily home program activities in a log, and 3 times a week he received a call from the therapist to verify his adherence. The patient also had 8 clinic visits, which focused on instruction to ensure adherence to the (TES + TRT) protocol and progression of the program. OUTCOMES: After the 4-week program, plantarflexor spasticity decreased and ankle dorsi- and plantarflexor strength improved. More important, there were notable improvements in gait velocity, walking endurance, and functional mobility. These gains were maintained at 4 weeks posttreatment. DISCUSSION: This accessible home program was safe and effective for decreasing impairment and improving function in an individual with long-term, chronic stroke. The gains were maintained 4 weeks posttreatment. Details are provided for developing a home program integrating somatosensory TES and TRT.

Effect of 4 weeks of Acu-TENS on functional capacity and beta-endorphin level in subjects with chronic obstructive pulmonary disease: a randomized controlled trial.

Our recent studies showed that one session of transcutaneous electrical nerve stimulation on acupoints (Acu-TENS) improved forced expiratory volume in 1s (FEV(1)) in patients with chronic obstructive pulmonary disease (COPD). This study investigated the effect of 4-week Acu-TENS on physical and psychosocial function in these patients. Twenty-eight patients were randomly allocated to receive 4-weeks of 45-min, 5-days/week, of either Acu-TENS (over Dingchuan), Placebo-TENS (same protocol without electrical output), or Sham-TENS (over the patellae). Variables measured before and after intervention included FEV(1), forced vital capacity (FVC), 6-min walk distance (6MWD), St. George's Respiratory Questionnaire score (SGRQ), beta-endorphin and blood inflammatory marker levels. Only the Acu-TENS group attained significant improvement in FEV(1) (p=0.046), physical activity (p=0.007) and total SGRQ score (p=0.028). The increase in beta-endorphin (p=0.012) correlated positively with the improvement in FEV(1) (r=0.526, p=0.008). To conclude, 4 weeks of Acu-TENS improved the functional capacity of patients with COPD, probably due to the bronchodilation induced by beta-endorphin elevation.