Comparing the Effects of Short-Term Liuzijue Exercise and Core Stability Training on Balance Function in Patients Recovering From Stroke: A Pilot Randomized Controlled Trial.

AIMS: Liuzijue Qigong (LQG) exercise is a traditional Chinese exercise method in which breathing and pronunciation are combined with movement guidance. Breathing is closely related to balance, and LQG, as a special breathing exercise, can be applied to balance dysfunction after stroke. The purpose of this study was to observe the clinical effects of short-term LQG exercise on balance function in patients recovering from stroke. METHODS: Stroke patients were randomly divided into an Intervention Group (IG) (n = 80) and a Control Group (CG) (n = 80). The IG received conventional rehabilitation training plus LQG and the CG received conventional rehabilitation training plus Core Stability Training (CST). All patients received treatment once a day, 5 times a week for 2 weeks. The primary outcome was Berg Balance Scale (BBS). Secondary outcome measures were static standing and sitting balance with eyes open and closed, Fugl-Meyer Assessment (FMA), Maximum Phonation Time (MPT), Modified Barthel Index (MBI) and diaphragm thickness and mobility during quiet breath (QB) and deep breath (DB). RESULTS: Compared with the CG, the IG showed significant improvement in the BBS (10.55 ± 3.78 vs. 9.06 ± 4.50, P = 0.039), MPT (5.41 ± 4.70 vs. 5.89 ± 5.24, P = 0.001), MBI (12.88 ± 6.45 vs. 10.00 ± 4.84, P = 0.003), diaphragmatic mobility during QB (0.54 ± 0.73 vs. 0.33 ± 0.40, P = 0.01) and diaphragmatic mobility during DB (0.99 ± 1.32 vs. 0.52 ± 0.77, P = 0.003), Cop trajectory in the standing position with eyes open (-108.34 ± 108.60 vs. -89.00 ± 140.11, P = 0.034) and Cop area in the standing positions with eyes open (-143.79 ± 431.55 vs. -93.29 ± 223.15, P = 0.015), Cop trajectory in the seating position with eyes open (-19.95 ± 23.35 vs. -12.83 ± 26.64, P = 0.001) and Cop area in the seating position with eyes open (-15.83 ± 9.61 vs. -11.29 ± 9.17, P = 0.002). CONCLUSIONS: The short-term LQG combined with conventional rehabilitation training significantly improved the balance functions of stroke patients. It also improved static standing and sitting balance with the eyes open, diaphragm functions, maximum phonation time and the quality of daily life for stroke patients. CLINICAL TRIAL REGISTRATION: http://www.chictr.org.cn/edit.aspx?pid=25313&htm=4, Identifier: ChiCTR1800014864.

Effects of Liuzijue Qigong Posture on Aerodynamics of Phonation in Healthy Volunteers.

OBJECTIVES: To verify the possible function of Liuzijue Qigong (LQG), a kind of traditional Chinese health exercise, in improving phonation. METHODS: A total of 30 healthy volunteers (10 males, 20 females) without voice disorders were included. The subjects were asked to have phonation tasks at the sitting and LQG postures. Aerodynamic, electroglottographic, and acoustic parameters were measured. Expiratory Volume (FVC); Subglottic Pressure at comfortable phonation (SGP), Glottal Resistance (GR), Glottal Efficiency (GE); Contact Quotient (CQ), Mean Flow (MF), Fundamental frequency (F0), Mean Sound Pressure Level (SPL); Phonation Threshold Pressure (PTP); and Maximum Phonation Time (MPT) were measured and analyzed. RESULTS: In total subjects, the analysis showed a significant increase in FVC (P = 0.020), SGP (P = 0.043), F0 (P = 0.021), and PTP (P = 0.000) at the LQG posture when compared with the sitting posture, and there is no difference in CQ, MF, SPL, GR, GE, and MPT. CONCLUSIONS: The results showed LQG posture increased the respiratory support and glottal closure, while induced the respiratory system and vocal system in coordination to improve phonation. It is logical to postulate that LQG has potential in the management of voice disorders with glottal closure insufficiency.

Liuzijue qigong for stroke survivors with dysarthria / 中华物理医学与康复杂志

Objective:To document any improvement in the breathing control of stroke survivors with dysarthria after practicing Liuzijue qigong.Methods:A total of 157 stroke survivors with dysarthria and abnormal respiration control were randomly divided into an observation group and a control group. Both groups were given traditional breathing training and basic articulation training (including articulatory organ training and speech training). The observation group also received training in Liuzijue qigong. It requires inhaling through the nose and exhaling through the mouth while producing the speech sounds xu, he, hu, si, chui and xi. The training lasted two weeks. Both groups were then evaluated using the modified Frenchay dysarthria assessment. Maximum phonation time, maximum counting ability and volume were also recorded as secondary indexes.Results:After the 2-week intervention, significant improvement was observed in the average scores on all of the indexes, with all of the observation group′s average scores except for volume significantly better than those of the control group. The average volume scores were significantly improved, but not significantly different.Conclusion:Supplementing basic articulation training with Liuzijue qigong can improve respiratory function and the speaking ability of stroke survivors with dysarthria. It is worthy of wider clinical application.

Effectiveness of LiuZiJue Qigong versus traditional core stability training for poststroke patients complicated with abnormal trunk postural control: study protocol for a single-center randomized controlled trial.

BACKGROUND: Trunk function in stroke patients with hemiplegia is associated with respiration and core stability and is also found to be associated with balance and postural control and activities of daily living. LiuZiJue Qigong (LQG) is a traditional Chinese method of fitness based on breath pronunciation. The purpose of this study is to compare the clinical efficacy of LQG and traditional core stability training in the treatment of stroke patients with abnormal trunk posture. This protocol is written according to the SPIRIT 2013 statement. METHODS/DESIGN: This study is a single-center randomized controlled trial in which 160 stroke patients are randomly divided into a study group and a control group. Patients in the study group will receive LQG combined with conventional rehabilitation therapy, and patients in the control group will receive traditional core stability training combined with conventional rehabilitation therapy. All treatments will be done for 45 min/day, five times per week, for 2 weeks. The primary outcome (Trunk Impairment Scale) and secondary outcomes (Berg Balance Scale, Fugl-Meyer Assessment, Modified Barthel Index, Maximum Phonation Time, Dynamic and Static balance testing, and thickness and the mobile degrees of diaphragm) will be measured at baseline, 2 weeks, and the end of the rehabilitation course. DISCUSSION: The aim purpose of this research study is to compare the clinical efficacy of LQG and traditional core stability exercise in the treatment of stroke patients with abnormal trunk posture. TRIAL REGISTRATION: Chinese Clinical Trial Register, ChiCTR1800014864. Registered on 24 November 2018.

Liuzijue Qigong: A Voice Training Method For Unilateral Vocal Fold Paralysis Patients.

OBJECTIVES: Liuzijue Qigong (LQG), a kind of traditional Chinese health exercise (TCHE), is not only widely used to strengthen physical fitness and maintain psychological well-being in the elderly but has also been utilized to help improve respiratory function. As respiratory support is an important driving force for speech production, it is logical to postulate that the LQG training method with 6 monosyllabic speech sounds, xu, he, hu, si, chui, and xi, can help individuals (1) experience a relaxing and natural state of speech production, (2) eliminate voice symptoms, and (3) improve their overall body function and mood. In the current study, we hypothesized that the LQG method with these 6 sounds can be effective in improving vocal function in subjects with unilateral vocal fold paralysis (UVFP) in comparison with a conventional voice therapy method. METHODS: A total of 48 patients with UVFP who met the inclusion criteria were randomly divided into 2 groups. Twenty-four subjects in the experimental group were trained with LQG, and those in the control group received conventional voice training (abdominal breathing and yawn-sign exercises) for a total of 4 sessions, twice a week. Patients in both groups were assessed with acoustic tests, the GRBAS scale, the Voice Handicap Index (VHI-10), and the Hospital Anxiety and Depression Scale (HADS) pre- and posttreatment. Statistical analysis was conducted using nonparametric tests and t tests. RESULTS: There existed significant changes in maximum phonation time (MPT), jitter, shimmer, normalized noise energy (NNE), GRBAS scores, VHI-10 scores, and grade of A in HADS scores pre- and posttreatment in both the experimental group and the control group ( P < .004). However, no significant changes were seen posttreatment between the 2 groups ( P > .05). CONCLUSIONS: LQG could help improve vocal function in UVFP patients as our preliminary data showed no significant differences between LQG and conventional voice therapy methods.

Liuzijue Qigong vs traditional breathing training for patients with post-stroke dysarthria complicated with abnormal respiratory control: study protocol of a single center randomized controlled trial.

BACKGROUND: Stroke-induced dysarthria is caused by muscle weakness, sacral or muscular dystonia, and incoordination of the articulatory organ formed by organic lesions caused by cerebral vascular obstruction or sudden bursting of blood vessels in the brain, which may cause abnormal breathing patterns, pronunciation, resonance, rhythm, and unclear articulation. The Six Character Formula, or Liuzijue qigong (LQG), is an essential part of Chinese traditional exercises and focuses on breathing-speech synchronization. The purpose of the present study was to compare the effects of LQG with traditional breathing training (combined with basic articulation training in both groups) in patients with post-stroke dysarthria. METHODS/DESIGN: The proposed study will be a single-center randomized controlled trial. A total of 100 patients, with a modified Frenchay Dysarthria Assessment (FDA) dysarthria assessment score < 27 and with a FDA speech breathing level ≥ b will be randomly divided into study (LQG, n = 50) and control (conventional breathing training, n = 50) groups. Basic articulation training will be conducted once a day, five times a week for 3 weeks. Data collection will be conducted at baseline, 1 week, and 2 weeks post-treatment initiation and after completion of the treatment (3 weeks). Comprehensive analyses will be conducted to measure and compare any differences in speech breathing dysfunction levels, comprehensive evaluation of dysarthria, maximum phonation time (MPT), maximal counting ability, signal-noise (S/Z) ratio, and loudness scales between the study and control groups. DISCUSSION: This trial will provide evidence about the effectiveness of LQG for improvement of speech breathing function and speech ability in patients with post-stroke dysarthria complicated with abnormal breathing. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR-INR-16010215. Registered 21 December 2016.

Efficacy of Liuzijue Qigong in Individuals with Chronic Obstructive Pulmonary Disease in Remission.

OBJECTIVES: To investigate the effectiveness of a 6-month Liuzijue qigong (LQG) program in promoting physical and psychosocial function in individuals with chronic obstructive pulmonary disease (COPD). DESIGN: Single-blind, randomized controlled trial. SETTING: Seven hospital respiratory care centers in Beijing. PARTICIPANTS: Individuals with COPD (N = 126; mean age 71.1 ± 2.7, range 65-85). METHODS: Participants were randomly assigned to one of two groups: LQG (n = 63) and control (n = 63). Subjects in the LQG group received a LQG program consisting of four 45-minute sessions each week and daily walking for 30 minutes for 6 months. Control subjects walked daily for 30 minutes. Data collection was performed at baseline, at 6 weeks, and at 6 months. Primary outcomes involved functional capacity, and secondary outcomes involved quality of life. RESULTS: The LQG group had greater improvements in the 6-minute walk test (P = .02); specific airway conductance (P = .02); monitored functional task evaluation (P = .04); Medical Outcomes Study 36-item Short-Form Health Survey (SF-36; general health (P < .001), mental health (P = .03)); Chronic Respiratory Questionnaire (dyspnea (P = .05), emotion (P = .05), and mastery (P = .04) at 6-month follow-up. After 6 months, the control group had significant improvement only on the SF-36 mental health (P = .02). CONCLUSION: LQG promoted functional capacity and quality of life in older adults with COPD at 6 months and is a good alternative home exercise program for older adults in the rehabilitation of COPD.