IJCRR - Vol 06 Issue 19, October, 2014
MENTAL TAI CHI-BASED EXERCISE PROGRAMME VS TAI-CHI FOR INDIAN MULTIPLE SCLEROSIS PATIENTS: A PILOT STUDY
Author: Darshpreet Kaur, Kirandeep Kaur, Nidhi Billore, Gunjan Kumar, Ajay Kumar Singh
Background: Tai Chi postures have recently been shown in a number of randomized controlled trials to improve balance and posture in a variety of patient groups. Balance and mobility are problems commonly encountered by people with Multiple Sclerosis (MS). This pilot study examines the effect of Tai-Chi ± Mental practise on balance, gait and mobility in people with MS. Objective: To determine the efficacy of both protocols in inducing balance and mobility improvements.
Methods: About 25 volunteer MS patients were screened with Movement Imagery Questionnaire—Revised second version (MIQ-RS), Modified clinical test of sensory organisation and balance (mCTSIB) and Expanded Disability Status Scale (EDSS) before being included in this study. 16 people satisfying the inclusion criteria with Relapsing Remitting MS (RRMS) were randomly assigned to either a Tai Chi group or to Tai chi with mental practise group. The first group participated in 20 sessions of total 60 minutes duration (20 minutes mental practise followed by 40 minutes tai-Chi), for 10-12 weeks The second group participated in 20 sessions which were 40 minutes long for 10-12 weeks. Out of all the known forms of Tai-Chi forms, six wereselected an d practised during these sessions. Results: There was no significant difference between group 1and group 2 for age, gender, MS duration, MIQ score, mCTISB and EDSS. Both the groups showed significant improvement (p<0.05)post respective therapies. The percentage improvement post intervention in both the groups was comparable. Even though Group 1 performed better than Group 2 across most tests, the difference were not significant and consistent. Conclusions: Both the treatment protocols improve the balance and mobility of the RRMS patients and Tai Chi intervention showed considerable improvement in test scores. The impact of mental practice was not statistically significant across all tests. However, patients who were allotted to this group showed better comprehension of Tai Chi forms and higher retention rate.
Keywords: Mental Practise, Tai-chi, Multiple Sclerosis, Physical rehabilitation
Darshpreet Kaur, Kirandeep Kaur, Nidhi Billore, Gunjan Kumar, Ajay Kumar Singh. MENTAL TAI CHI-BASED EXERCISE PROGRAMME VS TAI-CHI FOR INDIAN MULTIPLE SCLEROSIS PATIENTS: A PILOT STUDY International Journal of Current Research and Review. Vol 06 Issue 19, October, 24-30
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The rehabilitation protocol ensured that each exercise group had a consistent intervention schedule on key training parameters which included the duration (60 minutes per session), frequency (2 times per week for 10 weeks), and training structure (i.e., a 5- to 10-minute warm-up, core activities, and a 5-minutecool-down). Participants in all three conditions were instructed not to engage in any additional home practice.
Group1: Received balance rehabilitation to improve motor, sensory and cognitive strategies.
Group2: Received balance rehabilitation to improve motor and sensory strategies. For improving motor strategies, 6 forms of Tai-Chi were selected. Training of Gait patterns was also borne in mind while designing Tai-Chi programme for both the groups. These tasks required stepping in different directions, while challenging subject’s postural stability and balance control. The somatosensory information was encouraged by large and coordinated movements in order to move the center of mass with speed, safety and balance.Emphasis was laid on improving vestibular and somatosensory information by a reduction of visual input. For this purpose certain forms of Tai-Chi were performed in different perceptual contexts. The patients were encouraged to exercise in eyes-closed condition. Group 1 also engaged in mental imagery of the desired tasks, while Group 2, underwent relaxation during that duration. For this purpose episodic memory of the patients in group 1 was targeted. Anterograde component of their memory was put into action by providing visual stimulation of the Tai-Chi form, which they will be performing on that day. Lapses in working memory were challenged by intermittently questioning about their perception of visual inputs. To insure proper execution of Tai-Chi forms patients were asked about the relevance of particular form to them and potential benefits they seem to obtain from it. Throughout 40 min Tai-Chi session it was ensured that both the groups perform symmetrical and coordinated movements such as trunk rotation and weight shifting from one foot to another foot, Controlled and coordinated displacement of the body’s center of mass over the base of support, Ankle sway toward and around the perimeter of the base of support, dynamic eye and head movements and anterior-posterior and medial-lateral stepping with rhythmical weight shifting for each form.