Adapting Tai Chi for upper limb rehabilitation post stroke : an exploratory feasibility and efficacy study
Background and Purpose: Tai Chi (TC) has been reported as beneficial for improving balance post stroke, yet its use for upper limb (UL) rehabilitation remains unknown. The purpose of this study was to evaluate the feasibility and efficacy of TC on UL rehabilitation post stroke. Methods: Twelve chronic stroke survivors with a persistent paresis underwent 60-minute adapted TC sessions twice a week for eight weeks and a 4-week follow-up evaluation. A 10-minute TC home program was recommended for the days without sessions. TC level of performance, adapted movements used, attendance to the sessions and duration of self-practice at home were recorded. Shoulder pain (Visual Analogue Scale (VAS)), motor function of the paretic arm ((Fugl-Meyer Assessment upper-limb section (FMA-UL), Wolf Motor Function Test (WMFT)) and paretic arm use in daily life (Motor Activity Log (MAL)) were measured at baseline, post-treatment and follow-up. A feedback questionnaire was used to evaluate participants’ perception of the use of TC at follow-up. Results: Eleven participants completed the 8-week study. A clinical reasoning algorithm underlying the adaptation of TC was developed based on different functional levels of the participants. Participants with varying profiles including severely impaired UL, poor balance, shoulder pain, and severe spasticity were not only capable of practicing the adapted TC but attended all 16 sessions and practiced TC at home more than recommended (a total of 16.51±9.21 hours). The self-practice amount for subgroups with lower UL function, shoulder pain or moderate-to-severe spasticity, was similar to subgroups with higher functional UL, no shoulder pain, and minimal-to-no spasticity. Participants demonstrated significant improvement over time in the FMA-UL (p=.009), WMFT functional scale (p=.003), WMFT performance time (p=.048) and MAL Amount of Use scale (p=.02). Shoulder pain of four participants decreased following TC (VAS 5.5±3, 3±2.8, 2.5±2.5 for the pre, post and follow-up period respectively). Moreover, participants confirmed the usefulness and ease of practicing the adapted TC. Conclusion: Adapted TC is feasible, acceptable and effective for UL rehabilitation post stroke. Low UL function, insufficient balance, spasticity, and shoulder pain do not seem to hinder practicing TC. Further large-scale randomized trials evaluating TC for UL rehabilitation are warranted.
Stroke Rehabilitation Upper extremity Tai Chi Feasibility Recovery