Improve Physical Function and Postural Control Complexity in Older Adults with Peripheral Neuropathy with Tai Chi
By John M. de Castro, Ph.D.
“slow and fluid movements improve the body’s alignment, posture, strength, flexibility, coordination, balance, and stamina. Many of these benefits of Tai Chi are consistent with many other forms of low-impact exercise, with the added benefit of focus on improved posture, balance, and alignment.” – Robert Humphries
The process of aging affects every aspect of the physical and cognitive domains. Every system in the body deteriorates including motor function with a decline in strength, flexibility, and balance. Impaired balance is a particular problem as it can lead to falls. In the U.S. one third of people over 65 fall each year and 2.5 million are treated in emergency rooms for injuries produced by falls. About 1% of falls result in deaths making it the leading cause of death due to injury among the elderly. Falls, with or without injury, also carry a heavy quality of life impact.
Peripheral neuropathy can compound the effects of aging on motor ability. It involves damage to the peripheral nerves carrying information to the spinal cord and brain. This results in deficits in sensory information from the body and motor control. Peripheral neuropathy can impair muscle movement, prevent normal sensation in the arms and legs, and cause pain. In this way peripheral neuropathy may further impair older adults motor abilities and increase the likelihood of falls.
Tai Chi training is designed to enhance and regulate the functional activities of the body through posture, regulated breathing, mindful concentration, and gentle movements. It includes posture and balance training and has been shown to improve balance and coordination. Indeed, Tai Chi training has been shown to reduce the likelihood of falls in the elderly. One possible way that Tai Chi training may contribute to the decrease in falls is by improving postural control. This interesting speculation has not been previously investigated in older patients with peripheral neuropathy.
In today’s Research News article “Complexity-based measures inform Tai Chi’s impact on standing postural control in older adults with peripheral neuropathy.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3640896/), Manor and colleagues recruited older adults (average age 71 years) with peripheral neuropathy. They were provided 3 1-hour Tai Chi classes per week for 24 weeks. They were measured before and after training for foot sole sensation, leg strength, mobility, functional ability, and postural control, including measures of balance, speed, area under the curve, and complexity of postural control while standing.
They found that in comparison to baseline, after Tai Chi training there were significant improvements in foot sole sensation, leg strength, mobility, and physical function, including knee extension, walking, and speed. There was also a significant increase in postural control complexity. In addition, they found that the greater the increase in postural control complexity the greater the improvements in foot sole sensation, mobility, and functional ability.
This study did not have a control condition so conclusions must be tempered with the understanding that the results may have been due to time-based confounding variables. Nevertheless, the results suggest that Tai Chi practice improves the physical condition and abilities of older adults with peripheral neuropathy. Aging is associated with a loss of motoric complexity. The improvement in postural complexity observed in the present study may then represent the ability of Tai Chi practice to restore this complexity and thereby help the older adults’ physical abilities.
So, improve physical function and postural control complexity in older adults with peripheral neuropathy with Tai Chi.
“We work to maintain great posture for a 60-120 minute class, reap the benefits, feel great, and then go home and try to emulate the posture in our natural environment.” – Scott
CMCS – Center for Mindfulness and Contemplative Studies
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Manor, B., Lipsitz, L. A., Wayne, P. M., Peng, C. K., & Li, L. (2013). Complexity-based measures inform Tai Chi’s impact on standing postural control in older adults with peripheral neuropathy. BMC complementary and alternative medicine, 13, 87. https://doi.org/10.1186/1472-6882-13-87
Tai Chi training enhances physical function and may reduce falls in older adults with and without balance disorders, yet its effect on postural control as quantified by the magnitude or speed of center-of-pressure (COP) excursions beneath the feet is less clear. We hypothesized that COP metrics derived from complex systems theory may better capture the multi-component stimulus that Tai Chi has on the postural control system, as compared with traditional COP measures.
We performed a secondary analysis of a pilot, non-controlled intervention study that examined the effects of Tai Chi on standing COP dynamics, plantar sensation, and physical function in 25 older adults with peripheral neuropathy. Tai Chi training was based on the Yang style and consisted of three, one-hour group sessions per week for 24 weeks. Standing postural control was assessed with a force platform at baseline, 6, 12, 18, and 24 weeks. The degree of COP complexity, as defined by the presence of fluctuations existing over multiple timescales, was calculated using multiscale entropy analysis. Traditional measures of COP speed and area were also calculated. Foot sole sensation, six-minute walk (6MW) and timed up-and-go (TUG) were also measured at each assessment.
Traditional measures of postural control did not change from baseline. The COP complexity index (mean±SD) increased from baseline (4.1±0.5) to week 6 (4.5±0.4), and from week 6 to week 24 (4.7±0.4) (p=0.02). Increases in COP complexity—from baseline to week 24—correlated with improvements in foot sole sensation (p=0.01), the 6MW (p=0.001) and TUG (p=0.01).
Subjects of the Tai Chi program exhibited increased complexity of standing COP dynamics. These increases were associated with improved plantar sensation and physical function. Although more research is needed, results of this non-controlled pilot study suggest that complexity-based COP measures may inform the study of complex mind-body interventions, like Tai Chi, on postural control in those with peripheral neuropathy or other age-related balance disorders.