MS4 McGovern Medical School at The University of Texas Health Science Center at Houston
Educational Objective: At the conclusion of this presentation, participants should be able to discuss the role of tai chi in improving balance outcomes for individuals who plateau after completion of a full course of vestibular rehabilitation.
Objectives: To evaluate the effectiveness of tai chi on balance function in patients with improved, but persistent dizziness following completion of a traditional vestibular rehabilitation therapy (VRT) program.
Study Design:Prospective cohort study.
Methods: Patients who completed traditional VRT with persistent symptoms of imbalance were prospectively enrolled in a tai chi program consisting of eight weekly one hour classes. Sessions utilized modified Yang style movements tailored to improve daily function. Therapeutic efficacy was measured prior to the first session and after the eighth using standardized assessments of balance function: the Dynamic Gait Index (DGI), Activities-Specific Balance Confidence Scale (ABC) and the Dizziness Handicap Inventory (DHI).
Results: 51 patients were enrolled from 2009 to 2016, of which 37 participants (34 females, 3 males) completed the full program with pre- and post-intervention testing. Mean age was 76.8 (range 56-91 years). Three patients were unable to complete all sessions and eleven were lost to followup on post-testing. Mean DGI increased significantly after completion of the Tai Chi program (p < 0.00001, paired t-test). Mean ABC increased from 63.6% to 67.9% on pre/post-testing, but was not statistically significant (p=0.08, paired t-test). A subset (n=18) of patients completed a pre- and post-testing DHI without significant change after therapy (p=0.62, Wilcoxon Signed Rank Test). However, age was negatively and moderately associated with change in DHI (rs=-0.57, p=0.01; Spearman's Rho). Overall, the majority (36/37, 97.3%) of patients demonstrated post-therapy improvement on one or more assessments.
Conclusions: Tai chi is a viable adjunct to empirically improve balance in patients who no longer attain benefit from traditional vestibular rehabilitation.