title: Tai Chi and vestibular rehabilitation improve vestibulopathic gait via different neuromuscular mechanisms: preliminary report.
abstract: BACKGROUND
  Vestibular rehabilitation (VR) is a well-accepted exercise program intended to remedy balance impairment caused by damage to the peripheral vestibular system. Alternative therapies, such as Tai Chi (TC), have recently gained popularity as a treatment for balance impairment. Although VR and TC can benefit people with vestibulopathy, the degree to which gait improvements may be related to neuromuscular adaptations of the lower extremities for the two different therapies are unknown.
  
  
  METHODS
  We examined the relationship between lower extremity neuromuscular function and trunk control in 36 older adults with vestibulopathy, randomized to 10 weeks of either VR or TC exercise. Time-distance measures (gait speed, step length, stance duration and step width), lower extremity sagittal plane mechanical energy expenditures (MEE), and trunk sagittal and frontal plane kinematics (peak and range of linear and angular velocity), were measured.
  
  
  RESULTS
  Although gait time-distance measures were improved in both groups following treatment, no significant between-groups differences were observed for the MEE and trunk kinematic measures. Significant within groups changes, however, were observed. The TC group significantly increased ankle MEE contribution and decreased hip MEE contribution to total leg MEE, while no significant changes were found within the VR group. The TC group exhibited a positive relationship between change in leg MEE and change in trunk velocity peak and range, while the VR group exhibited a negative relationship.
  
  
  CONCLUSIONS
  Gait function improved in both groups consistent with expectations of the interventions. Differences in each group's response to therapy appear to suggest that improved gait function may be due to different neuromuscular adaptations resulting from the different interventions. The TC group's improvements were associated with reorganized lower extremity neuromuscular patterns, which appear to promote a faster gait and reduced excessive hip compensation. The VR group's improvements, however, were not the result of lower extremity neuromuscular pattern changes. Lower-extremity MEE increases corresponded to attenuated forward trunk linear and angular movement in the VR group, suggesting better control of upper body motion to minimize loss of balance. These data support a growing body of evidence that Tai Chi may be a valuable complementary treatment for vestibular disorders.
authors.affiliation: Institute of Biomedical Engineering, University of New Brunswick, Fredericton, NB E3B5A3, Canada. cmcgibb@unb.ca
authors.forename: Chris A
authors.initials: CA
authors.lastname: McGibbon
authors.forename: David E
authors.initials: DE
authors.lastname: Krebs
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Parker
authors.forename: Donna M
authors.initials: DM
authors.lastname: Scarborough
authors.forename: Peter M
authors.initials: PM
authors.lastname: Wayne
authors.forename: Steven L
authors.initials: SL
authors.lastname: Wolf
mesh_terms: D001696:Biomechanical Phenomena; D005081:Exercise Therapy; D005684:Gait; D006801:Humans; D008875:Middle Aged; D026302:Tai Ji; D015837:Vestibular Diseases / Q000503:physiopathology / Q000534:rehabilitation*
references.citation: Phys Ther. 1997 Apr;77(4):371-81; discussion 382-4
references.pmid: 9105340
references.citation: Ann Neurol. 1990 May;27(5):528-32
references.pmid: 2360793
references.citation: Clin Neurophysiol. 2000 Oct;111(10):1838-42
references.pmid: 11018500
references.citation: Arch Otolaryngol Head Neck Surg. 1999 Nov;125(11):1191-5
references.pmid: 10555688
references.citation: Exerc Sport Sci Rev. 2003 Apr;31(2):102-8
references.pmid: 12715975
references.citation: Am J Occup Ther. 1987 Feb;41(2):90-5
references.pmid: 3551621
references.citation: Arch Phys Med Rehabil. 1998 Mar;79(3):317-22
references.pmid: 9523785
references.citation: Acta Otolaryngol Suppl. 1997;528:116-20
references.pmid: 9288254
references.citation: Eur J Med Res. 1996 May 24;1(8):361-8
references.pmid: 9360934
references.citation: J Rheumatol. 2002 Nov;29(11):2410-9
references.pmid: 12415602
references.citation: Otolaryngol Head Neck Surg. 2003 Feb;128(2):240-50
references.pmid: 12601321
references.citation: J Vestib Res. 1994 Nov-Dec;4(6):461-79
references.pmid: 7850042
references.citation: Proc R Soc Med. 1946 Mar;39(5):273-8
references.pmid: 19993269
references.citation: J Gerontol A Biol Sci Med Sci. 1996 Nov;51(6):M303-12
references.pmid: 8914503
references.citation: J Biomech. 2002 Aug;35(8):1011-8
references.pmid: 12126660
references.citation: J Vestib Res. 2004;14(6):467-78
references.pmid: 15735329
references.citation: J Vestib Res. 1993 Winter;3(4):419-29
references.pmid: 8275275
references.citation: Phys Ther. 1992 Jul;72(7):505-14
references.pmid: 1409883
references.citation: Acta Otolaryngol. 2001 Jan;121(2):241-4
references.pmid: 11349787
references.citation: J Biomech. 1990;23(5):503-6
references.pmid: 2373723
references.citation: Arch Phys Med Rehabil. 2004 Jan;85(1):142-52
references.pmid: 14970982
references.citation: Phys Ther. 1994 Feb;74(2):129-42
references.pmid: 8290618
references.citation: J Gerontol A Biol Sci Med Sci. 2001 Jul;56(7):M428-37
references.pmid: 11445602
references.citation: J Appl Physiol (1985). 2000 May;88(5):1804-11
references.pmid: 10797145
references.citation: J Biomech. 2002 Feb;35(2):199-205
references.pmid: 11784538
references.citation: J Am Geriatr Soc. 2002 Apr;50(4):746-54
references.pmid: 11982679
references.citation: ORL J Otorhinolaryngol Relat Spec. 1994 Nov-Dec;56(6):325-30
references.pmid: 7838484
references.citation: J Biomech. 2001 Apr;34(4):481-90
references.pmid: 11266671
references.citation: Arch Phys Med Rehabil. 1997 Aug;78(8):886-92
references.pmid: 9344312
references.citation: Otolaryngol Head Neck Surg. 1998 Jul;119(1):49-54
references.pmid: 9674514
references.citation: Otolaryngol Head Neck Surg. 1995 Jul;113(1):77-87
references.pmid: 7603726
references.citation: J Neurophysiol. 1998 Sep;80(3):1211-21
references.pmid: 9744933
references.citation: J Am Geriatr Soc. 1994 Apr;42(4):405-12
references.pmid: 8144826
references.citation: Clin Exp Pharmacol Physiol. 1998 Dec;25(12):1032-7
references.pmid: 9888002
references.citation: J Vestib Res. 1997 Mar-Jun;7(2-3):189-218
references.pmid: 9178224
references.citation: Neurology. 1998 Sep;51(3):838-44
references.pmid: 9748036
references.citation: Otolaryngol Head Neck Surg. 1992 Feb;106(2):175-80
references.pmid: 1738550
references.citation: J Am Geriatr Soc. 1996 May;44(5):489-97
references.pmid: 8617895
references.citation: Otolaryngol Head Neck Surg. 1993 Oct;109(4):735-41
references.pmid: 8233513
references.citation: J Biomech. 2001 Nov;34(11):1387-98
references.pmid: 11672713
references.citation: Clin Biomech (Bristol, Avon). 2001 May;16(4):324-33
references.pmid: 11358620
references.citation: Phys Ther. 1990 Dec;70(12):799-807
references.pmid: 2236223
references.citation: Acta Otolaryngol Suppl. 1995;520 Pt 1:199-201
references.pmid: 8749118