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Improving Balance with Tai Chi
By the Vestibular Disorders Association with contributions by Gaye Cronin, OTD, OTR, Atlanta
Ear Clinic, Atlanta, GA
The profound dizziness, vertigo, and exercises that focus on postural
imbalance symptoms commonly experi- orientation (positioning the trunk and
enced with vestibular (inner ear balance) head in alignment to each other as well
disorders can cause overwhelming fatigue as to the ground and to the visual field)
and anxiety. Many people suffering from and postural equilibrium (coordinating
vestibular disorders limit their activities movement strategies to center and
because of these factors as well as fear of stabilize the body).3 Extensive medical
falling, a risk that increases eight-fold in literature, as well as the direct experience
those actively experiencing the symptoms of physical therapists and other clinicians,
of their disorder.1 supports Tai Chi as an excellent
complementary therapy to vestibular
Falling can cause injuries that severely rehabilitation.
impair mobility or end lives, especially for
people aged 65 and older, for whom falls What is Tai Chi?
are the leading cause of both fatal and Originating in China centuries ago, Tai
non-fatal injuries.2 However, prolonged Chi (a shortened version of the more
inactivity reduces one’s ability to compen- traditional name tai chi chuan) is a
sate for a vestibular disorder and often martial art characterized by gracefully
contributes to other problems, including flowing movements and postures. Tai Chi
loss of bone and muscle mass, heart is popularly practiced throughout the
disease, and obesity. The emotional pain world, often with an emphasis on
of social isolation and the loss of formerly maintaining good health and promoting
enjoyed activities can be no less profound. longevity. It emphasizes the intercon-
nected nature of the body and mind
Fortunately, many types of vestibular dis- (Figure 1), combining “physical
orders respond well to vestibular rehabili- movement, breathing techniques, and
tation therapy (VRT). VRT exercises are cognitive tools to strengthen the body,
designed to help recalibrate the complex relax the mind, and balance the flow of
interaction of sensory and motor life force,”4 also known as chi (also
functions required for good balance. Tai spelled ki or qi). Chi loosely means
Chi also challenges this same complex “energy,” and people performing Tai Chi
interaction. Both VRT and Tai Chi involve postures and movements—also called
© Vestibular Disorders Association ◦ www.vestibular.org ◦ Page 1 of 7
forms—are encouraged to visualize or from touch sensors in the muscles and
imagine their own Chi in order to improve joints—in the balancing process.6
their movements and focus. It generally promotes a greater
awareness of body and movement.7
Figure 1. The interconnected
nature of body and mind and
In addition to balance benefits, Tai Chi
concept of balance is symbolized by
offers a broad range of well studied
the yin-yang symbol traditionally
associated with Tai Chi. positive health impacts for cardiovascular,
respiratory, and immune system
As is common with martial arts, there are improvement.6 Increased endurance and
several different schools and styles of
mental focus, as well as an improved
practice, some more vigorous and chal-
sense of well-being, have also been
lenging than others. However, all share
reported from programs using Tai Chi
the same forms, which depending on
activities. With the right style and
style, instructor, or level of experience
program, Tai Chi is a gentle, low-impact
can be performed in combinations ranging
activity easily enjoyed by a wide range of
in complexity from just a few to over a
people, including older adults, who are
hundred. The most popular type of Tai Chi
disproportionally affected by vestibular
is the simplified 24-form version devel-
disorders coupled with complicating
oped from the Yang style by the Chinese
factors affecting compensation. These
Sports Committee in 1956 as a public
factors include multi-sensory loss and
health program. It offers the advantage of general mobility limitations.8 Tai Chi
maintaining many traditional Tai Chi prin-
improves performance of the activities of
ciples while being simple and gentle
daily living, and is also particularly helpful
enough to be practiced by people of all
in reducing the fear of falling and the
ages and physical ability.
general stress that so often accompany
symptoms of dizziness and vertigo.7
Balance benefits of Tai Chi
Tai Chi improves balance in several ways:
Clinical observation of Tai Chi
It strengthens and improves ankle
One of us (G.C.) has observed the
flexibility, creating a more stable
positive affects of Tai Chi in clinical
stance.4,5
practice (Atlanta Ear Clinic, GA) from
It helps to distribute movement more
working with many patients requiring
evenly among the ankle, knee, and
vestibular rehabilitation and balance
hip joints, enabling faster and
retraining. Before beginning any
smoother walking.4
treatment plan, patients who present with
It helps reduce postural sway by
balance disorders are carefully evaluated
optimizing the use of proprioception—
with a sensory organization test (SOT) for
sensory input received by the brain
their skill in organizing visual, vestibular,
and proprioceptive information during six
© Vestibular Disorders Association ◦ www.vestibular.org ◦ Page 2 of 7
tasks of increasing difficulty. Other week version of program has been shown
clinical norm-referenced balance to be effective in improving functional
assessments are also used to evaluate balance and reducing falls by 55% in
patients’ static and dynamic balance physically inactive persons aged 70 or
abilities. older.10
Our interest in using Tai Chi in treatment To facilitate this program’s imple-
was prompted in part by following eight mentation at community and senior
patients who enrolled in a six-week Tai centers, a simplified version of the TCMBB
Chi class. Prior to the class, all had program is being taught to instructtors.
demonstrated abnormal SOT scores. In One of us (M.R.) attended this training at
addition, four had experienced falls, and Emanuel Legacy Hospital (Portland, OR)
two were using assistive devices for led by Suman Sensei Barkhas, a
walking (one cane and one walker). After nationally certified yoga therapist and Tai
completing the six-week Tai Chi class, all Chi teacher-trainer. The program modifies
eight patients scored within normal the 24-form Yang style even further to a
ranges on the SOT and exhibited gentle, easily performed eight-form style.
increased confidence and activity levels. The eight forms were chosen for their
The two using assistive devices were able accessibility as well as their focus on
to discontinue using them, and six months “weight-bearing and non-weight-bearing
later, none of the patients had experi- stances, posturally correct body
enced falls.8 Since then, many patients at alignment, and multiple, coordinated
the Atlanta Ear Clinic have significantly movements executed in a continuous,
improved their balance and overall quality circular, and flowing manner.”11
of life by incorporating Tai Chi into their
vestibular rehabilitation program. The lynchpin of this eight-form style is
the first form students learn, and is called
Implementing a Tai Chi program for hold a ball (Figure 2). This form begins by
fall prevention firmly rooting and centering the stance,
A variety of Tai Chi programs are
then focusing on visualizing chi, drawing
available for implementing at a clinic or
it out from the center of the body and
community level. One example is Tai Chi:
then shaping the hands in a circle around
Moving for Better Balance (TCMBB), a
it. Students then gently step from side-
Yang-style program developed by
to-side, a movement often repeated
Fuzhong Li, PhD, of the Oregon Research
throughout the rest of the forms. The
Institute (Eugene, OR). It is supported
next seven forms—part the wild horse’s
with a grant from the Centers for Disease
mane, single whip, hands like clouds,
Control to help create clinically appropri-
repulse monkey, brush knee, fair lady
ate, evidence-supported fall-prevention
works the shuttles, and grasp the
strategies.9 A six-month, three-times per
peacock’s tail—borrow their names and
© Vestibular Disorders Association ◦ www.vestibular.org ◦ Page 3 of 7
movements from the natural world as
well as activities historically common to A user-friendly resource package11 for
Chinese life. Fair lady works the shuttles, implementing the TCCMB program
for instance, references hands rising up advises class instructors to devote several
and down as if working a loom. minutes of each class to warming up and
cooling down and to progress slowly,
having students practice each form for 8–
10 times as needed. The program’s focus
is on building core strength and focusing
thought on balance so that participants
can become more aware of the body and
its movements. Safety is emphasized,
with instructors trained to encourage their
students to consult a health care provider
before engaging in the program and to
adapt the forms to their unique
circumstances and physical limitations.
Those with low or no mobility can start by
participating from a seated position. Also
emphasized is the sense of Tai Chi as fun,
a form of play with psychological benefits
Figure 2. The hold a ball form is the basis for
as profound as the physical ones. Instruc-
many of the movements in the “Tai Chi:
Moving for Better Balance” program. Photo tors are to encourage their students to
used with permission from Juliette McCawley take pleasure from performing the forms,
and distributed under a Creative Commons
and to focus their energy and breathing
license via
www.flickr.com/photos/75304241@N00/. on achieving a calm but alert state of
mind.
Each form coordinates multiple
movements of the hands and feet with Enrolling in a Tai Chi program
slow, relaxed breathing; for example, Before enrolling in a Tai Chi program,
hold a ball consists of 14 separate pos- seeking advice from a physical therapist
tures. The TCCMB program is designed to or physician with vestibular disorder
introduce only one or two forms in each expertise is strongly recommended to
class and to build to increasing levels of make sure that the forms can be
complexity. The last form students learn, performed safely. Additionally, because
grasp the peacock’s tail, consists of 23 Tai Chi instructors use varied programs
separate postures—a level of complexity and have different levels of expertise in
made possible by the program’s helping people with balance disorders,
careful attention to building on previous asking for recommendations from a
progress. health care provider can be useful when
© Vestibular Disorders Association ◦ www.vestibular.org ◦ Page 4 of 7
selecting the particular course to take. what level of mobility or physical ability
Senior centers and balance and wellness that individuals bring with them to Tai
programs are also good resources for Chi, improvement—and just as important,
finding qualified instructors. enjoyment—is possible for everyone.
It is important to take a class for Additional resources
beginners that is taught in a gentle style Some helpful publications from the
such as Yang, with session lengths no Vestibular Disorders Association (VEDA)
longer than an hour. Ideally, the course include Balance and Aging and Vestibular
should be taught by a qualified instructor Rehabilitation: An Effective, Evidence-
who is widely experienced with teaching Based Treatment. For more information
people with balance disorders or limited on Tai Chi: Moving for Better Balance,
mobility. Once a program is selected, a contact Li Fuzhong (www.ori.org) or
discussion with the Tai Chi instructor is Suman Sensei Barkhas
important so that he or she is aware of all (http://shantalaya.com).
balance challenges or other physical
problems that may limit mobility. Tai Chi References
emphasizes deliberate and gentle 1. Agrawal Y, Carey JP, Della Santina CC,
movement, but it is still possible to Schubert MC, Minor LB. Disorders of balance
and vestibular function in US adults. Arch
perform the forms incorrectly, leading to
Intern Med. 2009;169(10):938–944.
strain or injury. A Tai Chi instructor well 2. Self-reported falls and fall-related injuries
experienced in teaching people with among persons aged >65 years—United
States, 2006. MMWR Morb Mortal Wkly Rep.
vestibular disorders can provide careful
2008; 57:225–229.
one-on-one instruction to correct errors in 3. Horak FB. Postural orientation and equilib-
movement and help to prevent rium: what do
we need to know about neural control of
overstrain. The instructor may also help
balance to prevent falls? Age Ageing.
to adapt the program as needed. 2006;35(suppl 2):ii7–ii11.
4. McGibbon CA, Krebs DE, Parker SW,
Scarborough DM, Wayne PM, Wolf SL. Tai
Finally, anyone starting a Tai Chi course
Chi and vestibular rehabilitation improve
should be prepared to commit to an 8–12
vestibulopathic gait via different neuro-
week program, because benefits take muscular mechanisms: preliminary report.
Bio Med Neurol. 2005;5(3).
time to become noticeable. Classes do not
5. Gauchard GC, Jeandel C, Tessier A, Perrin
require wearing special athletic
PP. Beneficial effect of proprioceptive physi-
equipment or clothing, although wearing cal activities on balance control in elderly
human subjects. Neuroscience Lett.
loose-fitting clothing and flat comfortable
1999;273:81–84.
shoes or going barefoot is recommended.
6. Gauchard CG, Gangloff P, Jeandel C, Perrin
Programs with an accompanying DVD, PP. Influence of regular proprioceptive and
bioenergetic physical activities on balance
such as is available for the TCMBB
control in elderly women. J Gerontol. 2003;
program, make home practice easier once
58(9):846–850.
the Tai Chi class concludes. No matter
© Vestibular Disorders Association ◦ www.vestibular.org ◦ Page 5 of 7
7. Wayne PM, Krebs DE, Wolf SL, Gill-Body J, Xu J, Lin M, Tingzhong Y, Sutton B,
KM, Scarborough DM, McGibbon CA, Tompkins Y. Translation of an effective Tai
Kaptchuk TJ, Parker SW. Can Tai Chi Chi intervention into a community-based
improve vestibulopathic postural control? falls-prevention program. Am J Pub Health.
Arch Phys Med Rehabil. 2004;85:142–152. 2008;98(7):1195–1198.
8. Cronin GW. Clinician Handbook for the 12. Tai Chi: Moving for Better Balance [Version
Treatment of Vestibular Disorders. Atlanta, 5]. Eugene, OR: Oregon Research Institute;
GA: Atlanta Ear Clinic; 2000. 2008.
9. Stevens J, Sogolow ED. Preventing Falls:
What Works—A Compendium of Effective
© Vestibular Disorders Association
Community-based Interventions from
Around the World. National Center for Injury
Prevention and Control. Atlanta, GA; 2008. VEDA’s publications are protected under
10. Fuzhong L, Harmer P, Fisher KJ, McAuley copyright. For more information, see our
E, Chaumeton N, Eckstrom E. Tai Chi and permissions guide at www.vestibular.org.
fall reductions in older adults: a randomized
controlled trial. J Gerontol. 2005;60A:187– This document is not intended as a substitute
194.
for professional health care.
11. Fuzhong L, Harmer P, Glasgow R, Mack K,
Sleet D, Fisher J, Kohn MA, Millet LM, Mead
© Vestibular Disorders Association ◦ www.vestibular.org ◦ Page 6 of 7
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