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Tai chi and Parkinson's disease

Parkinson's disease is a neurological disorder which arises from the progressive death of cells located in the substantia nigra of the midbrain. Though some of its symptoms were described many years ago, the most substantial contributions were made by James Parkinson's An Essay on the Shaking Palsy in 1817 and Jean-Martin Charcot. Indeed, it was Jean-Martin Charcot who pioneered the renaming of the disease after Parkinson.

The death of neurons in the substantia nigra results in a number of movement disorders which collectively comprise parkinsonian symptoms. These dying cells normally exert their function by secreting dopamine, and as their numbers decrease, there is a reduced capacity to release sufficient dopamine. Thus, the current mainstay of therapy entails augmenting secretion or prescribing dopamine (levodopa). These treatment options can lessen the effect of the symptoms considerably, but their effectiveness decreases over time. A number of studies are currently under way to improve our understanding of the disease and possibly find new therapeutic alternatives. Perhaps the most intriguing advancement would be the possibility of repopulating the decreasing substantia nigra neurons with stem cells.

Many view Parkinson's disease as a disease of shakiness, however there are other significant movement aberrations, most notably bradykinesia (slow movement). Such impairments can lead to a progressive inability to maintain balance and adversely affect quality of life. It is therefore prescribed that patient management should also encompass exercise.

In a recent article published in the New England Journal of Medicine, it was the query of the authors to assess whether practicing tai chi can improve progressive motor impairments compared to strength training exercises (currently employed) and stretching (study control). The authors were able to report "...that a program of twice-weekly tai chi for 24 weeks, as compared with a resistance training program or a stretching program, was effective in improving postural stability and other functional outcomes in patients with mild-to-moderate Parkinson's disease." Also of note is that these improvements were maintained three months after intervention.

In their discussion, the authors also states that "Although these improvements indicate that tai chi would be effective in enhancing neuromuscular rehabilitation, the mechanisms behind the therapeutic change in participants' motor control and mobility remain less understood and warrant future exploration."

Though far from a cure, these findings may help improve the quality of life for the, according to the Parkinson's Disease Foundation, ~1 million Americans currently living with Parkinson's disease.