The Effect of Tai Chi on 24 4 59

8/16/2019 The Effect of Tai Chi on 24 4 59

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The Efect O Tai Chi onMild Alzheimer’s patients

ประสทธผลของไทช ในผ ป วยอลไซเมอรระดบตน

Miss Chomlak Kongart

Student ID: 5779051153

For qualifying examination (QE)

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Background and Rational

• In Thailand, the percentage of young andworking age population will continue todecline from 2010 to 2040, while the numberof elderly population continues to increase, from 13.2 percent in 2010 and is estimated to be32.1 percent in 2040 !nodel et al., 201"#.

• The characteristic of elderly had manyunderlying disease $ diabetes, hypertension

and dementia.• In Thailand, the pre%alence of dementia is

22&,000 in 200" and it is e'pected 4"2,000 in2020 and 1,233,000 in 20(0 )*I )sia +asificand non)*I )sia +acific#.

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• Increasing prevalence o dementia has a badpotential impact or status and the public healthsystem o a country This is because dementia disease can be possible side efects! such as social and economic burden or the amily

• "p to no#! medications have not yet beensho#n efective in stopping this particulardisease! and some have problematic side efects $ut some practices! li%e regular e&ercise! have sho#n progress in delaying the advance o Alzheimer's disease

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Background and

Rational


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• According to (ancheva et al )*++,-

that up to .+ percent o people #ith

Alzheimer’s also have symptoms o depression and an&iety /ue to dementia people may eventually #ithdra# rom all activities and di0culty to balance themsel in all activities

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• The physical activity such as Tai Chi could improvethe balance and prevent elderly on the rail problem such as ris% to all

• Many studies have suggested that tai chi can help

boost older adults’ immunity to viruses andimprove their balance! thereby helping to prevent alls )1i! 2! 3armer! 4! 2itzgerald! 5 et al! *++6-

• Tai chi can help improve physical condition! muscle

strength! coordination! and 7e&ibility8 ease painand stifness8 reduce depression and an&iety! improve sleep and balance )1i! 3armer! 9 2isher! *++6-

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Gap of Knowledge

• Many studies have sho#n that Tai Chi has bene:cialefects on balance! alls! and non;vertebralractures! depression and an&iety but in Thailand doesn't have study yet

•

Many studies have investigated methods to preventdementia symptoms! but e# have investigated theefect o Tai Chi on dementia patient

• Importantly the evaluation o the health status odementia in this study implemented three methods!

namely 3am;/! 3am;A and berg $alance slcae )$$<- #hich are still rare to be used simultaneously to evaluate the efect o Tai;chi to#ard the cognitive improvement o the mild Alzheimer patients

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=esearch >uestion

• Does Tai Chi intervention treatment is able to

reduce Anxiety, Depression and improveBalance for Mild AD.?

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=esearch Ob?ectives

General Objective

• To study effectiveness of Tai Chi practice model on

anxiety, depression and balance in mild Alzheimers

patients

Specific Objectives

• To measure Anxiety, Depression and Balance before

and after experiment of control and trial !roups.

• To compare Anxiety, Depression and Balance

bet"een control and trial !roups before and after

experiment.

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=esearch 3ypothesis

The Taichi practice significantly affects to

ameliorate the )n'iety, *epression and

-alance after e'periment.

• There is significant different an'iety score ,*epression score ,-alance score between

inter%ention and control group after Tai chi pr

actice. ttest#

• Taichi practice affects significantly to

ameliorate the )n'iety, *epression and

-alance on trail group after Tai chi program.

pair ttest#

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Conceptual Framework

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Literature e!ie"


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1iterature =evie#

Alzheimer’s disease can be divided in tothree phases

Mild;


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1iterature =evie#

AD detection4ositron emission tomography )4ET-!

Computed tomography )CT- and

Magnetic resonance imaging )M=I-scans

Alzheimer’s disease afects on

A loss o cognitive unctioning

/epression! an&iety andbalance

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1iterature =evie#

Tai chi Tai;Chi is derived rom traditional

Chinese martial arts

Tai;Chi practice breathing and rela&ingbody movement slo# and smoothrhythm o movement Its practice is associated #ith a lo# metabolic load and si

gni:cant psychological bene:t and @uality o lie )Chen! *+*-

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Tai Chi and Al Zheimer

Sno"den et al#$ %011

&h'si(al a(ti!it' or e)er(ise *tai+(hi,im&ro!ed (ognition in older adults

C# -ang$ Collet$ .Lau$ %004,

egular tai (hi e)er(ise ma' hel& "ith&reser!ation o/ gloal ailit' in elders at

risk o/ (ogniti!e de(liner'e$ S(heinthal$ Kemarska'a$ . 2ru(hno$ %007

tai (hi are sa/e$ (ost+ee(ti!e "a's toim&ro!e oth &h'si(al and &s'(hologi(al/un(tioning o/ older &eo&le

-ol/$ arnhart$ llison$

Coogler$ . 6tlanta ICSI$ 1997,

ai Chi has een (hara(teri8ed as mind+od' inter!entions and as meditati!e

mo!ements

Kasai et al#$ %010 6/ter si) months o/ inter!ention$ the CC rou&sho"ed signi;(ant im&ro!ement on theeha!ioral Memor' est and Memor'Com&laint S(ale

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Measuring health statusfor mild Alzeimer case

• amilton Rating !cale for"epression #am$"%

• amilton An&iet' Rating!cale #AM$A%

• Berg(s Balance !cale #BB!%

1<


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esear(h Methodolog'


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• This is an pre#experimental research study, t"o !roups,

pre#test # post#test desi!n.

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esear(h Design

$ % $xperimental

!roup

C % Control !roup

&' % (re#studymeasurement

&) % (ost *study

measurement

+ % Tai # chi

=1

=1

C

=%

=%

>

ollo" u& 1% "eeks

ollo" u& 1% "eeks

ollo" u& %4 "eeks

ollo" u& %4 "eeks

>


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• The target population o this study #as a participant

#ho had been ormally diagnosed #ith mild Alzheimer

stage and treated in 5ing Chulalong%orn 3ospital

•

)nclusion criteria – 4atients #ho diagnosed o mild Alzheimer stage B+ years old

and over

– oluntariness to participate in this study

– Able to spea% and understand Thai #ith no severe hearing

impairment

• *&clusion criteria

– =egular practice o Tai;Chi

– 4atients #ho #ere un#illing or unable to participate

– Emergence o ne#er symptom

– older people #ith blindness8

2o&ulation and sam&le si8e

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2o&ulation and sam&le si8e

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ampel size "as calculatin! by implementin!

-#(o"er application. The result as follo"

$ffect desi!n /d0 123 /4ee,et.al )2250Alpha error 2.26

(o"er /'#70 2.56

$xperimental !roup 8)

Control !roup 8)

Total sample 18


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• the D participants #ere randomly byusing the e&cel program rom all adpatient

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3amilton an&iety ratting scale)3AM;A-

3amilton depression scale)3AM;/-

$erg balance scale )$$


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3amilton depression scale)3AM;A-

• The scale designed to assess theseverity o a patient’s an&iety Eacho the items contains a number o sy

mptoms and each group o symptoms is rated on a scale o zero to our! #ith our being the most severe

a


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The @uestionnaire is designed or adults andis used to rate the severity o theirdepression byG 4robing mood! 2eelings o guilt!


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The $erg $alance


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&uestionnaires "ill examine in the part of

reliability and validity in all of by nurse and

9uestionnaires test before use in the pro:ect.An alternative /meditation0 therapy manuals "ill

examine for reliability and validity by expert

and trial out before use in the pro:ect.

@alidate o/ resear(h tools

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i hi i


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•

The intervention group undertoo% a Tai;Chipractice protocol! #hile a control groupreceived usual care

• The TC sessions #ill involve group practice#ith instruction given in both verbal andvisual orm to demonstrate both the movements and the basic theory behind each action

• Each TC session #ill consist o 6 minutes o

#arm up! *6 minutes o TC practice and +minutes o cooling do#n The TC #ill be ledby a s%illed instructor #ho has been practicing TC and have TC instructor certi:cate

ai+(hi Inter!ention

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i hi I i


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• TC sessions #ill ta%e place during * #ee%s#hich contact #ith instructor

• T#o time per #ee% and + min per time

)#arm;up! tai;chi practice and cool do#n-

ai A (hi Inter!ention

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Data Colle(tion

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aseline data /or all &arti(i&ants "as(olle(ted ' the resear(her and theresear(h assistant em&lo':• the ?amilton rating s(ale /or an)iet'

*?6M+6,$• ?amilton rating s(ale /or de&ression

*?6M+D,$•

erg alan(e s(ale *S, instrument#• But(ome assessment data "as

(olle(ted at "eek e/ore 1%"eek$ a/ter1% "eek and a/ter %4 "eek#


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Data 6nal'sis

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• (ersonal data , ;amA, ;amD and BB score

"ere analysis by descriptive statistics in

fre9uency, percenta!e, mean and standard devi

ation• Compare personal data and symptom of

anxiety, depression and balance score "ill be

analyzed by Chi#s9uare test, fishers exact test.• To compare the different bet"een experiment#

control and before and after, the student t#test

"ill be applied


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• To compare the diferent bet#eenbeore and ater apply tai;chiprogram in e&periment group by

using pair t;test

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/ata Analysis


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• 2or ethical consideration! the proposal #illbe submitted or approval rom Jolden

Kubilee Medical Center! Mahidol "niversity

•

4articipants #ill receive both #ritten andverbal inormation beore they agreed toparticipate

• Inormed signed consent

• They have to right to reuse to participate inthe study

• 3ave reedom to #ithdra#al

• Their inormation #ill be %ept con:dentially!and not used or other purpose

thi(al Consideration

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• /ue to the limitation o the research

coverage! this study potential to produce a selection biases because this selection ocused on only patient #ho treated at the5ing Chulalong%orn 3ospital.

Limitation

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• 2irstly! the result o this study may helpincreasing the #ell;being those #ho has aproblem to the Alzheimer’s This study endeavor to bene:t elderly persons and eldersL amilies! community! and anyone #ho has interested in the topic

•


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esear(h s(hedule

Activities

Months

1 % 3 4 5 < 7

Elaborate proposal and literature

review

Explore site visit for Alheimer

!ool development and approval fromEthical committee

!rial out technique and intervention

study in mild Alheimer"s patients

#ata collection

#ata analysis

$riting research paper and publication

d t


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#escription !otal Amount (%aht)

1#ata &ollection and processing

Communi(ation *ele&hone$ a)$ Internet, 10$000

Stationar' *&a&er$ toner$, 10$000

Lo(al rans&ortation Costs *a)i$ (ar rent$

messenger,

10$000

'ubtotal *+***

% Field survey and Questionnaires ,aunching

Instrument and Eui&ment 30$000

uel and other e)&enses 3$000

'ubtotal -+***

3 Expertise &onsultation

=uestionnaires !alidit' and reliailit' 15$000

'ubtotal ./+***

4 0roductions

e&ort *2ro&osal$ 2rogress and Com&lete &a&er, 1000

6rt "ork$ (o!er &age 3$000 'ubtotal 1+***

udget


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The Effect of Tai Chi on 24 4 59