Treatment2Go Exploring Hand Therapy Manual Tai Chi Flow Into Function
Mandatory Practice time indicated in manual
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Tai Chi for Balance and Function Introduction:
What is tai chi? Trudy S. Goldstein, PT
3rd Black Belt Instructor
We will be covering Covered Topics
• The history and styles of tai chi. • 6 different types of Qi Gong exercises.
• Concepts of chi energy and Traditional • The fi rst 5 s teps of T ai Chi Chung. Chinese Medicine. • The use & modification of tai chi to • The research supporting the use of tai promote balance and function. chi in rehabilitation.
Covered Topics Covered Topics
• The movements that make up tai chi, that can be used as ther ex. • How to find a qualified tai chi instructor or class for you or your patient. • How to integrate tai chi into your current rehabilitation program. • And how to document tai chi in the • How to progress levels of movement to medical record. challenge or assist your patient. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
The Challenge We Face The Challenge We Face
I have to teach you You have to do the the basics of how to exercises without do tai chi without hihaving an itinstruc tor personally watching there to correct your you perform the movements. form.
This Course in Interactive
• Since tai chi is an advanced motor skill, this course will be interactive. How did I get into tai chi
My journey • This means you will have to stop this presentation at times in order to practice these new skills.
My Journey What is Tai Chi?
• First of all, I’m a scientist by nature with • 2nd most-used a BS in Biology from UConn. exercise in the world? • IhI have a second sc ience degree in PT. • Why isn’t it taught in • Yet, here I am talking to you about an OT and PT schools? exotic Asian exercise form that I strongly believe can help your patients. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
What is tai chi? Many Styles of Tai Chi
• It is one of the major • Tai chi is an umbrella name for a type of martial arts from exercise that comprises hundreds if not China. thousands of styles. • It means the “supreme ultimate” • So there is not just “one” tai chi, the or the “great breath.” same as there is not just “one” aerobic exercise or strengthening exercise.
Two Main Categories The History of Tai Chi
The Main Form Qi Gong of Tai Chi • Based on the philosophy of Taoism • 100s of Styles: • Thousands of years old – Merging one’s energy – Chuan • “Breathing Exercises” with universal energy – Chung • Thousands of Styles –Chi – “way to enlightenment” – Cheh, etc.
“Soft Overcomes Hard” The History of Tai Chi
☯ Lao Tsu
• Author Tao Te Ching Tai Chi is the physical manifestation of ☯ Concept of “yin” Taoist thought. energy • Or “yielding” in tai chi Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
The History of Tai Chi The History of Tai Chi
• Exact roots unknown • Chang San Feng is thought to have • Lost in secrecy and developed tai chi at the illiteracy Shaolin Temple on Wudang Mountain in • “Wild History” the 1200s. – Analogous to Roman & Greek mythology • It is a “soft-style” or “internal type” of martial – Integral to our art based on kung fu “western” culture
The Crane & the Snake Tai Chi Chuan Classics
“In every movement, the entire body should be light and agile and all its parts connected like a string of pearls.”
The History of Tai Chi Chi and Energy Flow
• The Next Master: Chen (1771-1853) Chi • “Secrets” of China begin to spread • Internal energy • Tai Chi Chuan evolves: • Steam or vapor – Chen, Yang, Wu, and Sun Styles • Prana • In the 20th century, China develops the •Life force 24-step Tai Chi Form for all. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Chi and Energy Flow Chi and Energy Flow
• Yin and Yang The Three Treasures of Life • Opposing complementary Jing Chi = prenatal energy forces Chi = vital energy • Yin = female energy Shen = spirit • Yang = male energy
Traditional Chinese Medicine Traditional Chinese Medicine
Disease results from an imbalance Life and health or disruption of the chi flow. result from an ample flow of chi • How is this possible when we can “see” throughout the the pathogen under a microscope? body. • But if it’s just a matter of being exposed to a germ, why don’t we all get sick?
Traditional Chinese Medicine Traditional Chinese Medicine
Rules of the Five Prevention Elements “the good doctor treats disease • Wood, fire, earth, bfbefore it se ts i n metal, water …the poor doctor • Each element afterward.” nourishes the next but restricts another -Chinese Proverb (fung shui) Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Background of Tai Chi Using Tai Chi for Rehabilitation
• This knowledge can give us a quiet This course will begin confidence in our treatment planning, to teach you simple especially when it involves exercises that tai chi and qi gong WtWestern medi diihcine has no t ye tfllbt fully embrace d. exercises for improving balance and function in your patients.
Using Tai Chi for Rehabilitation
But know that this course can only offer you a “glimpse in the window” of what tai chi really is and its potential for health. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
We are being asked by
• Insurance companies, as well as our own The Benefits of Tai Chi: professional organititjtifizations, to justify the treatments we are What the research says. providing to our patients
The Problem So what does the research
• The evidence we need is not always • Tell us about tai chi and its purported available. health benefits?
• We, in OT and PT, used to think that • In general, you will see that the data medical research was “the gold supports the use of tai chi as a cost- standard.” effective multi-dimensional treatment. • But, that too has been compromised.
What does that mean? Validity and Reliability
It means, that although any given research • Many of the studies we’ll be discussing study might focus on only one health benefit, have similar validityyy and reliability to for example that tai chi improves balance, other research in OT and PT. other benefits occur at the same time, ie decreased pain or increased strength. • They also have some of the same flaws, such as small sample size. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Study Populations Study Populations
• I have tried to use recent studies, and • We are only just now seeing studies whenever possible, the highest level of done on patients with pathology. evidence. • Many of these preliminary studies are • Most of the initial studies were done on pilot studies or case studies. healthy populations.
Stress Management Stress Management
• In general, psycho-neuro-immunologists • Tai chi, as well as other types of believe that over 80% of illnesses that exercise, has been found to have a we see are do to the effects of stress. ppygositive effect on our ability to manage stress. • Since we cannot eliminate stress, it becomes important to be able to • Let’s look at the evidence. manage that stress.
Stress Management & Relaxation Stress Management & Relaxation
Jin, 1992 Other supporting studies: • RCT of 96 tai chi – Wall, 2005 practitioners – Wenneberg, 2004 • Decreased salivary – Sandlund, 2000 cortisol – Chen, 1997 • Similar to brisk – Sun, 1996 walking Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Self-Esteem & Self-Confidence Self-Esteem & Self-Confidence
Li, 2002 • Other studies supporting: • RCT of seniors –Wang, 2004 and Weiser, 1995 • Increased self- esteem • Felt they were more attractive and strong
Pain Balance and Gait
Bhatti, 1998 • There are many – RCT of 51 adults with LBP studies in this area. – Practiced tai chi 1x/week for 6 weeks • Most people are – Decrease in average & worst pain aware that tai chi Hartman, 2000 improves balance. – RCT of 33 adults with OA, 2x/week for 12 weeks • Let’s look into some – Increased self-efficacy for arthritis of the evidence.
Balance and Gait Balance and Gait
Wolf, 1996, 1997, 2003 (2004) Pilot studies with Parkinson’s Disease • FICSIT Study with 200 Community Seniors – Increased balance and gait speed • Tai chi compared to computerized balance – Increased TUG platform training – Increased functional reach • 47% decreased risk of falls Venglar 2005, Kluding 2006, Li 2007 • 15% decrease in fear of falling Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Possible Ways Tai Chi Works Balance and Gait
• Improves control of forward momentum Other supporting studies: – Hass, 2004 • Wolfson, 1996 • Hong, 2000
• Helps with vestibular system • Jacobson, 1997 • Mak, 2003 – Tsang, 2004 • Husted, 1999 • Voukelatos, 2007
• Increases stepping strategy of stance leg • Hain, 1999 • Zijlstra, 2007 – Gatts, 2007
Balance & Gait Eccentric Quad Strength
• Wolfson’s study in JAGS proved that TC • Lan, 1998 could maintain balance gains in the over 80 • Wu, 2002 population because it had high compliance. • Choi, 2005 • Voukelatos’ study in JAGS in 2007 was on 700 community seniors practicing different • Also, increased styles of tai chi resulting in a decreased erector spinae number of falls. – Chan, 2003
Cardiac Effects Cardiac Effects
Young, 1999 Other supporting studies: • RCT 62 sedentary adults • TC 2x/wk for 12 weeks • Channer, 1995 • Compared to moderate aerobic exercise • Lan, 1999 • Lee, 2000 • Both groups had the same decrease in blood pressure • Lu, 2003 Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Peripheral Circulation Peripheral Circulation
Wang, 2001 & 2002 Richardson, 2007 • Increased capillary flow in regular tai chi • Pilot study on 18 practitioners seniors with diabetes • May prevent or decrease PVD • Increased plantar • Small sample size, but promising studies! sensation • Increased balance
Pulmonary Effects Increased Trunk ROM
Lan, 1999 • Lan, 1998 • 1 year program of 108 step Yang Style, • Husted, 1999 4x/week for post-cardiac bypass patients • Hong, 2000 • Increased VO2 Max by 18% • Hugel, 2000 • Good compliance
Improved Agility & Motor Control Effects on Immune System
Supporting studies: There is also some evidence to support the – Jacobson, 1997 fact that tai chi practice improves the immune – Yan, 1998 respp,yonse, by increasing gp the production of – Wong, 2001 regulatory T-Cells. – Tsang, 2003 – Hass, 2004 – Xusheng, 1990 – Lee, 2003 – Irwin, 2003 & 2007 – Yeh, 2007 Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Immune System What other benefits occur
• Irwin’s 2007 RCT in JAGS showed that • Osteoporosis has become a major specific immunity to the varicella zoster health issue in western society. virus (chicken pox) increased by 50% in a • AihtAs a weight-bibearing exerc ise, tihitai chi group of seniors doing tai chi 3x/week. can have a positive effect on bone. • It’s gentle nature makes it perfect for seniors to use.
Maintains Bone Mineral Density Improving Function
Tai chi is considered Li, 2001 effective and safe • RCT of 94 seniors for post -menopausal • Yang 24 step tai chi vs . women. normal activities control • 2x/week for 6 months • 65% increase in all – Qin, 2002 levels of function – Wayne, 2007
Literature Recap Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
What is Qi Gong?
Qi Gong • Qi Gong is much older than tai chi, possibly thousands of years old.
For breathing, balance, and • It means “to increase internal energy function. through effort and determination.”
Breathing Exercise Generating Energy
We will be focusing • Many people on the physical describe Qi Gong as breathing exercises. aspects of Qi Gong and its benefits in • Although this is true, rehabilitation, rather Qi Gong also than its ability to involves much more. generate and conserve energy.
Dynamic or Yang Qi Gong Qi Gong vs. Tai Chi Form
• All martial art classes • More stationary
• Medicine • Easier to learn the – Moving meditation basics – Disease-curing exercise • Easier to learn from – Life-prolonging exercise a video Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Especially Beneficial For: Levels of Qi Gong
Children & Seniors with: • I have arbitrarily created levels of Qi Gong to assist therapists in their: •Anxiety – treatment ppgrogressions and • Memory problems – medical documentation • Breathing problems • These levels DO NOT exist outside of any • Balance problems Trudy Goldstein courses!!
Goldstein’s Levels of Qi Gong Goldstein’s Levels of Qi Gong
Level 1 Sitting • Relaxed standing or • UUoeetsE movements wu shi posture • Spinal alignment • UE movements • Feet flat • Spinal alignment • Breathing • Breathing
Goldstein’s Levels of Qi Gong Rules for Learning Qi Gong
Level 2 • You must protect yourself! • Rooting • UE & LE movements • Spinal alignment • Breathing Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Rules for Tai Chi and Qi Gong Rules for Tai Chi and Qi Gong
1. Tai chi is about what YOU can do, not what I 3. Tai chi is a PAIN-free exercise. can do. If you feel pain or discomfort, STOP! You are doing something wrong. 2. This is YOUR journey or your patient’s You may need a teacher to help find the journey problem in your technique.
4. Tai chi is a STRAIN-free exercise as well. If you feel you are trying too hard… you are.
Rules for Tai Chi and Qi Gong Wu Shi Posture
5. Tai chi builds self-awareness. Focus on the “Infinity Posture” quality of your movements, not on how far – This is the beginning you can move or how low you can go. position of tai chi and qi gong. 6. “Do no harm.” Modify the movements for yourself as well as your patients. Although – It promotes stability you are not a tai chi master, you ARE a of the body and helps clear the mind. therapist.
Sitting Wu Shi Posture Now it’s your turn
• Sit with hips, knees, and ankles at 90° Sitting Wu Shi Posture Practice Time • Sit unsupported if possible – It is imperative that you take the time now • Elongate spine to practice with us as this posture is the basis for all future Qi Gongs and Tai Chi • Lift head up and tuck in chin (axial extension) movements!!! • Touch tip of tongue to roof of mouth • The activity is over when you lose spinal alignment. For documentation purposes, you • Rest hands on lap, palm up can measure the time in seconds. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Level 1 Wu Shi Posture Now it’s your turn
• Stand relaxed with knees unlocked Level 1 Wu Shi Posture Practice Time • Tuck your tailbone “under” – Let’s practice. • Lift head up, tuck chin in • Feel your spine elongate as your head floats up
• Touch tip of tongue to roof of mouth • Focus on your breathing and keep relaxing • Relax arms, let hands hang down comfortably
Level 2 Wu Shi Posture Now it’s your turn
• Stand unsupported feet shoulder-width apart Level 2 Wu Shi Posture Practice Time • Bend hips, knees & ankles slightly – Let’s practice. • Tuck your tailbone “under” • Feel the even weight distribution in your feet
• Lift head up, tuck chin in • Root. Let the weight sink into your ankles • Touch tip of tongue to roof of mouth • Focus on breathing and relaxing • Relax arms, let hands hang down comfortably
Posture Partner Who could benefit?
• “Body awareness” aspects of Wu Shi posture. • Patient s who could benefit from practicing Wu Shi posture? • Many of our patients have poor body awareness and stand in poor postures. • Discussion:
• Practicing Wu Shi posture helps in this area. –Anxiety (Children with ADD), High BP – Breathing problems – Postural problems – Balance problems Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Wu Shi Posture vs. Yoga Pose “Be Here Now”
Similar to Mountain Pose • The student can use Wu Shi or Infinity Posture for physical or mental “grounding.” • Similar focus on: • In a way , it freezes time , by allowing us the – Awareness gift of living in “the present.” –Posture – Breathing • It frees us from worrying about the past or – Relaxation what might happen in the future. • This helps us relax.
The Sunset Breath Sitting Sunset Breath
“Gathering Heaven • Begin in sitting Wu Shi posture. to Earth” • Place right hand palm up within left hand. Energetically, it brings the universal energy • Separate hands and circle above as you into the body and inhale. stores it in the • Touch thumbs & index fingers. Dan Tien. • Push down to dan tien as you exhale.
Now it’s your turn Level 1 Sunset Breath
Sitting Sunset Breath • Stand relaxed or in wu shi posture. – First, set yourself into wu shi posture. • Repeat the same arm movements as in – Now add the arm movements, but don’t sitting. strain – Add breathing and and keep relaxing. – Activity over when spine or arms fatigue. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Now it’s your turn Level 2 Sunset Breath
Level 1 Sunset Breath • Stand in wu shi posture. – Keeppy your hands “soft” (gentl y cu pped ) • Begin just like in sitting. – Keep your shoulders down (not shrugged) • Add in lower extremity movements. – Feel your chest open as you inhale. – Press against a light force as you exhale.
Now it’s your turn Who could benefit?
Level 2 Sunset Breath • Clients who could benefit from the Sunset Breath? – Begin in wu shi posture. • Discussion – As you inhale, circle your arms upward and –Anxiety extend your knees. – Postural Problems – As you exhale, when your hands pass by – Breathing Problems your belly button, let your knees and – Shoulder Problems ankles flex, rooting you into the ground.
Specific Adaptations Specific Adaptations
For patients with anxiety or stress For patients with postural problems – Use imagery – Re-emphasize all aspects of Wu Shi – CttitbthiConcentrate on quiet breathing – AltflthhtdAs arms elevate, feel the chest expand – Use music – As arms lower, feel the chest close in – Keep “elongating” spine Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Specific Adaptations Specific Adaptations
For patients with breathing problems For patients with shoulder dysfunction – Coordinate breathing with arm motions – Reduce ROM within pain-free range – Focus on rib expansion/contraction – FflidtiFocus on fluid motion – Begin to work temporal component – Keep both arms symmetrical – Can use imagery to decrease anxiety – Keep elbows and shoulders “down” – Press down (co-contract) during exhale
Challenging the Patient Now it’s your turn
Change posture to Sunset Breath in Horse Position Horse Position – If possible, keep feet in parallel – Same as wu shi except: – Elongate spine, tuck your tail bone under.
– Set feet greater than – Coordinate your LE movement with shoulder-width apart breathing. – You should feel your quads working!
Challenging the Patient The Fountain
• How can we increase the difficulty of • This qi gong is this activity? recommended for children by Peter – Slow down movemen t Choy, a tai c hi – Slow down breathing teacher and author. – Add light resistance • I have found it – Alter surface or footwear beneficial for all age groups. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Sitting Fountain Now it’s your turn.
• Begin in Wu Shi posture, with hands palm- Sitting Fountain down on thighs. – Begin in wu shi posture. • Lift elbows to ~80° elevation. – Inhale as your arms elevate and exhale as • Sink elbows down while letting arms lift up. they float downward. • Let the arms drop slowly down, like snow – The imagery of “becoming a fountain” is flakes floating to the ground. very important to this qi gong and greatly enhances the breathing pattern and relaxation effect.
Level 1 Fountain Now it’s your turn
• Stand relaxed or in wu shi posture. Level 1 Fountain • Set the hands palm down at “belly button” – Begin in relaxed standing or wu shi. height. – Keep elbows below shoulder height. • Perform the same arm movements as in – Enjoy the movement and “being a fountain” sitting. – As water is ever-flowing, keep the arm • During inhalation, touch the tongue to the roof motions continuous and fluid. of mouth.
Level 2 Fountain Now it’s your turn
• Pedestal stance. Level 2 Fountain – Place heels together and toes out to form a “v” – Begin in pedestal stance. •Begin arm movements. – Focus on the imagery and allow the picture • Add knee releases with weight sinking into of falling water to influence your ankles as arms float down. movement. • Add touching tongue to roof of mouth on – Let the arm movements and breathing be inhalation. continuous and flowing. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Who could benefit? The Crane Takes Flight
• What kind of patient do you think could benefit from The Fountain? • This qi gong helps free up shoulder – AitAnxiety motion. – Breathing Problems • It also coordinates – Shoulder Problems upper and lower – Postural Problems body movements. – Balance Problems
Sitting Crane Takes Flight Now it’s your turn
• Begin in Wu Shi posture, with arms by sides. Sitting Crane Takes Flight • With elbows and wrists relaxed and bent, – First set yourself in Wu Shi posture. elevate wrists upward as if flying. – DhdbiddflDrop your hands by your sides and fly. • Dorsiflex wrists, drop elbows first and then let – As your arms elevate, breath in. hands float back down. – As your arms float down, breath out. • Activity over when arms or back fatigues, or if patient becomes SOB. – Let the tongue touch roof of mouth.
Level 1 Crane Takes Flight Now it’s your turn
• Stand relaxed or in Wu Shi posture. Level 1 Crane Takes Flight
• Begin arm movements with breathing. – Begin in Wu Shi posture. – Lift your elbows first and then try not to think about anything but flying. – Keep relaxing and letting your arms float up and down. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Level 2 Crane Takes Flight Now it’s your turn.
• Stand in Wu Shi posture or Horse Position Level 2 Crane Takes Flight • Begin flying. – Begin in Wu Shi or • As your arms lower, bend your knees as if Horse Position. doing a mini-squat exercise. – Start flying. – Don’t think too much. – Just fly.
Patients with the following could benefit: Challenging the Patient
For patients with •Anxiety • LE Strength Problems • Breathing Problems • LE Flexibility Problems – LE Weakness • Postural Problems • Motor Control Problems – In-coordina tion – Balance Problems • Shoulder Problems • Balance Problems – Transfer Problems • Wrist Problems • Difficulty with ADLs – ADL Problems
Challenging the Patient Now it’s your turn
Change the lower The Crane Takes Flight in Front Stance body position to Front Stance – Front leg, knee does not go beyond foot
– Similar to lunge – Back hip in neutral (important for THA) – Front foot flat – Don’t drop too low – Back foot on ball of foot (heel off) – You should really feel your balance challenged and your quads working. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Floor-to-Stand Transfer Floor-to-Stand Transfer
Floor-to-Stand Transfer Other Activities
• Many ADLs require full • The Crane Takes Flight teaches the proper kneeling. motor pattern for the trunk and entire lower • We need to teach our extremities for many other activities: patients the proper – Normal gait motor control. – Stair climbing and descending • The Crane Takes Flight – Sit-to-stand transfers (including toilet) is one way to teach this.
Patient Ability? Patient Ability
• For example, does the patient have • If not, the patient might need to start enough ROM in the big toe and ankle? with supported heel-offs in Wu Shi or Horse Posture before ppgrogressin g to the • AthltAre the gluts and an kle musc les s trong advanced position of Crane Takes enough to lift the patient from the floor? Flight in Front Stance. • Does the patient have sufficient balance • All of these deficits, need to be to stand in this semi-tandem position? documented. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Recap of Basic Qi Gongs Recap of Basic Qi Gong
• The therapist needs to choose a level of Even though these are basic Qi Gongs, Qi Gong (Sitting, Level 1 or 2) that the theyyyg are still unbelievably high-level, ppypatient can successfully accomplish. compared to the simple exercises we • Often we try to teach too much in one commonly prescribe for our patients. session. • This can lead to frustration.
Recap of Basic Qi Gong Recap of Basic Qi Gong
• Don’t worry about what the patient is • Place your emphasis on the most doing wrong. important aspect you wish to get across.
• Be supportive, but don’t overly praise. • FlifihtiFor example, if you wish to improve shoulder ROM, don’t worry about the • Qi Gong is difficult to learn. patient’s knee movements.
Recap of Basic Qi Gong Mandatory Practice
• During future visits, progress the • Please review this section to ensure you program by adding in more features. understand • D’tfttdDon’t forget to document ti improvement! • Allott ed 30 mi nut es • We have to show that tai chi and qi gong are effective interventions for our patients. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
More Advanced Qi Gongs
• These Qi Gongs require a higher skill, More Advanced Qi Gongs because they include one or more of the followinggq qualities: – Asymmetrical motion – Chest expansion – Trunk rotation – Weight-shift
White Crane Spreads Its Wings Sitting Crane Spreads Wings
• This qi gong expands • Begin in sitting wu shi posture the chest and is asymmetrical. • Hold invisible ball in front. • It provides a very • Right hand lifts palm up and pronates natural UE stretch. overhead. • There is a lot of • At same time, left hand pushes down and to forearm rotation. side.
Mandatory Practice Time Now it’s your turn. 15 minutes Basic Sitting Crane Spreads Its Wings • Repeat that 5 times.
– Begin in Wu Shi posture. • Do the opposite. – Hold an invisible 8 inch ball in front of you – right hand down, left hand pronates up with the left hand on top. – repeat this 5 times – Push your left hand down and to the side. • Alternate the hands. – Lift your right hand up. At chest height, pronate your right hand (palm away) & lift up. – repeat 5 times. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Who could benefit? Who could benefit?
• In the basic version of this qi gong, the Patients with emphasis is on forearm supination and pronation combined with shoulder scaption. – Colles Fracture – Ro tat or C uff D ysf uncti on • There is also a scapular depression component on the other arm. – Difficulty using functional rotation of the forearm. • This qi gong requires greater motor control with opposite arm motions occurring at the same time.
Now let’s add chest expansion How do you feel?
Sitting Crane Spreads Its Wings • “Expansion and contraction” are important concepts in tai chi and qi gong. – Begin in wu shi posture holding a “ball.” • Can you feel a difference in how your arms – As your hands cross each other, “round connect to your thorax during these motions? your back & scrunch.” (scapula abduction) – As you spread your wings, expand your • Can you feel your back muscles working? chest as if stretching. (scapula adduction) • Could you feel a difference in your breathing?
Challenging the Patient Level 1 Crane Spreads Wings
• Expanding and contracting the rib cage is • Begin in relaxed standing or wu shi posture. especially beneficial for patients with breathing problems. • You can “advance” any qi gong by adding this expansion and contraction principle. • You should document this progression of the exercise, showing patient improvement. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Mandatory 30 Minute Practice Challenging the Patient time: Stop, Rewind and review Level 1 Crane Spreads Its Wings • We can also challenge the patient’s breathing ability by altering the pattern. – Begin in relaxed standing or wu shi. – Regular Breathing – Begin with the basic qi gong, focusing only on the arm motions. – Inhale as wings spread, exhale as contract – Now add in the expansion/contraction – Exhale as wings spread, inhale as contract principle. – Inhale for one full movement, exhale on the alternate
Breathing Patterns Practice Begin Level 2
Level 2: Crane Spreads Its Wings •Beggpin in wu shi posture and hold “ball.” • Contract body and sink into ground by bending your knees and ankles. • As you spread wings, extend your knees.
Challenging the Patient Let’s do it
Change posture to Empty Stance Empty Stance – Start in wu shi posture – 90% WB on back leg – Turn out your right foot – Challenges balance 45° (hip in ER) – Increases quad – Place your left foot ahead strength of your right foot ~4” – Sink 90% of your weight 90% WB – Can be done to back onto your right foot advance Level 1 or 2 Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Combine Qi Gong with Empty Stance Did you notice?
• Begin in wu shi; step into Empty Stance. • Arm positions can be altered as well. • Begin Level 2 Crane Spreads Its Wings. • The right forearm is not – Do you feel the increased energy (ie quadriceps pronatdithited in this activation) in your back leg? variation (arrow). – What differences do you feel from wu shi posture? • All qi gong & tai chi exercises can be – How would you document these differences? modified to suit an individual’s needs!
Wave Hands Like Clouds
• Wave Hands Like Let’s move on to our last Clouds is one of the QQgi Gong. main movements in TiChiChTai Chi Chuan. Wave Hands Like Clouds • The motion is directed by the waist and it involves major weight-shifting.
Sitting Wave Hands Like Clouds Mandatory Practice Time
• Begin in wu shi posture. Sitting Wave Hands Like Clouds – Begin in wu shi posture. – Start activity with your right arm raised, out to side. – Drop arm down and twist trunk to left while pushing right palm to the left side. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Continue Let’s Practice
Sitting Wave Hands Like Clouds • Right side only.
– Elevate right arm to chest height. • Do this with me 5 times. – Twist trunk to right while floating arm • Try to float your arm as if it were a cloud across to right side. moving lightly in the wind. – Your right arm will make a clockwise circle. • Now let’s try the left side.
Continue Using Left Arm Mandatory Practice Time
Start with left arm raised and out to side. • 15 minutes to review • As the arm drops, move your left palm across • Stop, rewind, replay, review yyyypgour body as if you were pushing water. • Raise your arm and float it at chest height back toward the left. • Remember to rotate your trunk back & forth.
Now use both arms Level 1 Wave Hands Like Clouds
• Do not attempt this until you can circle each • Begin in standing or wu shi. arm separately. This will take practice. • Start with one arm, progress to two. • This is a high level coordination activity which is similar to “Double Dutch” in jump roping. • Main motion is still axial rotation. • After you have accomplished the trunk and arm movements successfully, add in the inhalation and exhalation. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Mandatory Practice time Begin Level 2 “box style” 10 – 15 minutes Level 1 Wave Clouds Like Hands Level 2 Wave Hands Like Clouds – Begin in Wu Shi posture – Start with Level 1 • Start with ri ght arm moti on b y it self • Focus on weight distribution • Left arm then both arms • Begin basic, linear or “box”style • Keep arms “light as feathers” and float • Begin in wu shi, but shift weight to right leg • Add axial trunk rotation • Right arm is “up”, left arm is “down” • Add breathing • Let’s me demonstrate and then you can do it.
Beginning Level 2 Wave Hands Continue Beginning Level 2
• Start with most of your weight on your right • Most of your weight is on your left foot and foot. Your right hand up. your right hand is up. • Switch your right hand down, left up. • Rotate trunk right , but your weight stays left. • Rotate trunk left, but weight stays right. • Now shift your weight to right foot. • Shift your weight to left foot. • Switch hand positions: right down, left up. • Switch hand positions: right up, left down. • Keep alternating sides.
Progress Level 2 Breathing
Level 2 Wave Hands Like Clouds • Don’t forget to breath! – Progress the weight shift to continuous • It’s easiest to inhale going one direction • Now let the movements flow with each other andhld exhale as you reverse. • Speed up the movements to become fluid • Only when you add in the deep relaxed • Stop thinking and just follow breathing, does this complex activity • If it’s still difficult, try with one arm only actually become Qi Gong. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Illusions Self-Defense Cloud Hands
• Despite the illusion that the motion is being caused by the arms circling, the “cloud hands” are bibeing powered db by spi nal axi ilal ro ttitation.
• Despite the peaceful and relaxing nature of this activity, this is really a powerful martial arts block or attack called “ward off.”
Did you notice? Who could benefit?
• For self-defense • This qi gong is time-consuming to learn, purposes, I needed limiting who you can teach it to. to perform “ward off” ifin fron ttt stance. • But it is very beneficial and enjoyable to do for patients (including children) with problems in: • For rehab purposes, – Motor Control – Breathing I can alter the – Anxiety – Balance stance to best –Any joint –Etc. benefit my patients. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Review of Qi Gong for Rehab Basic Qi Gongs
• Basic Qi Gongs & Stances 1. Infinity (Wu Shi) • Tai Chi & Qi Gong Principles 2. The Sunset Breath • Ways to assist or challenge a patient 3. The Fountain 4. The Crane Takes Flight • Goldstein’s Levels & Documentation 5. The White Crane Spreads Its Wings • Generating Energy 6. Wave Hands Like Clouds
Basic Stances Tai Chi & Qi Gong Principles
• Wu Shi • Relax and breathe – Sitting and standing • Be aware • Horse Stance • Elongate the spine • Front Stance • Rooting • Empty Stance • Know your weight distribution
Tai Chi & Qi Gong Principles To assist patient
• Fluidity • Place in more stable (safe) postures • Expansion and contraction • Limit ROM so patient can succeed without pain or frustration • Seek stillness (relaxation) • Use imagery • Intent • Speed up movement for fluidity of motion • Have fun! • Don’t teach too much Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Goldstein’s Levels of Qi Gong To challenge patient REVIEW • Change stances • Sitting • Slow down movement – Posture, UE movement, breathing • Emphasize coordinating upper body motion, with lower body, with trunk, with breathing • Level 1 • Use self‐defense application (resistance) – Add relaxed standing or wu shi posture • Focus on mental aspects (memory) • Level 2 – Add rooting, weight shift, coordination of UE & LE movements
Documentation Documentation • Basic documentation required “The job is not – Measure impairment or functional loss complete until the – Intervene with qi gong or tai chi exercise pppaperwork is done.” – Re‐measure • How to document tai chi and qi gong in the – PROVE the intervention works! medical record.
Documentation Example Documentation Tips
• Impairment: Balance Do • Measure: Berg Balance Test, Tinetti, etc. – Specify qi gong using English name • Intervention: Level 1 Crane Spreads Wings – Place copy of exercise description in chart – 3x/week for 2 weeks – Use flow sheets • Re‐Measure: Berg, Tinetti, etc. – Use CPT codes: • Did it work? • 97110 ther ex, 97112 neuromuscular re‐ed, etc. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Documentation Tips Qi Gong Wrap Up Don’t – Over‐explain the “weird” Chinese exercise – Use Chinese words, i.e. “Wu Shi” – Use Qi Gong or Tai Chi terminology • rooting, sink the elbow, tuck the tailbone, etc. – Call these “energy exercises” or “life‐ prolonging exercises” Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Tai Chi Chung
• Of the many styles of tai chi, I have chosen a lesser known style named Tai Chi Chung (TC Tai Chi Main Form Chung) to use for our rehabilitation purposes. • It is a more basic style than its popular cousin Tai Chi Chuan,
Tai Chi Basics Tai Chi Building Blocks
• As you can see from watching the These movements, that combine to movie, it is more difficult to learn the form the choreographed dance we know multi-step movements of tai chi of as tai chi, are powerful in their own compared to the more static qi gongs. right and can be used alone to create very effective therapeutic exercises.
Tai Chi Building Blocks Tai Chi Building Blocks
• Some of these components are the • Wu Shi Posture same building blocks of qi gong. • Fighting Stances – WShiPtWu Shi Posture – Front Stance – Fighting Stances – Bow Stance – Blocks – Horse Stance – Attacks – Empty Stance – Proper Breathing Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Tai Chi Building Blocks Tai Chi Building Blocks
• Tai chi is a martial art. As such, it is made up • Blocks of blocks and attacks. –In • We will begin with 5 blocks from TC Chung. – OtOut (Wave Hands) • The movements are mostly circular in nature. –Out(Easy) • Remember, “sink the shoulders and elbows.” –Up (Keep shoulder elevation below 80°) –Down
Now it’s your turn Tai Chi Building Blocks
• Let’s practice 5 of each block on each The Shoulder Motions hand – The circular motions are gentle (yin) on – In (swatti ng fli es ) the shoulder complex and promote pain –Out (Wave Hands Like Clouds) free movement. –Out (“Easy” to side) –Up (Step 5) – These motions promote blood flow and healing to the glenohumeral joint. –Down
Tai Chi Building Blocks Rehabilitation Intent
The Intent How can we use these “blocks” as ther ex? – Speeded up, these – Unlike a lot of our standard “exercises” these blocks defend against blocks move the glenohumeral joint in multiple a punch or grab. planes. – As such, they are more natural and will better – Knowing how this restore many upper extremity FUNCTIONS. block works improves – Examples: the ability to do the • Reaching across the body or out to the side movement. • Cleaning a mirror (“wax on, wax off”) Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Tai Chi Building Blocks: Attacks Tai Chi Building Blocks: Attacks
The Chung • Learning the Chung
– Open-palm strike – Place hands supinated on iliac crests – Simil ar to Ta i Chi Chuan Push – Reach forward, gently extend elbow and wrist – Combines shoulder flexion, with elbow & – Hand should be wrist extension, and relaxed as if holding forearm pronation an egg.
Tai Chi Building Blocks: Attacks Tai Chi Building Blocks: Attacks
• Progress to a Double Chung The Bird’s Beak (= wrist strike or hook hand) – Start with hands supinated on iliac crests • Powerful hand – Reach both hands forward pronating at the position (yang) last possible second • First, oppose fingers – Your hands should make the letter “w” if and thumb your shoulder is in the correct position. • Add wrist flexion
Tai Chi Building Blocks: Attacks Tai Chi Building Blocks: Attacks
• The Bird’s Beak (Wrist Strike) Front Kick – Can you feel the intensity of this isometric – This is a relaxed exercise? locked-leg kick – What kind of patient do you think could benefit from this? – Motions are hip flex, – What wrist condition would this be knee extension, and contraindicated for? ankle dorsiflexion Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Tai Chi Building Blocks: Attacks Tai Chi Building Blocks: Attacks
• Front Kick The Intent – Even though this attack is normally very – Speeded up these active (yang), we will be using it attacks would work in extensively for BALANCE activities. the real world. – Exact position of the – We really want to focus on the stance leg hand or foot is critical and a relaxed gentle off-loading of the to prevent injury upon kicking leg. striking an object.
Rehabilitation Intent Tai Chi Building Blocks
• How can we use these “attacks” as Diaphragmatic functional exercise for our patients? Breathing – PtPromote eye-hdhand coor ditidination – The martial arts way – Reaching activities – Balance activities – Getting the patient to “hear us” – Strengthening activities
Examples of Combinations Using Putting It Together Chung Attack
• We can combine any of the building blocks together to create a more complex exercise. • Breathing and the chung – The easiest is to combine anyypy of the physical • Alternating chungs movements with the breathing. – We can also alternate a block or attack from one • Chung in wu shi, horse position, and extremity to the other. front stance – We can change stances. • Out-block and chung (Steps 1 and 2) – We can alternate a block with an attack. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Putting Building Blocks Together Form: Tai Chi Chung
• When a tai chi master puts one or more • First five steps of the form tai chi chung. of these buildinggg blocks together, • I have modified some of the movement a tai chi step is created. so that you can learn it in this video format. • When a tai chi master puts steps together, a tai chi form is created.
Easy Tai Chi Chung Easy Tai Chi Chung
• Modified for easier learning Step 1 – Begin and end with the Sunset Breath • Out-block left – Steps 1 - 5 • Step into front stance & chung right • Each “step” consists of an inhalation (Inhale on the block and and exhalation. exhale on the attack)
Easy Tai Chi Chung Mandatory Practice Time
• Practice • 5 to 10 minute review • Stop, rewind, replay, review – Sunset Breath
– Step 1 Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Easy Tai Chi Chung Easy Tai Chi Chung
Step 2 • Practice • Only the left arm – Sunset Breath moves – Step 1 • Out-block to left side, keep elbow bent, and chung to left side. – Step 2
Mandatory Practice Easy Tai Chi Chung
• 5 – 10 minutes Step 3-A • STOP, REWIND, REPLAY, REVIEW • Unload left leg slowly • Tap ahead left • Pivot 180° on right foot • End in left front stance
Easy Tai Chi Chung Easy Tai Chi Chung
Step 3-B • Practice – Sunset Breath • In left front stance – Step 1 • Out-block left arm – Step 2 • Chung right – Step 3 Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
MANDATORY PRACTICE Easy Tai Chi Chung TIME • 10 – 15 minutes Step 4 • STOP, REWIND, REPLAY, REVIEW •Only left arm moves
• Out-block left (inhale)
• Chung left (exhale)
Easy Tai Chi Chung Easy Tai Chi Chung
• Practice Step 5 – Sunset & Step 1 • Shift weight back to – Step 2 right leg with double – Step 3 up-block (inhale) • Shift weight forward – Step 4 to left leg with double chung (exhale)
Easy Tai Chi Chung Mandatory Practice Time
• Practice • 15 minute practice
– Begin Sunset • STOP, REWIND, REPLAY, REVIEW Breath
– Steps 1 - 5
– End Sunset Breath Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Using the Form Tai Chi Chung Using the Form Tai Chi Chung
• Most of the research on the benefits of • Other areas that may benefit more from tai chi are based on the performance of the form tai chi (vs. tai chi exercise): the modified form of tai chi. – GitGait • To improve overall FUNCTION in your – Cardiopulmonary system patients, you should try to teach the – Motor control form tai chi (rather than the building blocks – Immune system or just one step.) – Endurance
The Intent of Step 1 or 3-B Tai Chi Principle
• The out-block defends against a punch Steps 1 or 3-B or a grab. “The motion should be rooted in the feet , • The step in and chung is the powered by the legs, counterattack. controlled by the waist, and expressed through the hands.”
– Tai Chi Chuan Classics
The Rehabilitation Intent The Intent of Steps 2 & 4
Steps 1 or 3-B • The side out-block defends against a punch or grab from a second attacker The motion of the on your left. entire body is similar to many common • The chung is the counterattack. ADLS. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
The Rehabilitation Intent The Intent of Step 3-A
Steps 2 & 4 • The front kick attacks the original
• The combined UE attacker standing in front of you. motion of the out-block to the side is commonly • You pivot and turn 180° to face a third used in ADLS. attacker who has come up behind you. • It is easier to perform Step 2 than to try a more standard abduction exercise.
The Rehabilitation Intent The Intent of Step 5
Step 3-A (the 180° turn) • The up-block protects your face and central body from a punch • Patients often lose the ability to maneuver or pivot and turn • The double chung is a powerful • Often they can walk OK, but take many tiny counterattack. steps on turning • We can adapt Step 3 to teach the ability to pivot.
Tai Chi Principles for Step 5 The Rehabilitation Intent
• Contraction and Expansion Step 5: Up-Block – During block, body contracts – During double chung, body expands • Holding or carrying objects • Yielding and Redirecting Energy – During block, body shifts weight to back leg (yields) • Using the whole – During attack, energy is redirected toward target body, including the “core muscles” and • Rooting back extensors – Back leg must be firmly rooted, push heel into floor Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
The Rehabilitation Intent Review of Tai Chi Chung
Step 5: The Double • Begins and End with Sunset Breath Chung • Step 1: Block & Chung Right This is the classic pushing maneuver • Step 2 & 4: Out-block and Chung Left using the entire • Step 3: 180° turn & Step 1 body. • Step 5: Up-block and Double Chung
MANDATORY PRACTICE TIME • DUE to the difficulty of learning these moves take this time to • STOP, REWIND t o STEP 1 and REVIEW • 20 – 30 minute reveiw Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Sitting Tai Chi
• For many of our patients with balance Sitting Tai Chi problems, even Easy Tai Chi is too difficult. • Modifying tai chi into the sitting position will still provide many of the same benefits. For patients with balance issues. • Sitting balance and strength of the back extensors will also be challenged and improved.
Sitting Tai Chi Chung Now it’s your turn
• Begin with a sitting Sunset Breath • Let’s practice. • Perform Steps 1, 2, & 5 on the right. • If possible, keep your back off the back ofthf the ch ai r so thtthat you ex tensor • End with a sitting Sunset Breath. muscles have to work. • Repeat on the left. • Work your whole posture. • Let’s do 5 on each side.
How does that feel? The Intent & TC Principles
• What differences do you feel in your arms? Trunk? Legs? • They remain virtually the same. • Hbtbthi?MtlHow about your breathing? Mental • If anything , they are intensified as the focus? Mood? patient can now be more aware of postural alignment, balance, and the • Is your balance challenged? quality of movement. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Who could benefit? Learning to Balance
• What patient populations could be helped by sitting tai chi? • Back to the basics. – BlBalance pro blems • Sitting ba lance is an – Breathing +/or endurance problems important “baby – Patients on restricted WB step” on the way to –Anxiety function. – LE problems
Challenging the Patient Challenging the Patient
Improving sitting balance & strength For breathing and endurance problems – Sitting Posture – Do tai chi non-stop for aerobic capacity. • Su pported to uns u pported sitting – Use calming imagery of flowing water. • Unsupported sitting to balance disc on seat • Emphasize trunk movement (contract/expand) – Emphasize expansion of chest during chungs and side out-block. – Head/eyes in neutral to following hand – Emphasize relaxed “chung” – Untargeted “chung” to targeted
Challenging the Patient Challenging the Patient
Sit-to-Stand Transfer Sit-to-Stand Transfer
Moving freely By using tai chi posture between postures is & rooting principles , important in tai chi patients can better as well as being a control the activity. mobility task in rehab. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Challenging the Patient It’s still a martial art
Knowing when to Supported Standing emphasize the fighting aspect of As with all activities , titai chi tai chi can be done in a protected • Macho standing posture. • Release anxiety • Just for Fun
The form vs. the steps Review of Tai Chi Principles
Reminder • Whether sitting or standing, the tai chi • The steps of tai chi principles remain the same. (sitting or standing) can – PtPostural lli alignmen t be used as ther ex. – Rooting (weight distribution) • The form tai chi – Intent (including the eyes) helps restore – Expansion and Contraction general function. – Connected movements (like a string of pearls)
Review of Tai Chi Principles Tai Chi is Different
• Yielding • Tai chi also exercises the mind. • Breathing • It is therefore, never boring.
• Have FUN!!! • There is always some way to challenge
(In China, they refer to the patient practicing tai chi as – Teach a new step, a new stance, etc. “playing” tai chi!) – Show the intent in self-defense Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Tai Chi is Different
• One reason that tai chi has such a high compliance rate is because it is DIFFICULT, not because it is easy! • There is a high sense of accomplishment. • It is also fun. • Its main side effect is being beneficial to body and mind. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Goldstein’s Balance Program
• I have tried to use a variety of postures and Goldstein’s Tai Chi Balance levels to create this program. Progressions • Once again , no tai chi instructor or practitioner outside this course will have heard of this program. • Please refer to your manual for a concise version of this balance program.
Goldstein’s Balance Program Sitting Balance Program
• This is not the only balance program • Level 1: Wu shi posture that can be created out of the exercise • Activity over when back slouches. Measure time. form tai chi. • Level 2: Add Qi Gong exercise • Symmetrical to asymmetrical • You have permission to use the sheets • Measure time or number of reps. in your manual for documentation purposes as long as you do not change • Levels 3 & 4: Sit on balance disc them. • Level 5: Sit on physioball
Medical Documentation Standing Lateral Stability
• Place a copy of the Sitting Program (that is in • Level 1: Wu Shi posture your manual) into the patient’s chart as a reference for insurers. • Level 2: Horse position weight-shift • Level 3: Add foot-glide in and out
• This should greatly simplify the ability to use • Level 4: Add hip flexion (complete unweighting) tai chi for balance, while fulfilling basic • Level 5: Add Golden Rooster documentation requirements. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Lateral Stability Program Lateral Stability Program
Level 1 Level 2 • = the standing qi • Horse position or gong Wu Shi . Wu Shi posture • Can progress with • Rooted weight-shift – Hands on water • Directed by waist – Standing like a tree • Powered by legs
Practice Levels 1 & 2 Lateral Stability Program
• Level 1 we have done before as a Level 3 meditative Qi Gong. – Gliding foot stays in contact with floor
• Ll2ithihthiftMkLevel 2 is the weight shift. Make sure Level 4 you glide your pelvis side to side. – Gliding foot lifts off completely • Don’t bop up and down. – When placed back down, stays in contact with floor again • Pretend the ceiling has been lowered. – Stance knee and ankle kept bent & rooted
Practice Levels 3 & 4 Mandatory Practice Time
• Make sure you keep the gliding foot in • 10 minutes to review contact with the ground. • STOP, REWIND, REPlAY, and • Recen tblt balance researc hidith indicates thtthat REVIEW this “light touch” provides valuable feedback to our balancing mechanism. • Only need to lift foot off ground 1 inch. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
MANDATORY PRACTICE Lateral Stability Program 5 minutes Level 5 STOP, REWIND, REVIEW: Golden Rooster Practice Level 5 - Rooster
– Add UE in-block to same side as flexed hip – Stance leg flexed and rooted
Lateral Stepping Lateral Stability Program
• Combine the weight-shift with a step to Lateral Stepping with Weight Shift the side. – Similar to side-stepping but… – Uses tai c hi con tro lle d we ig ht s hift • Both knees & ankles kept flexed • Abduct left leg out, touch toes then heel NWB • Gradually weight the left leg (unweight right) • Adduct right leg in, repeat
Practice Lateral Stability Program
• Lateral step with weight shift Wave Hands Like Clouds with Stepping
– Keep both knees flexed. – Very advanced – Step ou t toe fi rst , th en h eel with no WB . – Then weight that side. – Combines Qi Gong with weight shift – Slide the other foot in. – Progresses to lateral stepping Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Lateral Stability Program Challenging the Patient
Wave Hands with Stepping Advancing the Program – Add weights or go slower – Increase step length – Use unstable surface • ie. foam mats, foam rollers, etc. – Close eyes
Review Lateral Stability Program Review Lateral Stability Program
Levels 1 - 5 Lateral Stepping Program – Begins with even weight-bearing – Uses control instead of momentum – PtihtProgresses to weight-shifting – Uses sensory input from gliding leg Cloud Hands with Stepping – Strengthens stance leg – Ends with FWB and NWB – Adds trunk rotation – Coordinates total body movement
Review Lateral Stability Program Medical Documentation
Important Point • Remember to place a copy of the Lateral Program (or something similar) into the patient’s – Goldstein’s Balance Programs do NOT chart as a reference for insurers. replace what you’ ve already been doing to promote balance and functional gait. – We need to control momentum as well. • This should greatly simplify the ability to use tai chi for balance, while fulfilling basic – Do both programs! documentation requirements. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Standing A/P Stability A/P Stability Program
• Level 1: Front Stance Level 1 • Level 2: Empty Stance • Front Stance – Hands resting b y side • Level 3: Anteroposterior Weight-Shift • Can progress with • Level 4: The Road Ahead – Bilateral chung • Level 5: Crane Stance – Weight distribution from 50/50 to 70/30
A/P Stability Program Practice Levels 1 & 2
Level 2 • This is a review of two of the stances. • Empty Stance • In front stance, begin with equal weight on each leg = 50/50 – Back leg “rooted” – Front foot “light” • Now put more weight on front leg without bending your back over leg. Just shift. – Alter front foot position • Empty stance is with 90% of weight on the • Quadriceps intensive! back leg.
A/P Stability Program Practice Level 3 Weight Shift
Level 3 • Begin in front stance. Keep the step length relatively short. – Weight-shift back and forth between Front Stance and Empty Stance. • NhiftihtbktbklNow shift weight back onto back leg. – Progress by changing front foot position The back leg knee should bend. • Foot-flat • Shift back and forth, by gliding “under • Toe-off the ceiling”. Don’t bob up & down. • Heel-off (cat stance) Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
A/P Stability Program A/P Stability Program
Level 4 Level 5 • The Road Ahead • Crane Stance (the icy path) – Begin in cat stance – Similar to compass tapping – Spread “wings” – Back foot “rooted” – Lift front foot up off of – Slide “empty” front foot ground along ground
Practice Level 5 Forward Stepping
• Crane Stance is similar to the Golden • Now we need to combine the weight- Rooster, but with wings to sides. shift with a step forward. • AtiitActivity goes from li lihtght we ihtight-bibearing • This is ca lled Tai Chi Wa lking. on front leg to non-weight bearing.
A/P Stability Program Practice Tai Chi Walking
Tai Chi Walking • Remember the slower this is done, the – Begin forward (similar to duck walk) harder. • Both knees & ankles lightly flexed • RtitRoot into your an kltkles at every s tep. • Step forward with right foot into empty stance • Flatten right foot but still NWB • If this becomes easy, you can alter the • Shift weight onto front foot gradually step direction 45° when this walking • Glide up rear foot into cat stance (empty) becomes “crescent walking.” Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
A/P Stability Program Challenging the Patient
Tai Chi Crescent Walking Advancing the Program – Progress direction to 45° – Add weights or move slower • Both knees & ankles lightly flexed – Increase step length • Step 45° forward with right foot (empty) – Use unstable surface • Flatten right foot but still NWB • ie. foam mats, foam rollers, etc. • Shift weight onto front foot gradually – Close eyes • Glide up rear foot into cat stance (empty)
Review A/P Stability Program Review A/P Stability Program
Levels 1 - 5 Tai Chi Basic Walking – Begins with even weight-bearing – Controls weight-shift instead of using momentum – PtihtProgresses to weight-shifting – Uses sensory input from gliding leg Tai Chi Crescent Walking – Strengthens stance leg – Adds maneuverability – Ends with FWB and NWB – Requires more strength and stability
Review A/P Stability Program Medical Documentation
Remember… • Remember to place a copy of the A/P Stability Program (or something similar) into the – Goldstein’s Balance Programs do NOT patient’s chart as a reference for insurers. replace what you’ ve already been doing to promote balance and functional gait. – We need to control momentum as well. • Flow sheets can then refer to this program.
– Do both programs! Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Recap of Balance Progressions Balance Progressions in Manual
• Remember you are more than welcome to copy the Balance Progression as is, in your manual for use in the medical record. • You do not have the right to alter the Balance Progression and use my name or picture on the form. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Critical Thinking • With this intro to tai chi, can you see how to use it to help your patients? Critical Thinking • UtilUp until now, you hblihave been learning a new skill set. • You haven’t had much time to process the information.
Critical Thinking Critical Thinking
• What tai chi activities would help you • What tai chi activities would you use for teach a patient to get off the floor? an 8 year old child with a loss of ROM from a fractured wrist? – BlBalanc ing in fron t s tance – Crane Takes Flight – Bird’s beak and chung attacks – Controlling breathing – Crane Takes Flight – Mental focus – Crane Spreads Its Wings
Critical Thinking Critical Thinking
• What tai chi activities would help a • What could you use to patient with reaching ability? teach opening a door? – The ch ung (open pa lm-stik)trike) – CSdWiCrane Spreads Wings – Targeting with the chung attack – Chung – Step 1 or 2 of Tai Chi Chung – Step 5 of TC Chung – Crane Spreads Its Wings – Bird’s Beak (for Grasp) Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Critical Thinking Critical Thinking
• What tai chi activities would help a • What tai chi activities would help a patient with hemiparesis regain sitting patient with emphysema increase balance? tolerance for ADLs? – Sitting Qi Gongs – Qi Gong focusing on relaxation, or on – Sitting Tai Chi expansion/contraction of chest – Sitting Balance Progression – Main form Tai Chi Chung focusing on relaxed movement done aerobically.
Critical Thinking Critical Thinking
• How about getting • What tai chi activity would be beneficial on & off the toilet? for a patient who works all day at a comppyuter keyboard? – Ll2Level 2 Crane Takes Flight in – Crane Takes Flight Infinity Posture with – Bird’s Beak arms in front – Tai Chi main form
Critical Thinking Critical Thinking
• Which tai chi activities might be better • Which tai chi activities might be better for children under 12 years old? for teenagers? – Qi Gongs – MiMain form titai c hi – Imagery – Self-defense applications of tai chi – Building blocks of tai chi – Wave Hands Like Clouds
Elyse HS Story Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Critical Thinking Beneficial for Your Patients
• What tai chi activities can help YOUR • If you think that tai patients? chi has potential to help your patients, or your mother, or your children, or yourself… • You might want to learn more.
How do you find a class? General Class Information
• Levels: – often mixed – beginner to advanced students in same class • This sometimes causes concern for new students.
General Class Information Understanding Tai Chi
• How long does it take to learn the basic • How long does it take to really “shape” (choreographed steps) of tai chi? understand tai chi? – Short form: under a year – Long form: 1 - 2 years
• Why is there such a large range? • Master Liang’s answer: Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Let your fingers do the walking Call and ask questions
• Check on-line • Try to speak directly to instructor. • Check phone book • GlGauge general • Check with recreation demeanor. departments • Be inquisitive, but • Check local colleges respectful.
Questions to ask Questions to ask
What style of tai chi? What is the focus of the class? – Actual style does not matter. – Self-defense (push-hands, sticky-hands) – What matters is that instructor knows that – SlfSelf-i&hlhimprovement & health there is more than one style of tai chi. – Spirituality – Beware of exaggerated claims and – Relaxation boasts that “this style is the best, etc.” • Is this what you want or need?
Questions to ask Questions to ask
Does the instructor still study tai chi? What are the instructor’s credentials?
– Veryyp important. – Affiliated with any school or master?
– Best instructors continue to learn. – How long has he/she studied tai chi? – Even masters study with other masters. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
Instructor Credentials Questions to ask
• Caveat Emptor: How large is the class? Buyer Beware! – Class size ranges from 4 to 50+. – Arthritis Foundation – Large class can indicate popular teacher. – Internet certifications – Large class has a lot of energy. – No belt system – Small class has more individualized – T.T. Liang’s “diploma” instruction.
Questions to ask Questions to ask
Can you take a free class? Can the instructor modify the movements for any injury or – No matter the format, (on-going class, 8-12 problem you may have? week seminar, etc. ) you should be able to try one class free. – Hopefully yes, but some instructors insist there is only one way to do tai chi “right” – If the instructor insists you must pay before trying a class, money is more – If you have an injury, find a better important than learning. Walk away. qualified instructor who can protect you.
The Answers The Answers
• Need to match your goals and desires • Does the instructor’s temperament or as best as you can. teaching style suit you? • After try ing a c lass, does it fee l “r ig ht”? – KldblKnowledgeable – Respectful • Do you like the other students in the – Pleasant class? – Controls the class so learning can occur Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
The Answers What if you can’t find a class?
• Are the classes close to home or work? Options:
– Remember, we are only human. • Kung fu class? – The proximity of the class matters. • Tae Kwon Doe or Karate class? – Ask yourself, if it is a cold or wet night, will you still go to class if it’s 30 minutes away? • Yoga?
Other Resources This Course
• Because it is difficult to learn tai chi • On-line courses without a live instructor, this course has • Instructional DVDs focused on qqgi gon g and a modified eas y form of tai chi. – Can learn basic Qi Gong – Very difficult to learn • I hope that you will be inspired to seek tai chi out a tai chi instructor and explore tai chi in more depth.
Other Styles of Tai Chi Other Resources
• Remember there are hundreds of styles • Books of tai chi and qi gong. • Internet
• The most popul ar f orm i n th e wor ld is – Difficult to learn tai chi the yang style of tai chi chuan. and qi gong • I have introduced you to only one minor – Excellent for history, viewpoints, concepts, style of tai chi and some basic qi gongs. and principles. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
But, You Have Work To Do The Best Way to Learn Tai Chi
• I still recommend that you practice • Without doubt is with an instructor. these techniques until you become ppgroficient enough in them to teach your • But what do you know that an instructor patients. does not?
• Your patients will know if you are not • You know about patients, pathology, sure of yourself, won’t they? rehabilitation and restoring function.
How Will You Know? How Will You Know?
• How do you know when you are • When you can do the first 5 steps of tai proficient enough in this rehab tai chi? chi main form, facing in the same direction,,p for 5 repetitions… • Firs t o f a ll, r ig ht now you are rea dy to teach any of the basic qi gongs. • You are ready to go “back and forth” doing tai chi continuously. • You could probably teach the Balance Progressions as well. • Let me show you what I mean by that.
How Will I Know? If you do all that
• When you can do the first 5 steps of tai • You will have an amazing amount of tai chi continuously back and forth without chi movement. a mistake 4 times… • You w ill have many op tions o f teac hing • You can teach yourself the form “lefty” the building blocks or the whole form. or on the opposite side. • Instead of having 5 steps, plus the • Let me demonstrate that for you. opening and closing qi gongs = 7 steps Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
If you practice… Tai Chi as a New Tool
• You will have 10 steps, plus the opening • I hope you can see that tai chi can be and closing qi gongs for a total of 12 used as an exciting new tool for steps of tai chi movement. rehabilitation. • This is plenty for rehabilitation purposes • But it is not for all patients. • This is even enough to begin a wellness • No treatment tool or exercise is useful group with. for every patient.
Tai Chi is the Same But Tai Chi is Different
• Yes, tai chi is just another exercise. • Aside from being challenging and complex, people feel strongly about • Yes, it has been tested for hundreds, if doing tai chi. nottht thousand s o f years, and dh has been found to be beneficial for health. • Patients and students are captivated by • Yes, it is the second most-used it and want to learn more. exercise form in the world.
Tai Chi is Different Tai Chi is Different
• It is difficult for me to convey to you how • Mary is 65 years old and has severe people feel about tai chi. Parkinson’s Disease. • She agree d to answer some ques tions about her tai chi training. • So I would like you to watch an interview I had with one of my students • Neither she nor I knew what I was going by the name of Mary Maguire. to ask her. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com
What did you see? What is it?
• She does not talk about tai chi as most • Honestly, I’m not sure. people talk about going to therapy or gggoing to a gym. • Tai chi is truly captivating if not somewha t a ddic tive. • There is something else going on here. • Maybe it is the positive message tai chi • Tai chi touches people beyond mere conveys of being about ability rather exercise…beyond mere therapy. than disability.
Thank You Wrap Up
• For taking your time to learn about tai • I hope you will consider seeking out a chi and how it can benefit you and your tai chi instructor and learning more patients. about tai chi yourself. • I think you can see that we have just • But if you don’t, this course should have scratched the surface of how tai chi can provided you with sufficient knowledge be beneficial to us as well as patients. and skill of basic tai chi and qi gong techniques to help your patients.
Remember Mailing List for Courses • If you or your patient make mistakes • If you would like to be on my preferred learning this highly advanced motor skill mailing list for QUEST’s on-site activity…LAUGH! courses,,y you can contact me with y our information at [email protected]. • And try again. • Thank you for participating in Tai Chi for • Never forget that Tai Chi is FUN! Balance and Function. Tai Chi Balance Exercise Progression
Trudy S. Goldstein, PT
Sitting Program
Level 1: Chair with hips/knees at 90/90 and both feet flat on floor, back unsupported. Deep breathing. Static trunk. Progress arm position from resting to “hugging”. a. resting on lap or table or arm rests b. out to sides as if palms resting on top of water c. “hugging” a tree trunk at belly button level
Activity “over” when back slouches. Measure time to document endurance.
Level II: Chair with hips/knees at 90/90 and both feet flat on floor, back unsupported. Qi Gong breathing with dynamic trunk rotation and arm motion. a. symmetrical Qi Gong movements b. asymmetrical Qi Gong movements
Activity “over” when patient is tired or loses alignment. Measure # of reps.
Level III: Level I sitting on a balance disc, both feet flat on floor, back unsupported.
Level IV: Level II sitting on a balance disc.
Level V: optional: can progress to sitting on a physioball. Standing Tai Chi Balance Exercise Progression
Trudy S. Goldstein, PT
To promote lateral stability
Level 1: Bilateral standing in Eternity Posture (similar to Mountain Pose in yoga). Progress arm position from resting to “hugging”. a. resting by side b. out to sides as if palms resting on top of water c. “standing like a tree”
Activity “over” when patient tires or loses alignment. Measure time to document patient status +/or progress.
Level II: Bilateral standing in Horse Position with knees in proper alignment, hands on hips. Shift side to side slowly, coordinate with breathing. Don’t go up & down, but glide “under a bar.”
Activity “over” when patient tires or loses alignment. Measure # of reps.
Level III: Begin as Level II. Slide one foot in next to the other and then replace it back into horse position. Place the foot down, pause, then shift onto that side. Repeat other side.
Activity “over” when patient tires or loses alignment. Measure # of reps.
Level IV: Begin as Level III. Slide one foot alongside the other, on toes, light WB. Lift up foot (flex hip) and replace it on toes. Glide it along the floor, back to original horse position. Place the foot down, pause, then shift onto that side. Repeat other side.
Activity “over” when patient tires or loses alignment. Measure # of reps.
Level V: (Golden Rooster Stands on One Leg)
Begin as Level IV. While flexing right hip, elevate right shoulder to ~70°, right elbow to ~70°, forearm and wrist in neutral. Place left hand under right elbow, forearm pronated (palm down). Repeat other side.
Lateral Stepping with Weight Shift
Similar to “regular” side-stepping, but uses Tai Chi weight shift. Begin Horse Position or Eternity Posture. Shift weight fully to left with knees flexed. Step out to side with right foot, touch down toes first, then heel. Then “glide” weight over to right. Shift weight over to left leg and continue as above moving toward the right.
Reverse direction.
This activity progresses to “Wave Hands Like Clouds” Standing Tai Chi Balance Exercise Progression
Trudy S. Goldstein, PT
To promote anteroposterior stability
Level 1: Bilateral standing in Front Stance (lunge position). Both sides. Front knee bent, knee does not extend over toe. Weight distribution: 50% each leg to 70/30. Progress arm position from resting to “bilateral push.” a. resting by side b. place arms in 90° or less of flexion, elbows slightly flexed, wrists dorsiflexed
Activity “over” when pt tires or loses posture. Measure time to document endurance.
Level II: Bilateral standing in Empty Stance with knees in proper alignment, hands on hips. Back knee flexed with 90% WB, front foot 10% WB. a. front foot begins foot-flat b. progress to ball of foot (cat stance) or on heel
Activity “over” when patient tires or loses alignment. Measure amount of time in seconds of isometric hold.
Level III: Begin in Front Stance with feet flat: 50/50 to 70/30 Shift position back into Empty Stance 90/10 Shift back and forth as if gliding “under a bar” a. advance to promote heel-toe gait
Activity “over” when patient tires or loses alignment. Measure # of reps or activity duration in seconds.
Level IV: The Icy Path Begin in regular bilateral standing. Shift 100% weight onto left leg. Advance right foot (plantarflexed) ahead and glide toes back and forth in front or to side.
Repeat other side.
Activity “over” when patient tires or loses alignment. Measure # of reps or seconds, and the direction of the foot-glide.
Walking The Icy Path (Crescent Walking)
With FWB on left, place right foot ahead at 45 degrees with no weight on it. Shift weight forward onto front foot.
Bring up left foot even with right with 10% WB for balance.
Shift to FWB on right, place left foot ahead at 45 degrees with no weight on it.
Shift weight forward onto front foot and repeat to other side.
Measure amount of time or distance or # of steps. Home Exercise Programs for Easy Tai Chi
Since you are just learning to use tai chi yourself, you might not feel confident yet in writing out a home exercise program for your patients using the main form of Easy Tai Chi. To help you with this process, I have created three home exercise program sheets for you to give to your patients as you teach them tai chi.
The first home program sheet includes a mini-description of what tai chi is. I find that this is helpful for both the patient and family members, as much misinformation exists on tai chi. This program also includes the Standing Qi Gong “The Sunset Breath” which can be used alone or in conjunction with the form tai chi.
You may find that many of your patients never learn all 5 steps of Easy Tai Chi and that you rarely hand out Program 3, which recaps all 5 steps. Remember, the number of steps taught or learned is less important than the quality of the movement.
You have permission to use my Easy Tai Chi Home Exercise Programs “as is” in the medical record and/or as a hand-out for your patients. You do NOT have permission to change them in any way!
If you wish to create your own HEP based on tai chi, please feel free to do so. There are countless variations that may better suit your therapeutic practice. Just don’t use my picture or descriptions. Make up your own, just like you would any other kind of exercise or activity program.
I hope that these attached programs will help you use tai chi with your patients.
Good luck in your clinical practice.
Trudy S. Goldstein, PT
Tai Chi Home Program: 1
What is Tai Chi?
Tai Chi is an ancient style of martial arts that develops the body gently. It is considered an “internal” or “soft style” of martial arts and should not be confused with the “hard” styles that are depicted violently on television. Using slow, choreographed movements combined with controlled breathing, the body becomes stronger and more flexible. Tai Chi practice can improve heart and lung function, coordination, agility, and immune function. It has also been proven to reduce stress, improve concentration and memory, and elevate mood. Daily Tai Chi practice has been likened to a mini-vacation for the body and mind, resulting in an energetic feeling of well-being.
The Sunset Breath
Try to clear your mind of the outside world. Stand (or sit) with your legs shoulder-width apart and your hands by your side. Slightly bend your knees and relax while breathing normally.
Circle your hands to the outside, with your palms facing upward as you inhale.
Bring your hands together in front of your body or over your head, palms facing down.
Slowly exhale as you drop your hands down in front of your body, as if “pushing down on a light giant spring.”
Try to breath (diaphragmatically) in through your nose and out through your mouth.
Tai Chi Chung: Step 1
Bring your hands to your pelvic crest, resting palm up.
1. a. Step forward with the right leg. The right knee is bent, the left knee is straight.
b. The left hand scoops (blocks) up CCW from groin, past face circling back down to reset, palm up on pelvic crest.
c. The right hand attacks (chungs.)
Practice 10 reps, 2x/day. Relax and concentrate on flowing movement. Call with any questions.
Easy Tai Chi Home Program: 2
Begin with Sunset Breath.
Tai Chi Chung: Steps 1 -4
1. Step right into front stance, scoop left arm, chung right.
2. Side out-block to left with left arm. (Elbow bent, hand palm-up) Chung to side with left. Relax wrist and hand.
(Prepare for step 3 by bringing both hands, palm up, to pelvic crests.)
3. Tap left leg forward and turn 180° pivoting on your right foot. Your left leg (knee bent) should now be forward of your right leg.
Left hand scoops up CCW from groin, past face, over head and resets while the right hand attacks (chungs).
4. Repeat step 2 with left side out-block and left side-chung. No step.
End with Sunset Breath.
Step right foot up even with left foot and keep knees unlocked.
Circle both arms (as if doing a jumping jack) so they meet at your head, as you inhale. Slowly lower your hands, past your face and body, as you exhale.
Practice ___reps, ___x/day. Relax and concentrate on flowing movement as if in water.
Don’t worry about making mistakes. That is how we all learn. Call with any questions.
Easy Tai Chi Home Program: 3
Begin with Sunset Breath or Lotus Blossom
Tai Chi Chung: Steps 1 -5
1. Step right into front stance, scoop left arm, attack (chung) right.
2. Side out-block to left with left arm. (Elbow bent, hand palm-up) Chung to side with left. Relax wrist and hand. (Bring hands, palm up on pelvic crests.)
3. Tap left leg forward and turn 180° on your right foot into front stance. (Left foot forward, left knee bent, right knee straight.)
Left hand scoops up CCW from groin, past face, over head and resets while the right hand chungs (repeats step 1).
4. Repeat step 2 with left side out-block and left side-chung. No step.
5. Sink 90% weight back onto right haunch with right knee bent. Bring hands and elbows together in front of chest.
Shift weight forward and double chung.
End with Sunset Breath.
Practice ___reps, ___x/day.
Relax. Imagine you are in a peaceful place, with the sun shining on you. Feel its warmth. Meditate. Breathe slowly and deeply. Think positive thoughts.
Call with any questions.
Take a Live Tai Chi Course With Trudy
I hope that you have enjoyed this video presentation on Tai Chi and that it has inspired you to learn more about tai chi and qi gong.
Every year, I present three live Tai Chi for Rehabilitation conferences. If you would like a more interactive educational experience, where I can actually “correct” your movements and answer your questions directly, I would like to invite you to attend one of my workshops at a HUGE discount.
In addition to Easy Tai Chi, you will learn and become proficient in the first 5 steps of Level 3 Tai Chi and Level 1 Tai Chi for Balance. Plus you will get some needed practice time in a relaxed educational setting.
The cost of the 12 hour Tai Chi for Rehabilitation course is currently $415, but since you have already attended this video seminar, you can come for just $135. You will still get the complete course handouts and CEUs for 12 contact hours through my company QUEST Seminars.
In order to see the dates and locations of my upcoming courses, please go to my website www.questseminars.com. You can download a PDF brochure of my course which includes a registration form.
If you would like to attend, simply fill out the registration form and mail it in with a check made out to QUEST or Trudy Goldstein for $135. On the Knight Discount line, write in “Treatment2Go.”
If you happen to find a different course on my website that you would like to attend instead or in addition, you can still take a (smaller) discount. On the Knight Discount line of the brochure, write in “Treatment2Go” and take $25 off the listed tuition.
I hope I get a chance to meet you in person at one of my “Onsite conferences.”
Sincerely,
Trudy S. Goldstein, PT QUEST Seminars 25 Mountain Road Burlington, MA 01803 781-273-4978 [email protected]
Exploring Hand Therapy d/b/a Treatment2Go www.handtherapy.com & www.treatment2go.com
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