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Treatment2go Exploring Hand Therapy Tai Chi Flow Into Function Treatment2Go Exploring Hand Therapy Manual Tai Chi Flow Into Function Mandatory Practice time indicated in manual Exploring Hand Therapy, Corporation d/b/a Treatment2Go www.handtherapy.com www.treatment2go.com 727-341-1674 Fax: 727-388-3904 Treatment2Go is a trademark and d/b/a of Exploring Hand Therapy. Exploring Hand Therapy/Treatment2Go www.handtherapy.com & www.treatment2go.com 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 rs t 5 s teps o f Tai 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 secon d 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 in 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 me diihdicine 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
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