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Adapted Taiji/Qigong in ADHC Settings: Implementation Tips

Penelope J. Klein, PT, EdD!

Pamela Bartlo, PT, DPT, CCS!

Ruth Camann RN, BSN, DOPS2

George Picard, Taiji master3

1D’Youville College, Buffalo, NY, 2People, Inc, Williamsville, NY, 3St Catharines, ONT

Funded in part by: Community Health Foundation of Western & Central NY and D’Youville College. Buffalo, NY

ADHCA Saratoga, NY Apr 11, 2014

Objectives:

Explore feasibility of adapted taiji/qigong in ADHC settings

Experience inclusive Eastern exercise (modified taiji/qigong);

Gain from lessons learned from a successful programming trial; and

Suggest implications for practice and adoption of innovation.

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Session Outline:

REVIEW key points from APR 10 Overview

‘BEST PRACTICE’ PROJECT MAJOR LESSONS LEARNED

PRACTICE ‘SITTING ROUTINE’ FROM LEADER PERSPECTIVE

TIPS FOR DIRECT CARE STAFF

Q&A AND CLOSURE

Problems:

Physical activity is recommended for GENERAL HEALTH AND WELLNESS, yet those with CHRONIC MEDICAL PROBLEMS, disability and the elderly are least likely to meet recommended activity guidelines. (Especially true in ADHC settings)

Formal and informal CAREGIVERS of individuals with disability also need to attend to their own health and well being.

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Solution:

In the ADHC setting….

Provide daily opportunity for safe, health-promoting physical activity that could be adapted for individuals with varying levels of physical & intellectual abilities.

Effective, Feasible, Sustainable,

Inclusive, Serve both clients and staff.

Goal

IMPROVE QUALITY OF LIFE WITHIN ADHC OR RELATED SETTINGS FOR BOTH CLIENTS AND

CAREGIVERS

THROUGH

….

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Adapted Taiji/Qigong

Research Evidence

Health benefits of Tai Chi and Qigong are wellestablished. These include: improved sense of well being, calmness, immune boost, cardiovascular response, flexibility, balance and strength, diabetic control, and reduction of inflammation. (eg: heart disease, Parkinson’s, Alzheimer’s, Arthritis, COPD, diabetes, auto immune and immune suppression, brain trauma)

Feasibility of adapted Tai Chi/Qigong in the Adult Day Hab (ID/DD) and Dementia settings has been established.

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Demonstration Project

Study Design: controlled clinical trial – pragmatic Setting: 2 Day Hab Centers in WNY (PEOPLE, INC)Populations: Day Hab participants (202) and Staff (80+)

Length of Study: 6 mos active observation, 12 mos follow up

Intervention arms:Center 1 (n=99) AM DVD-led CHI TIME Ex + PM RelaxationCenter 2 (n=103) PM staff-led Relaxation CHI TIME

‘Relaxation/calming effect was the major benefit perceived by staff for themselves and their clients.’

Results: positive Program has been running continuously for 4 yrs at DVD-led Center

Study Conclusion

It is both feasible and beneficial to offer adapted tai chi/qigong programming, delivered either as DVD-led or staff-led, as an inclusive mind/body activity for adults with ID within the Day Hab setting. Staff-led programming, although more challenging to implement and sustain, appears to have added value. Therefore a combination of DVD and staff-led may be ‘best practice’.

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Sitting Routine

LET’S PLAY

“A quiet time to come together.”

Lessons Learned

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… From the first day of inception this program has had very positive benefits, not just for the individuals, but for staff also. Tai Chi is performed at the beginning of each day and is a great way to set the atmosphere or tone for the day and has absolutely accomplished this in a positive aspect. I would say that probably at least 70 to 80% of individuals actively participate in the actual physical movements of Tai Chi requiring various levels of assistance depending on the exercise that is being performed, with an additional 5 to 10% passively involved meaning paying attention and or performing some of the exercises at there own comfort level. There is no doubt that Tai Chi has had a positive influence, and my observation is that behavior incidents have decreased and the atmosphere of the building is harmonized and peaceful. I must say that the individuals in my room absolutely love it and look forward to participating every day. Chi Leader, DVD-led Center

Best Possible Outcome

Early Resistance

“not my job”

“don’t have time”

“against my religion”

Staff objections

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Passive Resistance

Not attending training sessions

“couldn’t schedule ’CHI Time’ today”

Staff attending to toiletting during this time

Staff using this time to complete paperwork

Staff changing session to more aerobic exercise

Organizational Barriers

PA announcements during sessions

Snack trolley disrupted sessions

Lack of clear staff compliance directives from Center Coordinator

DVD didn’t work

DVD player didn’t work

High OJT training needs in staff-led Center

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OJT trainer notes… (staff-led)

… This room took some time to organize and get settled for CHI time. Two of the participants seemed disrupted and showed slight behavioral withdrawal as they organized for Chi time. Instructors were not instructing at a steady pace and moved to from one to the next movement after 1 or 2 repetitions. I decided to join in and showed the movement in a slower controlled movement with more repetitions. One of the participants did the exercises very minimal. Further encouragement will be given to this room to encourage more participation. None of the participants in this room are wheelchair bound or showing significant ROM issues however, behavioral issues may be the challenges being faced with achieving full participation.

…This room might want to organize chairs into circle instead of rows. That way everyone can see each other to follow along. One person was completely removed from this group. There was one person in the room who tried to participate and seemed to be enjoying themselves. Most of the individuals sat quietly and listened to the music.

Planning for Success

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Successful Organizational Change

Effective innovation (It must work!)

Administrative endorsement (Big Bosses)

End user endorsement (perceived benefit)

Feasibility (congruence/time/effort/training/$$)

Sustainability (operational support)

‘Champions’ are Key to Success

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Implementation tips

Dedicated time to the Tai Chi exercise

Arrange the room – for space and line of sight

Set the mood: adjust lighting (blinds, etc.)

Minimize distractions (hold announcements)

Encourage Individuals to participate in preparing for program

Set the Mood

tips cont.

Know the exercises Know your clients Know your staff

Vocalize some initial direction

Give visual cues

All staff in the room should interact in the program

Integrated into Day Program life (E.G. Stop and do some of the exercises on a walk; after

lunch, before busing, beginning of the day )

Especially for Staff-led

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tips cont.

Incorporate the program into Valued Outcomes

Integration

E.G.Individuals helped lead ex, arrange chairs, and DVD or CD player, turned lights out.

Request to participate – verbalize preferences

Heath benefit

Can this work in your organization?

Who will be the expert at your facility?

What barriers do you anticipate?(Admin. Staff, individuals, family, environment, safety)

What adaptations might be needed?

How can we help?

kleinqpj@roadrunner.com 716 691 8578

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Q & A

My wish list

Corporate partners to endorse programming

‘Champions’ to implement

Standardized training for programming

co-ordinators and direct care staff

Funds to develop training materials

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Contact

kleinqpj@roadrunner.com

georgepicard.com

Village of Healing and Wellness

50 Gale Crescent

St Catharines ONT

Chi Time for Everyone DVD available for purchase: kleinqpj@roadrunner.com