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Adapted Taiji/Qigong in ADHC Settings: Overview

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 10, 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:

RELEVANCE

TAI CHI-QIGONG

SAMPLE MEDITATION

EXPERIENCE SITTING ROUTINE

‘BEST PRACTICE’ PROJECT

PLANNING FOR SUCCESS

SHORT DEMO

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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Physical Activity Mode:

Adapted Tai Chi/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 setting has been established.

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Tai chi chuan(grand ultimate) has martial arts origins. (200 AD, 1700’s, 1956) Choreographic dynamic postures

Qigong (air & rice ) has origins in Chinese Medicine (700 BC) mindful meditation (moving and static postures & self massage)

What is Tai chi/Qigong?

Meditation

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Sitting Routine

LET’S PLAY

“A quiet time to come together.”

Demonstration Project

Study Design: controlled clinical trial – pragmatic

Setting: 2 Day Hab Centers in WNY (PEOPLE, INC)

Populations: Day Hab participants (311) and Staff (80+)

Intervention arms:Center 1 (n=99) AM DVD-led CHI TIME Ex + PM RelaxationCenter 2 (n=104) PM staff-led Relaxation CHI TIME

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

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What do you see?

DISCUSS…

Day Hab Clients

Age range 18-87 yrs

60% severe or profound ID

ID, Seizures, CP, Autism, many multiply Dx’d

Vast majority non-ambulatory or balance impaired

(Direct Care Staff turnover 20-25% annually)

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Evaluation DATA

Daily logs of activity Participant engagement through daily log

reports Staff survey (anonymous) Focus groups Behavioral incident reports Fall data

CHFWCNY Falls collaborative

‘Best practice’ attributes

✔Admin approval = integration✔Staff approval = value perceived✔Client approval = enjoy✔Behavioral effect = quality of life✔Feasibility = sustainability

CHFWCNY Falls collaborative

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Admin Approved ✔

“The building has a different feel. (Quieter)”

“Less time dedicated to behavioral incident reporting,result: more personal time with the individuals”

“Expect this to improve staff retention.”

“We are expanding program to all of our Day Habs.”

“Requests for the DVD from our group homes andfamilies.” (included CHI TIME as part of our Family Day)

“We are in the process of getting the music played duringtransport.”

Staff Approved ✔

“I get to interact in a different way (a morepersonal level)”

“Creates ‘good energy’

“It relaxes me”

“The end-of-the-day CHI TIME is lovely. The lightsare out, and it is very relaxing.”

“We highly recommend this program.”

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Staff Feedback

… knows the routine anticipates the next exercise (some within 1-week)

… self-stimulating behavior (rocking) lessens

… socially disruptive behavior (yelling) is extinguished or lessens

… self-injurious behavior extinguished during and after our sessions

… participates by holding the CD player – behavior calms, able to join in a group activity

… increased socialization

Client approved ✔Tai chi makes me ...

“Feel Good”

“Happy”

“Cool, Calm & relaxed”

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Results (6 mos)

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

Approval: Admin 5/5 Staff 4.1/5 & 4.2/5

Client participation E1 64.79% & E2 67.28% (10-15% absent/day)

Behavioral incidents

E1 17.6% DVD-led

E2 22.6.% staff led

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)

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Begin Success from the TOP

Incorporate the program into Valued Outcomes

‘Champions’ are Key to Success

Our ‘Chi Leaders’Administrative, Staff & Client approved ✔

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Planning

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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My wish list

Standardized training for programming co-ordinators and direct care staff

Funds to develop training materials

Corporate partners to implement programming

Demonstration

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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