ADHCA Saratoga, NY Apr 11, Adapted Taiji/Qigong in ADHC Settings: Implementation Tips

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1 ADHCA Saratoga, NY Apr 11, 2014 Adapted Taiji/Qigong in ADHC Settings: Implementation Tips Penelope J. Klein, PT, EdD! Pamela Bartlo, PT, DPT, CCS! Ruth Camann RN, BSN, DOPS 2 George Picard, Taiji master 3 1 D Youville College, Buffalo, NY, 2 People, Inc, Williamsville, NY, 3 St Catharines, ONT Funded in part by: Community Health Foundation of Western & Central NY and D Youville College. Buffalo, NY 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. 1

2 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. 2

3 Solution: In the ADHC setting. Provide daily opportunity for safe, healthpromoting 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. 3

4 Adapted Taiji/Qigong Research Evidence Health benefits of Tai Chi and Qigong are well established. 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. 4

5 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 Relaxation Center 2 (n=103) PM staff-led Relaxation CHI TIME Results: positive Program has been running continuously for 4 yrs at DVDled Center Relaxation/calming effect was the major benefit perceived by staff for themselves and their clients. 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. 5

6 LET S PLAY Sitting Routine A quiet time to come together. Lessons Learned 6

7 Best Possible Outcome 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 Early Resistance Staff objections not my job don t have time against my religion 7

8 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 8

9 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 9

10 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 10

11 Implementation tips Set the Mood 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 tips cont. Especially for Staff-led 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 ) 11

12 tips cont. Integration Incorporate the program into Valued Outcomes 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?

13 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 13

14 Contact georgepicard.com Village of Healing and Wellness 50 Gale Crescent St Catharines ONT Chi Time for Everyone DVD available for purchase: 14

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