Notes on Anatomy and Physiology: Teaching Our Art in a Nursing Home

Not quite seven years ago, a well-known Australian geriatrician and member of the Taoist Tai Chi Society, Dr. Dick Lefroy, sent me a tape of people practicing the Taoist Tai Chi™ internal arts of health. All were residents of a long-term care facility. Each was dealing with dementia or with another disabling medical condition such as motor neuron disease or cerebellar stroke. Viewing the tape was so moving that the experience remains with me still. The real power and beauty of our art seems most apparent when practiced by those with significant health problems.

In an accompanying letter, Dr. Lefroy raised three questions. What follows is an outline of the questions he posed and a slightly edited version of my response at the time:

1. Can the performance of those with dementia, limited to an eccentric rendering of the foundation exercises, be regarded as Taoist Tai Chi™ internal arts of health?

To me, there’s no doubt that they are practicing the Taoist Tai Chi™ internal arts of health. Not perhaps in a way that is elegant to the eye but certainly in a fashion that introduces their bodies and minds to an exercise form that has a very long history. A form practiced in disparate parts of the world by students who find themselves in hugely different circumstances. A form capable of improving the health of all who make regular use of it.

Of course, the interpretation of the form will be significantly altered by each person’s health and situation. It is our instructors who help us gain the most benefit, stretching out the soft tissues, increasing strength and balance, taking pleasure in what our bodies are still capable of doing or relearning, and enjoying the company of others engaged in the same pursuit.

My first real experience of teaching students with dementia came when we set up a class in a nursing home close to where I live. Quickly, I realized that instructing in that setting was not at all like teaching during a health recovery week or class. Classes in a nursing home have their own priorities. Rather than looking for a profound change in the person’s physiology, one’s focus becomes providing, on a regular basis, an hour or so of friendship, pleasure, interest and satisfaction, knowing full well that the details of today’s teaching could be taught tomorrow as if it was fresh information.

And yet the situation in a nursing home is often more complicated than that. There are also residents with wrecked bodies but clear minds who are able to retain what they have learned and make definite progress over time if we guide them well.

2. Do those with dementia achieve physical and/or mental benefit from their practice?

Yes, they do. But we see the changes as modest when judged by the benefits experienced by those who practice without mental impairment.

I am reminded, as I write, of the extreme delight routinely provided by the sitting kicks to a man with cerebral palsy who has spent all his life in a wheelchair. He gets so much joy each time the kicks are done that he almost falls out of his chair. His delight is shared by all in the room. And although his form is very unusual, he is not hurting himself.

There is another woman, heavily sedated, who always falls asleep part way through the class. But she always beams when she sees me arrive.

Are these modest benefits worth the intervention? I believe they are and for the same reasons we care for anyone who has a progressive illness or is dying. For some with large cognitive deficits, the class may be primarily a way for us to enter into their lives, a structure that gives initial shape to a connection with people who have become invisible to society and often even to friends and family. The foundation exercises may be about all that they can manage but they are moving and temporarily engaged, and someone from the outside world is showing an interest in what their long lives have meant.

3. Who is able to teach this art – therapy staff (when available), visitors from the Society (when available) or other caregivers on staff?

For me, only students of the Taoist Tai Chi™ internal arts of health should instruct these arts. This applies as much to the nursing home situation as anywhere else. It takes a discerning eye and lots of experience to know what the art entails and what other things the Society has to offer. To judge what exercises would be most beneficial for a particular student and to respond to problems like a severely arthritic shoulder or a paralyzed side. To determine when it is safe to have the student stand or to remove the arm supports of a wheelchair to make more room for the body to practice.

You need to experience personally the benefits of this discipline to believe in its potential value for others and to have the patience to teach in often trying circumstances. The deeper our understanding, the more able we are to guide the practice of our students. And instructors need the support of others in the Society to remember that they are not just teaching an exercise and to gradually appreciate what it means to care for those who are ill or dying.

We do need to train more instructors to meet the increasing demand for classes in nursing homes. Each class presently being offered is an opportunity for a more seasoned teacher to train those more junior. Little by little, we will build the resources to offer instruction wherever interest is expressed.

Bruce McFarlane MD

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Filed under Anatomy and Physiology, Health Recovery, Health Watch, Helping Others

7 responses to “Notes on Anatomy and Physiology: Teaching Our Art in a Nursing Home

  1. When we think about the aims and objectives of the society, including “bringing Taoist Tai Chi to all communities”, I guess that nursing homes are simply another type of community in which individuals can directly benefit from practice of Taoist Arts. Some years ago here in Maldon, a tai chi class was started in conjunction with Age Concern, a non-govornmental body, and a local “Fall Stop” programme goverened by our local hospital. The participants had each experienced a fall, mainly connected with ageing, or had mobility issues, and were offered tai chi as a preventative measure against further injury. I remember watching a sports physiologist conduct a range of tests for each participant, including balance, strength, co-ordination, resting heart rate, blood pressure and lung function. These tests were repeated at 3 and 6 month intervals, and when compared against the original results clearly demonstrated remarkable changes, with the peak flow capability standing out as the most-improved function. Around this time I read a research paper that was investigating a relationship between lung function and the onset of dementia (Guo et al, Midlife respiratory function and the onset of Alzheimer’s) and remember thinking that if a little gentle exercise can have such a positive effect on lung function, then there should be the potential to benefit cognative ability and hopefully stave off deterioration in old age- health in the bank, it would seem. The mean age of the group was close to 70, showing that age itself is no barrier to improved health, demonstrated by some participants as a reduction in hypertension and associated medications, and a decreased use of asthma inhalers. The psycho-social aspects of well-being are harder to measure directly, but here in Britain, tea and cake always brings a smile, and I remember long, noisy teabreaks as people made new friends, helping to reduce the isolation that ageing sometimes brings.
    It seems then, that Taoist Tai Chi really can benefit body and mind, and that moving, breathing, relaxing and chocolate cakes are the secret weapons against old age!

  2. Jacky van den Boom

    Thank you so much Bruce for sharing this. Right time, right moment, right place: we will start a class in an intercultural nursing home in The Hague, The Netherlands in September!

  3. Marianne Schreuders

    Bruce,

    Thank you. I just finished my first season as a beginnersinstructor in the Netherlands. Reading this articles makes me even more determinded to do my very best to practise and develop my understanding of Taoist Tai Chi, so may be one day I may experience the joy of teaching a class in a nursing home.

  4. Julie A Gilligan

    ‘Little by little we will build the resources to offer instruction wherever interest is expressed.’ Yes indeed! I think this also depends to a great extent on the initial ‘interest’ being stimulated by proactive members and instructors spreading the word. I have been fortunate to take part in several local demonstrations to various ‘support groups’ for those living with such degenerative conditions as MS, Parkinson’s Disease and Motor Neurone Disease. Not only have these been a pleasure, they have helped me appreciate how the practice of Taoist Tai Chi can give people something positive when everything seems negative, and hope (realistic not miracle cure) when despair has set in. I write as someone who has lived with Parkinson’s for 12 years, has practised Taoist Tai Chi for six of them and instructed for two. Establishing classes in nursing homes would be wonderful and I would add hospitals, day care centres and patient involvement groups attached to medical practices (both conventional and complementary). The resources to do this would be extensive – and somewhat daunting I suspect – but I think that those of us who have benefited directly from Master Moy’s legacy need to speak out more and lift our heads out of our own personal comfort zone. And I rather think that the beneficiaries are every member, not just those who admit their dis-ease! Health Recovery Workshops (as I have discovered) are a real eye-opener, guaranteed to destroy any residual complacency and I think to awaken the understanding and compassion that is within us all. I think every instructor would benefit by going to one!

  5. vilda

    I wouldn’t go near a place where a resident was “heavily sedated”. I would not be able to just ignore it and congratulate myself because she smiled when she sees me. Nice for your ego. This woman is being sedated to death.

  6. Couple of years ago I was working for a disability charity and went to a specialist modern home for people with cerebral palsy. Most of the clients were showing significant curvature and were not receiving physiotherapy.

    I have in the past managed homes for people with dementia.

    My experience is that tai chi is very able – easily – to create lasting and excellent change. The problem is there are not enough qualified instructors and the task is huge – all people in “total institutions” and related extra care, sheltered and similar facilities need this!

    (Majority of the population actually!)

    I think taoist tai chi is well able to create revolutionary change in all our health and well being.

    How can we in the words of Picard “Make it so”?

  7. Pingback: Tai Chi bij dementie | werken in de ouderengeneeskunde

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