T’ai Chi Fundamentals®
Scientific Evidence for Innovative
Use of Tai Chi in Rehabilitation, Recovery,
and Wellness
AOTA Conference
April 2012
Charlene Avery, OTR/L, CTI, CLT;
Kelley Hutchison-Maravilla, OTR/L, CTI
Sandy Matsuda, PhD, OTR/L, GCFP, CTI
Tricia Medow, COTA, CTI
Kristi Rietz, OTR/L, CPRP, RYT, CTI
Contributing Author: Tricia Yu, MA
Please note that this session
has been moved to CC 125-126
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Table of Contents
Page
Title page ...........................................................................................................................................1
Table of Contents and learning objectives .........................................................................................2
Schedule for workshop and presenter contact information ................................................................3
Introduction to T'ai Chi Fundamentals® ...........................................................................................4 - 5
Breathing ............................................................................................................................................6 - 7
Pictures and Descriptions of Movement Patterns ..............................................................................8 - 9
Evaluation and Treatment ..................................................................................................................10
Toward More Holistic Therapy .........................................................................................................11
Summary of Research on Health Effects ……………………………..……………………………12 - 14
Guidelines for T'ai Chi Practice .........................................................................................................15
Reminders for Practicing T'ai Chi .....................................................................................................16
Documentation and Billing ................................................................................................................17-18
T’ai Chi Mind/Body Protocol………….……………………………………………………………19
T'ai Chi Fundamentals® Program Reviews, Books & Articles……………………………………..20
References ..........................................................................................................................................21 – 22
T'ai Chi Fundamentals® Certification Information…………………………………………………23
T'ai Chi Fundamentals® Resource Ordering Information .................................................................24
Clinical Overview of Movement Patterns …(To be handed out during Institute).....………………25 - 36
Learning Objectives:
1) Participants will identify the history of T'ai Chi Fundamentals® form with respect to application and
research .
2) Participants will learn 10-12 T'ai Chi Movement Patterns with activity analysis of the movements.
3) Participants will identify 10 therapeutic and health benefits for T'ai Chi.
4) Participants will identify 5 specific applications for O.T.
5) Participants will identify 7 resources of the evidence base for the therapeutic applications for O.T.
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Institute
Introduction: Introduction of presenters
Introduction to T'ai Chi and how it is used in
treatment
Demonstration of T'ai Chi Fundamentals® Form
TCF 1st Section TCF Patterns: Movement lab
T'ai Chi warm-ups
T'ai Chi Movement Patterns
Discuss Activity Analysis, etc: Lecture and Discussion
Research Applications
Activity Analysis & Functional Application
Grading T'ai Chi Fundamentals® for various
populations
Tools to use with T'ai Chi
Review 1st Section
Movement Patterns : Movement Lab
2nd section of T'ai Chi Fundamentals®
Training, corrections, silent practice
Discuss Activity Analysis, etc: Activity Analysis & Functional Application
Handouts: Documentation & Billing
Review
Question and Answer
Movement Patterns & Form: Movement Lab
3rd
Section of T'ai Chi Fundamentals®
Movement Patterns & 1st Section of Form if time
Discussion and Questions
Please feel free to email us with questions. Please put T'ai Chi or WOTA conference in the subject. Thank you.
Charlene Avery, OTR/L, CTI, CLT; [email protected]
Kelley Hutchison-Maravilla, OTR/L, CTI; [email protected]
Sandy Matsuda, PhD, OTR/L, GCFP, CTI [email protected]
Tricia Medow, COTA, CTI [email protected]
Kristi Rietz, OTR/L, CPRP, RYT, CTI ; [email protected]
Contributing Author: Tricia Yu, MA
Thank you very much to Betty Driessen for sharing her handouts and talent as a graphic artist.
Thank you to the many certified instructors who contributed to these handouts.
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FFoorr MMaasstteerriinngg TT''aaii CChhii BBaassiiccss
Introduction to The T'ai Chi Fundamentals® Program
As medical research validates the benefits of T'ai Chi practice, health professionals are seeking training in
this Chinese exercise in order to evaluate its applications as a complementary therapy. Growing numbers of older
adults as well as those with pain and physical limitations are also exploring T'ai Chi as an alternative exercise. In
addition, many community-based classes and wellness programs are including T'ai Chi in their curricula.
Individuals of all ages and physical abilities are finding their way into T'ai Chi classes. However, this ancient
exercise remains elusive to many who find its slow, complex movements confusing and difficult to master.
Description
T'ai Chi Fundamentals® Program bridges eastern mind/body health principles with the western medical
model. The first program of its kind, it provides both a simplified approach for mastering T'ai Chi basics and
describes T'ai Chi in terms that are useful to health care professionals. It presents a clear, systematic sequence for
learning the movements and mind/body integration processes of T'ai Chi that can serve as a complete exercise
program for many individuals. In addition, it can provide solid basic training for those who wish to progress to the
more complex forms of traditional T'ai Chi.
This program offers a systematic approach for mastering T'ai Chi basics that maintains the integrity of
traditional T'ai Chi. It modifies or eliminates problem areas that students consistently encounter in learning T'ai Chi
and provides essential groundwork for learning the traditional Yang Style Form. It includes the following three
elements:
1. The T'ai Chi Fundamentals® Form is an exercise form that adapts the movements and principles of
traditional Yang Style T'ai Chi Ch'uan into a practice routine that is accessible to a wide range of abilities. In
addition, it targets critical elements from the traditional form that enhance balance, coordination, strength and
endurance. Each section can be practiced as a complete and challenging program depending on the abilities of the
participant. It takes less than five minutes to perform.
The T'ai Chi Fundamentals® Form is taught in three sections. It incorporates the most basic and essential
functional movement components in the first section, and progresses to more complex patterns in the later sections.
It eliminates some of the more difficult details of the traditional form that relate specifically to martial arts
applications. This step-by step method provides an accessible approach for developing skills necessary for
performing the entire sequence, and a vehicle for clearly learning the movements.
2. The Movement Patterns are a series of exercises designed to reinforce important functional movements
repeated throughout the Fundamentals® Form. The Movement Patterns follow a motor development progression
and are practiced repetitively as a vehicle for training T'ai Chi skills. They are also an enjoyable, complete and
challenging exercise program on their own. These patterns integrate expressive arm movements and elements of
Qigong and take 4-12 minutes to perform, depending on the number of repetitions
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3. The Mind/Body Principles describe elements of T'ai Chi practice that enhance physical and emotional
well-being. These are guidelines for healthy human interaction as well.
Rationale
Accessibility: T'ai Chi Fundamentals® is designed to bring the many benefits of T'ai Chi to individuals
with a wide range of abilities. It can be taught by health professionals to their clients, in classes for older adults and
to those with limiting conditions. This program also is a creative tool for T'ai Chi instructors who are teaching
introductory courses. It is useful in classes of all experience levels for reinforcing basic postures and movements of
T'ai Chi.
Standardization: The T'ai Chi Fundamentals® Program is designed systematically and can be used as a
standard to facilitate research. There is a growing body of research on T'ai Chi that suggests that T'ai Chi practice
may have a wide range of positive physical and mental health outcomes. To date, the vast majority of studies have
been based in Yang Style T'ai Chi, the most widely practiced form worldwide. The T'ai Chi Fundamentals®
Program is based in popular Yang Style T'ai Chi and provides a standard movement sequence that follows a
systematic motor development progression. Designed with discrete, measurable increments in difficulty, it may
have broad application for researching outcomes for individuals whose abilities range from limited function to
advanced athletic skills.
Assessment and Treatment: The Movement Patterns in this program follow a motor development
progression and can be used as tools for both client assessment and intervention. By observing performance of these
movements, the teacher or therapist can assess misalignments that might contribute to physical limitations. These
precise patterns then can be used in the client's exercise program or as treatment strategies. They also can be
prescribed for daily practice to help correct these problem areas.
Precautions This program is not intended as a substitute for medical consultation. Remind your patients and students to
consult with a physician or therapist before embarking on this or any exercise program.
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Breathing
Diaphragmatic Breathing: This type of breathing makes better use of the muscles of the diaphragm and
reduces overuse and tensing of the upper chest, upper back, and neck muscles. It is easier to learn lying down,
but if that is not possible, sitting or standing position will be fine.
Placing the fingertips on the upper belly may help you to feel what is happening. As you inhale, let the
belly expand. As you exhale the belly will sink back down again. Explanation: As you inhale, the diaphragm
moves down into the abdominal area, giving the lungs more room to expand. By allowing the belly to expand
outward, there is more room for this to happen and the lungs can fill with more air.
Breathing and Quieting the Mind: This works well resting in a good sitting posture. However any position
will work (just avoid curling up in a ball).
Put your attention on your breath. Use a normal breath (Diaphragmatic breathing is considered a normal
breath). Just count your breaths until you reach 10. Then start the count over again. If you realize you are
counting breaths number 13, 14, 15, that is a clue that you are not really paying attention and your mind has
wandered. Start your count over again. Repeat for several counts of 10.
On the Job Breathing: Using this to prevent a build up of tension. Take 3 longer, slower breaths many
times throughout the day. You may want to attach this activity to certain cues: hanging up the phone, a certain
point in computer work, waiting for the elevator, etc. You can even practice better posture while you are doing
this.
Don’t worry about perfection in these exercises.
Just trying to do it will bring you some benefit.
Try adding the phrase: I breathe in with the calm and out with a smile.
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Breathing (continued)
An increased breathing rate is part of the fight or flight pattern. One way to break up that pattern is to
work on slowing the breath. The breath is always there. We always have it with us. There is no need to
worry if you have your favorite relaxation tape with you. You do have your breath.
Focusing your attention on your breath can serve as a link to the relaxation response. This can be
approached in several ways:
Just notice your breath. As it comes in through your nose, hits the back of your nose,
goes down your throat, and on into your lungs. Notice how it fills the lungs and chest. Does it
fill the upper chest, mid chest, or lower chest? Is the abdominal area moving? Then watch your
breath flow out of your body. There is no need to do deep breathing, try to get it to work a
certain way, or wonder if you are doing it right. Just observe what is there.
No need to work on this for a log time. Just take a moment to “catch your breath”. Let
your breath bring you back to the present. Just for a few breaths.
Try staying with one breath at a time. No need to be concerned about the next breath or
worry about the last one. Just stay right with the inhale and right with the exhale. Just this
breath. Just this breath.
If your mind wanders, just return to your breath.
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Evaluation and Treatment Using T'ai Chi Fundamentals®
Mechanical Evaluation Start at the feet and work up
• Base of Support Foot placement and mechanics
Ability to feel and maintain entire foot on floor
Width of stance
• Alignment of Knees
Static and dynamic
• Alignment of Pelvis Level without hip drop or hiking
Neutral pelvic tilt (Dropped tailbone)
• Neutral Spine Increased or decreased lumbar lordosis/thoracic kyphosis
Shoulders over hips
Substitution of spinal rotation for rotation at the hips
Head position
• Shoulders Relaxed Scapular stabilization with no shoulder shrug
Upper extremity range of motion
• Stability and Balance
• Weight Separation
• Source and Transmission of Power Motion is rooted in the feet, powered by the legs, directed by the torso, expressed in the hands.
• Ease of Movement
• Centering Breath Awareness Diaphragmatic Breathing Awareness of Body
• The Whole Picture - Mind/Body Effects Relaxed Alertness Moving Around Obstacles Spontaneous Action
• Codman's Exercise Heavy Arms and 70/30 Stance, Motion powered by the legs
Adapted from Gail Janz, PT and Judy Smith, PT by Charlene Avery, OTR
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Toward More Holistic Therapy
Just as all life is interconnected, the mind and body act together to create health. When one part of this
health is disrupted, the other components follow. Rather than treating only the disease or dysfunction, T'ai Chi
allows mind and body to join in the healing process to enhance and promote a more complete health. T'ai Chi
Movement Patterns and Form have many components that can be incorporated into a patient's rehabilitation.
Feet Rooted
• Creates a sense of strength and stability which promotes a feeling of calmness
• Reconnects the mind and the feet
• Paying attention to the feet starts work on proprioception
• Helps to get the person 'out of his/her head'
Slows the speeding mind Helps to focus Works on memory problems
Gentle Movement
• Slow rhythmic movement is calming to body and mind.
• Promotes idea of being gentle with self
• Teaches ease of movement which can be carried over to functional tasks
Balance
• Loss of balance creates physical and mental stress
Spring and Power
• Gives sense of increased energy
• Upward feeling of lift both physically and mentally
• Sense of ability feels good both physically and mentally
• Sense of lightness
Positive Outlook
• Focus on ability instead of inability
• Less focus on pain and disease
Therapeutic Use of Self, as Therapist
• Take 1-3 deep breaths before entering a room/area for therapy
• Take a few minutes at lunch to reconnect with yourself
• Use of your own good body mechanics and mind/body principles
Head as if suspended from above Shoulders and arms relaxed
Neutral pelvis, dropped tailbone Knees bent
Feet paper width/hip width apart Move from your center (of gravity/dan tien)
Motion is rooted in the feet, powered by the legs, directed by the torso, expressed through the hands.
Keep in mind that taking time to calm our minds, and relax our bodies ... affects not only ourselves ... but all
those whose lives we touch.
Adapted from Gail Janz, PT; Judy Smith, PT; and Tricia Yu, by Charlene Avery, OTR
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Summary of Research on Health Effects of T’ai chi Ch’uan
Current Research indicates that T’ai Chi practice can improve balance, reduce falls, and increase leg
strength. In addition it enhances cardiovascular, respiratory, and immune function. It also has been found to
lower blood pressure and cortisol levels, and promotes emotional well being.
T’ai Chi research website links (in no particular order):
http://www.ncbi.nlm.nih.gov/pubmed
http://www.worldtaichiday.org/WTCQDHlthBenft.html
http://www.taichiresearch.com/
http://www.mayoclinic.com/
https://www.health.harvard.edu/browse.php
http://www.cdc.gov/search.do?action=search&queryText=tai+chi&image.x=0&image.y=0
http://www.krapu4.com/taichi/research/
http//members.aol.com/sltcca/research/taire1.htm
www.taichihealth.com
1. Au-Yeung, S.S., Hui-chan, C.W., & Tang, J.C. (2009). Short-form Tai chi improves standing balance of
people with chronic stroke. Neurorehabilitation Neural Repair,23(5): 515-522.
2. Brown, D.R., Wang, Y.,Ward, A., Ebbeling, C.B., Fortlage, L., Puleo, E., Benson, H.,&Rippe, J.M.
(1995). Chronic psychological effects of exercise and exercise plus cognitive strategies Med Science
Sports Exercise 27 (5):765-75.
3. Callahan, L.F.(2009). Physical activity programs for chronic arthritis. Current Opinion in
Rheumatology. 21(2): 177-82.
4. Carbonell-Baeza, A., Romero, A., Aparicio, V.A., Ortega, F.B., Tercedor, P., Delgado-Fernandez, M, &
Ruiz, J.R. (2011). Preliminary findings of a 4-month Tai chi intervention on tenderness, functional
capacity, symptomotology, and quality of life in men with fibromyalgia. American Journal of Men’s
Health, 5 (5): 421-429. [Epub 2011 Mar15].
5. Chang, J.Y., Tsai, P.F., Beck, C., Hagen, J.L., Huff, D.C., Anand, K.J., Roberson, P.K., Rosengren, K.S.,
&Beuscher, L.(2011). The effect of tai chi on cognition in elders with cognitive impairment.
Medical Surgical Nursing, 20(3): 63-9.
6. Greenspan, A.L., Wolf, S.L., Kelley, M.E., O’Grady, M. (2007). Tai Chi and Perceived Health Status in
Older Adults Who Are Transitionally Frail: A Randomized Controlled Trial. Physical Therapy,
AbstractEpub ahead of publication PubMed.
7. Hackney, M.E., Earhart, G.M. (2008). Tai chi improves balance and mobility in people with
Parkinson disease. Gait Posture 28 (3), 456-60.
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8. Hall, A., Maher, C., Latimer, J., Ferreira, M. (2009). The effectiveness of Tai Chi for chronic
musculoskeletal pain conditions: a systematic review and meta-analysis.Arthritis& Rheumatism.
Jun15:61(6): 717-24.
9. Hallisy K. Tai chi Enhances Long-Term Management of Chronic Low Back Pain (Poster
Presentation).APTA Orthopaedic Section, February 11, 2011 (New Orleans, LA)Listed in the January
2011 issue of Journal of Orthopedic and Sports Physical Therapy.
10. Harmer, P.A., && Li, F. (2008) Tai Chi and falls prevention in older people. Medicine and Sport
Science, 52:124-34.
11. Hart, J., Kanner, H., Gilboa-Mayo, R., Haroeh-Peer, O., Rozenthul-Sorokin, N., & Elder, R. (2004). Tai
Chi Chuan practice in community-dwelling persons after stroke. International Journal of
Rehabilitation Research, 27, 303-304.
12. Holloway, E., & Ram, F.S. (2004). Breathing exercises for Asthma. Cochrane Database of Systematic
Reviews, CD001277.
13. Hulzebos, E.H., van Meeteren, N.L., van den Buijs, B.J., de Bie, R.A., Brutel de la Riviere, A., &Helders,
P.J. (2006). Feasibility of preoperative inspiratory muscle training in patients undergoing
coronary artery bypass surgery with a high risk of postoperative pulmonary complications: a
randomized controlled pilot study. Clinical Rehabilitation, 20, 949-959.
14. Irwin, M.R., Olmstead, R., &Oxman, M.N. (2007). Augmenting immune responses to varicella zoster
virus in older adults: A randomized controlled trial of tai chi. Journal of the American Geriatric
Society, 55, 511-517.
15. Lee, M.S., Pitler, M.H., & Ernst, E. (2008). Tai Chi for osteoarthritis: a systematic review. Clinical
Rheumatology, 27(2): 211-8.
16. Li, F., et al., (2012). Tai Chi and postural stability in patients with Parkinson’s disease. New
England Journal of Medicine. 9; 366 (6): 511-519.
17. Maciaszek, J., &Osinski,W.(2010). The effects of Tai Chi on body balance in elderly people—a
review of studies from the early 21xst century. American Journal of Chinese medicine. 38(2); 219-
29.
18. Petorius, E. (2009). The role of alternative and complementary treatments of asthma. Acupuncture
& Electro-Therapeutics Research, 34(1-2);15-16.
19. Reid-Arndt, S.A., Matsuda, S. & Cox, C.R. (2012). Tai chi effects on neuropsychological, emotional,
and physical functioning following cancer treatment; a pilot study. Complementary Therapy in
Clinical Practice, 18(1): 26-30.
20. Siu, J.Y., Sung, H.C., & Lee, W.L. (2007). Qigong practice among chronically ill patients during the
SARS outbreak. Journal of Clinical Nursing, 16, 769-776.
21. Skoglund, L., &Jansson, E. (2007). Qigong reduces stress in computer operators. Complementary
Therapy in Clinical Practice, 13, 78-84.
22. Song, R. Roberts, B.L., Lee, E.O., Lam, P., &Bae, S.C.(2010). A randomized study of the effects of t’ai
chi on muscle strength, bone mineral density, and fear of falling in women with osteoarthritis.
Journal of Alternative and Complementary Medicine. 16 (3); 227-233.
23. Taylor-Piliae, R.E. &Coull, B.M. (2012). Community-based yang-style Tai chi is safe and feasible in
chronic stroke: a pilot study. Clinical Rehabilitation. 26 (2) : 121-131.
24. Taylor-Piliae, R.E., Haskell, W.L., Walters, C.M., &Froelicher, E.S. (2006). Change in perceived
psychosocial status following a 12-week Tai Chi exercise programme. Journal of Advanced Nursing.
54, 313-329.
25. Uhlig, T., Fongen, C., Steen, E., Christies, A., &Odegard, S. (2010). Exploring Tai Chi in rheumatoid
arthritis: a quantitative and qualitative study. BMC Musculoskeletal Disorders, Mar 5: 11:43.
26. Verhagen, A.P., Immink, M., van der Meulen, A., &Bierma-Zeinstra, S.M. (2004). The efficacy of Tai
Chi Chuan in older adults: a systematic review. Family Practice, 21, 107-13.
27. Wang, C.,et al., (2010). Tai Chi is effective in treating fibromyagia: a randomized controlled trial.
New England Journal of Medicine, 363: 743-754.
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28. Wang, C., Bannuru, R., Ramel, J., Kupelnick, B, Scott, T., Schmid, C.H. (2010). Tai Chi on
psychological well-being: systematic review and meta-analysis. BMC Complementary & Alternative
Medicine, May 21; 10:23.
29. Wayne, P.M., Philips, RS. ( Spring 2008) The effects of Tai Chi on blood pressure: a systematic
review. Preventive Cardiology, 11:2, 82-89. 30. Wolf, S.L., Barnhart, H.X., Kutner, N.G., McNeely, E., Coogler, C., &Xu, T. (1996). Reducing frailty
and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta
FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. Journal of the
American Geriatric Society. 44:489–497.
31. Wooton, A.C.(2010). An integrative review of Tai Chi research: an alternative form of physical
activity to improve balance and prevent falls in older adults. Orthopaedic Nursing, 29(2): 108-16.
32. Yeh, M.L., Lee, T.I., Chen, H.H., & Chao, T.Y. (2006). The influences of Chan-Chunag qi-gong therapy
on complete blood cell counts in breast cancer patients treated with chemotherapy. Cancer
Nursing, 29, 149-55.
33. Yeh, M.L., Wang, C., Wyne, P.M., &Philips, RS. (2008) The effects of Tai Chi on blood pressure: a
systematic review. Preventive Cardiology, 11(2): 82-89.
34. Zijlstra, G.A., van Haastregt, J.C., van Rossum, E., van Eijk, J.T., Yardley, L., &Kempen, G.I. (2007).
Interventions to reduce falling in community-living older people: a systematic review. Journal of
the American Geriatric Society, 55, 603-615.
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Guidelines for Tai Chi Practice Tricia Yu
Mindfulness (Focus)
• Attention to the Present Moment
• Body Awareness
• Environment Awareness
Postural Alignment (Maintain a natural posture)
• Head Erect
• Spine Comfortably Aligned
• Shoulders Balanced, Aligned Over the Hips
• Weight Evenly distributed on the Soles of the Feet
Breath Awareness (Notice your breathing)
• Body Naturally Moves with the Breath
• Natural Diaphragmatic Breathing patterns
Active Relaxation (Relax actively)
• Mindfulness with Physical Relaxation
• Alert And Calm at the Same Time
• Stillness in Motion.
• Simultaneous Awareness of All Parts of the Body.
Slow Movement (Move slowly)
• Fosters Both Strength and Endurance
• Dramatic Load-Bearing Benefits.
• Slower and Lower: Greater Strength and Endurance Benefit.
Weight Separation (Separate your weight)
• Weight Ideally 100 Percent on one Foot,
• Contributes to Better Balance
• Promotes Increased Leg Strength.
Integrated Movement (Move from your center)
• Head, Trunk and Pelvis Rotate as a Single Column
• Rotation of Column Initiates Arm and Hand Movements.
Master Benjamin Lo's Five Basic Principles:
• Relax (Mindfulness, Active Relaxation).
• Body Upright (Postural Alignment).
• Separate Yin And Yang (Weight Separation).
• Move From The Waist (Integrated Movement).
• Fair Lady's Wrist (Wrists Neutral, Element of Active Relaxation).
Master William C.C. Chen's Objectives: • Simple
• Easy
• Natural
• Enjoyable
• Productive
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Reminders for Practicing Tai Chi Tricia Yu
Focus upon what is happening now.
This is the single most important aspect of this training. Bring your attention into the present moment.
Do the movements seem too complex?
Keep your attention on one aspect of the process. For example, stay focused on the movement of your
hands, the position of your feet, or changes in the direction you are facing. Notice your breathing, your
alignment. Relax.
Are you feeling frustrated because you can’t remember the movements?
Keep in mind that this is not a performance! Your own process is what is important. Just breathe and
relax into this moment. These exercises are for lifelong practice. There is no rush. You will be able to
remember the movements over time and through regular practice.
At Home:
Establish a regular time and place to practice.
Try practicing routinely, mornings before eating and evenings before retiring.
Do it everyday.
The length of practice is not as important as the regularity.
Each time before beginning, notice your posture, breathing and surroundings.
You can do this anytime to enhance your appreciation of this moment of life.
Spend as much time relaxing into the flow of the movements as you do checking for accuracy.
May you become as strong as an oak, flexible as a willow,
and clear as still water.
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Documentation and Billing
For T’ai Chi Fundamentals®
Documentation Ideas: Some Suggested Movement Patterns:
Cardiac/Pulmonary Related issues Horse Stance, Heavy Arms,
Diaphragmatic Breathing Techniques Crane Takes Flight, Gathering the Stars
Functional Relaxation
Instruction in Breathing and Relaxation
Community Mobility Crane Takes Flight, Bear Rooting,
Health Management and Maintenance Gather the Stars, T’ai Chi Stance,
Home Management (IADLs) Bear Moves with Crane Arms
Body Mechanics Skills Horse Stance, Crane Takes Flight,
Energy Conservation Ideas T’ai Chi Fold, Gather the Stars,
Fall Prevention Techniques T’ai Chi Stance, T’ai Chi Stance
Joint Protection Ideas (Arthritis, etc) with crane arms
Sensory Awareness & Processing: Proprioception, Vestibular, Visual Motor Integration,
Auditory Processing, Oculomotor, Depth Perception. Crane Takes Flight, Bear Rooting,
Gathering the Stars
Perceptual Processing: Body scheme, Right-Left Discrimination, Position in Space,
Spatial Relations, Kinesthesia, Body Awareness, Motor Planning Education. Seated & eyes closed for
any of the movements, Gathering the Stars, T’ai Chi Stance, T’ai Chi Power Move
Neuromusculoskeletal: Range of Motion, Muscle Tone, Activity Tolerance, Postural Control
and Alignment, Soft Tissue Integrity, Functional Strength, Neuromuscular Reeducation,
Postural Strengthening. Horse Stance, Holding the Moon, Crane Takes Flight, T’ai Chi Stance
Motor: Gross Coordination, Cross Midline, Bilateral Integration, Motor Control, Praxis,
Visual-Motor Integration, Standing Balance, Sitting Balance, Dynamic Balance, Functional Mobility,
Gait Training, Pre-Transfer skills, Movement Re-education. Crane Takes Flight, Hold the Moon, T’ai
Chi Stance, Gather the Stars, Dancing Crane, Flying Crane
Cognitive Integration: Attention Span, Initiation and Termination of Activity, Memory (short
and long-term), Sequencing, Spatial Operations, Problem Solving, Generalization,
1, 2, & 3 Step Direction Following, Concentration, Cognitive Retraining, Learning Retention,
Judgement, Distractability. Horse Stance, Crane Takes Flight, T’ai Chi Stance, Dancing Crane
Psychosocial Skills and Components: Self-Concept, Interpersonal Skills, Coping Skills,
Self Control, Social Conduct Skills (especially if group setting), Dementia, Depression/Anxiety.
Horse Stance, Crane Takes Flight, Gathering the Stars, Flying Crane, Dancing Crane.
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Goal Writing Ideas:
Auditory Perception Body Mechanics
Communication Functional Mobility
Cognition
Concentration for certain length of time
1, 2, & 3 Step Direction Following
Sequencing
Short-Term Memory
Visual Perception
Gait
Head and Neck Control
Independent Transfers
ADLs Related Posture
Home Management Sitting Posture/Tolerance
Health Maintenance Stronger
Reaching Generalization of Relaxation Techniques to Other Settings
Weight Shifting Increase Activity Tolerance
Coordination/quality of movements Maintain oxygen level
Less Fear, more confidence No Reported Falls
Push/Pull Movements Pain Free Movement
Resting Heart Rate Will Decrease
Pt behaviors, participation, compensatory techniques
Prevent, improve, enhance, adapt, quality of life, self-concept, health and functioning,
body mechanics
Billing:
Functional Mobility
Therapeutic Activities
Neuromuscular Re-education
Perceptual/Cognition
Self Care/Home Management
Safety Procedure
Sensory Motor Re-education
Gait Training
Strength/Coordination
Group Treatment
Strength/Endurance/ROM
Therapeutic Activities
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Tai Chi Mind/Body Protocol Process Practice Breathing, Posture Awareness and Relaxation exercises as a prelude to all movement instruction.
Remember to include all three elements each time, for as little as a few seconds or as long as a few minutes. Choose
whatever exercises within these categories are comfortable for you.
• If you are working individually, experiment with standing next to, as well as facing them during this process.
Then see what is the most comfortable.
• Provide simple instructions, cueing one element at a time, Avoid lengthy descriptions.
• Intersperse moments of silence after each simple verbal cue. This gives both you and your patient/student
ample time to directly experience the cues.
• Experiment with playing relaxing background music to help provide a calm atmosphere.
• Check in with your patients/students for feedback regarding what works for them.
• Encourage students and patients to create their own Tai Chi Mind Body Protocol, selecting the breathing,
posture and relaxation processes that work best for them.
Sequence 1. Sense/Observe
2. Inform/ Correct
3. Personalize/Create
This sequence can be explored over a number of sessions. All elements do not have to be included each time. When
cuing awareness, first invite your patients/ students to simply sense/observe what is actually occurring at this moment.
Then—perhaps at a later session, educate regarding corrections. Finally, encourage them to discuss and practice that
which works for them.
Elements 1. Breathing-Stationary–is the single most important aspect of this protocol.
• First, observe and feel what is occurring now—simply become aware of the breathing without attempting to
control or change it.
• Then introduce diaphragmatic breathing and how to recognize the process.
• Finally help patients discover the technique that works for them for practicing breath awareness using
diaphragmatic breathing patterns.
2. Posture Awareness-include generalized awareness of all parts of the body.
• First, observe and sense (or feel) what is occurring now—simply get in touch with the entire body.
• Then focus on proper alignment—make corrections as able and refocus on the new sensations occurring.
• Finally help patients develop a technique for getting in touch with their body and recognizing postural
tendencies.
3. Relaxation –A relaxed state is a by-product of having an observant, non-judgmental attitude, which creates a
peaceful state of mind. It is a process, rather than a goal.
• Practice relaxation techniques in a static position.
• It may be helpful to focus on one part of the body, and then generalize to the entire body, or to areas that are
more problematic.
• Then progress to relaxation with movement.
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Tai Chi Fundamentals® Program Reviews
“—A very important contribution to literature and to the video-instructional realm of professional education, a remarkable gift to the
world of rehabilitation. It makes a strong connection between the exercise form and its applicability in the clinical environment. Many
accolades for your brilliant and inspired work.”
—Jennifer Bottomley, PT, PhD, MS, Reviews in the Gerontologist and APTA’s Gerinotes
This program is of value for people who wish to learn about tai chi and want to engage in one rendition of the practice.” —Stephen
Wolfe, PhD, PT, FAPTA, review in Physical Therapy Journal
"Provides the health care practitioner with a much better understanding of the parallels and consistency of traditional Tai Chi with
western health and wellness exercise program. The very clear, well described, easily reproduced movement patterns can provide a
needed template from which researchers can maximize consistency of exercise technique when studying the effectiveness of Tai Chi."
-Rita Wong EdD, PT Chairperson, Physical Therapy Department, Marymount University
“Provides a simple, systematic approach which maintains the integrity of the traditional Yang style form.”
—Chewning, Yu, Johnson, in American College of Sports Medicine’s Health and Fitness Journal
“Health care providers have long needed a concise but easy-to-follow guide to Tai Chi, both for their own well-being and for patient
education. Yu and Johnson's Tai Chi Fundamentals does the trick. It will be of value to anyone who practices or is ready to fall in love
with this wonderful art.”
—Kenneth S. Cohen, M.A. author, The Way of Qigong and Healthy Breathing
"The exercises in particular seem suitable to an older population, including those with chronic health conditions. The analysis of
movement patterns from a physical therapy perspective is very helpful, as are the video clips showing older adults performing the
exercises with the therapist. I also appreciated the clips showing incorrect body posture and mechanics. It's good to see how not to do
the exercises! Lastly, the video is beautiful and evokes the peaceful spirit and focused concentration of Tai Chi practice."
-Jane Mahoney, MD Assistant Professor, Geriatrics, University of Wisconsin Department of Medicine
“Although the author has dozens of manuals and videotapes (on tai chi), only one is recommended for the health care professional: Tai
Chi Fundamentals for Health Care Professionals and Instructors--- this is the clearest, most concise and most comprehensive video
and manual available.”
—Jennifer Bottomley, PT, PhD, MS, in: Ortheopaedic Physical Therapy Clinics of North America Journal
“I recommend this beautifully illustrated book to the novice who seeks a door to enter the practice of taiji. The seasoned practitioner
may find the book deceptively simple; however upon closer review, Ms. Yu provides an important study of the basic movements of
taiji and teaching methods that will enhance an advanced student’s or teacher’s appreciation of the form.” —Noah Nunberg, review
in Journal of Asian Martial Arts
" ... The flow between Eastern Tai Chi and Western analysis is beautifully accomplished. The The complex movement of Tai Chi is
deceptively simple and its value as a therapeutic modality in western medicine can be overlooked... provides a clear explanation of
each movement both in the poetic Chinese tradition and the medical basis in movement retraining.... This is an important addition to
the library of any health care practitioner or movement specialis…..Will help any health care practitioner place their Cartesian training
of the body in the context of the whole person..." -Elaine Cress PhD, Associate Professor Gerontology Center, University of
Georgia
" Tai Chi Fundamentals is the simplest and easiest to learn. It is a unique exercise for all ages and physical conditions. The form
lubricates all the joints, eases the mind, relaxes the body and enhances balance. It is a perfect form of movement for senior citizens
and is a low impact exercise with no side effects. It is good for people with physical limitations and discomfort." -William C.C.
Chen, Grand Master, T'ai Chi Ch'uan
Tai Chi Fundamentals®
Program Selected Bibliography
For more information go to the articles link at taichihealth.com
SOFTWARE: Yu, T. and G Janz, Tai Chi Fundamentals Program Exercise Software Kit. Visual Health Information, 2008
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BOOKS: Kittel, M, Editor. The Doctors' Book of Home Remedies for Stronger Bones. Rodale Press, 1999.
Yu, T. Tai Chi Mind and Body. DK Publishing 2003. (Translated into eleven languages)
Yu, T., J Johnson, Tai Chi Fundamentals for Health Professionals and Instructors. Uncharted Country Publishing, 1999.
ARTICLES in PROFESSIONAL PUBLICATIONS: ________. "Tai Chi Program Developed for Health Professionals". PT Magazine. May, 2000.
________.”Tai Chi Fundamentals” Horizions CIGA Newsletter. 1.3 Spring 2004:1.
Arenz, D. “Reviews: Tai Chi Mind and Body” Taijiquan Journal. Spring/Summer 2004:44.
Bottomley, J. “The Use of Tai Chi as a Movement Modality in Orthopaedics.” Orthopaedic Physical Therapy Clinics of North
America 9.3 (2000): 361–373.
———. “Tai Chi Fundamentals for Health Care Professional and Instructors [review].” GeriNotes Jan. 2001: 34.
Bottomley, J., and J.T. Sykes. “Lessons From China” [reviews Tai Chi Fundamentals for Health Care Professional and Instructors].
The Gerontologist 40.4 (2000): 509–510.
Chewning, B., J. Johnson, and T. Yu. “Tai Chi (Part 1): Ancient Exercise for Contemporary Life.” American College of Sports
Medicine Health and Fitness Journal 4.2 (2000): 1–6.
———. “Tai Chi (Part 2): Effects on Health.” American College of Sports Medicine Health and Fitness Journal, 4.3 (2000): 1–5.
DeFalco, J. “Incorporating Tai Chi and ROM Dance Exercise for Older Adults into Your Program.” Wellness Program Management
Advisor Oct. 2000: 4–5.
Dobson, S, “Tai Chi and Qigong Can be Applicable in the Acute-Care Setting” Advance for Physical Therapists 17:3 Jan 16 2006: 36.
Fritsch D., S. Watts, and T. Yu. “Range of Motion Dance: Bodyworkers Add Another Healing Technique to Their Tool Kits.”
Massage and Bodywork. Jun./Jul. 2000:12–22.
Johnson, J. and T. Yu. “Tai Chi for the Elderly.” GeriNotes Jan. 2001: 21–24.
Matsuda, S, D. Martin, T. Yu, “Ancient Exercise for Modern Rehab” Rehab Management Journal March 2005:24-27.
McKean, L. “Tricia Yu’s New Tai Chi Fundamentals Program: A Complementary Curriculum to ROM Dance.” Uncharted Country
Newsletter Spring/Summer 1999: 4–5.
———. “Therapeutic Applications of Tai Chi Fundamentals.” Uncharted Country Newsletter Fall/Winter 2001: 1–2.
Norton, A. “Tai Chi Gaining Ground as Exercise for Elderly. Medline Plus March 30 2005.
Nunberg, N. “Tai Chi Mind and Body Review.”Journal of Asian Martial Arts 2.14 (2005):87.
Van Ryzen, J. “Nurturing Body and Mind: Program Aims to Bring Tai Chi to Older Adults” Innovations, A Publication of the
National Council on Aging 35:1 Issue 1 2006: 13-17.
Wolf, S.L.”[Review of Tai Chi Fundamentals Materials” Physical Therapy Journal 80.11 (2000), 1132–1133.
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ARTICLES in LAY PUBLICATIONS: ________. “Go with the Flow with Tai Chi” Weight Watchers Magazine June.2005: 40- 44.
Bergin, M. "Tai Chi Book Spotlights Local Instructor". Capital Times 11 Aug. 2003:1B.
Berres, C. Tai Chi Classes for Therapists." Milwaukee Journal Sentinel 15 Oct. 2002.
Medaris, D. "Crane Takes Flight." Isthmus 8 Aug. 2003.
Schmidt, E "Offering Tai Chi with a Softer Sensibility." Milwaukee Journal Sentinel 12, Oct.2003:
Smith, C. " Review: Tai Chi Fundamentals for Mastering Tai chi Basics." Booklist 1 Sept.2003:
Sobel, S. “New Twist on Tai Chi” Weill College of Cornell University Food and Fitness Advisor
8:12, Dec.2005.
Sullivan, K. "Review: Tai Chi: Exercise for Lifelong Health and Well-Being" Video Librarian 18.06 (2003) 33.
"Tai Chi Workshop at Eagle Bluff." Fillmore County Journal 20 Oct.2003.
Teare, T "Your Personal Exercise Rx." Fitness Nov. 2003:141--143.
Wineke, W. "Madisonan's Book teaches Gentle Art" Wisconsin State Journal 15 Aug. 2003: D1-D5.
Additional Recommended Reading
Books on Yang Style, Cheng Man Ch’ing Lineage Tai Chi
Chen, William. Body Mechanics of T’ai-Chi Ch’uan. Wm. CC Chen, 2 Washington Square Village #101, New York 10012;1989.
Cheng, Man-Ching and Smith, Robert. T’ai-Chi. Rutland, Vermont: Tuttle;1967.
Davis, Barbara The Tai Chi Classics North Atlantic Press 2004
Jou,Tsung Hwa. The Tao of T’ai-Chi Ch’uan. Warwich NY: T'ai-Chi Foundation;1988.
Kline, Bob. Movements of Magic. Newcastle Publishing Co;1984.
Liang, T.T. T’ai-Chi Ch’uan for Health and Self-Defense. Boston: Redwing;1974.
Lo, Benjamin and Inn, Martin. (Translators) Cheng Tzu’s Thirteen Treaties on T’ai-Chi Ch’uan. Berkeley: North Atlantic Books;1985.
Lo, Benjamin et al. (Trans.) The Essence of T’ai-Chi Ch’uan. Berkeley: North Atlantic Books;1985.
Lowenthal, Wolfe. Gateway to the Miraculous. Berkeley: North Atlantic Books;1988.
Lowenthal, Wolfe. There Are No Secrets: Professor Cheng Man Ch’ing and His T’ai-Chi Ch’uan. Berkeley: North Atlantic Books;1991.
Wile, Douglas. Master Cheng’s Thirteen Chapters on T’ai-Chi Ch’uan. Brooklyn: Sweet Chi Press;1982.
Books on Brain Plasticity
The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science by Norman Doidge, Penguin 2007
Train Your Mind, Change Your Brain: How a New Science Reveals Our Extraordinary Potential to Transform Ourselves By Sharon
Begley, Ballantine Books, 2007
The Universe in a Single Atom The Convergence of Science and Spirituality By The Dalai Lama, Random House, 2005
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For Health Professionals and Instructors
Tai Chi Fundamentals® (TCF) Program Certification Information
General Description
The purpose of certification is to assure that instructors demonstrate the skills and knowledge necessary to teach all program
elements effectively. During the certification process, you demonstrate movement and verbal communication skills, and
create your written handouts for teaching the program to your students, patients and peers.
There are three levels of certification based on movement skills testing, and one written exam. Once you have completed the
written exam and been certified at Levels One, you can progress Level Two or Three simply by demonstrating your skills in
performing the more complex movements required for that level. There are no additional written exams. To keep
certification current, attend workshops or classes with qualified instructors a minimum of once every two years
Outline of Certification Requirements
Prerequisite for Application
1. Participation in Tai Chi Fundamentals® Professional Training Seminars and Intensives: 30 contact hours minimum. Home practice
is required, and additional study with TCF certified instructors usually necessary. Please note: these requirements may be met, in
part, by study with approved teachers.
2. Experience with Tai Chi Fundamentals® in individual or group settings. This may include the following:
• Applying, or observing application of, Tai Chi Fundamentals® Movement Patterns in individual therapy.
• Learning, teaching, substituting, and/or assisting in group classes.
3. Working knowledge of the video and text: Tai Chi Fundamentals® for Health Professionals
and Instructors, familiarity with Tai Chi Fundamentals®: For Mastering Basics video/DVD, Tai Chi
Mind and Body text, and familiarity with reviews about the program and its applications.
4. Accurate performance of movements and ability to communicate information at your certification level.
5. Recommendation by Certified TCF Instructor that applicant is ready to successfully movement test. This may require a private
evaluation and/or lesson, or can be done long distance via DVD evaluation
For more information go to http://www.taichihealth.com/HCPCert.html
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