According to CDC data, physical inactivity among people with a disability continues to be a serious concern. Physical inactivity not only tends to increase the risk for functional limitations and secondary health conditions, it also tends to make individuals with physical disabilities more reliant on multiple medications that often increase the chance of having adverse drug reactions and possible secondary health problems.
The factors that contribute to physical inactivity among people with physical disabilities include: lack of a suitable fitness program; limited transportation; inaccessible facilities and equipment; lack of affordability and lack of motivation.
During recent years, a great effort has been made to identify and develop health programs that are suitable for individuals with disability and will provide them with effective and low-cost exercise options. As tai chi chuan has increased in popularity, there has been growing interest in the therapeutic effect of tai chi programs in clinical settings. Numerous studies have shown that frequent tai chi practice contributes significantly to the improvement of mental and physical well-being, including for individuals with physical impairments. Tai chi chuan movements are slow, gentle, circular and initiated from the lower back. The movements require a high degree of synchronization between mind and body, creating a unified flow of energy.
Despite its health benefits, the conventional method of practicing tai chi requires participants to have some ambulatory ability. I have developed four moves of a seated tai chi chuan form, in an effort to develop a simple program suitable for people with ambulatory difficulty.
In the summer of 2008, we conducted a pilot study at Siskin Hospital for Physical Rehabilitation to explore the effects of practicing the four moves of seated tai chi chuan for people with ambulatory disability. During the eight-week study participants took part in 45-minute sessions twice weekly, and were encouraged to practice daily at home following an instructional DVD. Data gathered from this study suggests some very encouraging results. Preliminary results suggest that the frequent practice of seated tai chi chuan played a positive role in these participants' lives, improving their physical condition (including seated balance mobility and pain reduction). It also promoted self-confidence and encouraged a proactive lifestyle.
Shortly after the second week of the study, many participants reported experiencing improvement in balance and flexibility. By the third week, participants were reporting improved stamina and by week five, they reported improved strength as shown by their improved ability to transfer from wheelchair to car. Caregivers and family members also reported these improvements.
For example, during the sixth week of the study, Ms. B, a 70-year-old who has used a wheelchair since her stroke seven years ago, said, "I felt like my arms just took flight." She had been unable to use her left arm, which had become positioned stiffly against her side. Her elbow and wrist were flexed, and her fingers held in a fist. Caregivers had great difficulty bathing her left side because they could not abduct her left arm more than a few degrees. She began to get small but noticeable movement in her left arm. By week eight, with no reported intervention except the tai chi practice, she was able to lift her left hand to her mouth and elevate her left elbow enough to place it on the back of her wheelchair. Even more remarkable is her report that she began standing on her left leg and walking up steps for the first time in seven years. This outcome was completely unexpected, since the seated tai chi form used did not involve any leg movements whatsoever. In the post-study interview, she commented: "I made so much progress in seven weeks. I've enjoyed it, and I've been inspired by what I've seen others doing, and hearing them, and it helps me."
Another study participant, Ms. R, has paraplegia as the result of an automobile accident five years ago. She reported living every day with back pain which was accentuated by activities such as riding public transportation. She commented that she noticed quite unexpectedly one day that her daily activities no longer caused her pain. Her family commented on her ability to transfer from chair to car with much greater ease. She reported that her podiatrist asked her what she had been doing differently because both feet were the same temperature (perhaps suggesting improved vascularization) for the first time since her accident.
At end of this pilot study, a majority of participants wanted to continue a weekly tai chi chuan practice session. Although the arrangement of transportation continues as a barrier, most of them have continued with class at the hospital weekly since the study ended last September. When asked why they want to continue the class, the most commonly expressed sentiment was that this class has been making such a difference in their lives that they did not wish to miss it.
Although the sample size for the study was not large enough to draw any statistical conclusions, the changes experienced and reported by individual participants and their caregivers are impressive and encouraging especially with regard to perceived quality of life. The findings suggest that simply designed tai chi exercise programs structured according to the characteristics and needs of people with ambulatory disabilities, deserve further investigation. This tai chi form may be an effective, practical and economical complementary healing method, promoting self-confidence and a proactive lifestyle.
I wish to thank Dr. William Jonson, Dr. Nancy Fell, Dr. Janet Secrest and Dr. Glenn Haban for their invaluable input and assistance in writing this article.
Dr. Zibin Guo is a professor of Medical Anthropology at the University of Tennessee Chattanooga, and a tai chi master. He may be contacted at
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