Comments from VA Program Directors

The Impact of Wheelchair/Adaptive Tai Chi for Veterans Program Instructor Training Workshop

Feedback from VAMC Program Collaborators
September, 2018

DeVonda Elliott, PsyD., CTRS, Recreation Therapy Supervisor VHAJAC
The Tai Chi Chuan Program at the G.V. (Sonny) Montgomery VAMC have be instrumental as we incorporate modern day treatment modalities to serve Veterans. The Wheelchair Adaptive Tai Chi program was implemented in outpatient rehabilitation services by Occupation Therapists, short stay rehabilitation program by Physical Therapist, and in the Home Based Primary Care/Medical Foster Home setting by Recreational Therapist and Register Nurses. The Veterans were able to demonstrate at least 7 of the moves without any compliant of pain. The program is also being used with Employee Wellness, Mental Health and Social Work Services to address the psychological well-being of Veterans and well as staff. The Wheelchair Adaptive Tai Chi Chuan Program has pave the way for adaptive sports in a state that is unserved in the adaptive sports arena. Since completing the Tai Chi training the G.V.( Sonny) Montgomery VAMC have implemented a Tai Chi clinic for Veterans 2x a week.  Overall the Tai Chi Chuan program have made a great impact on the Veterans, staff and the facility.Â

Amanda Steele, CTRS, Recreation Therapy Supervisor. VA Palo Alto Health Care System
The wheel chair tai chi training that you provided was a huge success. The instruction given enabled our staff to learn the needed skills and knowledge to use this therapeutic modality with our Veterans.

Our Recreation therapy staff have implemented weekly Tai Chi programs in SCI and polytrauma system of care and in our Community Living Centers. The Occupational Therapist who took the training is offering classes through Complementary Alternative Medicine.

Kayla Forster, CTRS, RTC, Phoenix VA Health Care System
The training provided by Dr. Guo to our facility has immensely enhanced the treatment we have been able to provide to our Veterans. For our program it has helped us establish a unified Tai Chi form to use throughout our facilities which has allowed a more fluid process with all Therapists teaching the same techniques/form/adaptations. This has allowed for a better established program with more concrete concepts to use to improve the health and wellness of the Veterans we serve. We primarily serve those with mental health diagnosis or those with chronic pain.Â

In regards to the Veteran’s we serve we have observed and have Veteran’s self-report a plethora of benefits from this type of treatment. We have observed improved balance, increased flexibility, and decrease in symptoms of PTSD/Anxiety/Depression and has been a positive diversion from pain. I would like to share a few responses from Veteran’s in regards to the impact this treatment has been to their whole health.Â

“When I first started I couldn’t hardly get out of my chair and had to have people all around me, not I can stand up and even walk some.”

“It helps me to focus and really key into my thought processes to do all the moves.”

“By coming and doing the Tai Chi with others it makes me smile, helps me feel calm – gives me a sense of peace. I also like the companionship it provides. Before coming here I didn’t have anyone to talk to.”

“To be honest when we first started the new form I think a lot of us were apprehensive but not only have we come around we actually are seeing the benefits. I could never stand on one leg without falling over. Now I can hold it up for 5 seconds. Aside from that I can now squat down some so I have better flexibility.”

“Tai Chi helps me A LOT. I have Parkinson’s and do ballet for Parkinson’s at the Muhammad Ali Center twice a week and I would have to say this is just as good if not better.”

Heather A. Brown, MTRS, CTRS, VA Salt Lake Healthcare System
The wheelchair/adaptive Tai Chi program was a detailed experience that improved providers awareness to a new intervention modality. This program offered clinicians a hands-on experience to learn tai chi and necessary adaptations to serve populations of all abilities. The impact this program will have on veterans will assist in improving relaxation, mindfulness, stress and anxiety reduction, and overall physical health.

Madeline Uddo, Ph.D. Program Manager, PTSD Clinical Team Southeast Louisiana Veterans Health Care System
I am writing to express our deep gratitude to have had the opportunity for our staff to be trained by Dr. Guo. The training was enthusiastically attended by 17 staff members, including, physical therapists, occupational therapists, MDs, social workers, psychologists, and our wellness coordinator. We are committed to advancing the VA Whole Health initiative and are strong believers in complementary and integrative health interventions. This training will allow us to greatly expand our offerings of Tai Chi to Veterans throughout our facility, including several community based outpatient clinics that provide care to our rural and traditionally underserved populations. This training significantly increases our ability to provide this incredibly beneficial practice to Veterans across our system and has also energized our staff.

It was an honor to work with Dr. Guo. His wisdom and expertise were extraordinary. In the words of one of the participants, the training was “both grounding and inspiring.”

Jennie Tate MTRS, CTRS, FWOC VA North Texas Health Care System
This new 13 form of adapted/wheelchair Tai Chi is not only adapted for individuals in wheelchairs, but allows ambulatory challenged individuals to move, as the ambulatory forms do, while sitting.

At Fort Worth Out-Patient Center (FWOPC) in Texas, several veterans who can’t stand or walk have enrolled in this class. A veteran in a wheelchair needs to maintain upper body Range of Motion (ROM) as in the shoulders, elbows, and wrists, as well in the spine. This new wheelchair Tai Chi form provides full ROM in the shoulders/rhomboids. Some forms of Tai Chi, such as the 36 Yang form, is limited in the space movements are done, and do not allow for full ROM in the shoulders, or fully opening of the chest. The wheelchair veteran also needs to have ROM in his spine in the transversal plane, and core strength. As Tai Chi movements start in the lower body, the winding and unwinding of the lower back and shifting weight from one hip to the other promote flexibility in lower back. It stretches the back muscles, such as Lats and Trapezius muscles, and other low back and oblique muscles.

The increased flexibility in the spine and ROM in the upper body empower the veteran, and will allow him/her to be able to do Activities of Daily Living, Leisure and Recreation activities more effectively, and with less pain. The mobility in his adaptive Tai Chi form also allows the wheelchair veteran/participant to feel he/she is doing an active form of Tai Chi. One that is not “adapted” for him just to sit, but created for individual to be turn and move as in the ambulatory forms. Therefore several wheelchair veterans at FWOPC have been participating in this class, and have enjoyed the mobility of this form.

A veteran, who has ambulatory disabilities and uses a walker or cane, can’t do Tai Chi, as he needs to hold onto his ambulatory equipment to stand. By sitting in a wheelchair or rolling chair, he/she is free to do the upper body movement, and move in the form, safely. Thus this program allows my ambulatory challenged veterans to do the 13 form successfully and safely.

Another population that this form serves is the veteran who can walk, but has poor balance or is not able to coordinate his upper body movements and his feet in steps, as in the Yang 24 or 36 form. In the standing version of this form, the participant just stands in a broad stance and only does small lunge, or bend of one knee at time, while doing the upper body movements. This is wonderful activity to help the veteran with bad balance.

The turns, either 90% or 180% turns, match the turn of the wheelchairs and can be done either in 1-2 steps, as needed.

For the veterans who still have problems walking and doing the moves, yet would like a small challenge have the opportunity doing Section #2, either stepping back in the Sparrow tail, or balancing one leg, or semi balance during “separating heaven and earth”.For the veterans who still have problems walking and doing the moves, yet would like a small challenge have the opportunity doing Section #2, either stepping back in the Sparrow tail, or balancing one leg, or semi balance during “separating heaven and earth”.

To sum up this question, I have found that this 13 form of Tai Chi is well developed for any of my veterans with ambulatory challenges or disabilities, and recommend this activity for them.

In PTSD, fast and hard movements increase the heart rate and increase the depth and length of breath, which helps the veteran go from his Sympathetic Nervous System to the Parasympathetic Nervous System. This brings the veteran back into reality/present from “fight or flight”. However, sometimes the veteran can’t do the intensity of movements he/she needs to move from “fight or flight” and back into present.

Tai Chi Chuan can help achieve this for the veteran, the slow movements compared with deep synchronized breathing helps veteran achieve the mind/body connection and keep veteran safely in the present. Also deep breathing and the slow gentle movements help relieve anxiety, and allows the veteran to be able to function better in life, decrease hyper vigilance and lead to better socialization skill, and better health.

I have referred veterans with PTSD or high anxiety, and physical limitations to Tai Chi Chuan, either sitting or standing. The practice of the form leads to improved mind/body connection, less stress, and sense of success and empowerment.

Some veterans with high anxiety never leave their house, but will come to FWOPC for Tai Chi. Not only does it provide him/her with the benefits of increased ROM, increased O2 consumption, and other physical improvements, but gives the veteran socialization with other veterans, a connection with others, and increased self-esteem.

Even the healthy active veterans, like myself, who love the physical intensity of Yoga or other physical activities, can benefit from the smooth slow movements of Tai Chi Chuan, and the training of mind and memory to remember the sequence of form.

Tai Chi Chuan with the mind directing the body, and the circular, slow, graceful movements, is an effective physical exercise program that can optimize mental and physical fitness, self-efficiency, and increase mobility.

This program is a low-cost, safe and accessible form of exercise that can be done in groups or individually at home. And since it is designed to be done sitting, can be practiced anytime and any place.

This is why I love this 13 form Tai Chi Chuan and have chosen to develop into the Wellness program at FWOPC.