Term Paper On Tai Chi-Based Exercises For Seniors With Parkinson’s Disease
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Parkinson’s disease (PD) is a progressive disorder of the nerves that starts gradually and progresses over time (Mayoclinic.org, 2015). Marked improvement is possible with medication, but the principal symptoms include tremors, slowed movement, impaired balance and posture, loss of automatic movements, and speech changes. Exercise is important for these types of patients due to a noticeable decrease in symptoms and general well-being. However, an issue with patients suffering from Parkinson’s disease is a restricted ability to perform many types of exercise. Tai chi is an option for people who have problems with balance and coordination. A centuries-old system of smooth, slowing movements with gentle shifting of weight from one foot to the other, Tai chi has no related injuries and has been demonstrated to improve many types of physical problems such as those associated with Parkinson’s disease. It is recommended patients diagnosed with the disease perform regular exercise, but only certain types are possible. A discussion of the appropriate use of specific types of Tai Chi exercises for Parkinson’s disease patients shows improvement is possible in all areas of symptomology.
After Alzheimer’s disease, Parkinson's disease is the second most common affliction involving the neuromuscular system (Internicola, 2013). Over 1 million American are currently diagnosed with Parkison’s with the average age at the time of diagnosis being 60 years of age. No treatment is currently known that prevents or slows the progression of the symptoms. However, Harner et al. (2007) has conducted research into the importance of exercise as a component of the care plan for Parkinson’s patients. It helps to ease the symptoms of rigidity, motor coordination problems, tremors, slow movements, and unstable posture. It also improves general physical and mental health.
Studies by Bergen et al. (2000), Miyai et al.(2000), and Schenkman et al. (1998) show that exercise improves the ability of the patient with Parkinson’s to initiate movement, lengthen gait, and improve flexibility. According to the National Parkinson Foundation (2015), there is a strong agreement among doctors and physical therapists that improvement in mobility lowers the risk of falls and some other complications of the disease. Most researchers agree that the longer exercise is performed on a frequent basis, the more the benefits that result.
A study on mice by the University of Southern California (Fisher et al.) studied the brains of mice that exercised in a manner similar to a person on a treadmill. They found that the dopamine levels were the same in both the control group and the exercising group, but the active mice used the dopamine produced for efficiently. In addition, the substantia nigra and basal ganglia in the brain were modified by exercise to become more efficient. Researchers at the University of Pittsburgh also found that dopamine neurons became less vulnerable to damage due to an increase in such influences such as the glial-derived neurotrophic factor. By the time Parkinson’s patients are diagnosed, 40 percent to 60 percent of their dopamine neurons have been destroyed.
Dr. Melanie Brandabur (2015) states that while the exact mechanisms are not known, but stress worsens the symptoms of Parkinson’s disease. Anxiety and even panic attacks are not uncommon in these patients. Partnered with depression, it is possible changes in norepinephrine and serotonin are responsible. While treatment with medications such as Lexapro or Paxil can be effective, they may also result in more disruption of balance and cognition. Practicing Tai Chi is an excellent way to reduce stress by practicing controlled breathing.
Tai Chi is the most popular exercise on earth (Internicola, 2013). As the tradition spreads throughout the world from China, many Western physicians are recommending it to their patients, particularly the seniors. Many forms of exercise will sap your energy, leaving you both tired and nervous. Tai chi results in energy and a feeling of relaxation when finished. Just 20 minutes of practice a day can significantly improve most areas of physical fitness. Also, studies have shown that mineral bone density increases, endurance improves, the lower body is strengthened, and depression lessens.
A study by Li et al. (2007) observed 17 adults living in a community setting with a mean age of 71.51 years; they were diagnosed with mild to moderate idiopathic Parkinson’s disease. They completed a 5-day program with exercise each day for 90 minutes daily. For 10-15 minutes the patients were seated. The outcomes were measure by face-to-face interview on feelings of safety and physical performance. Attendance was 100 per cent and there were no safety issues. All the participants were pleased with the program and expressed enjoyment in the exercises. A pre-test and post-test evaluation of performance in the 50-foot walk, up-and-go, and functional reach showed significant improvement.
Most Tai chi programs are performed in a group and this contributes to the success of the programs. When patients with Parkinson’s exercise with others, they know there will be help of they need it. Partners also motivate the others in the groups and engage them in the exercise.
Specific Tai Chi Exercises for Parkinson’s Disease
When performed in a continuous motion, the movements of Tai Chi incorporate rotations of the trunk and body, extension and flexion of the knees and hips, shifting weight smoothly from one foot to another coordinated with movements with the arms, and alignment of the spine (Li, Fisher, Harmer, & Shirai, 2003). Particular mechanisms of posture stability involves specific pathways for neuromuscular control and somatosensory engagement. This reduces the risk of falling, an ever-present danger for Parkinson’s patients. Tai Chi emphasizes spinal alignment for posture and by shifting weight from one foot to the other in various directions, balance is improved. As the student flows through the movements, different parts of the body take turns as stabilizer and mover. The slow, even pace of the movements creates an awareness of speed, force, and range of motion.
However, not every Tai Chi movement is appropriate for people with Parkinson’s disease. For instance, many involve standing on one leg, squatting low while stretching one leg outward, or kicking higher than the waist. The specific movements of the Tai Chi form taught to Parkinson’s patients is at the discretion of the instructor. The beginning Tai Chi student begins with learning how to distribute weight evenly between the feet and coordinating breathe with movement. Achieving a state between relaxation and being tense is a state of readiness that the students strives to maintain throughout the exercise. A qualified teacher of Tai Chi has a wide repertoire of forms that employ such movements as:
Single Whip.Taking a step with one foot with the arms outraised optimizes balance without raising the toe from the floor. The feet remain firmly planted as the hands “cast the net”, twisting the spine to one side with the arms outraised. The toes rotate until they face each other, creating a stretch in the ankles, knees, and hips. The feet remain planted as the weight shifts to the other foot, rotating the spine in a gentle movement as far as the hips allow. The one arm drops beneath the other so the palms face each other. The arm with the palm down extends far to the side while the other palm rotates to the face. With the full weight on one foot, the other foot steps out into the Bow and Arrow Stance.
As you can see, there is absolutely no impact on the joints and no possibility of loss of balance. In the event the practitioner becomes fatigued, he can simple stop and rest. The entire body is stretched in this movement and it can be done back and forth from side to side without incorporating other moves if the student feels he is not yet ready to move on. Breathing slowly in and out with each movement calms the “monkey mind”.
Floating Hands. This is a very simple exercise that doesn’t move the feet at all for patients with severe balance problems. It can even be performed sitting in a chair or on a stool. The hands are at the sides with the palms facing back. The hands “float” up slowly with a deep breath. At the shoulder level, the fingers drift toward the ceiling and the hands descend with the exhale. If the student is standing, the knees bend and straighten with the movement. The visual is that the hands are weightless and as they fall from the sky, the stroke a giant kitten. The imagery and balance is improved if the practitioner can perform the movement with his eyes closed.
Beat the Drum. Another beginning movement is based on the small Chinese drum that is mounted on a stick with two balls on strings on either side of the drum. As the stick is rotated back and forth, the balls strike the drum. The movement mimics the motion of the drum and it twists from one side to the other. From the standing position, the student turns to the right, lifting only the heel of one foot, the body rotates completely to one side. Imitating the balls striking the drum, the palm of one hand covers the sternum, and the back of the other hand is placed on the lower back. On the exhale, the knees bend slightly. On the inhale, the body rotates to the other side and the hands reverse. The gentle turning and dropping is not a challenge physically, and the body is only extended as far as is comfortable. As the exercises become easier, the stretch is extended further, the knees bend more, and the breathes become deeper and more even.
Tai Chi places primary importance on balance control; it is this focus that enables the exercise to be appropriate for the treatment of Parkinson’s patients for improvement of mobility and postural instability. Under the supervision of therapists and a qualified instructor, Tai Chi has been shown to be a beneficial and enjoyable form for exercise of people struggling with the limitations of Parkinson’s disease.
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