Monday, July 16, 2012

The Gait of Classical Tai Chi Walking and Dementia

Hexagram 30, Li The Clinging, Fire I Ching

Nine in the third place means: In the light of the setting sun, Men either beat the pot and sing Or loudly bewail the approach of old age. Misfortune. "Here the end of the day has come. The light of the setting sun calls to mind the fact that life is transitory and conditional. Caught in this external bondage, men are usually
robbed of their inner freedom as well. The sense of the transitoriness of life impels them to 
uninhibited revelry in order to enjoy life while it lasts, or else they yield to melancholy and spoil
the precious time by lamenting the approach of old age. Both attitudes are wrong. To the superior man it makes no difference whether death comes early or late. He cultivates himself, 
awaits his allotted time, and in this way secures his fate."

Ikkyu, the Zen master, was very clever even as a boy. His teacher had a precious teacup, a rare antique. Ikkyu happened to break this cup and was greatly perplexed. Hearing the footsteps of his teacher, he held the pieces of the cup behind him. When the master appeared, Ikkyu asked: 

"Why do people have to die?"

"This is natural," explained the older man. "Everything has to die and has just so long to live."
Ikkyu, producing the shattered cup, added: "It was time for your cup to die."

Dementia, old age, lack of movement, the bain of old age?  Are you doomed to merely "clinging" to life as you reach old age or do you celebrate going into it by "living in the Springtime of your life"? There are numerous studies and articles about the health benefits of Tai Chi for any age, but there should be  much more written about Classical Tai Chi.  As with Tai Chi in general, the health benefits of Classical Tai Chi can be examined from different perspectives and with different intensity.  Unlike Tai Chi in general however, the health benefits of Classical Tai Chi will always be linked inextricably with the training of Internal Discipline which is the exclusive domain of Classical Tai Chi.

It is an unfortunate occurrence of old age that the elderly begin to move more and more from the extremeties of the body and less and less from the core of the body.  We hear the statement, "I feel stiff" quite frequently from elderly people, whereas one seldom hears that refrain from the young.

This is an excerpt from the book Understanding Dementia, which is meant to be a practical manual for primary care physicians and other health care professionals. Chapter 6 deals with theneurological examination, which includes an examination of gait (i.e. how someone walks).

"A crucial (and often neglected) part of the neurologic exam is the observation of gait. Common gait disorders associated with dementia are the hemiplegic gait, parkinsonian gait, ataxic gait and apraxic gait. The characteristics of a hemiplegic gait are well- known (circumduction at the hip, dragging of the affected foot, and lack of movement at the knee). Parkinsonian and ataxic gaits are also familiar to most primary care practitioners. The former, in its most characteristic guise, is accompanied by a stooped posture, loss of arm swing, shuffling, small steps, and festination - an ataxic gait is characterized by imbalance, and usually a broad couching stance in compensation. An apraxic gait is present when the previously learned motor activity (gait) can not be performed despite normal power and coordination of the legs. Typically the patient can stand, but has difficulty initiating gait, is very unsteady, takes small irregular steps, and their feet appear frozen to the floor. Detailed cuing (e.g. "life your right leg, now bend the knee, now put it forward.") often is helpful. This gait is consistent with both vascular disease and normal pressure hydrocephalus . "

Taken from Understanding Dementia: A Primer of Diagnosis and Management
© Kenneth Rockwood & Chris MacKnight, 2001
Chapter 6, pp 108-109

That is an interesting terminology:  "Detailed Cuing" (e.g. "lift your right leg, now bend the knee, now put it forward.")  This is exactly how Classical Tai Chi approaches its most basic training of Walking by using internal discipline.

I find the Walking exercises, training, practice of Classical Tai Chi to be tailor made for this dilemma.  One can intuit quite easily that it is important to maintain the ability to walk, what is more difficult is getting people to do it particularly if they feel unsteady.  

Moreso than any Tai Chi that I have experienced over 35 years, the Classical Tai Chi  takes this and goes right to the crux of the problem.  The elderly do not move from the core, they stoop, shuffle their steps and exhibit very little flexibility.  Any training should take the "core" movement into account  for the stagnation of the core is at the heart of the matter.  Any training should take a cognitive approach...talking, instructing exactly(How do you lift your leg..."lift the leg by using the abdominal and back muscle, by lifting the pelvis, etc."  It is part of the training to take "small steps" but with Classical Tai Chi the training makes the steps "regular".  The training encompasses schooling people in how to not have "feet frozen to the floor".  This is accomplished through teaching people to keep the body's center of gravity under control.  Not allowing the body to fall forward as is done in the everyday common walking motion.  Most importantly, one learns to pull the body forward or backward, not pushing with the legs.

In this way dementia patients can work toward a visceral understanding of proper body posure, foot position, body weight distribution, all while using a highly cognitive and unique training for gait dynamics.  

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