Gait, Fluid Cognition, and Balance John McKinney

Gait, Fluid Cognition, and Balance Welcome, Intro, Bio, Statement of Scope Results from Needs Assessment Defining terms Model of Gait Cognition Balance Relationship Literature Review (OHSU focused) Wearable Tec & other assessment tools Tai Chi Specialty Gait Practice Evaluations

Tai Chi is an empirically supported method for preventing falls and cognitive decline. If you take nothing else away from this presentation, you should remember that Tai Chi is an empirically proven method for preventing falls and dementia.

How American Style Tai Chi Supports Healthy Cognition Cognitive Set Shifting Memory (Forms) Attention (Focused, Shifted, Divided) Tai Chi Specialty Gait Practice (Dual Tasking)

Fall Prevention Specialist Tai Chi Gait Instructor John McKinney Fall Prevention Specialist Tai Chi Gait Instructor Over 30 years experience Bachelor of Science Psychology Specialty Contemplative Education Disclaimer, not a medical professional but a movement specialist. While the results of Tai Chi are empirically supported, it still requires a lot of hard work. I teach from an Eastern influence (go from cultural frame directly into the mechanism)

As a practice, Tai Chi explores and improves the relationship between the executive (cognitive) function and the gait and balance function. This relationship is known as dynamic integration.

Definition: Fluid Cognition focuses on attention, learning, and manages sensory integration.

Cognitive Skills Pyramid

Fluid Cognition: quick adaptive decision making based on sensory data Flexible thinking

Factors Contributing to Cognitive Impairment: Brain shrinkage (Vascular) –affects memory first Connectivity loss (Usage + Vascular) Mild Cognitive Impairment (MCI) may be REVERSABLE Dementia (usually) is NOT REVERSABLE Now dementia is caused by Brain Shrinkage and Connectivity loss

Dementia is caused by: Tai Chi works because: Activates learning Brain shrinkage (Vascular) Connectivity loss (Usage) White Matter Lesions Tai Chi works because: Activates learning Trains mental focus and set shifting Bimodal exercise: physical and mental coordination Tai Chi is an adept response because it targets the precise causes of dementia. Many exercises and routines are successful in preventing dementia, but Tai Chi even more so.

Gait includes locomotion, axial rotation, and contralateral limb extension

Elements of Normal Gait Initial foot push-off begins the gait cycle. Center of gravity goes forward beyond base of support (fall risk increases). Contra lateral limb extension Axial rotation transfers the energy the step across the centerline to begin the next gait cycle.

Balance: is the body’s process of managing spatial sensory integration, that is your personal spatial awareness.

Elements of Balance Balance system integrates sensory input from 3 subsystems: Vision Vestibular system ( sensing gravity and acceleration) Proprioception (knowing where you are in space) Age Related Changes in the Balance System

In conclusion: Tai Chi focuses on your Dynamic Integration, ensuring your personal and cognitive awareness of your body in space.

QUESTIONS ?

Self Actualization through Gait Training “I’m a Walker” Motor Function Here’s the mechanics of how Tai Chi gait training works. Motor Function Sensory Input and Integration

Literature Review Effectiveness of a Therapeutic Tai Ji Quan Intervention vs a Multimodal Exercise Intervention to Prevent Falls Among Older Adults at High Risk of Falling, JAMA Internal Medicine 2018 Authors Dr. Elizabeth Eckstrom, Dr .Fuzhong Li et al 2. The Motor Signature of Mild Cognitive Impairment: Results From the Gait and Brain Study, Journals of Gerontology 2014 3. Tai Ji Quan and global cognitive function in older adults with cognitive impairment: A pilot study, Archives of Gerontology and Geriatrics 2014 Authors Dr .Fuzhong Li, Peter Harmer et al. Literature Review: not sure if we landed on which paper(s) to site?

focus on physical and psychological safety present moment awareness My classroom: focus on physical and psychological safety present moment awareness no judgment intentional movement My Classroom: The importance of good instruction, creating and maintaining a safe space where students can learn and explore. Limits on narrative, focuses on student perspective.

Demonstration of Specialty Gait Step

Principles of Specialty Gait Steps Push from foot to hand Listen with the whole body store gait energy in the circle Demonstration

Principles of Specialty Gait Steps Demonstration

MMSE Cognitive Assessment tool MiniBest Balance Assessment tool Other resources: OHSU balance study Wearable devices MMSE Cognitive Assessment tool MiniBest Balance Assessment tool My Classroom

Thank You! Questions….