1. Gait, Fluid Cognition, and Balance
John McKinney

2. 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

3. 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.

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

5. 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)

6. 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.

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

8. Cognitive Skills Pyramid

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

10. 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

11. 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.

12. Gait includes locomotion, axial rotation, and contralateral limb extension

13. 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.

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

15. 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

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

17. QUESTIONS ?

18. 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

19. 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 Authors Dr .Fuzhong Li, Peter Harmer et al.
Literature Review: not sure if we landed on which paper(s) to site?

20. 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.

21. Demonstration of Specialty Gait Step

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

23. Principles of Specialty Gait Steps
Demonstration

24. 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

25. Thank You!
Questions….