Prime Motionz: Tai Chi-based Balance Exercise and Fall Prevention

What is Prime Motionz?

Balance and fall prevention in the elderly has been a prime focus in my previous private practice and even today in my clinical undertakings. I developed the Tai Chi-based Exercise Program that we incorporated into our physical therapy clinic years ago.

The concept was, it is a proprietary exercise routine that combined physical therapy therapeutic exercises, using the slow and controlled movements of Tai Chi as a medium. The routine focused on all the elements required for an effective balance and fall prevention program:

. Relaxation

> relaxes muscles > lowers the center of gravity Lowered center of gravity > increases load on lower limbs > over time increases sensation and awareness of lower limb movement.

• Transfer of Weight:

Shifting body weight from leg to leg through incremental movements. Starting with a small range of movement and gradually build up to a wide, square base stance.

• Muscle Strength

Muscle bulk and therefore strength decrease with age. A bent-knee stance and movement work to strengthen lower limb muscle (particularly the quadriceps muscles) (however, always work to an individual’s limitations. If a bent knee stance is too difficult, then do the movement without bent knees).

• Instability

This involves issues such as increased body sway, low mobility, and postural instability. Increasing age is also associated with reduced sensation in lower limbs and is consequently associated with a loss of righting reflexes and an increase in body sway, which can lead to falls.

o Gait:

Decreased stepping height and decreased stride length. Women tend to have a narrow walking and standing base, closer foot placement, erect posture > difficulty stepping down from stools/benches. Men tend to have a small-stepped gait, wider walking and standing base, and stooped posture.

Tai Chi addresses gait problems by teaching the “correct” movement of lower limbs. This is done by lifting lower limbs from the knee rather than the foot; lifting lower limbs without misaligning the pelvis, and teaching to place heel down first when moving forward (toes first when moving back). Also, teaching movement with appropriate weight transfer, posture, and slightly bent knees improves stride length

o Posture:

Tai Chi also teaches participants to maintain a relaxed posture with an elongated spine.

• Coordination/Mobility:

Tai Chi consists of moving from one stance to another in a slow, coordinated, and smooth way. This trains students in improved mobility and increased body awareness.

The Prime Motionz Story

This all started during my early days of clinical practice in the US, at one of the upscale retirement facilities in Fort Myers, Florida.

There was this very elegant lady, her name was Pearl. I don’t remember her last name but she made a big impact on my budding clinical brain.

Poised, always well dressed, whenever she comes for her physical therapy sessions. She was always well put together. Cashmere pink sweaters, white well-ironed slacks, silver-grey heat that seemed to be always well-coiffed. She also always wore an expensive string of pearls and a very warm and welcoming smile to all she speaks with.

She was of a slim but fit build. She has invited me a few times to her high-rise apartment to share a snack. During that time, any snack to me was a novelty, having just arrived from my country. We were hired as physical therapists for a large Rehab contracting company, Novacare, Inc.

Miss Pearl, which I fondly called her, suddenly stopped coming for her therapy sessions. Wondering what happened, I inquired from one of the facility nurses if they had seen her.

I was later informed that Miss Pearl FELL and broke her hip and was admitted to the hospital. That was devastating news to me. She was not just a patient but she had become a friend. One whom I looked up to and admired for her friendliness and class. The epitome of grace and ladyhood in my impressionable eyes.

A few weeks later, our department was notified that Miss Pearl was back but she is not going back to her high-rise apartment but will be admitted for short-term care. Not wasting any moment. I went to the subacute wing of the facility where she was admitted.

The sight that met me was devastating. This was not the poised and dignified lady I have come to know and admire. Sheets askew, skinnier, and mumbled unintelligible words. The second blow was, she did not recognize me at all! Each time I went to visit her, she seemed to be all dopey and confused. She manages to smile and acknowledge my presence as she does to everyone. But she did not remember my name nor who I was, and how I worked with her in physical therapy.

The downward health spiral that followed after Miss Pearl's fall, came too fast. In a matter of weeks. She had to be on a feeding tube to sustain herself as she was not eating at all. She kept losing weight.

The last thing I heard from the facility staff was that she has departed. Not one to really show emotions and confide in people, her passing away affected me tremendously. I did not even realize I suffered from depression which stayed with me for months. I just thought it was just plain old homesickness.

This special person made an impact on my life and career. I saw firsthand, the debilitating and ultimately fatal effects of falling. I can just imagine how many older adults suffer from the debilitating aftermath of falls each year. The statistics are staggering.

Grim Facts About Falls in Older Adults

*One in four Americans aged 65+ falls each year.

*Every 11 seconds, an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall.

*Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults.

*Falls result in more than 2.8 million injuries treated in emergency departments annually, including over 800,000 hospitalizations and more than 27,000 deaths.

Just a further review of the facts of falls in the elderly. The estimated cost to treat injuries sustained from these falls is estimated to exceed $50 billion dollars from the year 2015 and may reach $67.7 billion in the year 2020. Furthermore, Medicare and Medicaid shouldered 75% of these costs.

The Concept of Physical Therapy Therapeutic Exercises Using Tai Chi as a Medium

Years after, I was blessed to have had the chance to open my own practice. It was my mission and goal to provide physical therapy services that also focused on improving balance and prevention.

Research has shown that Tai Chi, a Chinese martial art, has been proven to decrease the risk for falls in the elderly. It prompted me to learn more about this study as released by researchers at the Emory University.

This study indicated consisted of two groups. One group focused on just doing the Tai Chi classes, and the other group did just the usual wellness classes.

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***The Tai Chi participants in the most recent study took classes twice a week. Tai chi consists of slow, rhythmic movements that emphasize trunk rotation, weight shifting, and coordination. The wellness group met once weekly, where educational materials on exercise, fall prevention, nutrition, and medication management were provided but with no formal instruction on exercises.

A brief summary of this study. Over the 48-week study period, 46 percent of the participants did not fall. The percentage of participants that fell at least once in the tai chi group was 47.6 and 60.3 percent in the wellness education group.

The results showed that Tai Chi had the most profound effect in fall prevention, reducing the risks of multiple falls by 47.5 percent when compared to balance training and wellness education." (credit to a press release of Janet Christenbury on 2/24/2004 for Emory University, Atlanta, Georgia)***

>>>>>>>>>Click here to learn more about this study

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The Prime Motionz, Tai-Chi Based Exercise Program for Balance and Fall Prevention, was then conceived in 2003 at my first ever physical therapy clinic in Melbourne, Florida. This was also due to our patient's requests to be able to continue an exercise program after they have completed physical therapy. Initially, it was limited to only patients of the clinic who graduated from the PT program. It was offered every Tuesday & Thursday afternoons at the clinic.

Let me share an informational video I produced years ago, about 2003 I believe. This was regarding falls and as an introduction to the Prime Motionz Program that I developed.

Word in the community, however, got around and we had to accommodate the public as well. The clinic soon became too small to accommodate the number of students. We had to move the classes to be conducted at the Palm Bay Community Center where there is ample space. It soon became official that the class became a FREE community offering by the city of Palm bay every Thursday from 2:00 to 3:00 PM.

Word about the Tai-Chi-based Prime Motionz exercise program grew. Soon, local doctors started referring more patients to the clinic who can benefit from the program. We integrated the Prime Motionz routine into our physical therapy program. This was especially helpful to patients who suffer from joint pains from arthritic conditions, post-surgical conditions including hip and knee replacements and fractures.

The results from patients and students who participated in the program were significant. Testimonials below:

TESTIMONIALS

(Note: These testimonials were unscripted and taken from a simple digital camera at that time. Six or seven megapixels at that time. LOL)

The number of participants in the Prime Motionz program I conducted at the Palm Bay Community Center grew. This was even more so during the winter months where snowbirds came down. Some winter classes I offered had attendees of anywhere from 30 to 70 participants. The center had to open up three sections of the hall to accommodate everyone. I also had to bring in some of my staff, physical therapists, and assistants just to monitor and spot everyone to ensure safety.

A local TV News Channel got wind of the community program and invited me to talk about the program. I admit I am not used to having cameras in my face and was very (very) nervous during the interview. This was a random interview, unscripted. I very much appreciated the fact that the program caught attention locally.

The Interview

The responsibilities of having to run three clinics that soon grew became a priority for me. I had to give up doing the classes myself. Soon I had to delegate and let one or two of my students continue the program. The program was offered for many years at the community center run by my students. I did visit when I could, to offer lectures, tips, and coaching to learners when I could.

The rollercoaster of life soon took me for a ride. The following years were a gargantuan effort to keep my family intact. Domestic challenges got in the way. Life happened and so did my stormy divorce.

My passion, however, for the Tai Chi-based exercise program I created did not wither away. It was because I witnessed the exceptional benefit I saw in my students and patients.

This is a new beginning for me to revive this program and improve on it; to reach out to more people. Not limited to my local community.

The age of advanced technology prompted me to conceptualize a remote learning program that people from anywhere in the world can avail of, and also reap its benefits.

My Concept of a Membership Site

1. An educational hub where members can access free courses (books, audios, and videos) on general health, disease prevention, and management, physical therapy-related self-help topics.

2. Members can access or download free E-books on their specific health topics. A variety will be provided. Mostly on Self-Improvement, Health and Fitness, Natural Health, Topics can include education on specific ailments:

Parkinson's disease, Osteoarthritis, Strokes, Dizziness and Vertigo/Vestibular Rehabilitation, Fibromyalgia, Headaches/Migraines, Common Aches and Pains, Natural Remedies, Improving Gait and Ambulation, Joint Replacement Coping Strategies, How to Care for Loved Ones with Specific Illnesses, and more.

3. Scheduled Free Zoom Classes featuring the Prime Motionz Exercise Program (This will feature the different routines, each routine on different days as scheduled) Sitting, Standing, and the Dynamic Form. To be featured are the more Advanced Prime Motionz Fan (Using a Tai Chi Fan) Prime Motionz Ball (Using a Tai Chi Ball), and the Prime Motionz Sword (using a wooden or light metal sword). This can also be hosted by a guest instructor, maybe a chair yoga teacher, silver sneakers instructor, osteoporosis classes, and others.

4. Weekly or Bimonthly Newsletters. This can contain very helpful class updates and new courses or classes, E-books that members can choose to avail themselves, and other offers.

5. Prime Motionz Store. Where members can purchase unique health items or products. Some they can use for the Prime Motionz Routine. It can be T-shirts with the Prime Motionz Logo, gift items, Prime Motionz Video Compilation of all the Routines that they can do themselves at home.

To make the program available to participants to practice at home, a patient suggested having a video of the routines that they can buy. This all the routines, plus the instructional videos as well. Check it out below. Don't laugh. People no longer have DVD units nowadays, but as a matter of fact, I do have patients recently who requested a DVD of this exercise program!

To keep up with the current technology, it will be necessary to find ways on how to deliver these exercise routines conveniently to participants. Maybe an app, or a link, not sure. Will definitely need a geek for that later!

6. Community Outreach. This was a relevant activity that helped promote the clinic and our programs. In the past, I organized health fairs that included other health providers in the area. Symposiums were also conducted with sponsors, about Balance and Fall Prevention involving local doctors (neurologists, rheumatologists, geriatricians, family physicians, and other specialists) Now that there is a loosening of restrictions due to the pandemic, this can be a future activity that needs planning.

7. Scheduled Zoom Conferences or Symposiums for Members with a Guest Speaker. This can be anyone in the medical or health field that can be invited to give a short lecture, webinar, which can also help promote the speaker.

8. Member Contests & Challenges. This can be their journey about their health, doing the Prime Motionz Program, and others.

9. Automated Webinars. This where members can attend automated webinars on certain health topics as well.

These are just some ideas of what my membership site would feature if I do have one. I understand that this is a major undertaking and will require a lot of planning, the right people, staff, and the right platform most of all.

My passion burns, however. And if I learned how to navigate posting articles on a website, or a blog site (which was not an easy feat for a technologically challenged individual like me), I can learn and will give it my best shot.

Just being able to reach out to the world using the powerful reach of the internet, and raise awareness would be very rewarding.

My Dream of a Balance and Fall Prevention Center Facility

In dreams, we can dream big, right? So here it is. I'll make it brief, however, but maybe, just maybe, this is an opportunity for me to convey my dream, even in words I expressed here.

I have a dream..... (this reminds me of the powerful words of MLK) of a facility where it will not only be a physical therapy clinic but also the comprehensive hub of health services and programs including..... yes you guessed it: A Center for Balance & Fall Prevention!

The concept of this facility is that it will have an open area where the Prime Motionz Classes and other Fitness Classes can be conducted; spaces both indoors and outdoors in beautifully landscaped, tranquil surroundings. Water cascading downward from rocks, a rock garden, sitting areas where participants and patients can rest. A walkway or Japanese-style bridges with handrails so even frail ones can enjoy. (Sigh)

Inside the facility is, of course, (wink) the physical therapy clinic with state-of-the-art equipment. But what will make it unique is that it will feature unique devices and equipment I have conceptualized for balance retraining and fall prevention.

It will also feature a "Balanz" gym, where most equipment is designed towards improving balance, coordination, proprioception for the elderly. Membership needed, of course. See? I'm learning fast.

Regular gyms abound for the healthier population, but there is none suited for the more feeble ones. I just feel that this population is underserved when it comes to promoting their quality of life too.

When I do reach my golden years, it would be so fulfilling to see more of these types of facilities; knowing that perhaps, this article has reached caring young ears and would make it happen. If perchance, I am not able to.

“You see things; and you say, ‘Why?' But I dream things that never were; and I say, ‘Why not?'” – George Bernard Shaw