I principi ispiratori della disciplina nei consideranda della direttiva

This section highlights the changes made to the first draft of the TCAS programme following discussion between the researcher and the Tai Chi instructor: four Tai Chi movements in the first draft were omitted and two others were added to the final movements included. An extra component, Qigong was also added. The final version of the TCAS programme can be found in Appendix 4.

1. Beginning meditation (sitting)

No changes were made to this section of the programme.

2. Joint-loosening exercises

The elbow exercises mentioned in the previous section were omitted because it was decided that the elbows would be relaxed if the shoulders were relaxed, thus there was no need to include this exercise. In its place, head and neck loosening exercises were introduced because it may be beneficial to relax these areas to help maintain central body alignment.

Loosening the neck may help to relax the shoulders down, thus elbows will be lowered.

Additionally, exercises to loosen the hand joints were included in preparation for upper limb movements.

3. Leg-strengthening exercises

As mentioned above, a semi-squat position (whilst adopting a high posture) is encouraged which helps to strengthen the leg muscles (Lan et al., 2013). Leg-strengthening occurs because bending the knees can place a large load on the muscles of lower extremities (Tsang & Hui-Chan, 2005.) This semi-squat position is often known as ‘sinking,’ a concept adopted by Tai Chi practitioners. An additional leg strengthening exercise was added to replace the movement ‘turning the wheel’. Rather than practise ‘turning the wheel’, the instructor thought it better to practise the sinking and rising aspect of this form behind a chair without the arm movements.

4. Qigong exercises

According to a practitioner of Qigong, Tai Chi consists of sequential forms, whereas within the practice of Qigong are individual exercises (Zhang, 2000), hence Qigong may be viewed as being warm-up exercises. Following discussion with the Tai Chi instructor, it became clear that it is common practise to incorporate Qigong exercises into any Tai Chi practice to allow for the smoothness and controlling of Tai Chi movements.

Qigong exercises chosen for TCAS involve seated and standing exercises. Practising

movement whilst seated before standing is important because the ability of each participant can be assessed within safe parameters. The Qigong exercises chosen by the instructor involve arm movements, encouraging the participant to gain spatial awareness. To help gain spatial awareness, participants are encouraged to look at their hands during the

movements. Looking at the hands also helps to control the movements.

5. Balance-training exercises

Tai Chi includes weight-shifting, which help participants’ ‘limits of stability’. Limits of stability are the points at which the centre of gravity approaches the limits of the base of support, requiring a correction strategy to return the centre of mass to the base of support.

To help participants recognise their own limit of stability, the concept of an imaginary

balance line was introduced by the instructor, which is numbered from one (on the left), two (the middle) and three (on the right), depicted in Figure 4 (permission to use these

photographs has been given by Richard Morley). This line is imagined by the participant during a parallel stance. Weight is shifted from position two to one, from position one to two, from position two to three, then from position three to two. Participants pause once they reach each position to gain insight into their limits of stability. It is stressed that participants should not move out of the imaginary line’s range, or they may lose their balance.

As weight is shifted from one leg to another, participants are encouraged to imagine

another line going down the centre of the body, representing the centre of gravity, depicted in Figure 4. As weight is shifted, this centre of gravity line should remain in the centre to maintain central alignment and balance. An upright stance is essential for the body to maintain balance, another principle of Tai Chi. To maintain body balance in Tai Chi, participants align their spines vertically without leaning forwards, backwards or sideways (Galante, 1980) with the head held upright whilst facing forwards (Chengfu, 2005). If the head is too far forward, it may cause the participant to lean forward, resulting in loss of balance. By maintain the centre of gravity, weight-shifting becomes a smooth movement.

To practise smooth movements, participants are encouraged to shift along the imaginary balance line without pausing, should they become confident in their limits of stability.

Following this, single-leg rooting may be practised. However, participants were encouraged to lift only the heel as opposed to the whole foot because lifting the whole foot may prove to be too difficult.

Figure 4 Centre of gravity during parallel stance

Once participants have achieved the aims of the weight-shifting exercises in the parallel stance, weight-shifting may then be practised in the bow stance (see Figure 5). A bow stance is where the practitioner places one foot forward so that the knee and toes are lined up perpendicularly and the leg supports 60 per cent of the body’s weight (Yang, 2010.)

Participants mirror the instructor so that the exercises are practised in group synchrony.

Weight-shifting in the bow stance prepares the participant for the Tai Chi stepping by positioning the foot in the stepping position. Participants are thus able to give an indication as to whether they can move on to this stage in the programme.

Figure 5 Centre of gravity during bow stance

6. Tai Chi movements

It was the original intention of the researcher to create a ‘form’ for stroke survivors by amalgamating different Tai Chi movements. However, on reflection, it was concluded that stroke survivors may find this too difficult. Therefore, the TCAS programme was confined to individual movements. The final draft of the Tai Chi programme focusses on integrating the movements with Tai Chi stepping.

Four movements included in the first draft of the programme were omitted. These are presented in Table 9, along with justification for the omissions.

Table 9 Tai Chi movements omitted from the TCAS programme Movement omitted to the TCAS

programme Justification

Turning the wheel This movement was incorporated into the leg strengthening section of the

programme. Mastery of the practise of rising and sinking was needed before introducing arm movements.

Parting the Wild Horse’s Mane This was too complicated for stroke survivors recently discharged from

hospital. Given the 12-week timeframe, it was decided that this is too short to be able to advance to more complex movements.

Cloud Hands This exercise is not conducive to mix with stepping because it involves stepping to the side.

Repulse Monkey Stepping backwards is very advanced and may be practised following completion of the final programme. However, the short time frame makes it unlikely that this advanced level of the programme would be reached by participants.

Movements added to the programme are presented in Table 10.

Table 10 Tai Chi movements added to the final Tai Chi exercise programme Movements added to the

TCAS programme Description Justification Play guitar Both arms are raised,

shoulder-width. This exercise helps

participants understand their limits of stability in

preparation for more challenging exercises.

Single whip Arms are moved out to

the side whilst stepping. This exercise is more advanced and challenges balance further than ‘play guitar’ due to the wider arm movements.