Dance as a form of therapy for children with Cerebral palsy

Introduction

After a long time, therapists have come to appreciate that there is a relationship between human behaviors whether psychological, physical or social and dance. This is because dance has a therapeutic potential since it helps us to express our feelings and concerns. From ancient times dance has been associated with healing rituals. For instance, in the medieval era in Europe people danced to avoid bubonic plague and also in Italy the tarantella dance is believed to cure the bite of spiders. As a result, dance therapists have come to conclude that individuals can be able to heal from complications such as Cerebral palsy through dance movements. Therefore, dance therapy helps children with cerebral palsy to improve posture, muscle coordination and gain body awareness that enhances their participation, self-esteem and communication skills.

A brief introduction to cerebral palsy

Cerebral palsy is a neurological and physical movement disorder that affects victims at early childhood. The condition affects body movement, muscle coordination, balance and posture of the victims. Approximately about 2.1% of babies suffer from cerebral palsy in every 1000 births. Other population-based studies show that about 1 out of every 323 children is born with CP in the United States. These studies also indicate that CP is common within boys than among girls because 77.4 % of the recorded cases are boys while 58.2 % of the cases are girls[1]. CP condition is worse because out of this total population, about 41% of these children are likely to develop other complications such as epilepsy and autism among other motor disabilities.

One common cause of cerebral palsy is pregnancy complications such as premature birth and low birth weight. In the United States, about 6.2 % of 1000 births of children weighing 1500 to 2,499 grams are likely to suffer from cerebral palsy while the condition gets worse in children weighing less than 1,500 grams because 59.5 % of 1000 births are likely to suffer from cerebral palsy[2]. Globally, 43.7 % per 1000 births of premature children born between 28 to 31 weeks of gestation are likely to suffer from cerebral palsy. Another common cause of cerebral palsy is genetic disorders that run through the family line. Studies show that 2% of the totals cerebral palsy cases per year are attributed to genetic disorders[3]. Finally, cerebral palsy can be caused by injuries to the part of the brain that controls motion and coordination.

Children that are suffering from cerebral palsy often express particular signs and symptoms. First, they have muscle coordination and movement problems such as stiff and weak muscles. This explains why such children suffer from poor movement, balance and posture. Second, victims of cerebral palsy may experience problems of sensation, vision, hearing, and speaking because the coordination between their brain and nervous system is poor[4].  Third, such children also have slow thinking and reasoning process which may lead to seizures and poor performance in school. Finally, one can identify a child with cerebral palsy when they cannot roll, walk or crawl like other children within their age bracket.

Two types of classifications: based on the problem and the affected area give the various types of cerebral palsy. Classification based on problems have three kinds which are spastic, ataxic and athetoid. Spastic cerebral palsy causes a problem of stiff muscles; ataxic causes a problem of poor coordination while athetoid causes problems associated with writhing movements. On the other hand, classification based on affected area has four types which are monoplegia, diplegia, hemiplegia, and paraplegia[5]. Monoplegia means that only one limb is affected while diplegia means that the legs and the lower body are affected. Hemiplegia means that one side of the body is affected while paraplegia means that all legs and the lower body part are affected.

From the above classifications, cerebral palsy causes five types of movement abnormalities that can be corrected through dance therapy. First, hypotonia is the kind of muscle tone abnormality that causes resistance to movement. The two common muscles affected by this abnormality in children with cerebral palsy is the neck and the trunk. Hypotonia affects the posture of the child which affects their sitting and walking positions. Second, spasticity is an abnormality that causes tightness in the muscles of children suffering from cerebral palsy.  As a result, such children have a difficulty holding items because their arms and legs are turned inward. Dance helps these muscles to stretch from their tightness which helps the child with cerebral palsy to gain better muscle tone.

Third, dystonia is another movement abnormality caused by twisting and abnormal repetitive movements in the joints. Children with this disorder may experience conditions such as scissoring of one leg across the other and inwards turning of the wrist during dance lessons. Four, weaknesses abnormality is caused by less muscle strength which affects the movement of the muscles. The dance involves the following of a rhythm which helps children with cerebral palsy to improve their muscle coordination and strength. Finally, asymmetry is a movement abnormality caused by cerebral palsy which affects the child’s posture and trunk stability. Dance can improve the trunk stability of children with cerebral palsy because it strengthens the joints as one responds to the rhythms[6]. Therefore, cerebral palsy causes hypotonia, spasticity, dystonia, weaknesses and asymmetry movement disorders in the victims.

A brief introduction to dance as a form of therapy

Dance has existed for many years, and it has been defined as a sequence of movement made in response to the rhythm of the music. Dance has been used for many functions such as entertainment, healing, weight management and others do it as a hobby or career. Dance can be utilized as a form of therapy because it supports the intellectual and emotional development of the body. According to American Dance Therapy Association (ADTA), dance therapy is the “psychotherapeutic use of movement as a process which furthers the emotional, social, cognitive, and physical integration of the individual[7].” From this definition, we learn that people can use dance to express their feelings which lead to emotional, psychological and cognitive development. Fran Levy supports the definition of dance therapy by ADTA when he says that “body movement reflects inner emotional states and …changes in movement behavior can lead to changes in the psyche, thus promoting health and growth[8].” Therefore, According to Fran and ADTA dance has the power to heal people who have emotional problems, intellectual deficits, and life-threatening illnesses such as children suffering from cerebral palsy.

From the above definitions of dance therapy, it is clear that dance therapy is different from regular dancing in the following ways. First, dance therapy is more than regular exercising achieved through dance movement because it is a form of feeling expression. Dance therapy helps people to unconsciously or consciously express their feelings and emotions which they cannot express in words leading to emotional and physical relief[9]. Second, dance therapy goes beyond helping individuals to attain cardiovascular endurance, muscle tone, balance, and coordination to helping them develop specific body language, non-verbal behaviors, and emotional expressions. This means that dance therapy is a form of emotional and physical treatments that helps people to deal with emotional imbalances such as depression and other disorders such as cerebral palsy.

The history of dance therapy can be explained in three waves of development. Dance therapy is a concept that came into existence in the 1900s when Carl Gustav Jung coined the phrase dance as psychotherapy in his article. Carl’s ideas did not gain root until the 1950s when Marian Chance founded the American Dance Therapy Association (ADTA) in the United States which created the first wave of dance therapy. Marian was a dance instructor who argued that dance is a form of treatment after she observed that most of her students used dance as a way to express their feelings. Marian claimed that dance therapy is the “rhythmic action in unison with others results in a sense of well-being, relaxation, and good fellowship[10].” This means that dance is not just a form of a routine carried out for relaxation and entertainment, but it is a healing process that promotes the growth of one’s well-being. She later became a teacher of dance at St. Elizabeth Hospital in Washington to help students who suffered from emotional, physical and cognitive problems such as children with cerebral palsy.

The second wave of dance therapy occurred during the 1960s when other therapists began to support Marian and Carl’s ideas. This created an era where therapists such as Isadora Duncan, Martha Graham, and Doris Humphrey began to experiment with the psychotherapeutic applications of dance. For instance, in 1960, Mary Whitehouse created a movement promoting the use of dance as a form of therapy that develops better listening and expressing skills in people. Later, other dance therapy organizations such as Carter’s Commission on Mental Health were founded to use dance therapy to treat mental illnesses[11]. This lead to the third wave of dance therapy development where therapists began to use dance to deal with specific illnesses such as cerebral palsy in the 1990s.

Theorists who believe that dance is a form of therapy base their arguments on the following principles. First, they believe that the body and the mind processes are interrelated such that they affect each other. This means that when one moves during a dance process, it impacts the total functioning of the body and the mind which leads to therapeutic benefits. Second, movement in dance is a mirror of one’s personality. People use dance to express their inner self through the unconscious or conscious process of dance which helps them to attain a therapeutic feeling of emotional control[12]. Finally, therapeutic advantages of dance are mediated non-verbally which means that dance affects the patients in various ways that are not evident externally but have inherent benefits such as healing of emotional problems.

Horowitz in his article “Healing in motion: dance therapy meets diverse needs,” argues that dance therapy has several goals[13]. First, it creates an environment that helps the individual to reach their achievements and discover their limitations both physically and emotionally. Second, helps individuals to attain a healthy self-image by increasing their body awareness, spontaneity and creativity through dance movements. Third, helps people to manage their emotions such as anger and stress through teaching them the art of muscle control and stabilization. Finally, it supports the cognitive and physical growth of individuals through strength training which supplies more energy to the body. Also, it helps people to integrate their individual needs and social competence through the action of dance which helps them to deal with intra-psychic conflicts, emotional problems and structural deficiencies of life.

Case studies of the connection between dance therapy and cerebral palsy

Many dance therapists and researchers have conducted various studies to test the connection between dance therapy and cerebral palsy. The results of these therapists and researchers have a promising proof that dance can be used as a form of therapy for children with cerebral palsy. For instance, In 2010 Robert Wechsler and Alicia Penallba carried out a study to test if dance motion has any impact on children with cerebral palsy. In their study they used a sample of 32 participants from New York City in the United States. 31 participants of the 32 subjects in the study were children with ages ranging from 5 to 13 while the remaining participant was a 40-year-old man who acted as a control experiment[14].

The researchers worked with each separately in sessions of 15-30 minutes and gave each the opportunity to control music and sounds with their movements. Their motion response was them recorded using two technologies which were a video-camera based system and electrode-based physical touch system. The video camera was able to measure the pace of the motion while the electrode-based physical touch system measured the ability of the participants to control sound. Later, results were tabulated based on the physical ability of the participants to make and control specific movements in a form of motion as they responded to the rhythm in the music. The results were then analyzed based on the factors of the type of cerebral palsy, the age of the participant, amount of voluntary and non-voluntary movement and response to musical rhythm through gestures and other dance movements.

From this study Wechsler and Alicia found out that all the children responded to the movement in various ways. Most of them improved their response and movement with time after they began to feel successful control of their environment. Also, as they children carried out the dance moves one would notice a sense of pleasure and confidence in their body and faces. Thus, a dance made these children forget their handicapped conditions and helped them to let themselves enjoy the movements by taking control of their environment[15]. The more the child dance, the more he/she became happy and one would notice that they felt a form of therapeutic healing from their conditions.

In another study of 2012 Citlali et.al administered a dance program on a group of suffering from cerebral palsy to test if it improved the healing and participation of the children. They used questionnaires, surveys and interviews which they conducted on the parents, therapists and children in a tertiary rehabilitation hospital, one outpatient physical therapy clinic, and one community center. From their study, they found out that the children with cerebral palsy reported great improvements in their posture, body awareness, and self-esteem after the dance program. From these findings, they concluded that dance programs can be used as a form of therapy and rehabilitation for children with cerebral palsy which increases their participation and physical well-being. Thus, from these two case studies, we learn that dance has been used as a successful therapy for children with cerebral palsy.

Benefits of dance therapy to children with cerebral palsy

Dance therapy helps children with cerebral palsy to communicate, express and restore their inability which heals their everyday emotional, cognitive and physical problems. Dance therapists believe that children with cerebral palsy can benefit from dance therapy in various ways. First, dance therapy helps cerebral palsy patients to attain better coordination of the mind and the body. Children suffering from this condition have poor coordination of their muscles and nervous responses which make them be unable to perform body functions such as walking, crawling and running. Dance is a process that involves the movement of different parts of the body that must be well coordinated to comply with the rhythm of the music. For this reason, dance encourages children with cerebral palsy use their limbs and other body parts that may be hard to coordinate in a fun way. Since dancing is fun the child with not concentrate on their weakness but they will put effort to be able to respond to the rhythm of the music through movement[16]. As the child responds to the rhythm, they can gain coordination between their limbs and other body parts which help them overcome movement disabilities caused by cerebral palsy such as stiff muscles.

Second, dance therapy helps children with cerebral palsy to attain body stabilization through strength and posture improvement. Dance is a form of strength training that increases muscle and cardiovascular endurance. As a result, children suffering from weak and stiff muscles can benefit from the dance because it encourages them to stretch their muscles as they respond to the movements of dance. Most cerebral palsy children suffer from poor posture which makes them be unable to stand straight. This condition can be corrected through specific dance movements such as the ballet and dance devices such as the pole which encourages the child to attain a good posture. Also, as the child learns to respond to the reciprocal and repetitive movements in the dance they attain a sense of control and balance which increases they body and mind stabilization. For children with cerebral palsy dance, therapy helps them to improve the monitoring, strength and balance during movement which creates a sense of stabilization in their limbs making them overcome the problems of poor posture caused by the disorder.

Third, dance therapy helps children with cerebral palsy to attain body awareness which helps them to celebrate their achievement and work on their limitations. As the child dances, there can identify what they can do and what they have to work harder to achieve. This awareness in good for children because helps them to understand themselves better. Just like adults who try different things to know their personality, children also understand themselves through their strengths and weaknesses. For instance, a child with cerebral palsy will notice that they cannot move their hands quicker like other ordinary people when they are suffering from stiff muscles[17]. A dance therapist must help this child to react positively to this discovery by helping them to overcome their limitations. As the child overcomes their weaknesses through repeated dance therapy classes, they can develop a body awareness.

Finally, dance therapy helps children with cerebral palsy to improve their self-esteem, communication skill and increase their participation in day to day activities. Most people view children with cerebral palsy as handicapped creatures who must be confined to a wheelchair for the rest of their life. In most cases, this treatment makes such children suffer from low self-esteem, poor communication skills and prefer to be isolated from other people[18]. In worst scenarios such children are made to believe that they cannot do anything for themselves which reduces their participation in the societal affairs. Dance therapy can be used as a corrective measure in this scenario because it encourages such children to overcome their weaknesses. As these, children learn to overcome their limitations through dance they develop positive attitudes and can relate more to people.

In conclusion, dance is a form of therapy for children with cerebral palsy. This condition has the symptoms of poor muscle coordination and movement problems, reduced sensation, vision, hearing and speaking and slow thinking and reasoning process. It is caused by premature birth, genetic disorders and injuries on the brain. The condition causes five types of movement disabilities which are hypotonia, spasticity, dystonia, weaknesses and asymmetry. Dance therapy which is the use of movement to improve one’s emotional, social, cognitive and physical well-being can be used to heal this condition. Therefore, for children with cerebral palsy, dance helps them to attain better coordination, body stabilization, and body awareness and develop their self-esteem, communication skill and increase their participation in day to day activities.

 

 

 

 

 

 

 

 

Notes

[1] Langwith, Jacqueline. 2011. Cerebral Palsy. Farmington Hills, Mich.: Greenhaven Press.

 

[2] Levete, Sarah. 2010. Explaining Cerebral Palsy. Mankato, Minn.: Smart Apple Media.

 

[3] Langwith, Jacqueline. 2011. Cerebral Palsy. Farmington Hills, Mich.: Greenhaven Press.

[4] Wechsler, Robert and Alicia Peñalba. 2010. “Motion Tracking: A Music And Dance Tool For People With Cerebral Palsy”. Palindrome Inter.Media Performance Group 3 (2): 40-400.

 

[5] Langwith, Jacqueline. 2011. Cerebral Palsy. Farmington Hills, Mich.: Greenhaven Press.

[6] Mehta, Devika. 2016. “A Case Study Of The Movements Of A Child Diagnosed With Cerebral Palsy Within The Context Of Dance Movement Psychotherapy At A School For Special Needs | Indian Journal Of Dance/Movement Therapy”. Cmtaisite.Wordpress.Com. https://cmtaisite.wordpress.com/category/a-case-study-of-the-movements-of-a-child-diagnosed-with-cerebral-palsy-within-the-context-of-dance-movement-psychotherapy-at-a-school-for-special-needs/.

 

[7] “American Dance Therapy Association”. 2015. Springer.Com. http://www.springer.com/psychology/psychology+general?SGWID=0-40459-6-642809-0.

 

[8] Johnson, Carolyn. 1996. “Dance And Other Expressive Art Therapies: When Words Are Not Enough”. Art Therapy 13 (3): 214-215. doi:10.1080/07421656.1996.10759227.

 

[9] Goodill, S. 2005. An Introduction To Medical Dance/Movement Therapy. London: Jessica Kingsley.

 

[10] Lepecki, André. 2012. Dance. London: Whitechapel Gallery.

 

[11] Goodill, S. 2005. An Introduction To Medical Dance/Movement Therapy. London: Jessica Kingsley.

 

[12] Johnson, Carolyn. 1996. “Dance And Other Expressive Art Therapies: When Words Are Not Enough”. Art Therapy 13 (3): 214-215. doi:10.1080/07421656.1996.10759227.

 

[13] Horowitz, Sala. 2000. “Healing In Motion”. Alternative And Complementary Therapies 6 (2): 72-76. doi:10.1089/act.2000.6.72.

 

[14] Wechsler, Robert and Alicia Peñalba. 2010. “Motion Tracking: A Music And Dance Tool For People With Cerebral Palsy”. Palindrome Inter.Media Performance Group 3 (2): 40-400.

 

[15] López-Ortiz, Citlali, Kim Gladden, Laura Deon, Jennifer Schmidt, Gay Girolami, and Deborah Gaebler-Spira. 2011. “Dance Program For Physical Rehabilitation And Participation In Children With Cerebral Palsy”. Arts & Health 4 (1): 39-54. doi:10.1080/17533015.2011.564193.

 

[16] Klevberg, Gunvor Lilleholt, Sigrid Østensjø, Sonja Elkjær, Ingvild Kjeken, and Reidun Birgitta Jahnsen. 2016. “Hand Function In Young Children With Cerebral Palsy: Current Practice And Parent-Reported Benefits”. Physical & Occupational Therapy In Pediatrics, 1-16. doi:10.3109/01942638.2016.1158221.

 

[17] Mehta, Devika. 2016. “A Case Study Of The Movements Of A Child Diagnosed With Cerebral Palsy Within The Context Of Dance Movement Psychotherapy At A School For Special Needs | Indian Journal Of Dance/Movement Therapy”. Cmtaisite.Wordpress.Com. https://cmtaisite.wordpress.com/category/a-case-study-of-the-movements-of-a-child-diagnosed-with-cerebral-palsy-within-the-context-of-dance-movement-psychotherapy-at-a-school-for-special-needs/.

 

[18] Levete, Sarah. 2010. Explaining Cerebral Palsy. Mankato, Minn.: Smart Apple Media.