Can somatic dance practices reduce acute pain for children and young people in hospital?

Small Things Dance Collective

Aims The aim of this study was to assess whether Improvised Somatic Dance (ISD) can have a positive effect on children and young people experiencing acute pain. ISD is a non-traditional and non-directive or improvised approach to creative dance and movement education/reeducation.  

The study was led by Small Things Dance Collective (STDC) in collaboration with Alder Hey Children’s Hospital’s Research Department, Pain and Sedation Service, Play Specialists and was part of Alder Hey’s progressive Arts for Health programme.  
Context It followed an exploratory qualitative study (2008-9) which utilised an Interpretative Phenomenological Analysis (IPA) and created evidence of effects and benefits of ISD with children and young people on the acute wards of oncology and neuromedical (Dowler, 2013).

Funding Edge Hill University’s REF investment fund and Arts Council England.  
Timescale location and setting  January- June 2013 at Alder Hey Children’s NHS Foundation Trust in Liverpool, on three hospital wards, Orthopaedic, Cardiac and Neuromedical.

Description of the arts activity

Artistic approach and medium Improvised Somatic Dance is an inclusive approach that empowers participants to engage in movement and/or dance from their current situation and condition, including their experience of pain and their emotional and physical circumstances.  It can incorporate therapeutic touch and play with the somatic dance practitioner responding to the individual child or young person and their interest.

Participant engagement Although the approach is person centred and each ISD session is unique, a loose structure may be identified, which outlines three stages:-
Firstly, a meeting place, where the practitioner enters the participant’s space.  The practitioner enters quietly, with a soft gaze; slowly introducing themselves following the timing of the child or young person.  They wait for a verbal or non-verbal invitation from the child to move closer, sometimes a sensory object/toy/musical instrument is used to mediate that space.  
For children with an Acquired Brain Injury (ABI) the practitioner may use touch as a place of communication.  The touch quality has the same intention of an ‘invitation’; it is a listening, non-directive touch; a ‘being with’ rather than ‘doing to’ touch.

The second phase is the duet, a time to explore movement and creativity together.  This includes the subtle movement of the breath to a more physical and expansive moving through space; playing with sensory objects, creating story through imagination, but can also stay within the realms of barely perceptible or micro dances, such as, small shifts in muscular tone, quality of movement and relationship.

Finally, ending arrives with rest and relaxation. This could be by using objects like feathers and balloons with a soft quality or restful touch, rolling body balls or drawing.

Details of the project participants

Target population The study included 25 infants, children and young people aged 14 months old to 17 years.  They were in hospital for surgical procedures or neuro-rehabilitation following Acquired Brain Injury (ABI).
The participants were experiencing acute pain, described as the ‘…most common type of pain experienced by children resulting from injury illness, or, in many cases, necessary medical procedures.’ (AAP, APS 2001)  
Recruitment/referral The children and young people were identified and referred by clinical and play specialists on the wards, as their pain persisted despite appropriate pharmacological management.

Project management

Roles/responsibilities The study was developed by STDC in collaboration with the hospital’s research department and Edge Hill University where Principal Investigator Lisa Dowler was a Senior Lecturer in Dance (2007-15).  Lisa Dowler and Cath Hawkins adopted a practitioner-researcher role under supervision of Alder Hey Arts for Health and the Pain and Sedation Service.
Ethics and consent Ethical permission was granted by EHU’s Faculty of Arts and Sciences Research Committee and the hospital’s research department. All participants’ names were changed to protect anonymity and the data is safeguarded by STDC (registered Charity No. 1162128).

Consent was sought first from parents/carers and then the child or young person participating.
Cost The ISD sessions were at free to participants.

Evaluation methods and findings

Qualitative data
General themes were of relaxation and generally feeling ‘better’, including those on the orthopaedic ward whose pain score remained the same (see table 1, no’s 1 and 6).  Some children were unable to comment as they were non-verbal,  and others fell asleep due to relaxation.  Three children and young people on the orthopaedic ward commented that they felt a change in the affected body part and improved movement.

General responses and themes arising from witnesses for all 25 sessions i.e. parents, artist, hospital staff, were that participants were happier, less anxious or more settled and more able to move.  On the two surgical wards children and young people often had anxiety about movement and on the neuromedical ward the children and young people were unsettled and unable to rest.  The somatic dance sessions reduced anxiety and tension for all participants

Learning
There is potential for somatic dance to be included more widely within paediatric healthcare and pain management.  It is a flexible, gentle and safe approach, which can complement pharmacological and existing non-pharmacological approaches to pain management. As the relationship between the arts, wellbeing and recovery evolves it is anticipated that somatic dancers can support nurses and other health professionals both on the wards as part of a multidisciplinary team and through Continued Professional Development opportunities.

Publication Dowler, L (forthcoming) Can somatic dance practices reduce acute pain for children and young people in hospital? Journal of Nursing Children and Young People, accepted for publication 21st July 2016

Bibliography
Dowler, L. (2013), Improvising on the ward: Exploring somatic dance and potential in paediatric health care, Journal of Applied Arts & Health, 4, 2, 163–178

Supported using public funding by the Arts Council England