In my time shadowing pediatric occupational therapy at Aspire Pediatric Therapy, I learned a great deal about specific neurodevelopmental disorders, the incredibly important link between the mind and body, and the nuanced way therapy must be approached for children. After coming in with some self-formulated ideas on occupational therapy, I built a whole new outlook on the healthcare profession, seeing it as an upcoming, ever-changing therapy packed with diversity and creativity. I also began to observe the numerous links that occupational therapy shares with dance, and I contemplated places within therapy where dance may be incorporated as an effective therapy technique.
From day one of my shadowing, I was struck by the very diverse population the therapists worked with. Children in occupational therapy are usually recommended to attend therapy by a physician or through the school system, and they are prescribed occupational therapy for everything from social, physical, emotional, or intellectual disabilities. In the clinic, I saw therapists working closely with children from six months old to 17 years old. However, the majority of the patients were somewhere between the ages of six and eight. During a day in the clinic, I never saw a patient with the exact same complaints or goals to work on. Thus, each therapy session varied wildly from the ones before it. Some of the more common diagnoses that appeared in patients were children on the autism spectrum (CARS), children with ADHD, and children with delayed development. In addition to these patients, we worked with a variety of other patients with diagnoses such as cerebral palsy, Turner’s Syndrome, blindness, poor body awareness, oculomotor problems, social behavior disorders, conduct disorder, oppositional defiant disorder, down syndrome, and even an incredible girl who had half of her brain removed and was relearning how to go about life. Even amongst the children with the same diagnoses, they never had the same goals or dysfunctions, and they never responded to the same treatments. Thus, every session required therapists to be ready to improvise new ways to help the child accomplish his or her goals.
One of the more common therapy techniques was playing in the gym and completing obstacle courses. Many of the children we worked with, especially those on the autism spectrum, had difficulties with proprioception and motor planning, practices that must be put into actual use for the children to learn them. For a child to be able to play freely and safely, they must be aware of the capabilities of their own bodies; thus, when a child struggles with proprioception, they are often afraid to move in certain ways, cannot perform motor skills, and risk getting hurt from poor self awareness. When a child exhibited these struggles, the main form of therapy was encouraging them to play in ways that utilize the full body and require a lot of proprioception. Thus, when a 6-year-old girl experienced fear of jumping off of steps due to not understanding the movement of jumping in her body, the therapist literally guided her on how to jump. The therapist first started by spotting the girl, having her bend her knees and then lifting the girl from the stairs to the ground. Slowly the therapist started to pull away her support and after a few sessions, the girl was able to jump off the stairs on her own. The therapist was demonstrating to her how her body worked and conditioning her to be less afraid of her own body mechanics. This technique of acknowledging proprioception is often employed in the dance arena as well, so I was very comfortable understanding this sensory aspect. As dancers we are taught to use our skills of proprioception to correct technique in our bodies and feel our movement in mindful ways. Knowing the limits and possibilities of our body allows us to perform complex movements and connect to movement in a different way. Although the complex ideas of using dance and proprioception to influence our movements may be a little too complex for children to comprehend, I am curious if therapists could teach dance to children with proprioception deficiencies in order to work on their body awareness. Dance may help them get to know their own bodies better and to understand the mechanics of their bodies more clearly. Dance also is an activity that incorporates the whole body, thus it will definitely work out the proprioceptive areas of the brain. In the gyms, the therapists also work on motor planning with the patients. When learning a new motor action, we require conscious thought and planning of that action. Often when carrying out a motor activity, our brain breaks down how to perform the activity by putting the activity into steps. When a child struggles with motor planning, or has motor apraxia, they fail to plan out movement and thus struggle with carrying out the movement. These movements can be anything from fine motor movements, like feeding themselves with a spoon and handwriting, to gross motor movements like climbing and walking on stairs. These deficiencies in motor planning in turn cause clumsiness, improper form, and fear. At the clinic, the most common way to practice motor planning was through obstacle courses. Obstacle courses contain a specific, easy to distinguish sequence of steps. For example, an obstacle course may be swing on trapeze swing, climb up the ladder, slide down the slide, step on the buckets one foot at a time, and then balance on one leg. As patients working on obstacle courses progressed through sessions, they were able to handle more steps in the obstacle courses since they were improving in their motor planning. The obstacle courses allowed the children to think about and plan what steps they needed to take in order to accomplish their goal of completing the course. Once again, dance also shares this need for motor planning in order to be executed well. In learning a dance phrase, dancers must remember a sequence of steps and consciously think about the steps in order to correctly perform them. This again makes me wonder if teaching dances to children with motor apraxia would give them an interesting and possibly less obvious way to work on motor planning. Dance could help children find a greater sense of awareness of their own bodies as well as allow them to learn how to plan movement more efficiently; this could result in the children being able to perform more play activities, motor skills, and self-care behaviors with confidence.
In my sessions shadowing, I was surprised to find out the immense amount of emphasis therapists placed on rhythm and musicality. Prior to shadowing, I knew that music therapy was an upcoming oddity in pediatric therapy, but I will admit I did not understand how much musicality is emphasized in childhood development. Essentially, the real use of music in the occupational therapy setting seemed to be mostly linked to teaching children listening skills and practicing motor planning. For multiple patients, the therapists had children spend some time working with Interactive Metronome, a computer program that involves a patient using a clapper sensor to try and clap or stomp exactly at the same time as a rhythmic beep being produced by a computer. The computer produces the beats in a consistent rhythm that the child must learn and get accustomed to. Then the goal is to clap or stomp at exactly the same time as the computer beeps; the computer provides feedback letting the patient know how many milliseconds early or late they are from hitting the beat exactly. The hope with Interactive Metronome is that children will practice working on listening and paying attention for an extended period of time (the sessions of rhythmic beats last for about two minutes with no breaks) as well as work on auditory processing and motor planning. They must plan out when to move their body in order to hit the beats properly, and they must properly process when beats sound in order to hit the next beat accurately. Learning synchronization and timing helps with motor coordination and almost all executive processing. When watching the children work on this task, I was surprised by how consistently difficult it was for them. Very few of the children I watched could hit even one beat in a session accurately. Many of them had a real deficiency in keeping time with a beat. This lack of fluency with timing seemed to carry out into a variety of other tasks the children had deficiencies in, such as motor planning, listening skills, and coordination. This made me wonder if poor synchronization was the root of many other issues within the occupational therapy realm. Obviously, dance constantly encourages attention to timing and conscious processing of rhythm. I wonder if teaching dance to children with auditory processing and timing deficiencies would make larger improvements in their skill base, especially the types of dance that are very tied to musicality.
Without me realizing it, shadowing at Aspire Pediatric Therapy made a strong case for me that dance belongs in the world of occupational therapy. Dance constantly challenges the conscious and subconscious mind, requiring the coordination of proprioception, motor planning, auditory processing, synchronization, and attention. Dance is a very intellectual process. Throughout the summer, I was excited by the possibilities of the new insight I could bring to the already intriguing field of occupational therapy. I was particularly drawn to the young children on the autism spectrum, finding the way their minds work incredibly beautiful and intriguing. Thus, this field work study has influenced me to want to create a senior project of a dance-based therapy program that specifically targets certain occupational difficulties that children with autism face. I believe dance could integrate the many goals of occupational therapy in a new and hopefully successful manner.
Kelsey Kempner 