What does dance offer that other creative activities don't?
Readdressing the disembodied body. "Movement makes you feel good." Patient, Lanyon Ward.
We
are conceived, born and live in movement. Our bodies are designed to
move and suffer from lack of movement. Movement integrates experience.
We cannot help but move ourselves, our emotional sentient selves, when
we move our bones, muscles and flesh. Much of the process of stroke
rehabilitation involves coming to terms with a new sense of self, an
unfamiliar embodiment.
Rehabilitation is extremely complex
because the effects of stroke can mean that a patient's perception of
movement or orientation in space is confused. Sensory feedback may be
muddled so a light touch of a hand could be felt as painful, or words
that a patient wants to say come out as something entirely different.
Session notes 4 August 2010; dance artist - Jayne Devlin, supported by Rehab Support Worker (RSW)
We
began, as usual, with fine motor control of hands and fingers to up
tempo music, moving swiftly on to concentrating on core torso muscles.
We incorporated the legs, ankles and feet. Participants mirrored my
movements and followed spontaneous movement impulses of their own...
Tapping, pointing, picking, brushing...
Grasping, grabbing, releasing, unfolding...
Swaying, stretching, turning...
Fluid... continuous!
Staccato, forceful!
Rotating, kicking, connecting...
Responding, reacting, feeling, sensing.
Eyes tracking, following, leading.
Horizon.
Resting.
These
movements could occur in a physiotherapy session so why is dance
different? We think it is because the movement starts from a creative
impulse rather than a functional task. During one of her sessions
Caroline was struck by a patient's response, "so frail yet deeply
connecting with movement and eliciting a richness of engagement that
seemed to come from a place deep within her."
We wanted people to
respond and be motivated by our movement for movement's sake.
Motivation is deeply significant in successful recovery and depression,
the antithesis of motivation, is often one of the many debilitating side
effects of a stroke. We felt that a creative approach to movement would
encourage motivation by its playful nature. For us facilitation was
about easing the way, encouraging patients to feel relaxed and enabled
by the sessions. We were also aware that many medical interventions
require the patient to be passive while they are tested or treated. In
dancing the participant is self-activating and not a passive recipient.
The subtle and delicate act of creativity
"I could see she had really enjoyed it, her face was really lit up." Patient's husband, Lanyon Ward.
Due
to the brain's wonderfully intricate wiring, and each individual's
unique personality, no two people will display the same effects
post-stroke. One of the many challenges on the stroke ward was to see
beyond the results of the stroke, to the individual person. This is
particularly difficult when speech and movement are impaired because
they are such vivid indicators of personality. Here creative
interactions can play a valuable role as an expressive mediator between
the patient and staff. Creative dance provides potential for the
expression of personal and universal qualities. Creativity walks hand
in hand with play and in our sessions this was evident in the
spontaneous, often joyful responses of the participants. Supporting one
of Jayne's sessions Caroline observed, "...a gradual change in the
atmosphere from quiet, perhaps a little uncertain, to full
participation, laughter and smiles. Jayne transformed the ward from a
space of serious illness potent with stroke's challenges, into a joyful
playground."
Session notes 10 September 2010; dance artist - Caroline Schanche, supported by RSW
Working
with tissues last week led me to thinking about developing this theme
by working with different weights of paper because they would provide a
different challenge to coordination and the bright colours are
stimulating and cheerful.
To lively music we played with reaching
for paper, choosing favourite colours, ripping, throwing and scooping
up more paper. Everyone was encouraged to use their weaker hands.
Tidying up we started to assemble different colour combinations,
flattening the paper out, gathering it together and talking about
favourite colours or what the shapes made us think of.
Moving
with paper reinforced the warm-up activities by using them in a
different way. Sitting at the table and reaching for the paper engaged
the torso in alignment and stimulated fine motor control.
Participation and collective consciousness
"When I go back to my room I feel the benefit of attending this class." Patient, Lanyon Ward.
During
our sessions the participants ceased to be patients but became members
of a dance community. The significance of participation was in
overcoming self-consciousness and simply 'having a go'. Dance is a
challenge because when the material for the session is our bodies,
rather than clay or paper, we are very exposed. This is particularly
pertinent post-stroke when your body feels completely different. Dance
offers an opportunity to overcome vulnerability and to be carried along
by the moment. Some patients were anxious about not being able to
achieve but the positive effect of seeing other people in a similar
condition joining in was encouraging. When the activity is about a group
focus, attention is taken away from one's own disabilities and a shared
sense of achievement brings a sense of pleasure. The social nature of
the sessions meant that there was a lot of chatting. This was in
striking contrast to arriving on the wards and noticing how quiet the
patients were, often alone in their beds.
Practical tasks and the creative impulse
"My arms feel less stiff after the session." Patient, Lanyon Ward.
Added
to our creative approach to movement were the physical issues that we
learned about from the physiotherapists. These included:
- Postural alignment, locating and activating core muscles
- Stretching of contracted muscles .Coordination and control of sequencing movements
- Increasing concentration levels
- Relaxation.
We
wanted to incorporate these tasks into our sessions so that the dance
could be a creative response to a practical concern. Sometimes patients'
responses were so slight and subtle they were almost indistinguishable.
However, it was clear that these tiny physical responses were taking an
enormous amount of concentration and determination. The smallest of
physical responses can stimulate the neural pathways that need to be
reconnected in order for movement to be regained. Visualising movement
triggers responses in the brain even if the movement cannot be achieved
so we encouraged patients to imagine moving and used visual images to
inspire a physical response.
Session Notes 30 June 2010; dance artist - Caroline Schanche, supported by RSW
We
used spongy tubes as giant crayons drawing in the air. 'D' suggested a
snowman. 'G' was trying to suggest something and getting frustrated
because she could only think of the German, so we settled for an angel.
'M' suggested a robin and to finish the picture off a moon, stars and
fir trees were suggested. What was interesting for me was how much more
freely everyone moved when they were thinking about drawing a picture
and how it felt good to engage the imagination. It's curious that an
instruction like 'reach towards the ceiling' appears to be harder to
follow than 'draw a snowman in the air'. I wonder if it's because the
first feels like exercise and the second feels like play.
Dance and the art of transformation
"That was fun! It's good to do something different!" Patient, Lanyon Ward.
At
the start of the project our work took place in the day rooms to the
side of the ward and physiotherapists and RSWs selected participants. As
the project progressed Jayne felt the sessions were hidden from view
and the selection process did not fulfil an inclusive approach. Her
concern was that patients unable to leave their beds were not given the
same opportunity to participate.
Moving the sessions onto the
ward was a pivotal time in our work. The ripples of our interventions
were no longer to remain solely in the day rooms but became visible to
all. At this point we also began to shadow each other, providing peer
support and fulfilling the role of 'witness'.
Session notes 18 January 2011; dance artist - Jayne Devlin, supported by RSW, physiotherapist and Caroline
The
session revolved around my intention to evoke 'engagement and contact'.
My aim was to stimulate, activate, transform and subtly gain movement
in the patient's upper bodies by them watching me set in motion the
floating fabrics. All the women became animated during this time.
Caroline's
observation was, "The event that really validated being on the ward was
that towards the end of the session the very frail lady in her bed
suddenly began to engage, swaying her arms and humming with the music
and reaching for the bubbles that Jayne blew towards her. Had the
session taken place in the day room this would not have occurred."
What does dance offer that other creative activities don't?
Dance
springs from the body we inhabit. For a stroke patient to regain their
previous independence, it is crucial that they begin the arduous task of
learning to move again. Dance stimulates multiple processes at once.
When a patient reaches out, muscles, neurons, breath, fun and
relationship are all interrelated. There is no hierarchy in these
processes because they all need each other. As facilitators we danced
through the sessions hoping to illicit a kinaesthetic response in the
patients and to make every movement count whether it came from us or the
patients.
We called this article 'Moments of breath and hand
jive' because it brought to mind something of the scope of our work.
Sometimes the dance was to sit and breathe with a patient and breath was
the sound score. Sometimes the dance was a hand jive, the music was
Elvis and the group was 'rocking'. Dance has a seemingly infinite reach
and it all begins at home in our bodies.
contact Jayne Devlin:
weejayne@hotmail.com or 07840 109 505 / Caroline Schanche:
caroline.schanche@virgin.net or 07773 669 667
This
project was a partnership between the NHS Regional Stroke Nurse
Consultant and Arts for Health Cornwall, who commissioned a group of
eight artists from different disciplines.