Mykenzie_Cochrane_Honors_Thesis_SON.docx

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By

Mykenzie Cochrane

Senior Honors Thesis School of Nursing

University of North Carolina at Chapel Hill

May 1st, 2020

Approved:

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Abstract

The purpose of this study was to review and analyze existing literature to determine if Dance Movement Therapy (DMT) is a suitable therapeutic option for children and adolescents with neuromuscular disruptions, specifically Down Syndrome (DS), Cerebral Palsy (CP), and Autism Spectrum Disorder (ASD). DMT has been researched identifying its benefits on physical and mental well-being, but limited research has been conducted for its use with non-healthy populations, specifically those with neuromuscular disruptions. Using PubMed and CINAHL databases, 12 articles were reviewed and analyzed using the John Hopkins

Evidence Level and Quality Guide. Studies show that children with DS have had gross motor improvements and increased social interactions as a result of DMT. Children with CP who have experienced DMT had improvements in mobility, leading to greater independent functioning and overall well-being. Literature has shown significant improvements in social functioning, including communication and relationship development in children with ASD. Dance Movement Therapy has been found to have noteworthy impacts on physical, mental, and social well-being in children with DS, CP, and ASD; therefore, DMT should be

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Dancing is for All: The Impact of Dance Movement Therapy on Pediatric Populations with Neuromuscular Disruptions

Introduction

The American Dance Therapy Association defines Dance Movement Therapy (DMT) as the “use of movement to promote emotional, social, cognitive, and physical integration of the individual for the purpose of improving health and well-being” (Welling, 2014). Literature reveals that movement in general, specifically dance, has positive effects on physical, emotional, and social health (Welling, 2014). However, limited research has been conducted on the effects of dance in non-healthy individuals. DMT is a relatively new form a holistic therapy that

incorporates treating the mind and body together, based on the belief that the two are intertwined (Welling, 2014). Research has shown that healthy children who have received dance classes at a young age have significant improvements in balance, sensorimotor synchronization, and

therefore, motor development in comparison to children of the same age who didn’t receive dance classes (Anjos & Ferraro, 2018; Chatzihidiroglou, Chatzopoulos, Lykesas, & Doganis, 2018). In addition to improving physical health of children, dance has proven to promote mental health in teenagers. A study examined the effects of dance intervention classes on a group of adolescent females and participants noted an increase in self-confidence, self-trust, and body awareness (Duberg, Moller, & Sunvission, 2016). Many of these effects contribute to an increased overall well-being and psychological health (Duberg et al., 2016).

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Esbensen, & Bailes, 2019). Children with these disruptions are also prone to decreased mental well-being due to social exclusion, decreased self-esteem, and communication challenges amongst other factors (Lopez-Ortiz et al., 2018; Martin, 2014; McGuire et al., 2019). Little research has been conducted to assess the physical and mental effects of DMT on these populations. A professional dancer with Cerebral Palsy, Jerron Herman, wrote from his own personal experience about the positive impacts that dance has on those with disabilities (2019). Herman also discusses that dance can help deconstruct stigmas about disabilities, while also teaching others to embrace these populations’ physical differences (2019). In this literature review, articles were analyzed to determine if DMT can physically and mentally benefit children and adolescents, between the ages of zero to twenty-five, with the following neuromuscular disruptions: DS, CP, and ASD.

Focus was placed on these populations due to their neuromuscular effects. According to the National Institute of Child Health and Human Development (NICHD), people with DS commonly have delays in physical and social development, and decreased muscle tone, which can lead to impairments in physical and psychological well-being (2017). Children with CP have variable symptoms that can affect posture, balance, movement, and mobility (Centers for Disease Control and Prevention, 2019). As a result, children with cerebral palsy can have limited social interactions, functionality, and independence (Lopez-Ortiz et al., 2018). This can create feelings of loneliness, frustration, and lowered self-esteem (Lopez-Ortiz et al., 2018). Children with CP have many physical impairments, which can inevitably lead to decreased mental well-being as a result of their limitations. While children with CP have decreased functionality and

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display a varying degree of difficulties in social interactions, repetitive behaviors, speech, and nonverbal communication (2018). Newer research has also found that children with ASD can also have impairments in movement coordination (Scharoun, Reinders, Bryden, & Fletcher, 2014). As a result of the characteristic social behaviors, children with ASD have limited social interactions, which puts them at risk for isolation and loneliness (APA, 2018).

Children with these neuromuscular disruptions may have difficulties with their physical being in terms of mobility and independence, while also having a decreased mental well-being due to limited communication and social interactions. DMT has been explored as a possible treatment option for the mind and body, combining physical movement with nonverbal communication and self-expression (Welling, 2014). This literature review aims to analyze the literature surrounding DMT as a potential beneficial therapy option for children with

neuromuscular disruptions, such as DS, CP, and ASD. Methods

This literature review search was conducted using PubMed and CINAHL databases with combinations of the following key words: DMT, Dance Movement Therapy, Dance, pediatrics, adolescence, children, teens, adolescents, teenagers, Autism Spectrum Disorder (ASD), Cerebral Palsy (CP), and Down Syndrome (DS). The following inclusion criteria was used: published after 2014; available in English; included a form of dance as the main intervention; and included participants under the age of 25 years.

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inclusion criteria. Four of the articles had sufficient data but were completed with healthy children; therefore, they were included to establish a baseline for background information about DMT. In total, 12 articles we’re included in this literature review.

The reviewed articles were analyzed, and information regarding type of evidence, population, findings, and limitations were sorted into a matrix, shown in Appendix A. The four articles used for background information are also included at the bottom of the matrix, indicated with two asterisks. The matrix in Appendix A was completed based on John Hopkins Nursing Evidence-Based Practice Appendix G: Individual Evidence Summary Tool. There were four review studies, 3 randomized controlled trials, 3 pilot studies, one case study, and one research article. The level of evidence of each article was assessed based on the John Hopkins Nursing Evidence-Based Practice Appendix C: Evidence Level and Quality Guide, shown in Appendix C.

Results Down Syndrome

Dance program studies in children with DS have found improvements in physical abilities and mental well-being. Significant improvements were noted in gross motor abilities, such as standing, walking, running, jumping, and climbing stairs (McGuire et al., 2019). The participants’ caregivers noticed improvements in social interactions with peers, and credited the dance classes with providing a space for their children to interact with others (McGuire et al., 2019).

Cerebral Palsy

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range of motion, and coordination (Centers for Disease Control and Prevention, 2019). Research studies have found that children who participated in dance classes had improvements in balance, mobility, and coordination (Bruyneel, 2019; Ortiz, Egan, & Gaebler-Spira, 2016; Lopez-Ortiz et al., 2018; Stribling & Christy, 2017; Teixeria-Machado, Azevedo-Santos, & DeSantana, 2017; Withers, Muzzolon, & Zonta, 2019). Studies noted that an increase in mobility contributes to improvements in independent functioning, giving each child a greater sense of freedom (Lopez-Ortiz et al., 2018; Teixeira-Machado et al., 2017). DMT can also improve the range of motion in all axes of the hips, knees, and ankles creating increased mobility and independence (Teixeira-Machado & DeSantana, 2019). Postural instability is a common manifestation in CP, but DMT can lead to a more consistent center of gravity alignment decreasing swaying and increasing postural stability (Stribling & Christy, 2017; Teixeira-Machado et al., 2017). DMT can enhance abilities in range of motion, balance, coordination, and mobility, which have a direct correlation to improvements in gait (Lakes et al., 2019; Lopez-Ortiz et al., 2018).

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Teixeira-Machado et al., 2017; Withers et al., 2019). Multiple studies noted greater sense of overall well-being in terms of increased enjoyment, desire for more dance classes, and increased self-esteem and confidence (Lopez-Ortiz et al., 2018; Teixeira-Machado & DeSantana, 2019; Withers et al., 2019).

Autism Spectrum Disorder

For children with ASD, DMT targets physical, mental, and social deficits in a combined approach in order to holistically help the child grow and develop as expected (Martin, 2014). Although few studies have focused on DMT’s effects on physical health in children with ASD, improvements in synchronous movements have been found (Scharoun et al., 2014; Takahashi, Matsushima, & Kato, 2019). Scharoun et al., also noted that as DMT classes continued, children took less time to develop synchronous movements with the instructor (2014). The effects of DMT on mental health include improvements in body image, self-awareness, and enjoyment for movement (Scharoun et al., 2014; Takahashi et al., 2019). It has also been found that dance classes provide an emotional outlet, causing a decrease in aggressive behavior and symptoms of stress and anxiety (Scharoun et al., 2014; Takahashi et al., 2019). Caregivers of children with ASD noticed that as DMT sessions continued, there was a significant decrease in number of behavioral outbursts as well (Scharoun et al., 2014). The combined effects of DMT on mental health have led to an overall increase in well-being (Takahashi et al., 2019).

The majority of effects of DMT in children with ASD are found to be in social

functioning. Children with ASD who have completed dance classes have had an increase in self-expression, verbalizations, and emotional expressions, as noted by their caregivers and

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the class, including teachers and classmates (2014). DMT allows children to communicate non-verbally, causing them to have improvements in empathy, attunement, and even interpreting others’ facial expression (Martin, 2014; Scharoun et al., 2014). Children with ASD have had an increased tolerance to eye-contact and physical touch after completing DMT programs

(Scharoun et al., 2014). The various social functioning effects of DMT contributed to overall improvements in relationship development, social interactions, and verbal and non-verbal communication skills (Martin, 2014; Scharoun et al., 2014; Takahashi et al., 2019).

Discussion

This review of literature examined DMT research in children with Ds, CP, and ASD and demonstrated the need for further investigation regarding specifics, such as frequency, duration, and dance genre. The studies included in this review explored DMT’s effects on mental health, social functioning, physical health, or a combination of the three. When specifically studied, improvements were found in all areas of mental, social, and physical health, as shown in Appendix B. For example, studies that focused on the physical effects of DMT found

improvements. Thus, this literature review found that DMT should be considered as a possible therapy option for children with DS, CP, and ASD due to its positive effects on mental health, social functioning, and physical health. Further research is warranted to determine at what age DMT should be initiated, how often DMT classes should be held, and class duration. Future research should also consist of randomizing and blinding the studies while examining which dance activities/genres are most beneficial to each population.

Benefits of Dance Movement Therapy

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that dance can help with mental health issues, such as self-confidence, body image, behavioral issues, and overall well-being (Duberg et al., 2016). There were improvements in these mental health aspects, specifically, for children with CP and ASD (Lopez-Ortiz et al., 2018; Scharoun et al., 2014; Takahashi et al., 2019; Withers et al., 2019). This literature review found that children with ASD and CP had significant improvements in social functioning, such as communication and relationship development (Lopez-Ortiz et al., 2018; Martin, 2014; Scharoun et al., 2014; Takahashi et al., 2019; Teixeira-Machado et al., 2017; Withers et al., 2019). There was overwhelming evidence supporting physical health improvements in all three populations (Bruyneel, 2019; Lakes et al., 2019; Lopez-Ortiz et al., 2016; Lopez-Ortiz et al., 2018; McGuire et al., 2019; Scharoun et al., 2014; Stribling & Christy, 2017; Takahashi et al., 2019; Teixeira-Machado et al., 2017; Withers et al., 2019;). Improvements in all three areas of mental, social, and physical health contributed to an increase in independent functioning in children with DS, CP, and ASD.

Limitations

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results to only children with CP with the same level of severity. Although, this literature review focused on DMT’s effects on children and adolescences under the age of 25, three of the articles reviewed researched DMT effect on both children and adult participants (Bruyneel, 2019; Lopez-Ortiz et al., 2018; Takahashi et al., 2019). In order to keep results focused on children and adolescences, only data that focused on the desired population was included in this literature review.

Recommendations for Future Research

Research surrounding DMT in children and adolescences with DS, CP, and ASD is limited and needs to be further studied. Future research should also consider specific details and logistics surrounding DMT in order to find what methods are most effective. In current research there is not a standardized way to conduct DMT classes, how long they should last, or how frequent they should be. There is also a lack of research surrounding whether certain dance genres, such as ballet and hip-hop, are more effective in producing positive mental and physical outcomes than others. Future studies should create a standardized tool for pre- and

post-intervention testing and have larger sample sizes. Implications for Practice

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physical health. With continued DMT research, the holistic therapy should gain attention and become a suitable option for children with neuromuscular disruptions.

Conclusion

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Resources

American Psychiatric Association. (2018, August). “What is autism spectrum disorder?” Retrieved from https://www.psychiatry.org/patients-families/autism/what-is-autism-spectrum-disorder

Anjos, Isabelle de Vasconcellos Corrêa dos, & Ferraro, Alexandre Archanjo. (2018). The influence of educational dance on children's motor development. Revista Paulista de Pediatria , 36 (3), 337-344. Epub May 21,

2018. https://doi-org.libproxy.lib.unc.edu/10.1590/1984-0462/;2018;36;3;00004

Bruyneel, A.-V. (2019). Effects of dance activities on patients with chronic pathologies: scoping review. Heliyon, 5(7). doi: 10.1016/j.heliyon.2019.e02104

Centers for Disease Control and Prevention. (2019, April 30). “What is cerebral palsy?” Retrieved from https://www.cdc.gov/ncbddd/cp/facts.html

Chatzihidiroglou, P., Chatzopoulos, D., Lykesas, G., & Doganis, G. (2018). Dancing effects on preschoolers’ sensorimotor synchronization, balance, and movement reaction

time. Perceptual and Motor Skills, 125(3), 463–477. doi: 10.1177/0031512518765545 Duberg, A., Möller, M., & Sunvisson, H. (2016). “I feel free”: experiences of a dance

intervention for adolescent girls with internalizing problems. International Journal of Qualitative Studies on Health and Well-Being, 11(1), 31946. doi:

10.3402/qhw.v11.31946

Herman, Jerron. “Dance as art and therapy in cerebral palsy.” Wiley Online Library, John Wiley & Sons, Ltd, 10 Jan. 2019, www.onlinelibrary.wiley.com/doi/full/10.1111/dmcn.14151. Lakes, K. D., Sharp, K., Grant-Beuttler, M., Neville, R., Haddad, F., Sunico, R., …

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control in children with cerebral palsy—A pilot study. Frontiers in Public Health, 7. doi: 10.3389/fpubh.2019.00137

Lopez-Ortiz, C. J., Egan, T. J., & Gaebler-Spira, D. J. (2016). Pilot study of a targeted dance class for physical rehabilitation in children with cerebral palsy. SAGE Open Medicine, 4. doi: 10.1177/2050312116670926

Lopez‐Ortiz, C., Gaebler‐Spira, D. J., Mckeeman, S. N., Mcnish, R. N., & Green, D. (2018). Dance and rehabilitation in cerebral palsy: a systematic search and

review. Developmental Medicine & Child Neurology, 61(4), 393–398. doi: 10.1111/dmcn.14064

Martin, M. (2014). Moving on the spectrum: dance/movement therapy as a potential early intervention tool for children with Autism Spectrum Disorders. The Arts in

Psychotherapy, 41(5), 545–553. doi: 10.1016/j.aip.2014.10.003

McGuire, M. J., Long, J. F., Esbensen, A., & Bailes, A.. (2019). Adapted dance improves motor abilities and participation in children with down syndrome. Pediatric Physical

Therapy, 31(1), 76–82. doi: 10.1097/pep.0000000000000559

National Institute of Child Health and Human Development. (2017). “What are common

symptoms of down syndrome?” Retrieved from https://www.nichd.nih.gov/health/topics/ down/conditioninfo/symptoms

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Stribling, K., & Christy, J. (2017). Creative dance practice improves postural control in a child with cerebral palsy. Pediatric Physical Therapy, 29(4), 365–369. doi:

10.1097/pep.0000000000000450

Takahashi, H., Matsushima, K., & Kato, T. (2019). The effectiveness of dance/movement therapy interventions for autism spectrum disorder: a systematic review. American Journal of Dance Therapy, 41(1), 55–74. doi: 10.1007/s10465-019-09296-5

Teixeira-Machado, L., Azevedo-Santos, I., & Desantana, J. M. (2017). Dance improves functionality and psychosocial adjustment in cerebral palsy. American Journal of Physical Medicine & Rehabilitation, 96(6), 424–429. doi:

10.1097/phm.0000000000000646

Teixeira-Machado, L., & Desantana, J. (2019). Effect of dance on lower-limb range of motion in young people with cerebral palsy: a blinded randomized controlled clinical

trial. Adolescent Health, Medicine and Therapeutics, Volume 10, 21–28. doi: 10.2147/ahmt.s177867

Welling, Ande. “What is dance/movement therapy?” ADTA, 8 Nov. 2014, adta.org/2014/11/08/what-is-dancemovement-therapy.

Withers, J. W., Muzzolon, S. B., & Zonta, M. B. (2019). Influence of adapted hip-hop dancing on quality of life and social participation among children/adolescents with cerebral palsy. Arquivos De Neuro-Psiquiatria, 77(10), 712–722. doi:

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Literature Review Matrix

Based on Johns Hopkins Nursing Evidence-Based Practice Appendix G: Individual Evidence Summary Tool

EBP Question: In pediatric patients with neuromuscular disruptions, such as Down Syndrome, Cerebral Palsy, and Autism Spectrum Disorder, how does Dance Movement Therapy improve overall health?

Article # & Title Author & Date Evidence

Type Sample Size &Sample, Setting

Study Findings that help answer EBP

question

Limitations Evidence Level Quality #1; “Effects of

dance activities on patients with chronic pathologies: scoping review”

Bruyneel, A.-V.

July 2019

Scoping Review

- 51 Studies (24 RCT’s, 14 case studies, 12 controlled studies, 1 Quasi-RCT) - 2545 total participants ages 7-89. - CP: 56 children - Intellectual Disability: 10 children)

- Dance activities were found to increase motivation, participation, and adherence to said dance activities rather than guided exercises.

- Five studies focused on children with Cerebral Palsy and found that the children had increased overall satisfaction (56 kids). Balance, motor skills, cognition, and symptoms were all also improved.

- All qualitative data. - Over-arching themes about Dance - Activities include the effects on adults as well as children.

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Article # & Title Author & Date Evidence

Type Sample Size &Sample, Setting

Study Findings that help answer EBP

question

Limitations Evidence Level Quality - In 1 study focusing

on 10 adolescents with intellectual disabilities found improvements in balance after 16 weeks'.

#2; “Moving on the spectrum: Dance/movement therapy as a potential early intervention tool for children with Autism Spectrum Disorders” Martin, M. November 2014 Research Article Children ages 0-5 years No actual sample size/setting – all theoretical work based off research

- DMT is an

appropriate therapy for children with Autism Spectrum Disorder as it targets the connection between early movement deficits and social/communicatio n challenges.

- DMT focuses on combining the mind and body, which makes it function with those who exhibit nonverbal communication, such as children on the autism spectrum. - One aspect of DMT, mirroring, has been shown to

- Not evidence-based - A theoretical framework based on Dance/Movement therapists’ findings and research on ASD and the relationship between

communication/socia l and motor deficits.

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Article # & Title Author & Date Evidence

Type Sample Size &Sample, Setting

Study Findings that help answer EBP

question

Limitations Evidence Level Quality increase attunement,

empathy, and social interactions.

#3;

“Dance/Movemen t Therapy as an Intervention for Children with Autism Spectrum Disorder”

Scharoun, S. M., Reinders, N. J., Bryden, P. J., & Fletcher, P. C.

September 2014

Review of 10 case studies + review

research of DMT and ASD.

- Reviewed 10 case studies - 5 individual and 5 groups. - Individual participant ages: 5, 4, 7, 4, 6

- Group participant ages: 4-6, 3-9, 6-7, 16-18, one group of 38 kids with mean age 5 years. All participants had ASD (except 1 individual who developed ASD-like symptoms after being abused and neglected)

- Therapists should work 1 on 1 with a child with ASD so that they can create a safe, trusting

relationship before being in a group setting.

- DMT should be individualized based on the clients’ current abilities and needs.

- Using of prop helps build contact

between therapist and client.

- DMT can alleviate physical and

psychological deficits in children with ASD.

- Mirroring can help children with ASD to communicate their needs because it shows that someone

- Reviewed single case studies.

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Article # & Title Author & Date Evidence

Type Sample Size &Sample, Setting

Study Findings that help answer EBP

question

Limitations Evidence Level Quality is paying attention to

them.

- Mirroring has the ability to improve body image and social skills #4; “The effectiveness of dance/movement therapy interventions for autism spectrum disorder: A systematic review” Takahashi, H., Matsushima, K., & Kato, T

April 2019

Systematic Review

Review of 7 studies between 1970 and 2018 (5 cohort studies, 2 case studies; 2 randomized)

- Mirroring helps those with ASD improve social skills, such as expressing emotions and synchronization. - DMT is proven to not only be an effective treatment for improving social skills, but also to prevent the development of characteristics ASD sociality.

- DMT has the potential to be a positive, effective therapy for children with ASD.

- Limited research on the topic for a systematic review (only 7 journals fit criteria).

- Subjective

outcomes can result in biases

- Studies reviewed are only cohort and case studies.

Level III.A

#5; “Pilot study of a targeted dance class for physical

Lopez-Ortiz, C. J., Egan, T. J., &

Gaebler-Pilot Study;

RCT 12 children with Cerebral Palsy with

- Children in the targeted dance class group had

- Heterogeneity in severity of CP in participants.

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Article # & Title Author & Date Evidence

Type Sample Size &Sample, Setting

Study Findings that help answer EBP

question Limitations Evidence Level Quality rehabilitation in children with cerebral palsy”

Spira, D. J.

September 2016 Gross Motor Function Classification scores II-IV (ages 7-15); control group (6) and dance group (6); Public school (large # of minorities w/ physical and intellectual disabilities)

improvements in the PBS (pediatric balance scale) immediately after the 4-week class, and 1 month after the 4- week class.

- Dance class allowed children to work on

strengthening and balance while also learning group dynamics and social skills.

- Children who see “therapy” as a fun activity can improve rehab outcomes.

- Small sample size (n=12)

#6; “Dance and rehabilitation in cerebral palsy: a systematic search and review”

Lopez‐Ortiz, C., Gaebler‐Spira, D. J.,

Mckeeman, S. N., Mcnish, R. N., & Green, D.

October 2018 Systematic Review of dance therapy and RAS 11 total articles, 6 involving dance; 2 were children and adults, 2 were only children; 1 case study, 5 clinical trial, 2 RCT, 3 pilot studies,

- When there is less of a stigma about disabilities, there is a greater participation. - Dance supports social integration for children with

disabilities.

- Combining DMT and RAS, allows for non-verbal and

- Not all studies’ methodologies were detailed and

explained

- Small number of studies on the topic of dance and RAS - Studies didn’t specify whether the dance RAS therapy was new to

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Article # & Title Author & Date Evidence

Type Sample Size &Sample, Setting

Study Findings that help answer EBP

question Limitations Evidence Level Quality emotional expression, creative movement, physical activity, and engagement with others.

- Dance and RAS improved body functions, such as: balance, gait, and walking.

participants or if they had previous experience. #7; “Dance improves functionality and psychosocial adjustment in cerebral palsy: A randomized controlled clinical trial” Teixeira-Machado, L., Azevedo-Santos, I., & Desantana, J. M.

June 2017 RCT: control group= kinesiotherapy , experimental group= dance 26 adolescents; 13 in each group (control group (CG) or dance group (DG))

- According to the Functional

Independence Measure, those in the Dance Group had improvements in independent functioning, mobility, and communication. - When comparing the control group and the dance group, those in the dance class had greater improvements in functioning, activity, participation, mobility and

- Performed

assessment tests on subjects before 1st session and

immediately after the 24th (or last) session, did not look at long-term effects of dance therapy

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Article # & Title Author & Date Evidence

Type Sample Size &Sample, Setting

Study Findings that help answer EBP

question Limitations Evidence Level Quality locomotion, communication, and cognitive function. - While improving physical fitness, dance was also beneficial to balance and dexterity, which mitigated deficits in coordination and posture. #8; “Adapted dance improves motor abilities and participation in children with Down Syndrome: A pilot study”

McGuire, M. J., Long, J. F., Esbensen, A., & Bailes, A.

January 2019

Pilot Study – 1 group, pre and post-test design; not randomized

6 children with DS ages 4-13 years, attended 1 hr dance class sessions weekly for 20 weeks.

- According to the GMFM-88

Dimensions D and E, there were

significant improvements in gross motor abilities such as standing, walking, running, jumping, and climbing stairs. - In a post-survey, caregivers reported improvements in interacting with peers, gross motor skills, endurance, and safety

awareness.

- No control group. - Small sample size. - Did not control for outside

therapies/activities

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Article # & Title Author & Date Evidence

Type Sample Size &Sample, Setting

Study Findings that help answer EBP

question

Limitations Evidence Level Quality - The oldest

participant (13 yo) had the smallest improvement in Dimensions D and E, but also had the highest pre-test scores.

- The gross motor benefits are greater for younger children and they are more likely to gain those skills earlier than those with DS who aren’t in dance programs.

- Program provided kids with DS with social interaction. #9; “Creative

dance practice improves postural control in a child with cerebral palsy”

Stribling, K., & Christy, J.

October 2017

Case Study 11-year-old with spastic triplegic Cerebral Palsy; Dance classes for 1-hr, twice a week for 8 weeks

- After the 8-week program, the participant’s center of gravity was more consistent and closer to midline.

- Pre and post tests show that the participant had a decrease in sway,

- Studied pre and post intervention measurements on a single participant, making it not generalizable to children with Cerebral Palsy.

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Article # & Title Author & Date Evidence

Type Sample Size &Sample, Setting

Study Findings that help answer EBP

question

Limitations Evidence Level Quality which indicates a

better postural control.

- The participant’s CP symptoms included impaired strength on both lower extremities and the right upper extremity. - At the end of the 8-week period, the

participant had more symmetry during motor control tests in the lower

extremities. #10; “Influence of

adapted hip-hop dancing on quality of life and social participation among children/ adolescents with cerebral palsy”

Withers, J. W., Muzzolon, S. B., & Zonta, M. B. October 2019 Pilot Study, non-randomized controlled trial, single-blind 18 children/ adolescents (ages 6-18) with CP; 9 in study group (hip-hop dance practice), 9 in control group (no

intervention)

- Based on the Pediatric Outcomes Data Collection Instrument, basic mobility and

transfer, sporting and physical function, and global function improved in the study group after the dance classes.

- According to the Child Behavior

- The majority of participants in the Study Group were Gross Motor Function Classification System Level I; functional

limitations were a barrier to

participation in hip-hop classes.

- Not randomized

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Article # & Title Author & Date Evidence

Type Sample Size &Sample, Setting

Study Findings that help answer EBP

question

Limitations Evidence Level Quality Checklist, those in

the Study Group showed a decrease in symptoms in the following areas after dance class: anxiety, depression,

aggression, externalizing problems, and total problems.

- The younger participants had greater

improvements in behavior after the dance program. - Greater

participation was positively correlated with outcomes. #11; “Effect of

dance on lower-limb range of motion in young people with cerebral palsy: a blinded

randomized controlled clinical

Teixeira-Machado, L., & Desantana, J.

March 2019

Blind RCT 26 participants with CP (Gross motor function classification scale III-V), ages 15-29 years. Randomly divided into

- Passive ROM was assessed before intervention and after. It was found that those in the DG had an increase in all axes of motion at the hips, knees, and ankles.

- Sample size of 26 - Only conducted over 3 months, no long-term

assessment or follow-up

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Article # & Title Author & Date Evidence

Type Sample Size &Sample, Setting

Study Findings that help answer EBP

question

Limitations Evidence Level Quality

trial” dance group

(n=13) and control group (n=13, completed physical therapy sessions as control). DG: 24, 1-hr sessions twice a week for 3 months.

- DMT can lead to increased ROM by improving movement control, physical ability, expression of emotion, and distraction from pain.

- The dance group had higher adherence than the control group due to the sense of belonging and social

interactions within dance class and performing. #12; “A six week

therapeutic ballet intervention improved gait and inhibitory control in children with cerebral palsy – a pilot study”

Lakes, K. D., Sharp, K., Grant-Beuttler, M., Neville, R., Haddad, F., Sunico, R., … Radom-Aizik, S.

June 2019

Pilot Study 8 children with CP, ages 9-14. 6-week ballet class (3x per week). Assessments done before intervention, during the last session, and 4-5 weeks' after.

- Half of the participants had an increase in handgrip strength in one hand, while one participant had an increase in both hands.

- Participants’ ambulation times decreased over time during all 3

assessments, while

- No control group. - Some testing measures were found to have insignificant results, indicating the need for a longer duration of

intervention.

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Article # & Title Author & Date Evidence

Type Sample Size &Sample, Setting

Study Findings that help answer EBP

question

Limitations Evidence Level Quality step and stride length

increased. #13; “’I feel free’:

Experiences of a dance intervention for adolescent girls with internalizing problems” ** Duberg, A., Möller, M., & Sunvisson, H. June 2016 Qualitative Randomized Controlled Trial

Total: 112 girls ages 13-18. Dance Group: 59 (24 of whom were interviewed), control group: 53

- There was an increase in self-trust, sense of freedom, and openness as a result of the dance program.

- The participants noted increase self-confidence.

- The participants said that their new self-trust and body awareness helped them achieve a new positive attitude. - The girls reported being involved in more social events, spoke their opinions more frequently, and developed

friendships with each other.

- The study was conducted over 8-months or an entire school year;

therefore, changes in attitudes could be from outside factors that can influence development. Level I.B #14; “Dancing effects on preschoolers’ sensorimotor Chatzihidiroglo u, P., Chatzopoulos, D., Lykesas, G.,

Non-randomized clinical trial Experimental group: 22 preschool children, mean

- Children in the dance group had an improvement in sensorimotor

- Small Sample Size, limits

generalizability

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Article # & Title Author & Date Evidence

Type Sample Size &Sample, Setting

Study Findings that help answer EBP

question Limitations Evidence Level Quality synchronization, balance, and movement reaction, and movement reaction time” **

& Doganis, G.

March 2018

age of 5 years 8 months - 8-week dance program, 2x/wk for 45 min.

Control group: 20 preschool children, mean age of 5 years 6 months – 8-week

unstructured free-play activities, 2x/wk for 45 min..

Pre-post measures of sensorimotor synchronizatio n, balancing on one leg, and movement reaction time

synchronization compared to those in the control group. - Children in the dance group had an improvement in balance, which can help influence basic motor skills.

#15; “The influence of educational dance on the motor development of

Anjos, Isabelle & Ferraro, Alexandre

RCT 85 children in

their 1st year of elementary school; randomly

- While both groups showed

improvements in motor development, those in the dance

- Over the course of the study, 4 children dropped out of the intervention group and 7 dropped out of

(29)

Article # & Title Author & Date Evidence

Type Sample Size &Sample, Setting

Study Findings that help answer EBP

question

Limitations Evidence Level Quality

children” ** September 2018 divided into 2

groups (intervention and control). Intervention group (n=51) had 2 dance class per week, for 1 hour, over 7 months. Measurements were taken before intervention, after intervention, and 6-8 months after the end of the

intervention. Control group (n=34)

group had greater improvements. - Those in the dance group also had sustained

improvements shown in measurements assessed 6-8 months after the dance classes ended.

the control group due to changing schools.

#16; “Dance as art and therapy in cerebral Palsy” **

Herman, Jerron January 2019 Not evidence; Commentary on the Systematic Review article #6 (Lopez-Ortiz et al., 2018)

Not Applicable - Lopez-Ortiz et al. can help prove the legitimate benefits of dance, or arts in general, in order to help better the physical and social needs of those with

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Article # & Title Author & Date Evidence

Type Sample Size &Sample, Setting

Study Findings that help answer EBP

question

Limitations Evidence Level Quality disabilities.

- Studies about the effects of dance movement therapy in those with

disabilities can help break down stigmas about disabled bodies by making these activities a norm.

- Research should focus appreciating the effects of cerebral palsy instead of trying to fix them.

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Evidence Level Assessment Tool

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