Bouncing Back: Dance/Movement Therapy in a Children’s Hospital

A “Day in the Life” retrospective from my first practicum internship as a Dance/Movement Therapy graduate student.

* Pseudonyms are used in place of all real names to maintain privacy and protect patient information. 

9:00am: Mary navigates the vinyl floor maze of the children’s hospital with ease, physical evidence of her near-twenty year reign as the lead Dance/Movement Therapist (DMT). Her hair is wispy and white, her eyes discerning. She is quick to smile and boasts a hearty chuckle and sarcastic New England sense of humor. It is Friday, her weekly scheduled time at the hospital. I try my best to keep her pace as a DMT graduate student intern adopting the unfamiliar rituals of this work. I adjust my security badge, with my earnest smiling face and “Healing Arts Intern” imprinted in bold. I feel my heart racing and repeat my grounding intentions to myself: I am here to offer light, to offer companionship, to offer an alternative. My internship supervisor Kendra, the Healing Arts Director and on-call pediatric Yoga Therapist, informed me early on about the importance of energetic boundaries. “This work is heavy, and if you don’t remind yourself of why you are here, and what you hope to offer, you risk losing your compassion.” Kendra is tender-hearted and sentimental, connected spiritually to this work. Mary sets firmer boundaries though is fueled by the emotional connections she makes with patients. I am taking it all in, one day at a time. 

9:05am: We squeeze Mary’s three-story rickety wooden cart into the corner of an elevator with a young family pushing a baby carriage, two surgeons in scrubs, and a hospital administrator. “Floor 5 please!” The crowd glances down at our cart, and we register their smiles and confusion. From an outside perspective, The Cart is an intriguing mystery, and sometimes a hassle: it has a permanent tilt and oftentimes likes to veer into the bustling current of people filtering past us. From a DMT perspective, The Cart is the key to providing successful interventions. Every DMT, Mary informs me, has A Cart, or some variation of it. The Cart holds props that therapists can use in their interventions with patients, whom they work with in individual or group settings. Our most visible props include a large beach ball wrapped in a plastic bag hanging off the side of the cart, along with a bag of bubbles and another bag of balls of various kinds and sizes, two medium-sized African drums, a box of tissues, a portable speaker, and fluorescent orange cones with plastic hoops up top. The Cart also has a bundle of long plastic music-making tubes tucked underneath, shakers and bells, paper streamers, a toilet paper roll (we weren’t sure why that got on there in the first place, but we thought it could be useful at some point), beanbags of different sizes, dance move instruction cards, animal-themed finger puppets, and scarves of varying sizes and textures (a staple DMT prop). We take a sip of our coffee drinks, and smile back at our audience. We stopped perching our coffee mugs on the Cart after they took a tumble on one particularly groggy morning, wetting our stack of hand-written intervention ideas. It’s a good thing a lot of our work lives on in body memory, as opposed to strict intervention outlines. 

9:07am: We park The Cart next to the Childlife Office and Janet, the Childlife Representative who Mary has worked with during her entire hospital tenure, invites us in. She hands us our patient list, complete with highlights and restriction notes, informing us of the priority patients that day as well as rooms that require personal protective equipment (PPE). Mary, Janet, and one of the long-time volunteers, Meg, fill each other in on their families (“Kids are doing well, just finished our family reunion up north,”) and recent discoveries (“This new app I have lets you scan food labels and learn about any hidden harmful additives or chemicals”). I squat on the floor during these friendly and familial catch-ups, since space is tight—  Janet’s office is lined with board games, stick-on nail kits, coloring books, Lego kits, and myriad toys waiting to be gifted out. I treat these conversations as a warm-up to the patient visits we’ll have later on, reminding myself of the importance of small talk and fighting the sense of urgency to get on with the day, a lingering tendency from my days of higher education office work and endless Zoom meetings. We are there to support presence, and social interaction, as well as aid the patients in their recovery journeys. 

9:20am: Janet scans the patient list she printed out for us, and explains that there are three new admissions who arrived the day prior. She gave one of the new arrivals, Emma, a medical procedure explanation using a baby doll, helping the patient understand where their new G-tube, a feeding tube that connects directly to the patient’s stomach, will be placed. “Emma could use some companionship this morning. She's having a hard time settling into the hospital environment, though enjoyed spending time with the college volunteers who read books with her. Just be wary of too much movement due to her stomach pains.” As a Childlife specialist, Janet is the heart of her pediatric hospital wing who keeps tabs on the pulse of the unit. She provides patient education, coordinates patient enhancement activities, runs donation distribution efforts, plans external facilitator schedules, and liaises between families, hospital workers, translators, and family advocates that the hospital employees. “Don’t visit room 568,” she says, crossing out his name on our list, “He reported a bad headache to the nurse and wants to be left alone.” Janet highlights Louisa’s name, a 17-year-old girl who we later learn has severe Autism Spectrum Disorder and a broken arm: “Her parents are out for lunch and she’s lonely, she loves the color pink and playing with her Barbies.” We nod and Mary and I simultaneously think to ourselves how we might integrate her dolls into our intervention. “Oh, and one more thing!” Janet says on our way out, while we pause in the doorway, “If you go into Max’s room, note that he’ll have to stay in his wheelchair hooked up to the hemodialysis machine— be mindful of his limited mobility, and potential abdominal pain.” Mary and I nod and station ourselves beside the cart— “Who shall we start with today?” Mary asks me, “Maddie, the 3-year old returning patient with brain cancer, Max, or Rosa, the 11-month old with Down’s syndrome?” 

9:25am: We start with Rosa, the sweet 11-month old who Mary and I have become quite fond of as we work with her week after week. We aren’t sure why she is stuck in the hospital, that information is classified, though Janet has encouraged us to move with her, use props, and interact socially. It’s a privacy issue we run into as contract workers, not full-time staff. We put on our sanitized masks, gowns, and gloves and scan the physical arrangement of the room (Are the curtains drawn? Is the TV on? Are there open beverages/meal items?), the social energy of the room (Is she alone, or are there family or other visitors present?), and the body movement of the patient (Is she alert— eyes open or closed? Is she moving at all or mostly stationary? What shape is her body in— a fetal shape facing away from the door, or sitting upright in her crib looking out at the hallway?). This morning, Rosa is standing on her feet looking directly at us, while her mother sits on the stiff hospital couch, having a conversation in Spanish with her friend. We knock quietly, signaling for permission to visit with Rosa, and entering after her mother smiles knowingly and nods. We greet Rosa with direct eye contact and let her respond to our presence before lowering her crib bars and placing a rubber ball in front of her. Rosa immediately taps the ball and pushes it away from her, signaling her remembrance of our shared “Tap, Tap, Rooooooll” game. We are impressed with her bodily memory, and pleased with her beaming smile and constant eye contact. I take a paper towel and wipe away her drool as Mary continues playing the game with her, sounding out the actions and then moving simultaneously with Rosa, guiding and exaggerating her movements to promote an increased range of motion. We have tried finger puppets, scarves, and a beach ball with Rosa, though she always prefers the rubber balls, her smile and giggles filling the room with a sweet and reassuring sound. These nonverbal cues are essential for our work, helping us build trust and report for the patients we work with, no matter their age, level of neurocognitive understanding, and language abilities. We reset Rosa’s hospital crib after we finish our session with her, take off our protective equipment, sanitize and re-glove our hands before wiping down the balls we used with hospital-grade cleaning wipes.

9:52am: Mary and I now park our cart in front of room 532, Max’s room. We peer through the window and see him seated in a wheelchair, watching TV while on dialysis, attached to a beeping metal machine looming over him. Mary teaches me the importance of offering a suggestion rather than a yes or no question to greet our patients. We knock on the door, and make eye contact while entering their space. “Hi,” she‘ll say, “Max, right?” He nods, and we introduce ourselves and let them know that Janet from Childlife thought he might be interested in some company this morning. We hold up the large beach ball, a prop we decided to bring in based on his age, mobility status, and the time of the day; we think the beach ball will be easy for him to pass without disrupting his cords. Max looks over at us and shakes his head— he points to his stomach and says it hurts. We nod in recognition, seeing his grizzly look of discomfort. “No worries, we’ll check in with you later on!” 

9:53am: We visit the patient next door, the 3-year old with brain cancer. Her mom, visibly worn out and fatigued, is brushing her daughter’s thin hair back carefully, avoiding the EEG wires and adhesive wrapping that help doctors monitor the electrical activity of her brain. Her daughter’s face lights up when she sees the shining beach ball in our hands, and the mother smiles upon seeing the delight on her daughter’s face. We had worked with Maddie one time prior, though she was in and out of a dreary sleep state. My gut clenched when we walked in the room, a deep heaviness settling within me. She’s so young, too young, I thought to myself. Mary had prepped me for this moment, though there is only so much preparation you can have when facing the unimaginable— a tiny, young child faced with a debilitating and completely life-altering, fatal disease. Her small body wearing a patient gown, wrapped in hospital sheets and draped in fuzzy blankets, a collection of stuffed animals and balloons and cards from family friends keeping her company, along with her mom, nestled in her own make-shift hospital bed on the couch, suitcases open nearby with the clothes, hygiene products, and snacks they’d need to sustain themselves for an unknown length of time at the hospital while receiving treatment and undergoing tests. Mary, following her intuition, gathered colorful scarves off her cart, and gently pulled them across Maddie’s body, stimulating sensation despite her barely moving body. We noted a subtle opening of her chest and widening of her limbs, reading an acceptance and subtle embrace of the touch. We offered a scarf to her mom, who quickly took part in our rhythmic draping, grateful for a role to aid in her daughter’s relief. Caregivers undergo immense psychiatric distress while seeing their young patients go through intense medical treatments, so DMTs pay special attention to involving them in patient interventions. Props help initiate group play, which can provide physical and emotional support and even distraction when needed to patients and their families alike. Research on hospital DMT work, spearheaded by Dr. Suzi Tortora and others, shows that DMT can be effective for reducing caregiver anxiety, as well as patient anxiety, and forging stronger social bonds. The patient gets to be a child again and play, while the parent gets to interact with their child as that–not as a suffering patient. Such was the case this time, when we enrolled mother and child both in a game of “Keepy Uppey.” This game is referenced and named in “Bluey,” a popular kids show, though it is also intuitive. Maddie and her mother happily and rhythmically passed the ball back and forth, giggling and present with each other and us. 

10:06am: The sound of a patient's shrieks lead us out to the hallway again, and into a double-patient room where a young boy on the far side of the room sat on his bed with his dad, severely distressed over a required IV needle placement in his arm. Mary and I offer a game of catching plastic hoops on our wrists as a distraction, making crab-like movements as we demo snatching the hoops after each toss. The nursing team gives up their first attempt, and the dad, seeing his son join our game, follows them out of the room, red-faced and sweaty. Mary engages the young boy, Lucas, in a conversation about his favorite games and sledding techniques, as we look out at the snowy parking lot down below. “Is it scary when you sled down the big hill in your backyard?” “How do you face that fear?” “You are brave when you face these difficult moments in the hospital, and know that you are not alone— all of the kids here have to go through similar hard moments.” Our game calmed him down, his screaming fit transformed into shy amusement and interest in us. Mary and Lucas continued playing the crab catch game and chatting, while I went to reassure his dad and offer my regulated nervous system to help him stabilize. He looked at me in tears, noting how hard it is to see his boy in so much pain. I offered comforting words, encouraged him to take some deep breaths, and to pace until he felt more relieved. When you are ready, please rejoin us— “Your presence is all he needs, and you’re doing a great job. It’s tough to see your boy going through this, but he needs to know it’ll be okay, and you can help him with that. We’ll be with Lucas until you come back.” Our work as hospital DMTs requires versatility and flexibility— we  work with movement, we work with breath, and we work with props, all in the name of supporting the vitality and wellbeing of the patients and families who experience some of their hardest days imaginable within these hospital wings. 

10:42am: Mary and I take a quick break, re-filling our water bottles and using the restroom, doing a full scrub of our hands— after a certain number of patient visits, our hands are too thoroughly lathered in hand sanitizer to feel clean anymore. We bring our sanitized beach ball into the room of Tatiana, an eight-year-old girl who we keep reminding to stay in bed. We take our positions on either side of her bed, making a circle with her mom. She keeps diving for the ball in her bed and standing up, risking tangling her attached IV cords and falling. Tatiana has a bright yellow wristband that signals a fall risk, having come out of a recent operation— one we are not informed of. We proceed with caution, and put on a slower tempo of kids music to encourage a shift in energy. Our beach ball game fluctuates between nice, gentle, passing, and pinball hospital room pinball, where the ball hits every object in the room and threatens to knock over the morning OJ. We swap out the beach ball for the crab-catching game with hoops instead, which Tatiana enjoys though ultimately asks to go back to the beach ball. 

Tatiana directs us to play the game by her rules: “Mary, you have to hit the window with the ball for extra points, and Mom, you have to block Mary’s pass,” and later, “We have to make it to ten passes, but Mom, you have to only hit it with your elbow.” “Why me?!” Her mom petitions, and we all giggle at the absurdity of the game’s evolution. When passing the beach ball back and forth, there is room for commentary on the observable game playing out in front of us, for imaginative thinking, for game strategy, as well as personal life. We learn about her pets at home and her hobbies, and what she is most looking forward to when she finally gets to return to school and see her friends. While we primarily engage with movement as DMTs, we recognize the importance of verbalizing feelings, stories, and bringing in the healing elements of music as well. The conversation started with direct observations of what happened in the room, “Great reach!” we affirm, “But try to keep your legs on the bed!” And “OOOOH! It almost bumped your head that time! That was a close one!” Tatiana delights in the frivolous drama of the game, screaming “NOOOOOO it fell into the lava pit floor!!!” And expresses dismay as we ask her to hug the ball close and infuse it with energetic love before we go visit another patient. 

11:04am: We visit with Kenneth, a sixteen-year-old boy with a cast signaling a broken leg. We learn he is a soccer player with a love for all things sports, eager to take on a competitive game of Keepy Uppey. Mary teaches me that the dollar-store beach ball she carries around is the holy grail for hospital DMT work. The beach ball is a special thing. One of the best things, in fact, for the work we do. When I first started working at the hospital, I overlooked the importance of working with a beach ball, and even adopted a cynical view of the toy— sure, it elicits joy, but how does it impact physical and emotional health? My internship experiences confirm that the magic of the beach ball goes so far beyond just the simple joy of tossing a ball back and forth, and the accessibility of it being a super light ball that does not inflict injuries and takes minimal effort to use. It’s the democratic and inviting nature of the beach ball that makes it shine. You can use a beach ball with everyone and anyone, whether you roll the ball on them, like we did with an immobile but alert patient the week prior so they could feel the somatic sensation and pressure, or you toss it back-and-forth with your arms, hit it with your head, or knee it up into the air. As we throw the ball to Kenneth, his reflexes are instantly engaged— QUICK! ACT FAST! We giggle, and as the ball hurdles towards him, he reacts instinctively. He instinctively knows what to do, and so do many of the other patients we work with. Kenneth catches it, then hits it back and forth with us for a long volley— he is skilled, we make note of his quick hand-eye coordination and measured use of force. The ball bops Mary in the head and we all giggle about her slower reaction time, before re-engaging in the back and forth toss, our eyes tracking it across the room, focusing on what might come our way at any time. Mary, a DMT as well as an Eye Movement Desensitization and Reprocessing (EMDR) therapist, intimately knows the importance of eye tracking for alleviating emotional distress. 

In addition to Kenneth’s coordinated movements, we note his transition from an initially slumped, inward posture, to a broadened, upright stance in bed, the muscle tone in his arms, core, and even legs actively engaged. The simple game of keeping the ball up in the air does not feel like a clinical intervention or physical therapy task, and as such, it also skirts around some of the mental inhibitions that might be present, especially when two women strangers ask to hang out with a teenage boy in his hospital room. The rhythmic exchange of a ball toss can start and end quickly, avoiding awkward set-up and transition time and allowing us to be flexible when working with patients for anywhere between 5 to 50 minutes. It also allows us to involve caregivers, and the care team— in this case, Kenneth’s nurse walks in, and holds up her hands to catch the ball. We widen the circle, involving her in a few rounds of toss before she checks his vitals and completes her rounds. When she leaves, we shrink the circle again, and complete our session with Kenneth— waiting for a lull in the rhythmic passing, and other signs of fatigue to signal our natural ending point. 

11:21am: Mary and I prepare our playlist for our next visit with Louisa, the 17-year-old with Autism Spectrum Disorder, stacking it exclusively with Moana songs. We introduce ourselves and start playing the music, Louisa’s eyes lighting up, her torso starting to sway side to side. She is laying in bed, her dolls lined up along her hospital bed railings. Mary picks one of her Barbies up, and hands one to me— we intuitively begin dancing with the Barbies, matching Louisa’s natural sway, even gently singing some of the songs as the lyrics come to us. Her mother comes in, and smiles, though Louisa’s face goes sour. NO! She yells, though it is unclear why. Her mother thinks she sat too close, and relegates herself to the couch. Mary gives me a familiar look— she has an idea— and steps out of the room, returning with our beanbags. She lays them out alongside Louisa, just like the dolls, and starts to put some on Louisa’s leg, where her Barbies had been dancing. She is giggling and swaying still, and picks up the beanbags, intrigued. We demonstrate playing catch with them, and she immediately throws them to us, laughing with delight as Mary and I catch them. She throws some to her mom, frustrated when her mom doesn’t catch the first two. NO! She yells again. Her mom tries to throw them back to Louisa, though she only wants to throw. All four of us settle into a pattern of catching all of the beanbags Louisa saved, and then returning them to her in bulk. She asked for us to all line up on one side of the bed, and by the end of four rounds of this game, we were all squeezed into the far corner of the room, on the tiny window ledge. We giggled in unison at her directive play and frustration when we didn’t get it— playing up the devastation of the moment with a big “OOOH NOOO! I’M SORRY!” She continued to toss to us for the rest of the session, until Mary and I informed her we could play one more game to close out. Her mother thanked us, relieved to see her teen having fun, and more than that, having fun WITH her mom. 

11:50am: Mary takes our list and nods her head with recognition— she warns me, don’t mention anything about “going home” or what the patient enjoys at “home.” The patient, a 8-year-old girl named Zara, has been hospitalized for inhaling too much smoke. Her family’s home burned down in the middle of the night due to a freak accident with the gas lines, and they experienced a traumatic evacuation. Their little girl was doing better, and was scheduled to depart that day— her last wish was to play in the hospital playroom, the spacious and bright activity room filled with an array of board games, more legos, DVDs, books, and plastic kitchen play props. Many kids beg their parents and nurses to go to the play room and have a break from their rooms that double as treatment sites. Mary’s eyes gleamed—  when we know we have a longer time with someone (she had a few hours until official release, at least), and the patient has full mobility, we bring out the Octoband, a stretchy fabric creation with eight “tentacles” that participants can grab hold of. This DMT-specific invention was originally designed for use with senior communities and is well-suited for use in group settings with patients and their families. And so, after Zara got tired of playing with the beach ball, and showing us her soccer and volleyball tricks, we pulled out the Octoband. We each held a tentacle, and danced around the circle— skipping around and calling out directions (“Hold it HIIIIGH! Now Loooooooow!). Our differing heights only added to the fun. Zara’s mom recognized this dance as a type of ribbon pole dance from her home community in Saint Lucia, which Mary knew a kindred version of from her Irish heritage (the maiden’s pole dance). We changed the music, and let Zara’s mom guide us in her intuitive version of the dance, feet shuffling faster, stomping down louder, and knees bending and hips shaking even more. When Zara’s hospital psychiatrist walked in the room to do her final check-in, she jumped right into our lively circle. When we all lost our breath together, this time from a joyous occasion of healing, Mary called for us to wrap Zara up with the stretchy fabric, covering her with hugs and love from her community here, sending her off with care and well wishes for the rest of her journey. 

12:40pm: Mary and I circle back with Max, who is now feeling better, though still stuck in his wheelchair while the transfusion continues. His attention is glued to the hospital TV still, one of many of our patients— including Rosa, the 11-month-old!— who are addicted to the instant stimulation and attention-grabbing nature of the TV screen, their telephones, or the hospital-provided iPads, which Mary abhors. She complains, “All the screen time is ruining their attention spans! Kids do not know how to have longer conversations or socially engage with people in-person anymore, and it’s so disheartening to see.” While the technology works as a useful entertainment option to distract patients from their pain and reprieve caregivers and nurses while they step out, Mary and I agree that eye contact, mutual play with physical props, and skin-to-skin contact is a more worthwhile pastime. Research shows this to be true as well, with cognitive development tied to our development of fine and gross motor skills, and emotional stability tied to our ability to co-regulate with other people in the room. When we enter rooms and patients or caregivers do not look up from their phones or computers, or ignore our presence, we withhold judgment— the constant visitations become routine for some, even after only a few hours in the hospital— and remember that the nature of their technological diversions are not our business. It is our business to offer an appropriate intervention to boost their health. For Max, we hope our shiny beach ball seems alluring now that his primary stomach pain has subsided, and are pleased when he lifts his hands to catch it!

12:55pm: Mary and I push The Cart back through the sterile hallways of the hospital, transitioning from the brightly colored walls of the pediatric hospital to the oil painting-lined walls of the regular hospital, and back up to The Healing Arts Office. Our HQ is a two-room office tucked between Oncology administrative suites and private secured lab rooms in an old concrete wing of the hospital. It’s hidden in plain sight, discoverable only through the small placard placed near the elevator, despite the department’s hand in organizing and placing thousands of artworks to add color to the sterile white walls of the old hospital. The office itself is stuffed to the brim with new and donated art supplies, framed paintings and photographs, and artist work stations. It is idyllic, my childhood dream creator space, and my eyes still widen with wonder every time I enter the office, greeted by an origami-decorated front door, and ceiling-high shelves overflowing with gallons of colorful acrylic and watercolor paints, brushes, and water trays, a shelf with beading supplies, googly eyes, sequins, pipe cleaners, stickers, foam cut-outs, wooden frames for painting, a rack of ukuleles and shakers, buckets of drum sticks and recorders, a vase of peacock feathers, yoga mats and bolsters, an entire closet stuffed with paper of all sizes, material, and colors, and collaging materials, and another closet filled with cards, coloring pages, crayons, oil pastels, colored pencils (mechanical and regular), fine and thick-tipped markers, sharpies, glitter pens, scissors, charcoal, and highlighters. The list goes on. Art projects from years’ past are stuffed into every nook and cranny of the office— origami stars, mini dioramas with little plastic animals, hand-held clay sculptures, painted paper plates and sock puppets, hand-bound notebooks, poems— as are photos of staff and patients, holding colorful art projects, blurred limbs in the midst of a dance move. We park our cart in its nook by the windows overlooking the gray exterior of the hospital, and I feel gratitude for the color and vitality this work brings into the lives of those confined in a sterile hospital setting while battling chronic disease and cancer, traumatic injuries, freak accidents, and mysterious internal dysfunctions.