Improving patient experience on acute paediatric hospital wards through improvisation and somatic dance.

Submitting Institution

Edge Hill University

Unit of Assessment

Music, Drama, Dance and Performing Arts

Summary Impact Type


Research Subject Area(s)

Medical and Health Sciences: Nursing, Public Health and Health Services
Studies In Creative Arts and Writing: Performing Arts and Creative Writing

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Summary of the impact

From Where You Are (FWYA) is an on-going dance and health research project at Alder Hey Children's Hospital, Liverpool (AHCH). Building on a pilot study (2008-9), it is the work of `Small Things Dance Collective' (STDC: Dowler, Hawkins). Evidence from the pilot study of the efficacy of improvised somatic dance (ISD) on ameliorating Neuromedical and Oncology patient experience and recovery, prompted two further research phases. Four impact claims are made here:

  1. Improved movement and wellbeing for patients
  2. Changing practices at the AHCH
  3. Benefits to dance practitioners
  4. Benefits to fundraisers

Underpinning research

Context: From Where You Are (FWYA): a three-phase research investigation of the complementary use of Improvised Somatic Dance (ISD) in treating children undergoing neuro-rehabilitation, cardiac or orthopaedic surgery, oncological treatment, or with acute psychiatric conditions, began in 2008. FWYA has been funded by Edge Hill University (internal research award), Alder Hey Children's Hospital (AHCH), National Lottery Awards for All and Arts Council England. Developed in collaboration with Play Service, Pain and Sedation Service and Research Department, AHCH, FWYA is supported by AHCH Arts for Health, and is a national leader for dance in a hospital setting. AHCH is the national coordinating centre for Medicines for Children Research, trains 600+ medical students annually, is among the largest children's hospitals in Europe (2,400 staff; 200,000+ patients annually), and a centre of excellence for treating cancer, heart, spinal, and brain disease.

McNiff's (1998; 2010; 2012) conception of arts-based research (ABR) inspired debate on dance and somatic movement in healthcare research (Poynor (2005), Levine (2013), Zaporah (2013)). Small Things Dance Collective (STDC: Dowler (Senior Lecturer, Dance Edge Hill University (EHU): 2007- present) and Cath Hawkins (EHU, associate tutor)) is contributing to current UK debates among dancers and clinicians, by using ISD in "a process-orientated approach to movement based on the natural structure of the body rather than a stylised vocabulary ... with reference to ... one's personal condition (physical, mental and emotional) — and the conditions in the environment in which one is working" (Poynor, 2005). FWYA is an ongoing investigation designed and carried out by STDC, and the name of Phase 1 of that investigation. Research phases: FWYA: qualitative study(1), 2008-2009; Invisible Duets (ID) 1: documenting creative practice for multiple audiences(2), 2011-12; Invisible Duets 2: pain study, 2013(3)). During 2009-11, EHU research investment funding supported Dowler to refine practice and design funding bids. Research questions:

  • How can ISD enhance hospitalised children's care? (Phase 1)
  • How might artists generate viable research models in health contexts? (Phase 2)
  • What documentation methodologies enable health and arts practitioners equally to appreciate ephemeral practice efficacy? (Phase 2)
  • How does ISD verifiably enhance paediatric healthcare? (Phase 1; 2; 3)
  • How may insights influence Arts and Health practitioners? (Phase 1; 2; 3)

Key Insights:

  1. ISD is an appropriate methodology for facilitating movement and dance in a clinical setting. ISD's flexible approach, responsive to individual responses to treatment, and staff logistical imperatives, complements medical interventions in acute clinical settings. (References: 1; 2)
  2. ISD can lead to pain reduction. Validated pain assessment tools confirm that in 92% of patients with acute pain following major trauma or surgical interventions, ISD reduced pain or pain perception. (References 3; 6)
  3. Young patients with acute medical conditions have inherent desires and capacities for creative expression through movement, `the primary mode of human communication' (Bainbridge-Cohen, 2008). Sustained engagement with ISD transformed (new-born to teenage; many non-verbal) patients' often difficult experiences; fear, pain and depression notwithstanding. Staff and parents/carers report ISD sessions improved well-being. (References 1; 5; 6)
  4. ISD is acknowledged by healthcare professionals as an effective complementary methodology, and positive contribution to in-patient experience and recovery. Demand for and interest in ISD is growing across AHCH departments. (References 1; 6).

References to the research

Where no URL available, items are available on request.

1. Dowler, L. (2013) Improvising on the Ward: Exploring Somatic Dance and Potential in Paediatric Healthcare, Journal of Applied Arts and Health 4.2 pp.163-178 (This is the leading peer reviewed journal in the subject with an international scope). Submitted in REF 2.


2. Conference Contribution: Improvising on the Ward Inspiring Transformations, University of Northampton Sept 2009; (organised by one of the leading universities in the country for arts and health, the conference was attended by over 200 delegates with over 50 presentations including a keynote address by Professor Shaun McNiff, considered the founder of integrative expressive arts. The Art of Good Health and Wellbeing, Melbourne, Nov 2010. (Organised by national arts and health organisation in Australia, Arts and Health Australia with over 180 speakers and 500 delegates.)

3. Conference Contribution: Dowler, L. and Hawkins, C. Poster Presentation: The Effects of Somatic Dance for Children and Young People with Acute Pain in Paediatric Healthcare. International Conference: Art, Culture and Wellbeing, Bristol 24-26th June, 2013. (Key conference in UK in past four years supported by Public Health) Delivered by Arts & Health South West on behalf of the National Alliance for Arts, Health and Wellbeing with the support of the Royal Society for Public Health
Conference academic partners: Canterbury Christ Church University, Durham University and University of the West of England.

4. Conference Contribution (Dolwer): Embodied Adventures in Medicine: Exploring the effects of improvisation for children and young people with acute pain in a clinical setting. International Contact Festival Dartington Conference: Political Ecologies in Contact: Articulating Improvisation Practices, 6-7th April, 2013. University of Falmouth (Founding college in the UK for contact improvisation. First academic research conference for contact improvisation in the UK).

5. Digital or visual media: Small Things Dance Collective (May, 2012) Invisible Duets films on STDC website (Dancers: Dowler L., and children on neuromedical ward; filmed, edited: Gersten-Roberts, J.).


6. Digital or visual media: Small Things Dance Collective (June, 2013) From Where You Are: A dance and movement project at Alder Hey Children's NHS Foundation Trust (commissioned by Alder Hey Children's Hospital: available and


Funding all for From Where You Are
Name of grant holder: STDC Grant title From Where You Are
Sponsor: Big Lottery Fund UK Awards for All
Period of grant (dates) Dec 2008-Nov 2009 Value £9600
Period of grant (dates) Dec 2011-Nov 2012 Value £9720

Name of grant holder: STDC Grant title From Where You Are
Sponsor Arts Council England Grants for the Arts
Period of grant (dates) Nov 2011-Dec 2013 Value £44,000

Name of grant holder STDC Grant title From Where You Are
Sponsor PH Holt Foundation Small Grants
Period of grant (dates) 2011 and 2012 Value £900 per year

Name of grant holder STDC Grant title From Where You Are
Sponsor Warrington Borough Council Arts Grant
Period of grant (dates) 2012 Value £607.50

Name of grant holder STDC Sponsor Neuromedical Ward Fund (Alder Hey)
Period of grant (dates) 2011/12 Value £2000

Name of grant holder STDC Sponsor Cardiac Ward Fund (Alder Hey)
Period of grant (dates) 2013/14 Value £2400

Name of grant holder STDC Sponsor Alder Hey Children's Hospital Arts Group
Period of Grant 2011-13 Value £4000

Details of the impact

The following impacts arose between January 2008 and July 2013.

1. Improved patient movement and wellbeing
Across pilot FWYA (oncology; neuromedical) and subsequent phases (neuromedical, cardiac, orthopaedic, acute psychiatric wards) ISD has proved to be effective in engaging young patients at AHCH. Many children become very inactive as a result complex conditions and long hospital stays. Patients who have been experiencing anxiety, pain or depression have engaged with STDC, enjoying their experience and enhancing physical and mental well-being. ISD is person-centred, allowing patients to make choices and lead sessions, in contrast to experiences of medical contexts, in which they have no control over treatment and/or experiences. ISD has been shown to be empowering and transformative of hospital experience. The skilful improviser listens, attunes to bodily expression, perceiving subtle shifts in tone and movement, holding a creative space, and accompanying another on imaginative journeys. Qualitative documentation draws from patient, parent, clinician and artist narratives (References 1, 2; Factual Statements (FS) 1-4). Interviews with STDC and patients' parents were broadcast on BBC North West Tonight (June 2012).

2. ISD research has changed practices at AHCH
Following a successful pilot phase, FWYA was extended to patients of other specialist teams, and STDC carried out a 20-week investigation of ISD efficacy for Neuromedical, Cardiac and Orthopaedic patients with acute pain. 92% of participants experienced quantifiable pain reduction, and this finding had an immediate impact on hospital practices: the Play Specialist (FS 4) invited STDC to support cardiac patients pre-surgery, in recovery and with pain management. The Pain and Sedation Service and Arts Coordinator placed STDC with multi-level orthopaedic surgery patients: an important development, as there was little engagement with the arts for health programme (FS 3) in Orthopaedic care. STDC received referrals from physiotherapists working across hospital wards, exemplifying a growing demand for ISD's incorporation in a multi-disciplinary approach to pain management, neuro-rehabilitation and recovery post-surgery. STDC have been invited by AHCH Pain and Sedation Service to share their findings at the Paediatric Pain Travelling Club Annual Conference (Birmingham Children's Hospital, April 2014); the inaugural dance practitioner presentation at this national event. The work in relation to pain is very interesting and encouraging. `The perception that pain will be induced by movement can result in a reduction of spontaneous movement, increased anxiety and associated muscle tension which can directly lead to increased pain. Dance improvisation in the wards, encountering patients who have different clinical conditions particularly cardiac, orthopaedic and neuromedical, has shown that participation in the dance programme has not only reduced patients' perceptions of their pain but that of their parents and clinical staff as well [...] In some cases patients have spent significantly less time in hospital because their requirement for medication and their rehabilitation has been more rapid. ' (FS1)

3: Benefit to dance practitioners
STDC have successfully documented the effectiveness of ISD in the From Where You Are and Invisible Duets films, greatly facilitating sharing of approaches, experiences and insights beyond AHCH, with both artists and health practitioners. The Foundation for Community Dance's national annual Summer School (2013) screened From Where You Are as an example of good practice on the Dance, Health and Wellbeing strand of this training. STDC attracted applications for CPD from artists and health practitioners, and are national leaders in training dance artists in ISD in clinical settings. Eight apprentices participated in their apprenticeship programme, with some thirty enrolling for Healthful Dancing training weeks (2012-13), and evaluation questionnaires confirm impact on individuals' professional development. Participant feedback is strongly positive, with all respondents rating the experience as very good or excellent. Examples of participants who expanded their practice include one now working with disability dance groups, and another now using ISD with elderly and frail clients. One participant commented, `I felt very honoured to hear Small Things, alongside the Guest Artists, the medical profession and families of the children attending Alder Hey hospital, discuss and share their experience. It was incredibly inspiring, refreshing and informative. The impact of the work undertaken by Lisa and Catherine has been of great significance.' An apprentice observed, `Being an apprentice has allowed me to experience new and exciting insights into this work. The first-hand experience I received is invaluable and has taught me so much about the importance of somatic/sensory work in a children's hospital and approaches on how to deliver such work in these settings.' (Other Source 1).

4: Benefit to fund raisers
A commissioned film documenting ISD at AHCH has been used by the hospital to raise their profile and enhance funding appeals and applications. The AHCH Arts Co-ordinator presented `From Where You Are: The Impact of Improvised Dance and Movement Practice on Patients at Alder Hey Hospital' at The Arts in Applied Psychology and Education Conference, Derby, 17th July 2013.

Currently STDC have a grant for this research from Arts Council England. The Arts Council England's Relationship Manager for Dance (RMD) has used the case study to advocate on behalf of award holders to ACE colleagues, recognising the innovation of this project and its impact on the arts and health agenda for ACE. (FS 5).

Sources to corroborate the impact

Factual Statements

  1. Consultant in Paediatric Intensive Care, AHCH — improvements in movement and well-being.
  2. Arts-Co-ordinator, AHCH — Changes in practice at Alder Hey, including extension of the FWYA project to the orthopaedic ward. Impact on fundraising efforts.
  3. Clinical Lead, Hospital Pain and Sedation Service, AHCH — Improvements in movement and well-being for children worked with in the FWYA project. Changes in practice at Alder Hey, including extension of the FWYA project to the orthopaedic ward.
  4. Senior Hospital Play Specialist — Improvements in movement and well-being for children worked with in the From Where You Are (FWYA) project. Changes in practice at Alder Hey, including extension of the FWYA project to the orthopaedic ward.
  5. Relationship Manager for Dance, Arts Council England — addresses impact of work on ACE's arts and health agenda.

Other Sources

  1. Evaluations of CPD and apprenticeships (by survey)
  2. Interviews with STDC and patients' parents were broadcast on BBC North West Tonight (June 2012)