臨床動作法 Clinical DOHSA-HOU
平成18年度夏季キャンプ一覧 全国大会のお知らせ やすらぎ荘 1泊相談の日程など ふぇにっくすのページへ
心理リハビリテイション・ホームページ Psychological Rehabilitation

針塚進氏による動作法ガイダンス
書籍・文献リスト
研修会やワークショップのご案内
全国キャンプ案内
やすらぎ荘ボランティアの会
ふぇにっくす
動作法に関するHPなど
心理リハビリテイションの会全国大会のお知らせ
English Page
HISTORICAL OVERVIEW AND PROSPECT ABOUT  PRACTICAL USAGE OF PSYCHOLOGICAL REHABILITATION (DOHSA-HOU)

SUSUMU HARIZUKA, Ph. D
(KYUSHU UNIVERSITY)

 
The purpose of this article is to review and to prospect the development of Psychological Rehabilitation(Dohsa-hou)from historical overview. The origin of Dohsa-hou was to apply a hypnosis to the children with cerebral palsy in 1966(Naruse, G. :1966), The hypnosis was effective to some of children, but not to all. From psycho1ogicalview point, a new concept of“Dohsa”and new treatments for the child with cerebral palsy were proposed for the disability of motor action in the children with cerebral palsy(Naruse, G. :1973). The concept of Dohsa means a holistic process of motor action which consists both of the inner psychic activities and of a bodily movement. Dohsa is schematized with mainly three activities of“intention", “striving”and “bodily movement”.The new treatments have mainly three kinds of method ; (1)relaxation training method, (2)“Tan-i(a unit of movement)Dohsa”training and(3)not only the child with cerebral palsy but to the one with various disabilities such as autistic disorder, hyper-activity, schizophrenia, Down's Syndrome, menta1retardation, depressive sate and maladjustment to schoolsince1978. The aims and meanings of these application were discussed and the possibility of further application as a psychotherapy in the future was prospected in the field of clinical psychology and in the various fields.


1. A history of Dohsa-Hou

   Dohsa-Hou have been developed for since l966 by Naruse and his colleagues in Japan. At first, Naruse, G. (1966)applied the hypnosis to some children with cerebral palsy(12-17year-old). The results were the followings. Under the hypnotic state, some one could lift up his arm which he had been not able to lift up under the awaked state. But he became not to be able to lift up the arm again when he was awaked. And, another one was not to be hypnotic. Naruse concluded that hypnosis was not always available for the child with cerebral palsy. He, however, paid attention to the children's stiffness of their body and applied relaxation techniques to the children. When the children was treat with relaxation treatment, their body became to be relaxed and to be easy for them to make their bodily movement.
   Based on the above research and clinical actives, Naruse wrote his book“Psychological Rehabilitation”(In Japanese)in 1973 and gave a new view point to the disabilities of motor action in the child with cerebral palsy. In other hand, cerebral palsied children have been treat in the medical field of muscle-skeleton systems or neurological systems; orthopedic surgery or brain surgery. In these medical field, it has been thinking that the disability of cerebral palsied child is caused by the dysfunction of physiological systems. This may be true as a scientific notion. But, we can make another point of view from the following three facts;(1)when cerebral palsied child is sleeping, he would be able to moves his arms or legs which he can't move when he is awaked state, (2)when he is hypnotized, he can move his arms according to hypnotizer's suggestion, and(3)when he is in front of many people, he becomes to be more difficult to speak than in front of familiar person. From these facts, Naruse made new notions that although the child's disabilities might be caused by psychological dysfunction, their disabilities would be influenced by his psychological activities(Naruse;1973). From psychological view point, a new concept of“Dohsa”and new treatments were proposed for the disabilities of motor action in the children with cerebral palsy.

2. What is“Dohsa”?

   Though“Dohsa”is a Japanese word, here it is given the psychological special meaning by Naruse(1973). The concept of“Dohsa”means a holistic process of motor action which consists of the inner psychic activities and of a bodily movement. When we intend to move some parts of body, we make striving to realize the bodily movement according to our own intention. If the striving is appropriate to the movement, the intended movement can be realized. The striving which has an exact intention to move his/her some parts of body is called as a“goal directed striving”. The intended movement coincides with the goal directed striving.“Dohsa”appears as bodily movement, but it has the inner psychological activities like as an intention and a striving. Thus the process of“Dohsa”can be divided into mainly two processes; one is a psychological process like as the intention and the striving, another one is a physiological process like as the bodily movement. But we can't divide an actual motor action of human being. So, psychologists, teachers and parents treat“Dohsa”as a holistic process of motor action. In other word, “Dohsa”is an expression of psychological and physical states of a person. Further a control of“Dohsa”is a self control of our psychological and physical activities. Thinking about the children with cerebral palsy, their disability of motor action is not due to only the stiffness or muscle hyper-tension of their body, but their unlearning how to strive to realize the appropriate bodily movement. So we treat the“Dohsa”which consists of two processes. Naruse(1973)schematized“dohsa”process like as the following; intention-striving-bodily movement(Fig.1). We perform“Dohsa”at any time without sleeping. That is, “Dohsa”are to be sitting, standing, walking, driving, writing, speaking and so on. Now we can automatically perform these“dohsa”, but we made efforts to learn them at the infanthood or at the beginnings. Though we are not conscious of an intention and a striving of the automatic“dohsa”, we have some consciousness of an intention and a little striving of the“Dohsa”. We can have three kinds of conscious experience of our bodily movement. When we are lifted up our arm by some one, we have any experience of a passive feeling just like being moved our body. When we rise up our arm unconsciously under a hypnotic state, we can have an experience of automatic movement without any intention. And when we lift up our arm by our self, we can have an experience of an active feeling just like moving by our self. The last one is an experience of“Dohsa”.



                    Fig.1 Schema of Dohsa Process

3. The aim of Dohsa-hou

   The aim of“dohsa-hou”is to help a child or a client to perform an appropriate“dohsa”. There are two kinds of inappropriate“dohsa”. The one is an unlearned“dohsa”. In this case, a child does not have so enough learning experience of“dohsa”that he can realize an appropriate bodily movement. That is, a child does not sufficiently learn how to strive to realize an intended movement. The another one is a mis learned“dohsa”which is due to learning an inappropriate“dohsa”. In this case, a child have learned an incorrect way to strive for an intended movement. So, a therapist should help him to learn a correct way to strive to realize an intended movement.

4. The method of Dohsa-hou

   In the situation of“dohsa-hou”, at fist a therapist give a“dohsa”task to a child, that is, a child is asked to perform a pattern of bodily movement as instructed by a therapist. When the therapist supports him to perform the task, he helps the child recognize a feeling of his bodily movement. And the child is asked to move his body with adjusting to a therapist's instruction. “Dohsa-hou”has mainly three kinds of training method. These are relaxation training method, “tan-i(unit)dohsa”training method and“tate-kei dohsa”training method.
(1)Relaxation training method
   The aim of relaxation training is to help a child make relaxation of his muscle tension(a stiff part of body)by himself.
a. “kata-yurume”(relaxation of shoulders) In back of a sitting child with crossed legs, a therapist asks him to lift up, to perk up, or to straighten his hunched shoulders by him self. If he can't make the movements, a therapist slightly holds his shoulders and help him move them easily.
b.“se-sorase”(relaxation of upper back of body) In back of a sitting child, a therapist holds child's back on the therapist's legs and asks him to bend his back backward. The therapist helps him bend his back easily by the therapist's hands putting on his shoulders.
c.“kukan-no-hineri”(relaxation of lower back and of shoulders) This is to help a child make relaxation of his lower back(waist)and of his shoulder.
(2)“Tan-i dohsa”training
   The aim of“tan-i dohsa”training is to help a child learn the most simplified movement of arms, hands and legs.
a. “Ude-age”task: A child is asked to lift up his arm which is straightened and to set it down slowly .
b. “Ude-mage”task: A child is asked to fold his arm at his elbow and to straighten it slowly.
c. “Te-no hiraki”task:A child is asked to straighten his fingers and to fold his fingers.
d. “Ashi-no mage-nobashi”task: A child is asked to fold his leg at his knee and to straighten it.
(3)“Tate-kei dohsa”training(“Tate”method)
   This“tate”method is a very important one. “Tate”means a kind of force which keeps vertically a sitting-posture or a standing-posture against gravity. In this method, a therapist helps a child strive to make muscle-tension of the parts of his body for keeping vertically his posture by himself. That is, a therapist asks a child to strive to straighten his body vertically against gravity.“Tate”method has 5 fundamental tasks. They are the followings; a. “Zai”task(sitting with crossed legs training) b. “Hiza-tachi”task(standing on knees training) c. “Kata-hiza-tachi”task(standing on knee training) d. “Litu-i”task(standing posture training) e. “Hokou”task(gait training)
A:“Zai”(Sitting posture)training
   Sitting posture on the floor is the primary posture for human being to keep his body vertical against gravity. In child development, it is the first posture when an infant makes his body vertical by himself. The sitting posture has quite different physiological and psychological meaning than a state in which the body is lying on the floor. The posture is one of active motor actions that a person operates his own body vertical against gravity. To make the upper part of the body stand vertically is not only to set it on the lower parts, but to operate the whole of body(neck, shoulders, waist, hips and legs)in order to keep the upper parts vertically. So the main task in this position is to make 1, 3, 4, 5“Ban”straighten in one line towards the ground and to make enable a child(trainee)to support his body on their buttocks. 1“Ban”represents“neck”part, 3“Ban”;“upper part of back, 4“Ban”;“center part of back”and 5“Ban”;“low part of back”
B:“Hiza tachi”training
   The importance of the kneeling posture has not been emphasized in medical rehabilitation and developmental psychology. In the techniques of neuro-physiological treatments(Bobath, l966), this posture has not usually been used. The only exemption is an unimportant techniques in which a child maintains a kneeling position by holding onto some stable object. In the Dohsa-hou, however, kneeling has always been an important posture. The term of“kneeling”generally includes all the positions in which a person's knees touch the floor. The kneeling posture used in the Dohsa-hou means the position in which a child is supporting himself/herself upright on his/her knees with a trunk and the thighs erect, so the aim of“Hizatachi”training is to enable them to support their body on their knees. As in“Zai”(sitting)training the main task was working on 1, 3, 4, 5“Ban, in“Hizatachi”training 6“Ban”will be added to the task(6“Ban”;“hip joint part”).
C:“Kata-hiza-tachi”training
  After“hizatachi”training, in order to make balance on each knee, to stretch each hip joint, and to stand firm against the ground(fumisime)on the knee, “kata-hizatachi”training should be practiced. In this training, the trainee should stand only on one knee.
D:“Litsui”(Standing posture)training
  The training of“litsu-i”(standing on feet)is as important as the other motor actions training. The aim of“litsu-i”(standing)training is to enable them to support their body on their feet. And the main point in this training is to press firmly towards the feet(fumishime).
E: Walking training
  Walking training is the last stage of“tate method”. Before starting his training, the trainee should be able to stand on his/her feet. After standing by himself and standing firm to the ground(fumisime), the trainee takes a step forward and balance himself on the standing leg, then alternately takes a step forward. In this training, the trainee will be able to put his/her foot forward while pushing firmly toward the ground(fumisihime). They will learn how to shift their body weight from one foot to another.

5. Application of“dohsa-hou”to people with various kinds of disability.

(1)1st“Yasuragi-sou Camp”was started.
   In 1972“Yasuaragi-sou”which was a welfare institution for people with disability to visit for having rehabilitation and also the Institute of Psychological Rehabilitation was established at the same building. The institute has held two kinds of the psychological rehabilitation training camp since l972 at Yasuragi-sou. The one is l week through camp. Another one is 2 days camp. Participants of each camp are 30 children, 30 mothers(or fathers), 30 trainers, 6 supervisors, one director and 3 managers. Psychological rehabilitation(Dohsa-hou)training camp has mainly the following 5 activities.

a)Dohsa-hou training; this is main activity of the camp and the training session is held three times a day.
b) Group activity(Group psychotherapy);generally most of children with physically disability have poor interpersonal relationship between same other children and few experiences to play in group, so they have two times group activity(playing, singing, dancing, painting and so on)a day. They become to be familiar with not only each other children but also the therapists.
c) Guidance(counseling)for parents ; as parents of the children have some anxiety or worry, a meeting for the parents is held once a day to give some information about their child or psychological counseling.
d) Guidance of daily life for children ; the camp has an exact time table of a whole day in order to make children regulate their daily behavior(diet, sleeping and so on). e)Trainer(therapist)training ; the camp has trainer-training program which consists of one hour lecture, one hour-personal and one hour-group supervising.
(2)Application to the child with autistic disorder or hyper activity.
   Konno(1978)applied“Ude-age-Dohsa-hou(lifting up arm Dohsa)”to the children with autistic disorder. According to DSM-W(l994), a child with autistic disorder has mainly three characteristics.
a) The child has qualitative impairment in social interaction. That is, he has impairment in the use of nonverbal behavior such as eye-to-eye gaze, facial expression and gestures, failure to develop peer relationships and lack of social or emotional reciprocity. In other wards, they cannot make emotional interaction to other, even parents.
b) The child has qualitative impairments in communication. He reveals delay in, or lack of, the development of spoken language, stereotyped and repetitive use of language and so on.
c) The child has restricted repetitive and stereotyped patterns of behavior, interests and activities. The results are the followings(Harizuka, S. l986;Konno, Y. l993;Yamamoto, Y. l993).
   The child become to have eye-to-eye gaze and to show facial expression to regulate social interaction. Their behavior become to be calm and stable, and their panic behavior become to be reduced. And some of them become to pay attention to other person and to understand the situation around him.
(3)Application to the person with schizophrenia
   Dohsa-hou was applied to the schizophrenic patients at a hospital in l980(Kamohara, K. et. l980;Tsuru, M. 1982). The chronic and long hospitalized schizophrenic patients show that their emotional expression is flattened, ;especially their facial expression is just like death mask. Most of them have stereotyped or rigid bodily movements and posture. After the application, their emotional expression become to be soft and rich, and their bodily movement and posture to be flexible. Some of them come to talk with a nurse or other patients, and begin to take a walk or to attend to recreation spontaneously.
(4)Application to the children with Down's Syndrome and the children with mental retardation
   The children with Down's Syndrome usually show such bodily postures as a chin raised up, back stooped, shoulder rounded and abdomen protruded. Also they have the motor retardations, that is, they need more months to begin to stand up, to walk and to speak than the normals. Most of specialists have pointed out that these delays of development are due to their muscular hypotonia. The investigation based on Dohsa-hou found that Down's disabilities of motor control and motor retardation are caused by more muscular hypertonia than muscular hypotonia in the children with Down's Syndrome(Satoh&Tanaka:l986). After the application of Dohsa-hou to the children, their bodily postures of chin, shoulder, back and so on were improve, and then their speech became to be more clear louder than before the application(Satoh&Tanaka:l986).
(5)Application to the aged person with physically disability
   Now in Japan the population of more than 65year-old people has been increasing. The aged people happen to have brain attack and to have physically disability. The nursing or supporting daily life of the aged people with physically disability is a very serious problem. Most of post-stroke hemiplegia patients show the disabilities of Dohsa like the children with cerebral palsy. Some patients who are hospitalized for long periods have become to be depressed or to be dementia states. So they became to be not able to speak at all and not to pay attention to others. Dohsa-hou was applied to these aged people(Nakashima, K.:1986;1988, Harizuka, S. :l993). The aged person who had not replied to Dohsa-hou task at the beginning became to have interaction to the therapist by means of Dohsa. Most of them became to move their arms and some parts of body by themselves. Some of them showed smiles and began to speak a little. Another of them became to express their physical or psychological states by verbal or nonverbal expression. Their activities got to be lively and their communication ability was improved.

6. Trends in Dohsa-hou

(1)Dohsa-hou at special school
   In last decade, Dohsa-hou have been getting to be more popular in the special school in Japan. There are about 200 special schools for physically handicapped children and about 490 school for mentally handicapped children in Japan. These schools have a special training program for improvement of Dohsa, communication, sensory function and psycho-somatic adjustment under the curriculum.
   About 80% of the schools for physically handicapped children apply the Dohsa-hou in the special program for improvement of Dohsa.
   About 67% of the schools for mentally handicapped children app1y it in the program for development of communication and of interpersonal relationship.
(2)Dohsa-hou at normal school
   The number of students with school refusal has been increasing at elementary schools and junior high school since 1994. Now there is one student with schoo1 refusal per fifty students at junior high schools in Japan.
   And also there are many students who are suffering for interpersonal relationship between friends at both elementary and junior high schools.
Therefore, Japanese Ministry of Education provides the school counselor at these schools. Some of the school counselors applied Dohsa-hou to the students with school refusal. And some of teachers applied Dohsa-hou to all class students for stress care management. The results of the application are that the students became to be able to understand each other and improved their interpersonal re1ationship, and that most of students with school refusal stopped to complain about their somatic condition or became to go to school.
(3)Workshop camps of Dohsa-hou: domestic and international trends
   About 50 workshop camps of“dohsa-hou”have been held every summer for 10 years at 35 prefectures in Japan. The participants as a client of the workshop are about more than 700 children and adults with physically handicap, mental retardation, Down's Syndrome or autistic disorder.
   On the international trends, l week workshop camp was held in l997 and l998, Korea. Malaysian teachers attended a workshop of Dohsa-hou in Japan and now the camps have been held for the students at the special school in Malaysia since 1993.
   In Thailand, Dohsa-hou was applied to the students at the special schools in l997. And the camp was started from l998. In Iran, workshop of Dohsa-hou was held in l998 and Dohsa-hou began to apply to the children with cerebral palsy, mental retardation, Down's Syndrome or autistic disorder at the institute for rehabilitation in Tehran.

References

Kamahara, K., Sasaki, S.,&Saito, M. 1980 For application of psychological rehabilitation on schizophrenes. The Journal of Rehabilitation Psychology, 8, 22-27.
Nakashima, K. 1986 The aged person with mutism:“Feel”the feelings of his body. Clinical Symposium for Disabled Children l, 79-85. Clinical Center for Disabled Children, Kyushu University.
Nakashima, K. 1988 A psychological approach for speech-therapy: a case study of Dohsa-hou for aphasia. Archives of Psychological Clinic, Kyushu University, 7, 31-36.
Naruse, G. 1973 Psychological rehabmtation. Seishin Shobou, Tokyo.
Harizuka, S. 1986 Application of Dohsa-hou to the child with autistic disorder and hyper-activity. The Journal of Rehabilitation Psychology, 14, No. 1”., 41-52.
Harizuka, S. l993 Dohsa-hou as a counseling for the aged people with physical disability. Journal of Rehabilitation Psychology, 20, No. 1, 15-22.
Konno, Y. l978 Motor-control method of lifting up arm for behavior changing a hyper-active child. Bulletin of Tokyo University of Education, 24,187-195.
Konno, Y. l993 Principles and practice of Dohsa-hou for autistic children. The Journal of Rehabilitation Psychology, 17・18・19, 97-102.
Satoh, S. &Tanaka, S. 1986 Trail of psychological rehabilitation camp to Down's Syndrome. Research Bulletin of Faculty of Education, Oita University. 8(1), (Educational Science)69-79.
Turu, M. 1982 Improvement motor action and changes of social action on shichizophrenic patients. In Naruse, G. (Ed. )Development of Psychological rehabilitation, The Institute psychological Rehabilitation, Fukuoka.
Yamamoto, Y. 1993 A case study of“Dohsa-hou”for autistic child. The Journal of Rehabilitation Psychology, 17・18・19, 103-10
Copyright 2006 The Institute of Psychological Rehabilitation