Synnøve Iversen

Narratives of embodied experiences – Therapy processes in Norwegian psychomotor physiotherapy

The aim of the study was to explore patients’ narratives of embodied experiences through treatment courses of Norwegian psychomotor physiotherapy (NPMP). An NPMP specialist and two patients with chronic back pain participated in two long-term treatment courses. Research data were drawn from in-depth interviews and repeated video recordings with patients and physiotherapist. Reflective notes were written by patients. In order to study the relationship between narratives and bodily expressions in succeeding sessions, a three-step procedure was applied: identification of main types of narratives, identification of sub-themes and detailed analysis of selected part-processes. Patients gave meaning to back pain as an expression of long-lasting relational strain. Two main narrative patterns were identified: “Being in touch with” and “Being detached from” the body. The patients described the treatment course as “becoming an embodied subject” changing their experience of back pain, their rhythm of breathing and sensation of legs. Change was based on the therapeutic relationship encouraging reflection on embodied experiences. The study showed how NPMP may assist the patient to develop potentially healing narratives and an improved sensation of their body by integrating a physical and a verbal therapy approach.

Self-perception as embodied knowledge – changing processes for patients with chronic pain

The studys purpose was to explore change and perception of change related to patients with chronic back and/or neck pain through treatment courses of Norwegian psychomotor physiotherapy. A multiple case synthesis of nine cases, nine patients and five physiotherapists, was based on in-depth interviews and repeated video-recordings. Patients wrote reflective notes. In order to study changing processes within and over sessions a two-step procedure was applied: identifying main changing patterns, and identifying patient groups concerning similarities and varieties of main changing patterns. Five changing patterns were identified: (i) to move restricted and non-restricted; (ii) to breathe restricted and non-restricted; (iii) to reflect in a non-exploring and exploring way; (iv) to not transfer and transfer experience from treatment to daily life; and (v) to be detached from and to be in touch with the body. Two patient groups were identified: the limited and the considerable change groups. The process of self-perception seemed to be integrated in all the changing patterns, and to be a basis for reducing pain, and changing movement, breath and expression within and outside therapy. Self-perception appeared as a process of varying acts and self-knowledge. Merleau-Pontys phenomenological perspective of perception may add to the understanding of change.

Intervention for 6-year-old children with motor coordination difficulties: Parental perspectives at follow-up in middle childhood

The aim of the study was to evaluate motor function in middle childhood for two groups of children with motor coordination difficulties who had received intervention at the age of 6 years. For group A (n=15) a high-dosage, targeted motor skills approach with a high degree of parental involvement had been applied, whereas group B (n=15) had received a low-dosage, basic motor skills approach with limited parental involvement. Parental follow-up descriptions of the childrens situation at home and at school 1–4 years after intervention, with primary focus on motor function at the levels of activity and participation, were compared with motor function as assessed with the Movement Assessment Battery for Children (M-ABC). No significant differences were found with regard to M-ABC sum-scores, but the parents from group A reported an overall more favourable situation at the levels of activity and participation. The children in group A were physically active, with frequent use of targeted motor skills learned during intervention. The majority of children from both groups displayed comorbid learning difficulties and attention deficits at follow-up. Parents considered their children vulnerable and worried about future social functioning.

Physiotherapy treatment of children with cerebral palsy: The complexity of communication within sessions and over time

Physiotherapy involves complex communication and interaction. The purpose of the present study was to conduct in-depth analyses of communication during treatment for children with cerebral palsy within sessions and over time. Treatment took place at the childrens educational settings. Subjects were participants in three long-term therapy courses. A multiple case synthesis of the cases was carried out on the basis of in-depth interviews with physiotherapists and teachers and repeated video-recordings. In order to compare processes of communication within and over sessions, a three-step procedure was applied: identification of main communicative patterns, identification of variability and stability of patterns, and detailed analysis of selected part-processes. Four main communicative patterns were identified: two divergent patterns labelled “Different and competing perspectives” and “Insecurity and confusion” and two convergent, labelled “Actively searching for common ground” and “Shared and effortless dialogue”. The variability of communication was considerable, within and over sessions, and also within the selected part-processes. The findings can be described and understood within a dynamic systems framework, capturing the complex dynamics of communication within and over sessions, as well as during specific moments.

Developing a participatory multidisciplinary team approach to enhance the quality of school start

The article discusses how participatory action research was applied during a three-year project at 27 schools in Norway in order to enhance the quality of school start. A multidisciplinary on-site team approach was developed, supported by workshops and dialogue seminars. External professionals from the supportive municipal health care system and special education/school psychology services assisted children and teachers in the first grade, focusing on early health promotion and support to children at risk of developing problems. The project was reported to improve multidisciplinary teamwork and relationships, to increase focus on developmental and health care issues, to develop professional knowledge and practical skills, to increase support to local educational staff, and to provide a better school-start for all and particularly vulnerable children. Local creativity and ownership within supportive administrative structures were reported as promoting factors, while available time and external professional resources were the main constraints. The building of learning partnerships based on face-to-face interaction appeared to be a particular strength of the approach.

Motor coordination difficulties in 5–6‐year‐old children with severe behavioural and emotional problems

Incidence, severity and types of motor difficulties in children with severe behavioural and emotional problems were evaluated. A group of 6‐year‐olds (n = 29) with such problems and controls (n = 29) were compared on the Movement Assessment Battery for Children (M‐ABC). The groups were compared on total scores as well as manual dexterity, ball skills and balance. Individual M‐ABC profiles were compared with Teachers Report Form profiles. It was found that 62.1% in the high‐risk group and 20.7% in the control group showed motor coordination difficulties. In the high‐risk group 55.2% fulfilled the criteria of the DSM‐IV for developmental coordination disorder, compared to 3.4% controls. The high‐risk group showed significant difficulties within all sub‐areas of the M‐ABC. There was a significant relationship between attention problems and manual dexterity difficulties. The combination of problems identified makes these children vulnerable with regard to school inclusion and in need of proper assessment and intervention.