Abstract
Dear Editor:
Pairing of concentrated breathing exercises with gentle movement and soft music can improve focus, can reconnect the body and mind, and can foster peaceful feelings for participants. Our pediatric palliative care team is frequently consulted for distress, anxiety, and pain within our free-standing children's hospital. We wished to expand our services beyond simply psychosocial and pharmaceutical interventions to consider integrating gentle yoga, tai chi, and qi gong at the bedside of pediatric palliative care patients with inclusion of child and family. Movement therapies, such as yoga, have been shown feasible in the pediatric outpatient setting. 1 Preliminary data have demonstrated improved pain, disability, mental health, gross motor function, and quality of life with incorporation of mindful movement.2,3 We thus partnered with a 25-year experienced pediatric occupational therapist who is also a registered yoga teacher and certified tai chi instructor. We offered all families with children or adolescents receiving pediatric palliative care consultations gentle music and movement exercises at bedside. Movement was modified based on participant physical need such as offering seated or restful postures. In our initial roll out of offering, 17 family caregivers and 7 pediatric palliative care patients participated in a mindful movement session in their hospital room (mean time 12 minutes for first session). Over half of these sessions occurred in intensive care settings. Family caregivers rated their overall wellness level before and after intervention by completing this sentence “in this moment in time, my body, mind, and overall wellness feel…,” using a 10-point scale with 0 representing “no distress” and 10 representing “extreme distress.” Similarly, participating pediatric patients rated their overall wellness before and after intervention by circling the face corresponding to their answer of “in this moment in time, I feel…,” using a 10-point scale with 0 representing very happy face and 10 representing very sad face.
The mindful movement intervention improved overall well-being scores by a mean 3.2 points for these guardians and a mean 1.6 points for patients. Every child and guardian involved had improved overall well-being scores after intervention and the difference in self-reported well-being scores was significantly different (p < 0.005). Many participants commented they felt more relaxed and would like to have the intervention repeated in the future (Table 1). There were no adverse outcomes.
This initial exploration demonstrated that it is possible and acceptable to bring gentle music and movement to bedside with a pediatric trained practitioner with measurable self-reported impact to child and family caregiver comfort, even in an intensive care unit setting. Our results show promise of mindfulness movement therapy in improving overall well-being of inpatient pediatric patients and their family caregivers. Bedside staff and clinician enthusiastic response to witnessing this intervention for children and their families resulted in our team now offering “Stretches in the Sunshine” at scheduled times on the back patio of our pediatric intensive care unit during the warmer months to provide access to meditative movement for staff resiliency and for pediatric patient and family care. One child summed up our palliative care field: “it feels even sunnier if we stretch together.”
Note: Intervention approved as exempt from full Institutional Review Board Review due to Quality Improvement nature. The last author would be glad to share Yoga, Tai Chi, Qi Gong Patient Education Handout and Policy upon request.