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Dohsa-hou
A Japanese Psycho-rehabilitative program for individuals with motor disorders and other disabilities

Asghar Dadkhah and Susumu Harizuka


Department of Clinical Psychology Center for Clinical Psychology and Human Development
Faculty of Education, Kyushu University, 6-19-1 Hakozaki, Higashi-ku, Fukuoka 812-81, Japan
E-mail: asgaredu@mbox.nc.kyushu-u.ac.jp
Web: http://www/rc.kyushu-u.ac.jp/~nagano/

Paper presented at the British Educational Research Association Annual Conference
(September 11-14 1997: University of York)

What is Dohsa-hou ?

In 1967, G. Naruse gave a new view point to the disabilities of motor action in cerebral palsy children. He made his notion on the basis of the fact that although the disabilities in cerebral palsy are resulted from physiological dysfunction, these may be influenced by their psychological activities. He made his view point based on the following three observations: subjects with cerebral palsy (a) move their body parts during sleep but not when awake, (b) move their body parts somewhat better during hypnosis, and (c) find difficulty in speaking infront of unfamiliar persons. Naruse therefore devised a psycho-rehabilitative technique for these subjects, called Dohsa-hou.

Dohsa means a holistic process of motor action which consists of the inner psychic activities of a bodily movement and Hou means method. "When we intend to move some parts of our 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" (Naruse, 1973). The method of Dohsa-hou is based upon such concept.

The process of Dohsa can be divided into two: one is psychological, (for example, intention and striving), and the other is physiological (for example, body movement, body posture). It is schematized as a process of "intention-striving-body movement" (Naruse, 1973). In the process of client's goal-directed striving, 'the trainer is able to activate the client's mind and facilitate the activity of his self through his experiencing of goal directed Dohsa' (Naruse, 1985, 1992).

The utility of Dohsa-hou for counseling as a supplementary technique is recently noticed because voluntary concentration and striving to client's own body for relaxation or motoric manipulation by himself making his matter of concern to direct inside and make him be easy to talk himself. These clinical experiences have helped some pioneers to open a new way to the study of "Dohsa therapy" which is one kind of nonverbal psychotherapy mainly using Dohsa-hou. Verbal tool is used only for supplementary help.

Has any research undertaken on this method ?

Ono (1983) and Konno (1978, 1993) applied Dohsa-hou to autistic and hyperactive children. The method improved their personal interaction, and eye contact with others. Kamohara (1980) and Tsuru (1982, 1985) applied Dohsa-hou to schizophrenic patients and found that their consciousness improved and their body pisture changed. Konno, Ohno, and Hoshino (1990) found that perception of self and others improved through muscular relaxation and postural training by Dohsa-hou. Harizuka (1988, 1992) applied the method to cerebral palsy children, the treatment was effective and it was important for the subjects who had disability, to keep their sitting-posture by themselves as a result of the technique. Others indicated that as the sense of muscular relaxation and the sense of stability in standing posture increased, positive changes in external perception occurred (Hatakeyama, Etoh, & Konno 1994).

Dadkhah (1996, 1997) applied Dohsa-hou to disabled sportsmen and disabled students in elementary school in Iran, as a result of training, their public aspect of their body-consciousness changed the most by experiencing a new mode of motor action which was different from the one they experienced before the training, they gained a better balance on their body while walking and running, and they improved their sports record time. The results indicated that this training is a useful method for helping disabled sportsmen to improve their body-consciousness, to gain control over both their own bodies and minds, and, in addition, that it maybe useful in making training programs for them.

In the field of Sports in Japan , Since Rome Olympic to Tokyo Olympic, some Dohsa-hou techniques such as relaxation, mental rehearsal and mental training was introduced to champion athletes for treatment of stage flight and training for game strengthening by Naruse (1975).

In these studies, the suitability of Dohsa hou method was examined. The method has been practiced on different kinds of disability and the efficacy of it has been established in general.

What is the mechanism of the treatment ?

Dohsa-hou is a new Psycho-rehabilitation training method in Japan developed with research and practical training. The accumulation of Dohsa training has been done by man to man (trainee and trainer). In the situation of Dohsa-hou, client is asked by the therapist to perform a pattern of body movements as an imposed motor task by therapist. In the process of client's goal directed striving, therapist helps client's Dohsa through which client has a chance to experience an action onto his own body according with the intended task, and for a cooperating work with his therapist to the same goal. Thus by Dohsa-hou, the therapist is able to activate client's mind and facilitate the activity of his self through the experiencing of goal directed striving for Dohsa , and working in cooperation with his therapist.

What is specific about this method ?

Many kinds of clinical trial have been reported in the field of body movement or motor action useful for physical and mental health. Some of them mainly aim to ask client to perform a Dohsa as an imposed task, and some do not include this performance. The former is named as one of Dohsa- hou, while the latter one is not. For instance, in Dohsa-hou, the therapist asks the client to strive to relax his/her muscle, or move body by himself, and in other therapy, they expect to be brought a state of body relaxation as a secondary effect of some other motor behavior such as dancing, running and so on. The latter case is not counted as Dohsa-hou because it aims body relaxation as a physiological phenomenon . On the contrary, Dohsa-hou treats client's striving to relax his own body by himself as psychological phenomenon through body work.

Dohsa Hou is different from physiotherapy and other psychotherapeutic methods. In the traditional psychotherapeutic methods, the motivation or striving is there but no program is undertaken by motoric way. In physiotherapy, clients' psychological aspects are not given due attention.

Who can benefit from Dohsa-hou ?

At the beginning, Dohsa-hou had the aim of improving the motor difficulty of cerebral palsied children (Naruse, 1967). Later it applied to autistic and hyperactive children (Harizuka, 1986). It stabilized their emotion, changed their daily life pattern of behavior, and also improved their postures. Schizophrenic patients can benefit from Dohsa-hou, their actions become vitalized to walk and in constant movement (tsuru, 1982).

It also applies to mentally retarded children, down syndrome children and young children with muscle dystrophy too. Aged persons with mental disorders are beneficial from this method. As a clinical use, in counseling for cases like depression, school refusal Dohsa-hou was effective. Recently after the Kobe earthquake in Japan, Dohsa-hou applied for the cases of PTSD(Post Traumatic Stress Disorder) and reported that it was quite effective.

What are the changes after the therapy?

Because of the Dohsa training, in case of cerebral palsied (C.P.) children, who can not sit properly will sit ,who can not stand up will stand up, who can not walk will walk. In case of autistic children, their eye-contact to others will improve and their emotion become stable. In case of mental retarded children (M.R.), their communication with others improve and they will find their position in each task properly. In case of down syndrome children, their body posture change and their emotion will be controlled. In the case of aged persons they become more socialized and bright and their state of communication will improve. And in case of counseling the emotion control has a great role.

Brief description of the method

Body parts - In this method, different parts of body called 'Ban' and expressed by numbers. As are shown in the figure the parts are as follow:

Ban 1 : neck

Ban 2 : two parts of scapula joint in back

Ban 3 : the upper part of the back between scapulas

Ban 4 : the middle part of back around the chest

Ban 5 : the lower part of back around waist

Ban 6 : hip joints

Ban 7 : knees

Ban 8 : ankles.

Ban 9 : feet fingers.

Ban 10 : shoulder joints.

Ban 11 : elbows.

Ban 12 : wrists.

Ban 13 : hands fingers

Basic ideas in Dohsa training

The basic ideas in Dohsa training are: 1) Relaxation, 2) Movement of arms, hands and legs - tan-i Dohsa, 3) 'Tate method'.

Relaxation - This treatment will be down by different techniques such as 'kata-

yorume', 'se-sorase', and 'kukan-no-hineri.

Tan-i Dohsa - The aim of 'tan-i Dohsa' training is to help the child to learn the

basic movement of arms, hands and legs by different techniques such as

'ude-age', 'ude-mage', 'te-no-hiraki', 'ashi-no-mage-nobashi'.

Tate method - In Dohsa training the idea of 'Tate' and 'Tate method' is very important. 'Tate' means making straight or putting in one line vertically. In this case it means by making the vertical body axis, putting different parts of body straight and vertical against the ground. The detail of the method will be explained in its sections. Beside the "Tate method" task, there are many other tasks related to the case disability and other problems. The therapist in this method is called as "trainer" and client is refereed to as "trainee" rather than patient. This reinforces the view of work primarily beings as an educational process.

Main tasks of training

Most of the trainees who can not make a proper sitting, standing on knees, and standing posture have either bending forward posture, or bending backward posture. In these postures, the trainees have a tendency of strengthening themselves by putting their effort in the wrong parts which causes bending forward or backward. The inappropriate bending forces should be changed to a straight direction (Tate).

The training aim is supporting the trainee to strengthen his/her body in vertical position towards the floor and make him/her able to take the proper posture of sitting, standing on knees and standing on feet. In the Dohsa training session, the training range varies from laying to walking. The children who are not able to stand and walk, are trained by the sequence of sitting, standing on knees, standing on feet and walking. There are 5 main tasks in Dohsa training:

1. Zai training (sitting with crossed legs training)

2. Hizatachi training (standing on knees training)

3. Kata Hizatachi (standing on one knee training)

4. Litsui training (standing posture training)

5. Hokou training (gait training)

Zai training - Sitting posture on the floor is the primary posture for human being to keep his body vertical against gravitation. 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 other than a state in which the body is lying on the floor. The posture is one of active motor actions that a person operates for his own body to be vertical against gravitation. To make the upper part of the body to stand vertical 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 vertical. So the main task in this position is making 1,3,4,5 "Ban" straight in one line towards the ground and to enable trainees to support themselves on their buttocks.

Hizatachi training - The importance of the kneeling posture has not been emphasized in rehabilitation medicine and developmental psychology. In the techniques of neuro developmental treatments (Bobath 1966), this posture has not usually been used. The only exemption is an unimportant technique in which a child maintains a kneeling position by holding onto some stable object. In the Dohsa-hou, however, kneeling has always been a very important posture. The term "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 themselves 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.

Kata Hizatachi training - After Hizatachi training, in order to make balance on each knee, to stretch each hip joint, and to stand firm against the ground (fumishime) on each knee, Kata Hizatachi training is practiced. In this training, the trainee should stand only on one knee.

Litusi training - The training of Litsui (standing on feet) is as important as the other motor action training. The aim of Litsui (standing) training is to enable them to support themselves on their feet. The main point in this training is pressing firmly towards the foot (fumishime) from the top. In this training the range of feet on the floor should be as follows:

Hoko training - Hoko (Gait) training is the last stage of "Dohsa training". Before starting this training, the trainee should be able to stand on his/her feet. After standing by himself and standing firm to the ground (fumishime), the trainee takes a step forward and balance himself on the forwarded leg, then alternately takes a step forward. In this training the trainee finds his/her feet and can put his/her foot forward while pushing firmly toward the ground. They will learn how to shift their body weight from one foot to other.

Who is Dr. Gosaku Naruse?

In 1967, Gosaku Naruse, a professor of Kyushu university in Japan, proposed a new view point in human motor action studies other than physiological view points considering the activity of muscle skeleton system or brain neural system. He called his view point Dohsa-hou or Dohsa method. This technique has been practiced in Japan beside the other psycho-rehabilitative programs such as Bobath and Vojta since 1967. Naruse's Jiko-control (self control) training (1981) included Jacoson's method of progressive relaxation for the purpose of psychotherapy. Professor Naruse's new achievement, which made it possible for the first time in psychological study expand even to the fields of clinical psychology and special education for disabled children. It also responded to the needs of the day to day by opening the field of psycho-rehabilitation. He was the first chairman of the three Japanese psychological associations, The Association of Japanese Clinical Psychology, The Japanese Society of Hypnosis, and the Japanese Association of Rehabilitation Psychology.

How to get more information about Dohsa-hou?

In Kyushu University, Center for Clinical Psychology and Human Development is responsible for Dohsa training. The information contact are:

Director & professor: Susumu, Harizuka Ph.D.
Center for Clinical Psychology and Human Development
Faculty of Education, Kyushu university,
6-19-1 Hakozaki, Higashi-ku, Fukuoka 812-81, Japan

Tel: +81-92-642-3158
Fax: +81-92-642-3588
E-mail: harizedu@mbox.nc.kyushu-u.ac.jp and asgaredu@ mbox.nc.kyushu-u.ac.jp

Web (Homepage):

http://www.rc.kyushu-u.ac.jp/~nagano/
http://www.rc.kyushu-u.ac.jp/~nagano/dohsa3.htm

References

Bobath, K. (1966). The motor deficit in patients with cerebral palsy. Surrey: Medical Books Ltd.

Dadkhah, A. (1996). The effect of Dohsa-hou on body consciousness in disabled sportsmen.

Dadkhah, A. (1997). Dohsa-hou - A Japanese psycho-rehabilitative program: Its impact on body consciousness.

Harizuka, S. (1986). Dohsa-hou for Autistic and hyperactive children. The Journal of Rehabilitation Psychology, 14, 41-52.

Harizuka, S. (1988). The technique of vertically straightening in dohsa-hou for sitting posture. The Journal of Education for Cerebral Palsied Child, 71, 9-14.

Harizuka, S. (1992). Dohsa-hou for making sitting posture with legs crossed. The Journal of Rehabilitation Psychology, 19, 27-33.

Hatakeyama, K., Etoh, H., & Konno, Y. (1994). The change of external perception through the experience of body relaxation. Proceedings of the 20th Congress of the Japanese Association of Behavior Therapy, 138-139.

Kamohara, K. (1980). For application of psychological rehabilitation on schizophrenics. The Journal of Rehabilitation Psychology, 8, 22-27.

Konno, Y. (1978). Motor control method by lifting up arm for action change on a hyperactive child. Bulletin of Clinical and Consulting Psychology, 24, 187-195.

Konno, Y. (1993a). Modification of self-image through autogenic training and Dohsa training. Proceedings of the 20th Congress of the Japanese Association of Behavior, July 26-30, Tokyo.

Konno, Y. (1993b). The relation between the experience of muscular tension tension-relaxation and perception of other person. Proceedings of 57th Annual Convention of Japanese Psychological Association, 235.

Konno, Y., Ohno, K., & Hoshino, K. (1990). The process of changes of self image through relaxation training. Japanese Journal of Hypnosis, 34, 17-19.

Naruse, G. (1967). Psychological rehabilitation of cerebral palsy-I: On relaxation behavior. Japanese Journal of Educational Social Psychology, 8, 47-77.

Naruse, G. (1973). Psychological rehabilitation. Tokyo: Seisin Shobo.

Naruse, G. (1975). On the application of hypnosis to sports. In Lars-Eric 	Unestal(Ed.), Hypnosis in the serventies. (pp.171-175). Sweden: 	Orebro,.

Naruse, G. (1981). A systematic method of Jiko-control. In J. Jeig (Ed.), Eriksonian Approaches to Hypnosis and Psychotherapy (pp. 391-398). New York: Bruner Mazel.

Naruse, G. (1985). Theoretical approach to Dohsa-training. Tokyo: Seishin shobo.

Naruse, G. (1992). Recent development of Dohsa-hou in Japan. The Journal of Rehabilitation Psychology, 19, 7-11.

Ono, M. (1983). Analysis of change on a hyperactive child through the motor action exercise. Paper presented at the Association of Japanese Clinical Psychology, Tokyo: Seishin Shobo.

Tsuru, M. (1982). Improvement of motor action and changes of social action on schizophrenic patients. In G. Naruse (Ed.), Evolution of psychological rehabilitation; Fukuoka: The Institute of Psychological Rehabilitation.

Tsuru, M. (1985). Dohsa method for schizophrenia, The association of 	Japanese clinical psychology. Case study of clinical psychology, 3, 	Tokyo: Seishin shobo.

This document was added to the Education-line database 28 October 1997