Jill Johnson assists Clarice Dunn, a home health care patient, with the ROM Dance.

Jill is a geriatric clinical specialist in physical therapy. She has used the ROM Dance with her elderly, home-bound clients and conducts ROM Dance training workshops nationally.


ROM: Please describe how you have used the ROM Dance in your practice.

JJ: I've mainly used the seated version of the ROM Dance with my geriatric home care clients. Most of these patients have recently been in the hospital and are greatly deconditioned. The seated ROM Dance is wonderful because it is gentle enough for people to start on their first day home. I rarely see much of an increase in heart rate or hear complaints of soreness from doing the sequence even in its entirety. It also provides a great opportunity to teach relaxed movement and use of the breath with movement. In this home care setting, I've used the ROM Dance with people who have a variety of conditions. Of course I've used it to promote range of motion in patients with arthritis, but I've also found it useful for cardiac patients as a warm-up or cool-down exercise and for patients with balance problems. Also, for people with knee replacements it can be used to start working the quadriceps muscle against gravity. In fact, I think that it can benefit anyone just getting out of the hospital and starting to move again. I've even found it helpful for patients dealing with depression and for those who are part of the Hospice program.


ROM: How do you get reimbursed for your work with the ROM Dance?

JJ: I bill it as "therapeutic exercise."


ROM: Describe in more detail a client who benefited from the ROM Dance.

JJ: I had one home care patient who needed to exercise because she was overweight and had diabetes. She was also very depressed and as with many other patients suffering from depression, her lack of motivation to exercise was a big detriment. She was very resistant to my visits and to the whole idea of exercising until I introduced her to the ROM Dance. Because she was someone who loved music and poetry, she responded very differently to this intervention. After a couple of weeks of doing the ROM Dance regularly, she started to feel the benefits of exercise and was more willing to try other things.


ROM: How do you prepare your patients to practice on their own?

JJ: I often start by teaching good posture, diaphragmatic breathing and relaxed movement. Then I have them follow along with the video without worrying about doing each movement correctly. Gradually, I focus on small sections, teaching the movements correctly, but I don't feel that this is as important as breathing, posture and just plain moving! I bring my own video along with information on how they can order their own copy. Unfortunately this cost is not covered by insurance. I would guess that about 90% of them have VCR's in their home. Many received these as gifts from their children and never learned how to use them so this is a great opportunity to show them how to operate their VCR's! If they don't have a VCR, I've used the audio version (sometimes I bring my own cassette player). I have also just taught them small parts of the sequence and imagery that I feel would be beneficial. This is a good opportunity to come up with my own ideas of imagery, while trying to find what best facilitates each patient's sense of relaxation. If necessary, I might also turn it into more functional imagery like "pretend you are at the edge of a river and you want to wash your face."


ROM: How do you encourage your patients to practice regularly?

JJ: Compliance is often a problem when giving someone a home exercise program. I have found that providing a client with a video to follow greatly increases their compliance and motivation. I also encourage them to practice the ROM Dance at the same time every day ­ before a meal, first thing in the morning, or at the end of the day. This turns it into more of a daily habit. I also really stress that it only takes seven minutes to range every joint in the body and that it's important to take this time for themselves. Many of them need to be reminded that if they do this for themselves that others around them will also benefit. Lastly, I encourage them to tune out any outside disturbances so they can relax and also reap the benefits of the meditation aspects.


ROM: Do you find that the ROM Dance works equally well with both men and women?

JJ: I find that the seated and standing Sunlight versions are more popular with woman than with men. I've never tried the Fireside Version but it makes sense that the image of a fire in a cabin setting might be more appealing than the sun and the beach to some men. I tend to do more standard T'ai-Chi movements with men if they don't appreciate the music and imagery of the ROM Dance.


ROM: Are there any other ways you would like to see the ROM Dance used?

JJ: I would love to see more group classes in nursing homes. Physical Therapists can actually bill medicare for short periods of group activity and this would be an ideal form of therapeutic exercise to do in a group. I'd also like to see it being used as part of wellness and prevention programs with the elderly.. We might eventually be able to bill medicare for this.


ROM: How have you adapted it to meet the needs of your clients?

JJ: I've added ankle weights for further strengthening, and have limited the upper extremity range of motion to a painfree range for some clients. I've also introduced active assisted range of motion for those with unilateral limitations.


ROM: What problems have you had with the ROM Dance? Any solutions to those problems?

JJ: In general, it seems like clients either really like it or they don't. As therapists, I think we need to realize that everyone has different needs and different learning styles. The ROM Dance offers us a multi-level approach of using imagery, music, and guided exercise but it won't appeal to everyone. We need to simply add it to our ever-growing list of options for helping people.

Jill Johnson, MS PT GCS, works at the Valley Regional Hospital and the New England Center for Integrative Health in New Hampshire where she also teaches yoga. She received her Bachelor of Science degree and Masters in Biomechanics from the University of Wisconsin in Madison. Jill has published numerous research articles on geriatric rehabilitation and received a grant from the Physical Therapy Foundation to study falls in the elderly. Additionally, she has presented at the annual meeting for the Gerontological Society of America on the use of the ROM Dance with home-bound, elderly patients.

Jill has been involved in teaching Eastern approaches to therapeutic exercise to physical therapists for many years. She is collaborating with Tricia Yu and Sue Austin, OTR, on the creation of the Reclining ROM Dance, and with Tricia on the Tai Chi Fundamentals videos and manual. Jill can be contacted by e-mail at: jillj@cyberportal.net