Toby is a battered child whose emotional and physical scars of abuse will be reduced through the use of creative dance as therapy.

1) Symptoms of Toby's reaction to the trauma of being physically abused, which include:

• frustration in completing difficult tasks
• social withdrawal; unwillingness to initiate play or conversation

• mild-moderate impairment in balance
• forearms positioned in 85 degrees of flexion
• flexion contractures in hands
• weakened bilateral grasp
• decreased fine motor coordination
• muscle tightness at hips and right leg

1) To enable Toby to deal with the trauma of being physically abused by providing a safe and supportive environment where such problems may be expressed and treated, thereby increasing personal causation. Achieving this goal will have a subsequent effect on Toby's social withdrawal and frustration with difficult tasks. To facilitate this. . .

• an awareness of control of one's body will be created (eg. feel one's heartbeat after strenuous activity and then clap and stomp the rhythm).
• Toby's control over the external environment will be confirmed (eg. Toby adopts a posture interpreted by the therapist who decides whether or not to enter his space).
• A therapeutic relationship will be established via a neutral shared experience. This relationship is crucial during this uncertain transition period in Toby's life (Jeffrey, 1997).

A precaution in therapy is Toby's impairment in balance. While the treatment should increase his muscular righting reactions, Toby's safety is paramount, and it is therefore advisable to do the activity on mats and/or have Toby wear a helmet.

Intra/Interpersonal
Increase personal causation by. . .

1. using play in conjunction with creative dance. According to Jeffery (1997), "Young children are unable to express their emotional needs and conflicts with the verbal ability of adults. . . Childhood has a language of its own, that is, play" (p. 279).
2. utilizing psychoanalytic psychotherapy as a tool of creative dance. It is therapy "that is expressive and exploratory and that endevours to reverse the evolution of emotional disturbance through reenacting and desensitizing traumatic events by freely expressing thoughts and feelings" (Kaplan & Sadock, 1998, p. 1266).
3. using activities of interest to Toby (eg. acting like a fireman putting out a fire).

1. Increase conceptualization by increasing attention and concentration through the treatment process as breaks become less frequent and the activities become more complex.
2. Increase problem-solving skills (eg. portray a kitten stalking a grasshopper).

1. Grade activities from minimal postural balance to increased postural balance. Note precautions.
2. Use movements which increase range of motion and reduce bilateral contractures of the hand, elbow, and hip by gently moving the limb from one limit of motion to the other three times, twice daily (Zemke, 1995, p. 409). (See assumption number five.)
3. Exercise small muscle groups due to Toby's weak grasp in both hands.
4. Use movements involving fine motor coordination.

1) Toby's social needs are being addressed through avenues other than therapy.
2) Toby is open to creative dance as therapy, since it is in the form of play.
3) Toby no longer has seizures.
4) Toby does not see his biological mother at this point in time. However, she is currently in counselling and wishes to regain custody of her son.
5) Toby's foster mother is eager to help him with range of motion exercises each day and to learn the procedure.

Potential stressors affecting Toby in therapy include Toby's frustration about the movements he is unable to do which he could do previously, and the discomfort involved in overcoming defense mechanisms.

In conclusion, creative dance has excellent therapeutic potential for addressing Toby's primary goal (dealing with physical abuse) and secondary goal (remediating physical dysfunction). Adaptations and grading of the activity were explored, as well as potential sources of stress.

1. Creek, J. (Ed.). (1997). Occupational therapy and mental health, 2nd ed. (pp. 279, 281-282). Edinburgh: Churchill Livingstone.

2. Jeffrey, L. (1997). Play therapy. In J. Creek (Ed.), Occupational therapy and mental health, 2nd ed. (pp. 279, 281-282). Edinburgh: Churchill Livingstone.
   
   
3. Kaplan, H. I., & Sadock, B. J. (1998). Synopsis of psychiatry, 8th ed. (pp. 1266). Baltimore: Williams & Wilkins.
   
   
4. Levy, F. J. (Ed.). (1995). Dance and other expressive art therapies. London: Routledge.
   
   
5. Payne, H. (1990). Creative movement and dance: In groupwork. Bicester, Great Britain: Winslow Press.
   
   
6. Trombly (Ed.). (1995). Occupational therapy for physical dysfunction, 4th ed. (p. 409). Baltimore: Williams & Wilkins.
   
   
7. Zemke, R. (1995). Remediating biomechanical and physiological impairments of motor performance. In C. Trombly (Ed.), Occupational therapy for physical dysfunction, 4th ed. (p. 409). Baltimore: Williams & Wilkins.