Breath Quality and Aspects of Motor Fitness are Key Indicators in Dance/Movement Therapy Assessment

Breath Quality and Aspects of Motor Fitness are Key Indicators in Dance/Movement Therapy Assessment | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Breath Quality and Aspects of Motor Fitness are Key Indicators in Dance/Movement Therapy Assessment Elizabeth Bell, Sarah Kruger, Elizabeth Freeman This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7829291/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Dance/movement therapy is a psychotherapeutic approach that uses movement, body awareness, and embodied communication to support healing and wellness across different populations. In dance/movement therapy treatment, movement serves not only as a primary mode of intervention but also as a tool for assessment. There is growing interest in quantifying internal and external variables within dance/movement therapy. However, the specific movement components most relevant for clinical assessment remain unclear. This study aimed to generate a framework of quantifiable components of movement and physiological function and examine how dance/movement therapists rate the importance of aspects of motor fitness, spatial engagement, and breath quality. Thirty-three therapists anonymously rated the importance of patient improvement in items defining speed/reaction time, balance, coordination, movement accuracy, agility, available space. A one-way analysis of variance revealed significant differences in importance ratings across components, F (6, 86.90) = 221.38, p < 0.001 . Notably, spatial engagement was rated as “not at all important” and was rated significantly lower than all other components (all p < 0.001). Although breath and all aspects of motor fitness were rated as important, post hoc analyses indicated that breath was rated significantly more important than speed/reaction time (p = 0.029) and movement accuracy (p = 0.025). These findings lay the groundwork for understanding which components of internal and external movement are clinically meaningful and emphasize the potential to integrate objective physical and physiological data into embodied therapeutic practice. Dance Movement Therapy Survey Figures Figure 1 Figure 2 Introduction Dance/Movement Therapy (DMT) is a psychotherapeutic approach that uses dance, movement, body awareness, and embodied communication to promote healing and wellness across different populations, including active duty service members and veterans (American Dance Therapy Association, n.d.; Winters & Freeman, 2022 ). While DMT is associated with subjective improvements in clinical behavioral health (Guzmán et al., 2017 ; Weitz & Opre, 2022 ), and rehabilitative outcomes (Dhami et al., 2015 ; Martinec, 2018 ) there remains limited evidence supporting its effectiveness. Given that movement serves as both an intervention and assessment tool in DMT (American Dance Therapy Association, n.d.), quantifying movement changes may offer a pathway to more objective evaluation. DMT is practiced in a wide range of settings, including schools, nursing homes, counseling and crisis centers and serves a wide range of populations. In these settings, therapists are often embedded within both behavioral health and rehabilitation clinics, adapting their practice to the available space and resources. Therapists may provide bedside care in palliative settings or convert non-clinical spaces, such as conference rooms, into treatment areas. Spatial use itself can reflect therapeutic progress: patients with trauma histories may initially exhibit more restricted, proximal movement patterns and avoid expansive or traveling movements. As therapeutic rapport develops and treatment progresses, patients often begin to move more freely and occupy more space within sessions. While therapists can observe and discuss such changes with patients, there is currently no standard framework to quantify motion changes. Sensor based motion analysis has been applied in several studies to examine movements within dance therapy (Gates et al., 2022; Prakash et al., 2025 ). However, a comprehensive framework identifying what components of motion are important to DMT assessment has yet to be established. In contrast, the field of athletic performance provides a well-recognized set of motor fitness components including agility, balance, coordination, power, reaction time, and speed (Michael Kent, 2006 ). These motor fitness attributes have demonstrated relevance in DMT contexts and may offer a useful foundation for conceptualizing movement within the discipline. For instance, agility is reflected in the ability to transition between movements (Dwiyasmono et al., 2023 ) and improved balance has been observed in DMT participants across populations (E.g., Takahashi et al., 2023 ; Wu et al., 2022 ). Coordination supports emotional attunement through movement and has been measured using accelerometers to assess interpersonal synchrony (Prakash et al., 2025 ). Strength, which contributes to power, has been documented as a DMT outcome (Wołoszyn et al., 2021 ) and reaction time has been measured through responses to musical stimuli (Chatzihidiroglou et al., 2018 ). Speed improvements in timed motor tasks have also been quantified (Berrol et al., n.d.). Despite these connections, identifying clinically meaningful components which can be measured objectively in DMT remains complex. External body movement distinguishes DMT from psychotherapy, however tracking movement performance is often a secondary consideration rather than a primary therapeutic goal. Instead, therapists work with varied populations and tailor interventions to individual needs, often prioritizing behavioral health through creative expression over physical rehabilitation (Bräuninger, 2014 ; Wiedenhofer & Koch, 2017). As such, movements in DMT are not always goal directed. Nevertheless, aspects of motor fitness may provide a useful foundation for developing a standard list of objective components related that could potentially be tracked in therapeutic contexts. Beyond the assessment of external movement, internal physiological signals, such as breath, may offer insight into clinical goals like emotional regulation (Grigonis, 2019 ). Breath is closely linked to both physiological and emotional states and tracking respiratory patterns may help therapists assess how patients use movement to regulate internal experiences (Levy, 1988 ). Breath is particularly relevant in military populations where trauma exposure is common (Winters & Freeman, 2022 ). Creative arts therapies, including DMT, play a vital role in interdisciplinary care for service members and their families, addressing both behavioral and rehabilitative needs (Chilton et al., 2021 ). Treatment goals often include helping patients use breath and movement to activate restorative physiological processes during and beyond therapy sessions (Winters & Freeman, 2022 ). Quantifying breath-focused movement practices may offer a way to track internal regulation. To assess the clinical relevance of external and internal measures a theoretical framework must be developed based on the perspectives of subject matter experts, such as dance/movement therapists, to identify which components are considered meaningful. Accordingly, this study developed a framework of components and items represent quantifiable components of movement. The investigation focused on how dance/movement therapists evaluate the importance of patient improvement in aspects of motor fitness, spatial engagement, and breath quality. Given that clinical measures of movement assessment were integrated into the definition of each objective component, it was hypothesized that the resulting items would demonstrate high internal consistency. Additionally, group comparison analyses were conducted to determine whether improvements in certain components were rated significantly more important than others. These findings may inform future research by introducing objective performance metrics to complement subjective assessments in therapeutic practice. Methods All procedures were conducted in accordance with applicable laws and institutional guidelines and were approved by the Towson University Institutional Review Board (IRB #2253). An anonymous online survey was administered using Qualtrics (Provo, UT) and distributed via email to therapists connected with the Creative Forces program and therapists associated with the American Dance Therapy Association ( Find a DMT , n.d.). Participants reviewed an informed consent statement prior to participation. Individual responses were recorded under randomly assigned identification numbers to ensure confidentiality. Data Collection Participants provided self-reported demographic information, including sex, race/ethnicity, educational background, their current or former status as a dance/movement therapist and their primary work setting (e.g., Department of Defense medical center, Veterans Affairs medical center, other medical centers, schools, psychiatric facilities, rehabilitation centers, nursing homes, drug treatment centers, counseling centers, crisis centers, or other). Participants were also asked to describe the population they currently or previously worked with and to report on their years of professional experience. This study aimed to employ a targeted survey instrument which could evaluate quantifiable components of movement and physiological function relevant to DMT. In the absence of an existing survey for this purpose, the authors sought to define and operationalize key aspects of motor fitness, spatial engagement, and breath quality. To develop items aligned with each component, the authors reviewed documentation from a workgroup of DMT clinicians associated with the Creative Forces Clinical Program ( Creative Forces: Clinical Program , n.d.) who were creating a standardized note template to support consistent observation and recording of movement during therapy sessions. The authors extracted the movement outcomes listed in these notes which were aligned with sport science definitions of aspects of motor fitness, spatial awareness, and breath (Michael Kent, 2006 ). Following this, the authors (EMB and EKF) met to review the full list of items and refine the language into concise bullet points suitable for inclusion in the survey. Although power is traditionally included in motor fitness assessments, it was intentionally excluded from this study due to its limited relevance to the expressive and integrative goals of DMT. Instead, the construct of speed was expanded to encompass both directional velocity and temporal responsiveness, serving as a conceptual proxy for certain power-related dynamics. This composite measure served as a conceptual proxy for certain power-related dynamics, reflecting the established relationship between speed and power observed in prior clinical movement assessments (Bell et al., 2021). Specifically, speed was redefined to include reaction time, measured as the latency between stimulus presentation and movement initiation. This approach allowed for the inclusion of dynamic responsiveness without requiring direct measurement of force output. The final framework included the following components: speed and reaction time, balance, coordination, movement accuracy, agility, use of space, and breath. Importance ratings were collected using a visual analog scale ranging from 0 indicating “not at all important to 100 indicating extremely important” (Fig. 1 ). Before each set of items participants were asked, “How important is it that your patients experience improvement in the following outcomes associated with [each component]?” Components and items were presented in a fixed order across all respondents (Table 1 ). After rating each set of items, participants were given an optional open-text field to respond to the prompt: “Do you have any comments or thoughts about changes in [the current construct]?” Survey submissions were excluded from analysis if no ratings were provided or if the participant did not complete all pages of the survey. For items where participants did not adjust the visual analog scale, a score of zero was recorded, reflecting the default position of the slider. Table 1 Within the online survey each respondent was asked "How important is it that your patients experience improvements in the following outcomes associated with [each component]" and used a visual analog scale (0-100) to rate each item. Component Item 1 Item 2 Item 3 Item 4 Item 5 Item 6 Speed / Reaction Time Access to playfulness or more accelerated movement initiation Ability to start to move or react to a change in the rhythm of music Faster dynamic shift between flowing and rigid movement (bound and free flow) Dynamic use of time (slow-fast, acceleration-deceleration) Balance Spatial awareness with respect to centeredness or reliance on internal coordinates Ability to be more stable while achieving a greater level of movement (documenting the limits of stability and balance reactions) Motor skills and mobility result in in a decreased fall risk Ability to more effectively stabilize body parts while producing effective movement Ability to mobilize and integrate body parts effectively Coordination Movement phrasing (meaning the kinetic chains of muscular action are set up in the moment of the initiation with sequence and follow-through to complete the phase) Body parts integration / access to developmental movement patterns such as core-distal, head-tail, upper/lower, right/left, cross lateral Self-synchrony (body parts moving in rhythm with oneself) Synchrony with music, partner, or other stimulus Synchrony with music, partner or there stimulus Access to tension flow attributes (flow adjustment, even flow, low, high, gradual, abrupt Accuracy Ability to attune to the expressive movements of others (kinesthetic empathy and reciprocity) Use of body shaping (forming the body to make a particular shape or changing the form of the body to bring about a specific type of relationship to other people or to the environment) Phrasing (meaning kinetic chains of muscular action are set up in the moment of initiation with sequence and follow-through to complete the phrase) Agility Ability to change body position with ease Ability to start and stop movement quickly Ability to more easily change direction while moving Access to dynamic range within movement repertoire Available Space Dynamic use of space Shaping in directions Shaping in planes Breath Ability to direct flow of breath (e.g. diaphragmatic vs. nasal breathing) Increased control of breathing cadence Ability to synchronize breath with movement Statistical Analysis To evaluate the internal consistency of grouped sub questions for each aspect, Cronbach’s alpha was calculated in SPSS (Version: 28.0.0.0 (190)) for each set. For each respondent, average scores were computed across sub questions within each aspect. Interpretation guidelines:α ≥ .90 = excellent, α ≥ .80 = good, α ≥ .70 = acceptable, α ≥ .60 = questionable, α ≥ .50 = poor, α < .50 = unacceptable (George, D. & Mallery, P., 2003 ). If reliability was acceptable or greater, these individual aspect scores were then averaged across all participants. To examine differences in perceived importance across constructs, a one-way analysis of variance (ANOVA) was conducted on mean importance ratings of each construct from all participants. Mean importance ratings of each construct were calculated by averaging responses across all sub question items within each construct. Prior to conducting the ANOVA, assumptions of normality of residuals and homogeneity of variances were assessed. In the event of assumption violations, appropriate adjustments were made to ensure the robustness of the analysis. Specifically, Welch’s ANOVA was used in place of the standard ANOVA when the assumption of homogeneity of variances was not met, and post hoc comparisons were conducted using the Games–Howell procedure from the “userfriendlyscience” package. All statistical analyses were performed using RStudio Version (2023.06.0 + 421) with a significance level set at α = 0.050. Results Participants Thirty-three dance/movement therapists responded to the survey between May 2024 and April 2025, including eight (24.2%) affiliated with military healthcare. Thirty participants identified as female, while sex data was unavailable for three participants. The sample included individuals identifying as White/Caucasian (n = 12), Hispanic/Latino/a (n = 5), Asian/Pacific Islander (n = 4), Black/African American (n = 2), and mixed or multicultural backgrounds (n = 4). All participants held at least a college degree, with most reporting graduate-level education in Dance/Movement Therapy or related fields. Degrees included master’s, doctoral, and post-graduate qualifications in counseling, psychology, expressive arts, and clinical mental health. Nearly all respondents (97%) were currently practicing. Participants worked across a wide range of settings, most categorized as “Other” (n = 12), followed Department of Defense or Veteran Affair medical centers (n = 8), Counseling Centers (n = 4), and Psychiatric facilities (n = 3), with additional representation from schools, nursing homes, and crisis centers. They served a wide range of populations, including children, adolescents, adults, and the elderly, as well as specialized groups such as veterans, individuals with traumatic brain injury, post traumatic spectrum disorder, autism, and those in psychiatric or correctional settings. Years of experience ranged from 3 to over 25 years, with a mean of approximately 9.7 years. Full self-reported work setting and population details are provided in the articles supplementary data. Internal Consistency of Items for Each Construct The internal consistency of each set of items within each construct was found to be good to excellent, with all Cronbach’s alpha coefficients equal to or exceeding 0.87 (Table 2 ). Table 2 Internal Consistency of Movement Constructs as Measured by Cronbach’s Alpha and Quartile Distribution of Importance Ratings for all participants and all Items. Components Cronbach's Alpha Item Minimum Quartile 1 (25%) Quartile 2 (50%) Quartile 3 (75%) Maximum Speed / Reaction Time 0.87 1 0 40 68 80 100 2 0 49 61 80 100 3 0 45 56 80 100 4 11 60 73 81 100 Balance 0.88 1 0 49 72 94 100 2 0 46 64 80 100 3 0 31 68 87 100 4 0 45 68 80 100 5 33 72 79 91 100 Coordination 0.89 1 10 46 68 79 98 2 10 50 74 89 100 3 10 53 73 91 100 4 0 53 78 87 100 5 0 40 73 86 100 Accuracy 0.93 1 0 53 70 82 100 2 0 50 63 80 100 3 0 39 51 75 97 Agility 0.90 1 0 50 60 76 100 2 0 48 62 73 100 3 0 50 69 80 100 4 5 52 70 91 100 Available Space 0.91 1 1 5 7 8 10 2 1 5 7 8 10 3 1 5 7 8 10 Breath 0.92 1 29 72 81 96 100 2 23 60 80 97 100 3 21 70 86 100 100 Note. Cronbach’s Alpha values indicate the internal consistency of items within each construct. Interpretation guidelines: ≥ .90 = Excellent, .80–.89 = Good, .70–.79 = Acceptable, .60–.69 = Questionable, .50–.59 = Poor, < .50 = Unacceptable. Mean Ratings of Importance Assumption testing revealed a violation of the normality of residuals, as indicated by the Shapiro–Wilk test (p < 0.001) . Additionally, Levene’s test for equality of variances was significant (p < 0.001) , indicating a violation of the homogeneity of variances assumption. Given these violations, Welch’s ANOVA was employed to account for unequal variances and potential non-normality. Figure 2 illustrates the quartile distribution of group mean importance ratings, calculated by averaging responses across all sub-component questions for each construct. Statistical analysis revealed a significant difference in perceived importance across constructs, F(6, 86.90) = 221.38, p < 0.001 . Post hoc comparisons using the Games–Howell procedure indicated that available space was significantly less important than all other constructs (all p < 0.001) , and breath was significantly more important than both speed/reaction time (p < 0.029) and accuracy (p < 0.025). Discussion This study explored how dance/movement therapists, evaluate the clinical importance of patient improvements in specific movement components, spatial engagement, and breath quality. A list of items representing quantifiable aspects of movement and physiological function was generated and then a survey was distributed to understand how improvements in these components are prioritized in therapeutic contexts. Respondents included dance/movement therapists representing a range of clinical environments and populations, offering varied perspectives. While improvements in aspects of motor fitness were considered important, improvements in breath were rated as significantly more important than improvements in speed/reaction time or movement accuracy. Conversely, the use of available space was rated significantly lower than all other components, suggesting it may be a less prioritized element in this context. These results offer valuable insight into how DMT practitioners conceptualize the therapeutic relevance of both internal physiological regulation and external movement expression. The high rating for breath underscores its central role in emotional regulation, trauma recovery, and nervous system modulation—particularly relevant in military populations (Winters & Freeman, 2022 ). Meanwhile, the lower rating for spatial engagement may reflect practical constraints in clinical settings rather than a lack of therapeutic value, suggesting a need for further exploration into how environmental factors shape therapeutic priorities. The internal consistency of the items developed for each targeted construct was assessed using Cronbach’s alpha. The relatively high alpha values (≥ 0.87) indicate strong interrelatedness among items, suggesting that they reliably measured their intended dimensions. While a high alpha does not inherently guarantee reliability, in this context it serves as a meaningful indicator of internal consistency. These items show strong internal consistency because these questions were developed from clinical questions based on biomechanical definitions of each concept. The relatively uniform variances across items suggest tau-equivalence, which assumes that each item measures the same underlying trait on the same scale (Tavakol & Dennick, 2011 ). Clinically, these findings support the clarity and coherence of each construct definitions, which may assist practitioners in setting more targeted goals and tailoring interventions based on well-defined aspects of motor fitness, spatial awareness, or respiratory function. Within the context of this study, the results also justify the methodological decision to average sub question ratings prior to comparing importance ratings across groups. The high importance placed on breath (e.g., flow direction, cadence control, synchronization) aligns with its established role in emotional regulation and trauma recovery (Grigonis, 2019 ; Levy, 1988 ). In DMT breath is a therapeutic tool that can be consciously modulated to support grounding (De Tord 2015), self-awareness (Mehling, 2011), and nervous system regulation (Berrol, 1992; Barbera, 2024). This significance was echoed in the comments, with one therapist noting, “Breath control can have an impact on movement and functioning, but I find for this population just the ability to engage in meaningful deep breathing (ones that regulate both body and brain) is of the greatest importance. ” Breath is particularly relevant in military populations where trauma exposure is prevalent (Winters & Freeman, 2022 ). Physiologically, breath is a central component of the cardiorespiratory system, directly influencing heart rate, oxygen exchange, and autonomic nervous system balance. Slow, diaphragmatic breathing activates the parasympathetic branch of the autonomic nervous system, promoting relaxation and reducing sympathetic arousal – key mechanisms in trauma-informed care. Consequently, breathwork offers a non-invasive accessible strategy for regulating internal states, especially for individuals experiencing hypervigilance or chronic stress. In DMT therapists often observe changes in breath quality such as increased depth, rhythm or ease – as indicators of emotional release, increased safety or therapeutic integration. In contrast, the relatively lower rating for use of space (e.g., dynamic use, directional shaping, planar shaping) was not rated as important. This result may reflect practical and contextual constraints that the clinicians work within rather than a lack of clinical relevance. Dance/movement therapy is used in various settings, such as Defense Health Agency treatment programs for active-duty military and Veteran’s Affairs hospitals. Even these connected centers treat populations with different conditions such as traumatic brain injury, post-traumatic stress, substance abuse disorders, geriatric or memory care, homelessness or vocational rehabilitation, perinatal or reproductive care, chronic pain, and amputations. Dance/movement therapists may not have a dedicated clinical space for providing treatment and must instead adapt to the needs and resources of their site. A therapist may provide bedside care to a patient in palliative care or transform a conference room into a group space by moving the furniture out of the way. In such contexts, spatial exploration may be limited or deprioritized in favor of more internally focused or relational interventions. Still, clinicians seem to note population-specific use of space with one commenting, “ Service members generally have 1 plan they like to move. Challenging these norms challenges cognitive and emotional structures creating space for new learning and expression.” Alternatively, other movement-related factors, such as balance, may indirectly influence spatial use. As one therapist observed, “ Most patients stay in a small movement space due to balance issues.” While spatial engagement may serve as a meaningful indicator of therapeutic progress—particularly in trauma-informed care—its lower rating may reflect the constraints of clinical practice in different environments. The results of this current study suggest that dance/movement therapists recognize the clinical value of motor fitness components. Patient improvements in all aspects of motor fitness including speed/reaction time, balance, coordination, accuracy, agility had mean ratings within the moderately to very important range (Fig. 2 ). This result aligns with existing literature that highlights their therapeutic relevance as outcome measures. For instance, DMT has been seen to improve fitness, functional balance, and mobility in older adults more effectively than stretching alone (Joung & Lee, 2019 ). Similarly, DMT has demonstrated benefits for individuals with neurodegenerative diseases, having positive effects on cognitive and motor function (Wu et al., 2022 ). These findings reinforce the integrative properties of DMT treatment and the role of movement-based interventions in promoting both physical and psychological well-being across varied populations (Koch et al., 2019 ). Still, each aspect of motor fitness has a clear DMT interpretation and is supported by literature which will be examined in the following paragraphs. In this study, speed and reaction time were conceptualized as a unified construct to reflect both the temporal sensitivity and velocity of movement adaptability which are core elements of DMT (e.g., initiating movement, shifting quickly, dynamic use of time, playfulness). Although this study found that respondents rated this aspect as important (Table 2 ). This finding aligns with existing literature that highlights the importance of speed quantification in DMT. Reaction time has been previously quantified within DMT as the ability to respond quickly to musical stimuli (Chatzihidiroglou et al., 2018 ), and improvements in speed—such as enhanced performance in timed motor tasks—have been documented in therapeutic contexts (Berrol et al., n.d.). The qualitative responses from participants revealed a deeper therapeutic emphasis on modulating speed, particularly through intentional deceleration. One therapist shared, “ I tend to focus more on how to help my clients learn ways to decelerate because they usually have no problem with acceleration,” highlighting the importance of slowing down as a strategy for regulation and control. Another noted, “ So many of my clients want to access changes quickly but get frozen. Many times, we focus on slowing down to access and then acceleration ,” pointing to the therapeutic process of sequencing movement to overcome inhibition (Hamel et al., 2024 ). These insights suggest that in DMT, speed is not merely about moving quickly but about cultivating the capacity to shift between movement states with awareness and intention. Shifting between states is crucial for traumatized populations who tend to experience hyperarousal of the autonomic nervous system and often struggle to “slow down” their physiological process, behaviors, and cognitive processes. Balance is a foundational component of motor fitness and plays a critical role in both functional mobility and injury prevention. In this study, balance was evaluated using multiple items, including spatial awareness, dynamic stability, fall risk, body stabilization, and mobility. Each of these items were rated as important (Table 2 ). Together these items illustrate the interplay between motor abilities and factors that mitigate fall risk. Improvements in balance after DMT have been documented in various populations (E.g., Takahashi et al., 2023 ; Wu et al., 2022 ) reinforcing its therapeutic value. Balance is a key factor in fall prevention, particularly among older adults and individuals with neurological or who are rehabilitating from an injury (Veronese et al., 2017 ). Therapists seem to be aware of this with one commenting that balance is, “( m)ore important with certain populations especially elderly and those with side effects of chemotherapy .” However, in the context of DMT assessment, balance may carry a more cognitive meaning. As one therapist explained, “ I utilize plays with balance in a much more metaphorical way for emotional processing as opposed to thinking of balance as a skill to be mastered .” In DMT, enhanced balance may signal increased body awareness, postural control, and confidence in movement—all of which are essential for supporting autonomy and reducing injury risk in clinical populations. Coordination is an aspect of motor fitness that emphasizes the ability to execute smooth, efficient, and synchronized movements and was rated as very important in this study (Table 2 ). Coordination, often called synchrony in DMT, is used to improve the ability to understand and share the feelings of others through physical attunement. In this study, coordination was assessed through several dimensions, including movement phrasing, developmental movement patterns, self-synchrony, synchrony with music or partner, and tension flow attributes. These elements reflect both neuromuscular control and expressive capacity, which are essential for embodied communication and emotional attunement. Recent studies rate movement-based mirroring tasks during DMT or use accelerometers to measure interpersonal synchrony (Manders et al., 2021 ; Prakash et al., 2025 ). In DMT, improvements in coordination may indicate enhanced body integration, emotional regulation, and relational attunement—key therapeutic goals across different clinical populations. Movement accuracy is a concept found in both motor fitness and DMT, though it is understood and applied differently in each setting. Rather than focusing on external performance outcomes, accuracy in DMT involves the ability to attune movement to internal emotional states and to others in the therapeutic space. The accuracy-specific items included attunement, body shaping, and phrasing, and illustrate how movement accuracy in DMT reflects a more expressive and relational focus (Jerak et al., 2018 ). These distinctions were echoed in participants’ qualitative responses. One respondent noted that, “ accuracy can be misunderstood as perfectionism ,” highlighting the potential misalignment between clinical and expressive interpretations. Another emphasized the relational dimension of accuracy in DMT, stating, “ Empathy and reciprocity are big cornerstones, I think, in DMT work: connecting one moving self to another moving self and developing better understanding; confidence; sense of community .” Together, these insights reinforce the idea that in DMT, movement accuracy is not about correctness or precision in a technical sense, but about presence, connection, and meaning making through movement. It reflects qualities such as authenticity, expressive clarity, and interpersonal attunement (Dieterich-Hartwell, 2024 ). Understanding this relationship between movement accuracy and emotional expression is essential for therapists to more effectively interpret client experiences and tailor interventions that support therapeutic goals. Agility, a key subcomponent of motor fitness, refers to the ability to quickly and efficiently change body position or direction in response to stimuli. Agility is required when transitioning from one movement to another and can be assessed through a person’s adaptability in body positioning (Dwiyasmono et al., 2023 ). In DMT, agility reflects not only physical responsiveness but also cognitive and emotional adaptability. In this study, agility was defined by movements involving positional changes, quick starts and stops, directional changes, and dynamic ranges of movement, supporting both functional mobility and expressive movement. This definition aligns with participant insights, such as one survey respondent’s observation that, “ this is more about increasing a patient’s comfort with moving their body in different ways, again not to meet an outside standard of agility.” For example, a traumatized patient may enter treatment with a restricted movement profile reflective of defense mechanisms and their therapist may work with them to be able to move with more dynamic changes to be able to better adapt to various settings. This perspective underscores that in therapeutic contexts, agility is not about performance metrics but about fostering confidence, adaptability, and embodied self-awareness. Smooth transitions and responsive movement in DMT can signal a client’s growing comfort, engagement, and psychological flexibility—key indicators of therapeutic progress. Generally, the importance ratings from our study reinforce the relevance of motor fitness components in DMT and support their use as a foundation for structuring movement-based assessments. Despite differences in clinical environments and patient populations, there is a shared understanding of which movement components are considered therapeutically important. Such consistency supports the generalizability of these findings across a range of contexts and strengthens the case for developing standardized assessment tools that can be applied in multiple settings. Given the wide range of populations served by DMT—including individuals with PTSD, TBI, chronic pain, and memory loss—future tools must also be flexible enough to accommodate varied therapeutic goals and clinical environments. Based on these results, future research may benefit from prioritizing the development of movement-based assessment tools that integrate both external indicators of motor fitness and internal physiological signals such as breath. Wearable motion sensors, heart rate monitors, and respiration monitors enable the non-invasive tracking of movement and cardiovascular function, which may be particularly valuable in dance/movement therapy for assessing embodied responses and physiological regulation during therapeutic movement. Limitations This study has several limitations. Participant selection was non-random. Participants were primarily women. The sample size was moderate (N = 33) and 24% of respondents were affiliated with military healthcare, which may limit the generalizability of these findings. Questions were displayed in the same order for all participants. Additionally, the use of self-reported importance ratings may not fully capture how these components are prioritized in actual clinical practice. Future studies could incorporate observational or longitudinal methods to examine how movement and breath patterns change over time and relate to therapeutic outcomes. Conclusion This study provides a foundational step in articulating how dance/movement therapists conceptualize key components of motor fitness, spatial engagement, and breath. By identifying which movement elements are perceived as most clinically important and demonstrating strong internal consistency across item groupings, this investigation offers an initial evaluation of theory that can guide future research and support the development of clinically meaningful measures. The findings suggest that breath, coordination, balance, and agility are central to therapeutic work, offering a clearer framework for prioritizing movement components in practice. These findings may guide future research by introducing objective performance metrics to complement subjective assessments in DMT. Such integration holds promise for enhancing the precision of assessment and deepening our understanding of embodied therapeutic processes, while ensuring that innovations remain grounded in the relational, expressive, and holistic values that define DMT. Declarations Author Contribution E.B, S.K. and E.F. wrote the main manuscript text, E.B completed all analysis and prepared all figures and tables. All authors reviewed the manuscript. Acknowledgement We would like to acknowledge Chandler Rhodes, PhD, for her guidance in shaping the study design. Special thanks to Karla G. Mendoza, BS for her support with participant recruitment. We also extend our sincere appreciation to the dance/movement therapists who generously shared their time and insights by participating in the survey. The authors are grateful to the past and current clinical and organizational leadership of the National Intrepid Center of Excellence and of Walter Reed National Military Medical Center for their support of creative arts therapies and Arts in Health programming. The authors also acknowledge Creative Forces®: NEA Military Healing Arts Network, an initiative of the NEA in partnership with the U.S. DOD and VA, managed in partnership with the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. and Mid-America Arts Alliance, for their ongoing endeavors to advance creative arts therapy clinical services and related research. Special thanks to all the healthcare providers of various disciplines who offered mutual support to one another throughout the COVID-19 pandemic.Disclosure StatementThe opinions contained herein represent the private views of the authors and are not to be construed as official or as reflecting the views, opinions, or policies of the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the National Endowment for the Arts, Department of Defense, or the U.S. Government. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. This material was created free of branding or market affiliations. The authors are operating solely as contributors. Data Availability Data is provided within the manuscript or in supplementary information files. References American Dance Therapy Association. (n.d.). What is Dance/Movement Therapy [Organization]. American Dance Therapy Association . Retrieved March 19, 2025, from https://www.adta.org/about Berrol, C. F., Ooi, W. L., & Katz, S. S. (n.d.). Dance/Movement Therapy with Older Adults Who Have Sustained Neurological Insult: A Demonstration Project . Bräuninger, I. (2014). Specific dance movement therapy interventions—Which are successful? An intervention and correlation study. The Arts in Psychotherapy , 41 (5), 445–457. https://doi.org/10.1016/j.aip.2014.08.002 Chatzihidiroglou, P., Chatzopoulos, D., Lykesas, G., & Doganis, G. (2018). Dancing Effects on Preschoolers’ Sensorimotor Synchronization, Balance, and Movement Reaction Time. Perceptual and Motor Skills , 125 (3), 463–477. https://doi.org/10.1177/0031512518765545 Chilton, G., Vaudreuil, R., Freeman, E. K., McLaughlan, N., Herman, J., & Cozza, S. J. (2021). Creative Forces programming with military families: Art therapy, dance/movement therapy, and music therapy brief vignettes. Journal of Military, Veteran and Family Health , 7 (3), 104–113. https://doi.org/10.3138/jmvfh-2021-0031 Creative Forces: Clinical Program . (n.d.). National Endowment for the Arts. Retrieved September 30, 2025, from https://www.arts.gov/initiatives/creative-forces/clinical-program Dhami, P., Moreno, S., & DeSouza, J. F. X. (2015). New framework for rehabilitation – fusion of cognitive and physical rehabilitation: The hope for dancing. Frontiers in Psychology , 5 . https://doi.org/10.3389/fpsyg.2014.01478 Dieterich-Hartwell, R. (2024). Interpersonal Synchrony in Dance/Movement Therapy: Neural Underpinnings for Individuals with Dementia. Journal of Alzheimer’s Disease : JAD . https://doi.org/10.3233/JAD-240239 Dwiyasmono, Setya Widyawati, Supriyanto Supriyanto, Sriyadi Sriyadi, & Sri Ningsih Sukirman. (2023). Therapeutic Dance Experimentation: Implementation of Post-Pandemic Movement Therapy. Research on Humanities and Social Sciences , 13 (10). https://doi.org/10.7176/RHSS/13-10-05 Find a DMT . (n.d.). American Dance Therapy Association. Retrieved October 12, 2023, from https://adta.memberclicks.net/find-a-dmt#/ George, D. & Mallery, P. (2003). SPSS for Windows step by step: A simple guide and reference. (4th ed., Vol. 11). Allyn & Bacon. Grigonis, N. (2019). Taking a Breath: Understanding the Interrelationship of Breath in Dance/Movement Therapy and Everyday Life [Sarah Lawrence University]. https://digitalcommons.slc.edu/dmt_etd/49/ Guzmán, A., Robinson, L., Rochester, L., James, I. A., & Hughes, J. C. (2017). A process evaluation of a Psychomotor Dance Therapy Intervention (DANCIN) for behavior change in dementia: Attitudes and beliefs of participating residents and staff. International Psychogeriatrics , 29 (2), 313–322. https://doi.org/10.1017/S104161021600171X Hamel, R., Waltzing, B. M., Hinder, M. R., McAllister, C. J., Jenkinson, N., & Galea, J. M. (2024). Bilateral intracortical inhibition during unilateral motor preparation and sequence learning. Brain Stimulation , 17 (2), 349–361. https://doi.org/10.1016/j.brs.2024.03.009 Jerak, T., Vidrih, A., & Žvelc, G. (2018). The experience of attunement and misattunement in dance movement therapy workshops. The Arts in Psychotherapy , 60 , 55–62. https://doi.org/10.1016/j.aip.2018.06.001 Joung, H. J., & Lee, Y. (2019). Effect of Creative Dance on Fitness, Functional Balance, and Mobility Control in the Elderly. Gerontology , 65 (5), 537–546. https://doi.org/10.1159/000499402 Koch, S. C., Riege, R. F. F., Tisborn, K., Biondo, J., Martin, L., & Beelmann, A. (2019). Effects of Dance Movement Therapy and Dance on Health-Related Psychological Outcomes. A Meta-Analysis Update. Frontiers in Psychology , 10 , 1806. https://doi.org/10.3389/fpsyg.2019.01806 Levy, F. J. (Ed.). (1988). Dance movement therapy . The American Alliance for Health, Physical Education, Recreation, and Dance. Manders, E., Goodill, S., Koch, S. C., Giarelli, E., Polansky, M., Fisher, K., & Fuchs, T. (2021). The Mirroring Dance: Synchrony and Interaction Quality of Five Adolescents and Adults on the Autism Spectrum in Dance/Movement Therapy. Frontiers in Psychology , 12 , 717389. https://doi.org/10.3389/fpsyg.2021.717389 Martinec, R. (2018). Dance Movement Therapy in the Wider Concept of Trauma Rehabilitation . 1 (1). Michael Kent. (2006). Motor fitness. In Oxford dictionary of Sports Science and Medicine . Oxford University Press. Prakash, N., Ramakrishnan, A., Vader, D. T., Goodill, S., Beardall, N., Moore, R. H., & Shim, M. (2025). Two ways to measure interpersonal synchrony in dance/movement therapy: Comparing accelerometer data with observational data. The Arts in Psychotherapy , 92 , 102245. https://doi.org/10.1016/j.aip.2024.102245 Takahashi, H., An, M., Sasai, T., Seki, M., Matsumura, T., Ogawa, Y., Matsushima, K., Tabata, A., & Kato, T. (2023). The effectiveness of dance movement therapy for individuals with Down syndrome: A pilot randomised controlled trial. Journal of Intellectual Disability Research : JIDR , 67 (7), 640–654. https://doi.org/10.1111/jir.13033 Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach’s alpha. International Journal of Medical Education , 2 , 53–55. https://doi.org/10.5116/ijme.4dfb.8dfd Veronese, N., Maggi, S., Schofield, P., & Stubbs, B. (2017). Dance movement therapy and falls prevention. Maturitas , 102 , 1–5. https://doi.org/10.1016/j.maturitas.2017.05.004 Weitz, N., & Opre, A. (2022). Combining Dance/Movement Therapy with Cognitive Behavioral Therapy in Treatment of Children with Anxiety Disorders: Factors Explaining Therapists’ Attitudes. American Journal of Dance Therapy , 44 (2), 186–209. https://doi.org/10.1007/s10465-022-09369-y Wiedenhofer, S., & Koch, Prof. Dr. S. C. (2017). Active factors in dance/movement therapy: Specifying health effects of non-goal-orientation in movement. The Arts in Psychotherapy , 52 , 10–23. https://doi.org/10.1016/j.aip.2016.09.004 Winters, A. F., & Freeman, E. K. (2022). Dance/Movement Therapy with Active Duty and Veteran Military Populations. In Dance/Movement Therapy for Trauma Survivors (1st ed., pp. 202–214). Routledge. Wołoszyn, N., Wiśniowska-Szurlej, A., Grzegorczyk, J., & Kwolek, A. (2021). The impact of physical exercises with elements of dance movement therapy on the upper limb grip strength and functional performance of elderly wheelchair users living in nursing homes—A randomized control trial. BMC Geriatrics , 21 (1), 423. https://doi.org/10.1186/s12877-021-02368-7 Wu, C.-C., Xiong, H.-Y., Zheng, J.-J., & Wang, X.-Q. (2022). Dance movement therapy for neurodegenerative diseases: A systematic review. Frontiers in Aging Neuroscience , 14 , 975711. https://doi.org/10.3389/fnagi.2022.975711 Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterial.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7829291","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":528329058,"identity":"a7200dd6-bbb8-4d81-964b-c15af84d3c03","order_by":0,"name":"Elizabeth Bell","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvUlEQVRIiWNgGAWjYDACCQbGAw8q4FxmorQwHEg4Y0CqlsQ2UrTwSzcfOJA474+cwfnDxx4wVFgnNhDSIjnnWMKBxG0GxgY30tINGM6kE9ZicCPHAKQlcdsNHjMJxrbDhLXY38j/cCBxDlDL+TNALf+I0GIgkQP0fgNQy4EcoJYGIrRI3DlmcCDhmLGx/Y20NImEY+nGBLXwz25++OBDjZycZP/hYxIfaqxlCWpBBQmkKR8Fo2AUjIJRgAsAADGHQyJaTme8AAAAAElFTkSuQmCC","orcid":"","institution":"Towson University","correspondingAuthor":true,"prefix":"","firstName":"Elizabeth","middleName":"","lastName":"Bell","suffix":""},{"id":528329059,"identity":"993acfd5-dbaa-42da-8c1e-b4f410bfdea8","order_by":1,"name":"Sarah Kruger","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Kruger","suffix":""},{"id":528329060,"identity":"a5478d3c-ff22-461e-b7f9-c1940fccb89e","order_by":2,"name":"Elizabeth Freeman","email":"","orcid":"","institution":"Creative forces: NEA Military Healing Arts Network","correspondingAuthor":false,"prefix":"","firstName":"Elizabeth","middleName":"","lastName":"Freeman","suffix":""}],"badges":[],"createdAt":"2025-10-10 17:23:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7829291/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7829291/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93612235,"identity":"9170ee38-22b8-49a9-a0f9-451a03129eed","added_by":"auto","created_at":"2025-10-15 16:16:59","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":384109,"visible":true,"origin":"","legend":"","description":"","filename":"20251010KeyAspectsANON2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7829291/v1/dac87547f2ffb1b846b239e7.docx"},{"id":93612224,"identity":"e02c0ed6-1fb0-4f83-bada-f4f7de27c849","added_by":"auto","created_at":"2025-10-15 16:16:58","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6876,"visible":true,"origin":"","legend":"","description":"","filename":"6e85fed8251b4856a8878b0302736c90.json","url":"https://assets-eu.researchsquare.com/files/rs-7829291/v1/8cb34596ec6b4631bcc6e11b.json"},{"id":93612226,"identity":"f25eea2a-9f96-43bb-bfce-814add582568","added_by":"auto","created_at":"2025-10-15 16:16:58","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":17623,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7829291/v1/2faebda00fc3d554c1f47727.xlsx"},{"id":93613230,"identity":"3f91df3d-e7fd-4aba-a3c0-04d269568c63","added_by":"auto","created_at":"2025-10-15 16:24:59","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":110407,"visible":true,"origin":"","legend":"","description":"","filename":"6e85fed8251b4856a8878b0302736c901enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7829291/v1/5b7fbb9adc4ba89b655429e3.xml"},{"id":93612225,"identity":"14d05641-efd4-4106-92ac-3bc404d44885","added_by":"auto","created_at":"2025-10-15 16:16:58","extension":"png","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":119339,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7829291/v1/a79f5e4b058da660ae0c9272.png"},{"id":93612231,"identity":"d1b2519d-618a-4e99-b8f7-0e22653bf32f","added_by":"auto","created_at":"2025-10-15 16:16:59","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":161103,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7829291/v1/f30952e332a5a84f574f9ce3.png"},{"id":93612228,"identity":"1e76185c-cdef-4c61-a14c-dd68051f5766","added_by":"auto","created_at":"2025-10-15 16:16:58","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":49662,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7829291/v1/fee36bf789039007f49d66f9.png"},{"id":93613229,"identity":"23d9e65e-d4b5-4ec8-8dea-eb196a7f1591","added_by":"auto","created_at":"2025-10-15 16:24:58","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":39192,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7829291/v1/410716479388cd4e1d4c18be.png"},{"id":93612227,"identity":"35e21eb6-ab28-4e19-a096-c8af444e39d4","added_by":"auto","created_at":"2025-10-15 16:16:58","extension":"xml","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":105657,"visible":true,"origin":"","legend":"","description":"","filename":"6e85fed8251b4856a8878b0302736c901structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7829291/v1/2fed79cc7a2fc6122a4746cf.xml"},{"id":93612236,"identity":"cdfa8f01-f713-4215-8fda-b7e0612ef6d0","added_by":"auto","created_at":"2025-10-15 16:16:59","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":115566,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7829291/v1/9582c780231f87e63d974abf.html"},{"id":93612223,"identity":"76bdc0f4-a3e5-4038-8040-a7d7110a6683","added_by":"auto","created_at":"2025-10-15 16:16:58","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":81241,"visible":true,"origin":"","legend":"\u003cp\u003eExample of the agility-specific items as presented in the Qualtrics survey interface.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7829291/v1/6b3212e1861d9e3b4ba0aae1.jpg"},{"id":93613228,"identity":"89b7ea17-85c0-4062-88fb-9939a4462dda","added_by":"auto","created_at":"2025-10-15 16:24:58","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":67218,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of mean importance ratings by quartile across all constructs. Asterisk indicates a significant post-hoc difference in importance between components\u003cem\u003e (*p \u0026lt; 0.050)\u003c/em\u003e.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7829291/v1/adc6d5a78366b1c78a0c107e.jpg"},{"id":93613664,"identity":"34caedda-ac92-40b1-bb76-2a6c2a657497","added_by":"auto","created_at":"2025-10-15 16:32:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":942612,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7829291/v1/8cfac12b-1053-446d-ae4e-e08d87c96e30.pdf"},{"id":93612221,"identity":"17277efe-2db3-4fe3-8413-8be8bfff4232","added_by":"auto","created_at":"2025-10-15 16:16:58","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":17623,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7829291/v1/0ba0c20bf7e72896602013fd.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Breath Quality and Aspects of Motor Fitness are Key Indicators in Dance/Movement Therapy Assessment","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDance/Movement Therapy (DMT) is a psychotherapeutic approach that uses dance, movement, body awareness, and embodied communication to promote healing and wellness across different populations, including active duty service members and veterans (American Dance Therapy Association, n.d.; Winters \u0026amp; Freeman, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). While DMT is associated with subjective improvements in clinical behavioral health (Guzm\u0026aacute;n et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Weitz \u0026amp; Opre, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), and rehabilitative outcomes (Dhami et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Martinec, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) there remains limited evidence supporting its effectiveness. Given that movement serves as both an intervention and assessment tool in DMT (American Dance Therapy Association, n.d.), quantifying movement changes may offer a pathway to more objective evaluation.\u003c/p\u003e\u003cp\u003eDMT is practiced in a wide range of settings, including schools, nursing homes, counseling and crisis centers and serves a wide range of populations. In these settings, therapists are often embedded within both behavioral health and rehabilitation clinics, adapting their practice to the available space and resources. Therapists may provide bedside care in palliative settings or convert non-clinical spaces, such as conference rooms, into treatment areas. Spatial use itself can reflect therapeutic progress: patients with trauma histories may initially exhibit more restricted, proximal movement patterns and avoid expansive or traveling movements. As therapeutic rapport develops and treatment progresses, patients often begin to move more freely and occupy more space within sessions. While therapists can observe and discuss such changes with patients, there is currently no standard framework to quantify motion changes.\u003c/p\u003e\u003cp\u003eSensor based motion analysis has been applied in several studies to examine movements within dance therapy (Gates et al., 2022; Prakash et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). However, a comprehensive framework identifying what components of motion are important to DMT assessment has yet to be established. In contrast, the field of athletic performance provides a well-recognized set of motor fitness components including agility, balance, coordination, power, reaction time, and speed (Michael Kent, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). These motor fitness attributes have demonstrated relevance in DMT contexts and may offer a useful foundation for conceptualizing movement within the discipline. For instance, agility is reflected in the ability to transition between movements (Dwiyasmono et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) and improved balance has been observed in DMT participants across populations (E.g., Takahashi et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Wu et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Coordination supports emotional attunement through movement and has been measured using accelerometers to assess interpersonal synchrony (Prakash et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Strength, which contributes to power, has been documented as a DMT outcome (Wołoszyn et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and reaction time has been measured through responses to musical stimuli (Chatzihidiroglou et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Speed improvements in timed motor tasks have also been quantified (Berrol et al., n.d.). Despite these connections, identifying clinically meaningful components which can be measured objectively in DMT remains complex.\u003c/p\u003e\u003cp\u003eExternal body movement distinguishes DMT from psychotherapy, however tracking movement performance is often a secondary consideration rather than a primary therapeutic goal. Instead, therapists work with varied populations and tailor interventions to individual needs, often prioritizing behavioral health through creative expression over physical rehabilitation (Br\u0026auml;uninger, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Wiedenhofer \u0026amp; Koch, 2017). As such, movements in DMT are not always goal directed. Nevertheless, aspects of motor fitness may provide a useful foundation for developing a standard list of objective components related that could potentially be tracked in therapeutic contexts.\u003c/p\u003e\u003cp\u003eBeyond the assessment of external movement, internal physiological signals, such as breath, may offer insight into clinical goals like emotional regulation (Grigonis, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Breath is closely linked to both physiological and emotional states and tracking respiratory patterns may help therapists assess how patients use movement to regulate internal experiences (Levy, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e1988\u003c/span\u003e). Breath is particularly relevant in military populations where trauma exposure is common (Winters \u0026amp; Freeman, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Creative arts therapies, including DMT, play a vital role in interdisciplinary care for service members and their families, addressing both behavioral and rehabilitative needs (Chilton et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Treatment goals often include helping patients use breath and movement to activate restorative physiological processes during and beyond therapy sessions (Winters \u0026amp; Freeman, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Quantifying breath-focused movement practices may offer a way to track internal regulation.\u003c/p\u003e\u003cp\u003eTo assess the clinical relevance of external and internal measures a theoretical framework must be developed based on the perspectives of subject matter experts, such as dance/movement therapists, to identify which components are considered meaningful. Accordingly, this study developed a framework of components and items represent quantifiable components of movement. The investigation focused on how dance/movement therapists evaluate the importance of patient improvement in aspects of motor fitness, spatial engagement, and breath quality. Given that clinical measures of movement assessment were integrated into the definition of each objective component, it was hypothesized that the resulting items would demonstrate high internal consistency. Additionally, group comparison analyses were conducted to determine whether improvements in certain components were rated significantly more important than others. These findings may inform future research by introducing objective performance metrics to complement subjective assessments in therapeutic practice.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e All procedures were conducted in accordance with applicable laws and institutional guidelines and were approved by the Towson University Institutional Review Board (IRB #2253). An anonymous online survey was administered using Qualtrics (Provo, UT) and distributed via email to therapists connected with the Creative Forces program and therapists associated with the American Dance Therapy Association (\u003cem\u003eFind a DMT\u003c/em\u003e, n.d.). Participants reviewed an informed consent statement prior to participation. Individual responses were recorded under randomly assigned identification numbers to ensure confidentiality.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData Collection\u003c/h2\u003e\u003cp\u003eParticipants provided self-reported demographic information, including sex, race/ethnicity, educational background, their current or former status as a dance/movement therapist and their primary work setting (e.g., Department of Defense medical center, Veterans Affairs medical center, other medical centers, schools, psychiatric facilities, rehabilitation centers, nursing homes, drug treatment centers, counseling centers, crisis centers, or other). Participants were also asked to describe the population they currently or previously worked with and to report on their years of professional experience.\u003c/p\u003e\u003cp\u003eThis study aimed to employ a targeted survey instrument which could evaluate quantifiable components of movement and physiological function relevant to DMT. In the absence of an existing survey for this purpose, the authors sought to define and operationalize key aspects of motor fitness, spatial engagement, and breath quality. To develop items aligned with each component, the authors reviewed documentation from a workgroup of DMT clinicians associated with the Creative Forces Clinical Program (\u003cem\u003eCreative Forces: Clinical Program\u003c/em\u003e, n.d.) who were creating a standardized note template to support consistent observation and recording of movement during therapy sessions. The authors extracted the movement outcomes listed in these notes which were aligned with sport science definitions of aspects of motor fitness, spatial awareness, and breath (Michael Kent, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Following this, the authors (EMB and EKF) met to review the full list of items and refine the language into concise bullet points suitable for inclusion in the survey.\u003c/p\u003e\u003cp\u003eAlthough power is traditionally included in motor fitness assessments, it was intentionally excluded from this study due to its limited relevance to the expressive and integrative goals of DMT. Instead, the construct of speed was expanded to encompass both directional velocity and temporal responsiveness, serving as a conceptual proxy for certain power-related dynamics. This composite measure served as a conceptual proxy for certain power-related dynamics, reflecting the established relationship between speed and power observed in prior clinical movement assessments (Bell et al., 2021). Specifically, speed was redefined to include reaction time, measured as the latency between stimulus presentation and movement initiation. This approach allowed for the inclusion of dynamic responsiveness without requiring direct measurement of force output. The final framework included the following components: speed and reaction time, balance, coordination, movement accuracy, agility, use of space, and breath.\u003c/p\u003e\u003cp\u003eImportance ratings were collected using a visual analog scale ranging from 0 indicating \u0026ldquo;not at all important to 100 indicating extremely important\u0026rdquo; (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Before each set of items participants were asked, \u0026ldquo;How important is it that your patients experience improvement in the following outcomes associated with [each component]?\u0026rdquo; Components and items were presented in a fixed order across all respondents (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). After rating each set of items, participants were given an optional open-text field to respond to the prompt: \u0026ldquo;Do you have any comments or thoughts about changes in [the current construct]?\u0026rdquo; Survey submissions were excluded from analysis if no ratings were provided or if the participant did not complete all pages of the survey. For items where participants did not adjust the visual analog scale, a score of zero was recorded, reflecting the default position of the slider.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eWithin the online survey each respondent was asked \"How important is it that your patients experience improvements in the following outcomes associated with [each component]\" and used a visual analog scale (0-100) to rate each item.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComponent\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eItem 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eItem 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eItem 3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eItem 4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eItem 5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eItem 6\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSpeed / Reaction Time\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAccess to playfulness or more accelerated movement initiation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAbility to start to move or react to a change in the rhythm of music\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFaster dynamic shift between flowing and rigid movement (bound and free flow)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDynamic use of time (slow-fast, acceleration-deceleration)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBalance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSpatial awareness with respect to centeredness or reliance on internal coordinates\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAbility to be more stable while achieving a greater level of movement (documenting the limits of stability and balance reactions)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMotor skills and mobility result in in a decreased fall risk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAbility to more effectively stabilize body parts while producing effective movement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAbility to mobilize and integrate body parts effectively\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCoordination\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMovement phrasing (meaning the kinetic chains of muscular action are set up in the moment of the initiation with sequence and follow-through to complete the phase)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBody parts integration / access to developmental movement patterns such as core-distal, head-tail, upper/lower, right/left, cross lateral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSelf-synchrony (body parts moving in rhythm with oneself)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSynchrony with music, partner, or other stimulus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSynchrony with music, partner or there stimulus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAccess to tension flow attributes (flow adjustment, even flow, low, high, gradual, abrupt\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAccuracy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbility to attune to the expressive movements of others (kinesthetic empathy and reciprocity)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUse of body shaping (forming the body to make a particular shape or changing the form of the body to bring about a specific type of relationship to other people or to the environment)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePhrasing (meaning kinetic chains of muscular action are set up in the moment of initiation with sequence and follow-through to complete the phrase)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAgility\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbility to change body position with ease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAbility to start and stop movement quickly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAbility to more easily change direction while moving\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAccess to dynamic range within movement repertoire\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAvailable Space\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDynamic use of space\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eShaping in directions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eShaping in planes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBreath\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbility to direct flow of breath (e.g. diaphragmatic vs. nasal breathing)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIncreased control of breathing cadence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAbility to synchronize breath with movement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eTo evaluate the internal consistency of grouped sub questions for each aspect, Cronbach\u0026rsquo;s alpha was calculated in SPSS (Version: 28.0.0.0 (190)) for each set. For each respondent, average scores were computed across sub questions within each aspect. Interpretation guidelines:α\u0026thinsp;\u0026ge;\u0026thinsp;.90\u0026thinsp;=\u0026thinsp;excellent, α\u0026thinsp;\u0026ge;\u0026thinsp;.80\u0026thinsp;=\u0026thinsp;good, α\u0026thinsp;\u0026ge;\u0026thinsp;.70\u0026thinsp;=\u0026thinsp;acceptable, α\u0026thinsp;\u0026ge;\u0026thinsp;.60\u0026thinsp;=\u0026thinsp;questionable, α\u0026thinsp;\u0026ge;\u0026thinsp;.50\u0026thinsp;=\u0026thinsp;poor, α\u0026thinsp;\u0026lt;\u0026thinsp;.50\u0026thinsp;=\u0026thinsp;unacceptable (George, D. \u0026amp; Mallery, P., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). If reliability was acceptable or greater, these individual aspect scores were then averaged across all participants.\u003c/p\u003e\u003cp\u003eTo examine differences in perceived importance across constructs, a one-way analysis of variance (ANOVA) was conducted on mean importance ratings of each construct from all participants. Mean importance ratings of each construct were calculated by averaging responses across all sub question items within each construct. Prior to conducting the ANOVA, assumptions of normality of residuals and homogeneity of variances were assessed. In the event of assumption violations, appropriate adjustments were made to ensure the robustness of the analysis. Specifically, Welch\u0026rsquo;s ANOVA was used in place of the standard ANOVA when the assumption of homogeneity of variances was not met, and post hoc comparisons were conducted using the Games\u0026ndash;Howell procedure from the \u0026ldquo;userfriendlyscience\u0026rdquo; package. All statistical analyses were performed using RStudio Version (2023.06.0\u0026thinsp;+\u0026thinsp;421) with a significance level set at α\u0026thinsp;=\u0026thinsp;0.050.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eThirty-three dance/movement therapists responded to the survey between May 2024 and April 2025, including eight (24.2%) affiliated with military healthcare. Thirty participants identified as female, while sex data was unavailable for three participants. The sample included individuals identifying as White/Caucasian (n\u0026thinsp;=\u0026thinsp;12), Hispanic/Latino/a (n\u0026thinsp;=\u0026thinsp;5), Asian/Pacific Islander (n\u0026thinsp;=\u0026thinsp;4), Black/African American (n\u0026thinsp;=\u0026thinsp;2), and mixed or multicultural backgrounds (n\u0026thinsp;=\u0026thinsp;4). All participants held at least a college degree, with most reporting graduate-level education in Dance/Movement Therapy or related fields. Degrees included master\u0026rsquo;s, doctoral, and post-graduate qualifications in counseling, psychology, expressive arts, and clinical mental health. Nearly all respondents (97%) were currently practicing. Participants worked across a wide range of settings, most categorized as \u0026ldquo;Other\u0026rdquo; (n\u0026thinsp;=\u0026thinsp;12), followed Department of Defense or Veteran Affair medical centers (n\u0026thinsp;=\u0026thinsp;8), Counseling Centers (n\u0026thinsp;=\u0026thinsp;4), and Psychiatric facilities (n\u0026thinsp;=\u0026thinsp;3), with additional representation from schools, nursing homes, and crisis centers. They served a wide range of populations, including children, adolescents, adults, and the elderly, as well as specialized groups such as veterans, individuals with traumatic brain injury, post traumatic spectrum disorder, autism, and those in psychiatric or correctional settings. Years of experience ranged from 3 to over 25 years, with a mean of approximately 9.7 years. Full self-reported work setting and population details are provided in the articles supplementary data.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eInternal Consistency of Items for Each Construct\u003c/h3\u003e\n\u003cp\u003eThe internal consistency of each set of items within each construct was found to be good to excellent, with all Cronbach\u0026rsquo;s alpha coefficients equal to or exceeding 0.87 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInternal Consistency of Movement Constructs as Measured by Cronbach\u0026rsquo;s Alpha and Quartile Distribution of Importance Ratings for all participants and all Items.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComponents\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCronbach's Alpha\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMinimum\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eQuartile 1 (25%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eQuartile 2 (50%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eQuartile 3 (75%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMaximum\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eSpeed / Reaction Time\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eBalance\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eCoordination\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eAccuracy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e97\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eAgility\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eAvailable Space\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eBreath\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNote.\u0026nbsp;Cronbach\u0026rsquo;s Alpha values indicate the internal consistency of items within each construct. Interpretation guidelines: \u0026ge; .90\u0026thinsp;=\u0026thinsp;Excellent, .80\u0026ndash;.89\u0026thinsp;=\u0026thinsp;Good, .70\u0026ndash;.79\u0026thinsp;=\u0026thinsp;Acceptable, .60\u0026ndash;.69\u0026thinsp;=\u0026thinsp;Questionable, .50\u0026ndash;.59\u0026thinsp;=\u0026thinsp;Poor, \u0026lt; .50\u0026thinsp;=\u0026thinsp;Unacceptable.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eMean Ratings of Importance\u003c/h2\u003e\u003cp\u003eAssumption testing revealed a violation of the normality of residuals, as indicated by the Shapiro\u0026ndash;Wilk test \u003cem\u003e(p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/em\u003e. Additionally, Levene\u0026rsquo;s test for equality of variances was significant \u003cem\u003e(p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/em\u003e, indicating a violation of the homogeneity of variances assumption. Given these violations, Welch\u0026rsquo;s ANOVA was employed to account for unequal variances and potential non-normality.\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the quartile distribution of group mean importance ratings, calculated by averaging responses across all sub-component questions for each construct. Statistical analysis revealed a significant difference in perceived importance across constructs, \u003cem\u003eF(6, 86.90)\u0026thinsp;=\u0026thinsp;221.38, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e. Post hoc comparisons using the Games\u0026ndash;Howell procedure indicated that available space was significantly less important than all other constructs \u003cem\u003e(all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/em\u003e, and breath was significantly more important than both speed/reaction time \u003cem\u003e(p\u0026thinsp;\u0026lt;\u0026thinsp;0.029)\u003c/em\u003e and accuracy \u003cem\u003e(p\u0026thinsp;\u0026lt;\u0026thinsp;0.025).\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored how dance/movement therapists, evaluate the clinical importance of patient improvements in specific movement components, spatial engagement, and breath quality. A list of items representing quantifiable aspects of movement and physiological function was generated and then a survey was distributed to understand how improvements in these components are prioritized in therapeutic contexts. Respondents included dance/movement therapists representing a range of clinical environments and populations, offering varied perspectives. While improvements in aspects of motor fitness were considered important, improvements in breath were rated as significantly more important than improvements in speed/reaction time or movement accuracy. Conversely, the use of available space was rated significantly lower than all other components, suggesting it may be a less prioritized element in this context. These results offer valuable insight into how DMT practitioners conceptualize the therapeutic relevance of both internal physiological regulation and external movement expression. The high rating for breath underscores its central role in emotional regulation, trauma recovery, and nervous system modulation\u0026mdash;particularly relevant in military populations (Winters \u0026amp; Freeman, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Meanwhile, the lower rating for spatial engagement may reflect practical constraints in clinical settings rather than a lack of therapeutic value, suggesting a need for further exploration into how environmental factors shape therapeutic priorities.\u003c/p\u003e\u003cp\u003eThe internal consistency of the items developed for each targeted construct was assessed using Cronbach\u0026rsquo;s alpha. The relatively high alpha values (\u0026ge;\u0026thinsp;0.87) indicate strong interrelatedness among items, suggesting that they reliably measured their intended dimensions. While a high alpha does not inherently guarantee reliability, in this context it serves as a meaningful indicator of internal consistency. These items show strong internal consistency because these questions were developed from clinical questions based on biomechanical definitions of each concept. The relatively uniform variances across items suggest tau-equivalence, which assumes that each item measures the same underlying trait on the same scale (Tavakol \u0026amp; Dennick, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Clinically, these findings support the clarity and coherence of each construct definitions, which may assist practitioners in setting more targeted goals and tailoring interventions based on well-defined aspects of motor fitness, spatial awareness, or respiratory function. Within the context of this study, the results also justify the methodological decision to average sub question ratings prior to comparing importance ratings across groups.\u003c/p\u003e\u003cp\u003eThe high importance placed on breath (e.g., flow direction, cadence control, synchronization) aligns with its established role in emotional regulation and trauma recovery (Grigonis, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Levy, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e1988\u003c/span\u003e). In DMT breath is a therapeutic tool that can be consciously modulated to support grounding (De Tord 2015), self-awareness (Mehling, 2011), and nervous system regulation (Berrol, 1992; Barbera, 2024). This significance was echoed in the comments, with one therapist noting, \u003cem\u003e\u0026ldquo;Breath control can have an impact on movement and functioning, but I find for this population just the ability to engage in meaningful deep breathing (ones that regulate both body and brain) is of the greatest importance.\u003c/em\u003e\u0026rdquo; Breath is particularly relevant in military populations where trauma exposure is prevalent (Winters \u0026amp; Freeman, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Physiologically, breath is a central component of the cardiorespiratory system, directly influencing heart rate, oxygen exchange, and autonomic nervous system balance. Slow, diaphragmatic breathing activates the parasympathetic branch of the autonomic nervous system, promoting relaxation and reducing sympathetic arousal \u0026ndash; key mechanisms in trauma-informed care. Consequently, breathwork offers a non-invasive accessible strategy for regulating internal states, especially for individuals experiencing hypervigilance or chronic stress. In DMT therapists often observe changes in breath quality such as increased depth, rhythm or ease \u0026ndash; as indicators of emotional release, increased safety or therapeutic integration.\u003c/p\u003e\u003cp\u003eIn contrast, the relatively lower rating for use of space (e.g., dynamic use, directional shaping, planar shaping) was not rated as important. This result may reflect practical and contextual constraints that the clinicians work within rather than a lack of clinical relevance. Dance/movement therapy is used in various settings, such as Defense Health Agency treatment programs for active-duty military and Veteran\u0026rsquo;s Affairs hospitals. Even these connected centers treat populations with different conditions such as traumatic brain injury, post-traumatic stress, substance abuse disorders, geriatric or memory care, homelessness or vocational rehabilitation, perinatal or reproductive care, chronic pain, and amputations. Dance/movement therapists may not have a dedicated clinical space for providing treatment and must instead adapt to the needs and resources of their site. A therapist may provide bedside care to a patient in palliative care or transform a conference room into a group space by moving the furniture out of the way. In such contexts, spatial exploration may be limited or deprioritized in favor of more internally focused or relational interventions. Still, clinicians seem to note population-specific use of space with one commenting, \u0026ldquo;\u003cem\u003eService members generally have 1 plan they like to move. Challenging these norms challenges cognitive and emotional structures creating space for new learning and expression.\u0026rdquo;\u003c/em\u003e Alternatively, other movement-related factors, such as balance, may indirectly influence spatial use. As one therapist observed, \u0026ldquo;\u003cem\u003eMost patients stay in a small movement space due to balance issues.\u0026rdquo;\u003c/em\u003e While spatial engagement may serve as a meaningful indicator of therapeutic progress\u0026mdash;particularly in trauma-informed care\u0026mdash;its lower rating may reflect the constraints of clinical practice in different environments.\u003c/p\u003e\u003cp\u003eThe results of this current study suggest that dance/movement therapists recognize the clinical value of motor fitness components. Patient improvements in all aspects of motor fitness including speed/reaction time, balance, coordination, accuracy, agility had mean ratings within the moderately to very important range (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This result aligns with existing literature that highlights their therapeutic relevance as outcome measures. For instance, DMT has been seen to improve fitness, functional balance, and mobility in older adults more effectively than stretching alone (Joung \u0026amp; Lee, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Similarly, DMT has demonstrated benefits for individuals with neurodegenerative diseases, having positive effects on cognitive and motor function (Wu et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). These findings reinforce the integrative properties of DMT treatment and the role of movement-based interventions in promoting both physical and psychological well-being across varied populations (Koch et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Still, each aspect of motor fitness has a clear DMT interpretation and is supported by literature which will be examined in the following paragraphs.\u003c/p\u003e\u003cp\u003eIn this study, speed and reaction time were conceptualized as a unified construct to reflect both the temporal sensitivity and velocity of movement adaptability which are core elements of DMT (e.g., initiating movement, shifting quickly, dynamic use of time, playfulness). Although this study found that respondents rated this aspect as important (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This finding aligns with existing literature that highlights the importance of speed quantification in DMT. Reaction time has been previously quantified within DMT as the ability to respond quickly to musical stimuli (Chatzihidiroglou et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), and improvements in speed\u0026mdash;such as enhanced performance in timed motor tasks\u0026mdash;have been documented in therapeutic contexts (Berrol et al., n.d.). The qualitative responses from participants revealed a deeper therapeutic emphasis on modulating speed, particularly through intentional deceleration. One therapist shared, \u0026ldquo;\u003cem\u003eI tend to focus more on how to help my clients learn ways to decelerate because they usually have no problem with acceleration,\u0026rdquo;\u003c/em\u003e highlighting the importance of slowing down as a strategy for regulation and control. Another noted, \u0026ldquo;\u003cem\u003eSo many of my clients want to access changes quickly but get frozen. Many times, we focus on slowing down to access and then acceleration\u003c/em\u003e,\u0026rdquo; pointing to the therapeutic process of sequencing movement to overcome inhibition (Hamel et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). These insights suggest that in DMT, speed is not merely about moving quickly but about cultivating the capacity to shift between movement states with awareness and intention. Shifting between states is crucial for traumatized populations who tend to experience hyperarousal of the autonomic nervous system and often struggle to \u0026ldquo;slow down\u0026rdquo; their physiological process, behaviors, and cognitive processes.\u003c/p\u003e\u003cp\u003eBalance is a foundational component of motor fitness and plays a critical role in both functional mobility and injury prevention. In this study, balance was evaluated using multiple items, including spatial awareness, dynamic stability, fall risk, body stabilization, and mobility. Each of these items were rated as important (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Together these items illustrate the interplay between motor abilities and factors that mitigate fall risk. Improvements in balance after DMT have been documented in various populations (E.g., Takahashi et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Wu et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) reinforcing its therapeutic value. Balance is a key factor in fall prevention, particularly among older adults and individuals with neurological or who are rehabilitating from an injury (Veronese et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Therapists seem to be aware of this with one commenting that balance is, \u0026ldquo;(\u003cem\u003em)ore important with certain populations especially elderly and those with side effects of chemotherapy\u003c/em\u003e.\u0026rdquo; However, in the context of DMT assessment, balance may carry a more cognitive meaning. As one therapist explained, \u0026ldquo;\u003cem\u003eI utilize plays with balance in a much more metaphorical way for emotional processing as opposed to thinking of balance as a skill to be mastered\u003c/em\u003e.\u0026rdquo; In DMT, enhanced balance may signal increased body awareness, postural control, and confidence in movement\u0026mdash;all of which are essential for supporting autonomy and reducing injury risk in clinical populations.\u003c/p\u003e\u003cp\u003eCoordination is an aspect of motor fitness that emphasizes the ability to execute smooth, efficient, and synchronized movements and was rated as very important in this study (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Coordination, often called synchrony in DMT, is used to improve the ability to understand and share the feelings of others through physical attunement. In this study, coordination was assessed through several dimensions, including movement phrasing, developmental movement patterns, self-synchrony, synchrony with music or partner, and tension flow attributes. These elements reflect both neuromuscular control and expressive capacity, which are essential for embodied communication and emotional attunement. Recent studies rate movement-based mirroring tasks during DMT or use accelerometers to measure interpersonal synchrony (Manders et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Prakash et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). In DMT, improvements in coordination may indicate enhanced body integration, emotional regulation, and relational attunement\u0026mdash;key therapeutic goals across different clinical populations.\u003c/p\u003e\u003cp\u003eMovement accuracy is a concept found in both motor fitness and DMT, though it is understood and applied differently in each setting. Rather than focusing on external performance outcomes, accuracy in DMT involves the ability to attune movement to internal emotional states and to others in the therapeutic space. The accuracy-specific items included attunement, body shaping, and phrasing, and illustrate how movement accuracy in DMT reflects a more expressive and relational focus (Jerak et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). These distinctions were echoed in participants\u0026rsquo; qualitative responses. One respondent noted that, \u0026ldquo;\u003cem\u003eaccuracy can be misunderstood as perfectionism\u003c/em\u003e,\u0026rdquo; highlighting the potential misalignment between clinical and expressive interpretations. Another emphasized the relational dimension of accuracy in DMT, stating, \u0026ldquo;\u003cem\u003eEmpathy and reciprocity are big cornerstones, I think, in DMT work: connecting one moving self to another moving self and developing better understanding; confidence; sense of community\u003c/em\u003e.\u0026rdquo; Together, these insights reinforce the idea that in DMT, movement accuracy is not about correctness or precision in a technical sense, but about presence, connection, and meaning making through movement. It reflects qualities such as authenticity, expressive clarity, and interpersonal attunement (Dieterich-Hartwell, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Understanding this relationship between movement accuracy and emotional expression is essential for therapists to more effectively interpret client experiences and tailor interventions that support therapeutic goals.\u003c/p\u003e\u003cp\u003eAgility, a key subcomponent of motor fitness, refers to the ability to quickly and efficiently change body position or direction in response to stimuli. Agility is required when transitioning from one movement to another and can be assessed through a person\u0026rsquo;s adaptability in body positioning (Dwiyasmono et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In DMT, agility reflects not only physical responsiveness but also cognitive and emotional adaptability. In this study, agility was defined by movements involving positional changes, quick starts and stops, directional changes, and dynamic ranges of movement, supporting both functional mobility and expressive movement. This definition aligns with participant insights, such as one survey respondent\u0026rsquo;s observation that, \u0026ldquo;\u003cem\u003ethis is more about increasing a patient\u0026rsquo;s comfort with moving their body in different ways, again not to meet an outside standard of agility.\u0026rdquo;\u003c/em\u003e For example, a traumatized patient may enter treatment with a restricted movement profile reflective of defense mechanisms and their therapist may work with them to be able to move with more dynamic changes to be able to better adapt to various settings. This perspective underscores that in therapeutic contexts, agility is not about performance metrics but about fostering confidence, adaptability, and embodied self-awareness. Smooth transitions and responsive movement in DMT can signal a client\u0026rsquo;s growing comfort, engagement, and psychological flexibility\u0026mdash;key indicators of therapeutic progress.\u003c/p\u003e\u003cp\u003eGenerally, the importance ratings from our study reinforce the relevance of motor fitness components in DMT and support their use as a foundation for structuring movement-based assessments. Despite differences in clinical environments and patient populations, there is a shared understanding of which movement components are considered therapeutically important. Such consistency supports the generalizability of these findings across a range of contexts and strengthens the case for developing standardized assessment tools that can be applied in multiple settings. Given the wide range of populations served by DMT\u0026mdash;including individuals with PTSD, TBI, chronic pain, and memory loss\u0026mdash;future tools must also be flexible enough to accommodate varied therapeutic goals and clinical environments.\u003c/p\u003e\u003cp\u003eBased on these results, future research may benefit from prioritizing the development of movement-based assessment tools that integrate both external indicators of motor fitness and internal physiological signals such as breath. Wearable motion sensors, heart rate monitors, and respiration monitors enable the non-invasive tracking of movement and cardiovascular function, which may be particularly valuable in dance/movement therapy for assessing embodied responses and physiological regulation during therapeutic movement.\u003c/p\u003e\u003cp\u003eLimitations\u003c/p\u003e\u003cp\u003eThis study has several limitations. Participant selection was non-random. Participants were primarily women. The sample size was moderate (N\u0026thinsp;=\u0026thinsp;33) and 24% of respondents were affiliated with military healthcare, which may limit the generalizability of these findings. Questions were displayed in the same order for all participants. Additionally, the use of self-reported importance ratings may not fully capture how these components are prioritized in actual clinical practice. Future studies could incorporate observational or longitudinal methods to examine how movement and breath patterns change over time and relate to therapeutic outcomes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides a foundational step in articulating how dance/movement therapists conceptualize key components of motor fitness, spatial engagement, and breath. By identifying which movement elements are perceived as most clinically important and demonstrating strong internal consistency across item groupings, this investigation offers an initial evaluation of theory that can guide future research and support the development of clinically meaningful measures. The findings suggest that breath, coordination, balance, and agility are central to therapeutic work, offering a clearer framework for prioritizing movement components in practice. These findings may guide future research by introducing objective performance metrics to complement subjective assessments in DMT. Such integration holds promise for enhancing the precision of assessment and deepening our understanding of embodied therapeutic processes, while ensuring that innovations remain grounded in the relational, expressive, and holistic values that define DMT.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eE.B, S.K. and E.F. wrote the main manuscript text, E.B completed all analysis and prepared all figures and tables. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to acknowledge Chandler Rhodes, PhD, for her guidance in shaping the study design. Special thanks to Karla G. Mendoza, BS for her support with participant recruitment. We also extend our sincere appreciation to the dance/movement therapists who generously shared their time and insights by participating in the survey. The authors are grateful to the past and current clinical and organizational leadership of the National Intrepid Center of Excellence and of Walter Reed National Military Medical Center for their support of creative arts therapies and Arts in Health programming. The authors also acknowledge Creative Forces\u0026reg;: NEA Military Healing Arts Network, an initiative of the NEA in partnership with the U.S. DOD and VA, managed in partnership with the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. and Mid-America Arts Alliance, for their ongoing endeavors to advance creative arts therapy clinical services and related research. Special thanks to all the healthcare providers of various disciplines who offered mutual support to one another throughout the COVID-19 pandemic.Disclosure StatementThe opinions contained herein represent the private views of the authors and are not to be construed as official or as reflecting the views, opinions, or policies of the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the National Endowment for the Arts, Department of Defense, or the U.S. Government. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government. This material was created free of branding or market affiliations. The authors are operating solely as contributors.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided within the manuscript or in supplementary information files.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAmerican Dance Therapy Association. (n.d.). What is Dance/Movement Therapy [Organization]. \u003cem\u003eAmerican Dance Therapy Association\u003c/em\u003e. Retrieved March 19, 2025, from https://www.adta.org/about\u003c/li\u003e\n\u003cli\u003eBerrol, C. F., Ooi, W. L., \u0026amp; Katz, S. S. (n.d.). \u003cem\u003eDance/Movement Therapy with Older Adults Who Have Sustained Neurological Insult: A Demonstration Project\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eBr\u0026auml;uninger, I. (2014). Specific dance movement therapy interventions\u0026mdash;Which are successful? An intervention and correlation study. \u003cem\u003eThe Arts in Psychotherapy\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e(5), 445\u0026ndash;457. https://doi.org/10.1016/j.aip.2014.08.002\u003c/li\u003e\n\u003cli\u003eChatzihidiroglou, P., Chatzopoulos, D., Lykesas, G., \u0026amp; Doganis, G. (2018). Dancing Effects on Preschoolers\u0026rsquo; Sensorimotor Synchronization, Balance, and Movement Reaction Time. \u003cem\u003ePerceptual and Motor Skills\u003c/em\u003e, \u003cem\u003e125\u003c/em\u003e(3), 463\u0026ndash;477. https://doi.org/10.1177/0031512518765545\u003c/li\u003e\n\u003cli\u003eChilton, G., Vaudreuil, R., Freeman, E. K., McLaughlan, N., Herman, J., \u0026amp; Cozza, S. J. (2021). Creative Forces programming with military families: Art therapy, dance/movement therapy, and music therapy brief vignettes. \u003cem\u003eJournal of Military, Veteran and Family Health\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e(3), 104\u0026ndash;113. https://doi.org/10.3138/jmvfh-2021-0031\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eCreative Forces: Clinical Program\u003c/em\u003e. (n.d.). National Endowment for the Arts. Retrieved September 30, 2025, from https://www.arts.gov/initiatives/creative-forces/clinical-program\u003c/li\u003e\n\u003cli\u003eDhami, P., Moreno, S., \u0026amp; DeSouza, J. F. X. (2015). New framework for rehabilitation \u0026acirc;\u0026euro;\u0026ldquo; fusion of cognitive and physical rehabilitation: The hope for dancing. \u003cem\u003eFrontiers in Psychology\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e. https://doi.org/10.3389/fpsyg.2014.01478\u003c/li\u003e\n\u003cli\u003eDieterich-Hartwell, R. (2024). Interpersonal Synchrony in Dance/Movement Therapy: Neural Underpinnings for Individuals with Dementia. \u003cem\u003eJournal of Alzheimer\u0026rsquo;s Disease : JAD\u003c/em\u003e. https://doi.org/10.3233/JAD-240239\u003c/li\u003e\n\u003cli\u003eDwiyasmono, Setya Widyawati, Supriyanto Supriyanto, Sriyadi Sriyadi, \u0026amp; Sri Ningsih Sukirman. (2023). Therapeutic Dance Experimentation: Implementation of Post-Pandemic Movement Therapy. \u003cem\u003eResearch on Humanities and Social Sciences\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(10). https://doi.org/10.7176/RHSS/13-10-05\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eFind a DMT\u003c/em\u003e. (n.d.). American Dance Therapy Association. Retrieved October 12, 2023, from https://adta.memberclicks.net/find-a-dmt#/\u003c/li\u003e\n\u003cli\u003eGeorge, D. \u0026amp; Mallery, P. (2003). \u003cem\u003eSPSS for Windows step by step: A simple guide and reference.\u003c/em\u003e (4th ed., Vol. 11). Allyn \u0026amp; Bacon.\u003c/li\u003e\n\u003cli\u003eGrigonis, N. (2019). \u003cem\u003eTaking a Breath: Understanding the Interrelationship of Breath in Dance/Movement Therapy and Everyday Life\u003c/em\u003e [Sarah Lawrence University]. https://digitalcommons.slc.edu/dmt_etd/49/\u003c/li\u003e\n\u003cli\u003eGuzm\u0026aacute;n, A., Robinson, L., Rochester, L., James, I. A., \u0026amp; Hughes, J. C. (2017). A process evaluation of a Psychomotor Dance Therapy Intervention (DANCIN) for behavior change in dementia: Attitudes and beliefs of participating residents and staff. \u003cem\u003eInternational Psychogeriatrics\u003c/em\u003e, \u003cem\u003e29\u003c/em\u003e(2), 313\u0026ndash;322. https://doi.org/10.1017/S104161021600171X\u003c/li\u003e\n\u003cli\u003eHamel, R., Waltzing, B. M., Hinder, M. R., McAllister, C. J., Jenkinson, N., \u0026amp; Galea, J. M. (2024). Bilateral intracortical inhibition during unilateral motor preparation and sequence learning. \u003cem\u003eBrain Stimulation\u003c/em\u003e, \u003cem\u003e17\u003c/em\u003e(2), 349\u0026ndash;361. https://doi.org/10.1016/j.brs.2024.03.009\u003c/li\u003e\n\u003cli\u003eJerak, T., Vidrih, A., \u0026amp; Žvelc, G. (2018). The experience of attunement and misattunement in dance movement therapy workshops. \u003cem\u003eThe Arts in Psychotherapy\u003c/em\u003e, \u003cem\u003e60\u003c/em\u003e, 55\u0026ndash;62. https://doi.org/10.1016/j.aip.2018.06.001\u003c/li\u003e\n\u003cli\u003eJoung, H. J., \u0026amp; Lee, Y. (2019). Effect of Creative Dance on Fitness, Functional Balance, and Mobility Control in the Elderly. \u003cem\u003eGerontology\u003c/em\u003e, \u003cem\u003e65\u003c/em\u003e(5), 537\u0026ndash;546. https://doi.org/10.1159/000499402\u003c/li\u003e\n\u003cli\u003eKoch, S. C., Riege, R. F. F., Tisborn, K., Biondo, J., Martin, L., \u0026amp; Beelmann, A. (2019). Effects of Dance Movement Therapy and Dance on Health-Related Psychological Outcomes. A Meta-Analysis Update. \u003cem\u003eFrontiers in Psychology\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e, 1806. https://doi.org/10.3389/fpsyg.2019.01806\u003c/li\u003e\n\u003cli\u003eLevy, F. J. (Ed.). (1988). \u003cem\u003eDance movement therapy\u003c/em\u003e. The American Alliance for Health, Physical Education, Recreation, and Dance.\u003c/li\u003e\n\u003cli\u003eManders, E., Goodill, S., Koch, S. C., Giarelli, E., Polansky, M., Fisher, K., \u0026amp; Fuchs, T. (2021). The Mirroring Dance: Synchrony and Interaction Quality of Five Adolescents and Adults on the Autism Spectrum in Dance/Movement Therapy. \u003cem\u003eFrontiers in Psychology\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e, 717389. https://doi.org/10.3389/fpsyg.2021.717389\u003c/li\u003e\n\u003cli\u003eMartinec, R. (2018). \u003cem\u003eDance Movement Therapy in the Wider Concept of Trauma Rehabilitation\u003c/em\u003e. \u003cem\u003e1\u003c/em\u003e(1).\u003c/li\u003e\n\u003cli\u003eMichael Kent. (2006). Motor fitness. In \u003cem\u003eOxford dictionary of Sports Science and Medicine\u003c/em\u003e. Oxford University Press.\u003c/li\u003e\n\u003cli\u003ePrakash, N., Ramakrishnan, A., Vader, D. T., Goodill, S., Beardall, N., Moore, R. H., \u0026amp; Shim, M. (2025). Two ways to measure interpersonal synchrony in dance/movement therapy: Comparing accelerometer data with observational data. \u003cem\u003eThe Arts in Psychotherapy\u003c/em\u003e, \u003cem\u003e92\u003c/em\u003e, 102245. https://doi.org/10.1016/j.aip.2024.102245\u003c/li\u003e\n\u003cli\u003eTakahashi, H., An, M., Sasai, T., Seki, M., Matsumura, T., Ogawa, Y., Matsushima, K., Tabata, A., \u0026amp; Kato, T. (2023). The effectiveness of dance movement therapy for individuals with Down syndrome: A pilot randomised controlled trial. \u003cem\u003eJournal of Intellectual Disability Research : JIDR\u003c/em\u003e, \u003cem\u003e67\u003c/em\u003e(7), 640\u0026ndash;654. https://doi.org/10.1111/jir.13033\u003c/li\u003e\n\u003cli\u003eTavakol, M., \u0026amp; Dennick, R. (2011). Making sense of Cronbach\u0026rsquo;s alpha. \u003cem\u003eInternational Journal of Medical Education\u003c/em\u003e, \u003cem\u003e2\u003c/em\u003e, 53\u0026ndash;55. https://doi.org/10.5116/ijme.4dfb.8dfd\u003c/li\u003e\n\u003cli\u003eVeronese, N., Maggi, S., Schofield, P., \u0026amp; Stubbs, B. (2017). Dance movement therapy and falls prevention. \u003cem\u003eMaturitas\u003c/em\u003e, \u003cem\u003e102\u003c/em\u003e, 1\u0026ndash;5. https://doi.org/10.1016/j.maturitas.2017.05.004\u003c/li\u003e\n\u003cli\u003eWeitz, N., \u0026amp; Opre, A. (2022). Combining Dance/Movement Therapy with Cognitive Behavioral Therapy in Treatment of Children with Anxiety Disorders: Factors Explaining Therapists\u0026rsquo; Attitudes. \u003cem\u003eAmerican Journal of Dance Therapy\u003c/em\u003e, \u003cem\u003e44\u003c/em\u003e(2), 186\u0026ndash;209. https://doi.org/10.1007/s10465-022-09369-y\u003c/li\u003e\n\u003cli\u003eWiedenhofer, S., \u0026amp; Koch, Prof. Dr. S. C. (2017). Active factors in dance/movement therapy: Specifying health effects of non-goal-orientation in movement. \u003cem\u003eThe Arts in Psychotherapy\u003c/em\u003e, \u003cem\u003e52\u003c/em\u003e, 10\u0026ndash;23. https://doi.org/10.1016/j.aip.2016.09.004\u003c/li\u003e\n\u003cli\u003eWinters, A. F., \u0026amp; Freeman, E. K. (2022). Dance/Movement Therapy with Active Duty and Veteran Military Populations. In \u003cem\u003eDance/Movement Therapy for Trauma Survivors\u003c/em\u003e (1st ed., pp. 202\u0026ndash;214). Routledge.\u003c/li\u003e\n\u003cli\u003eWołoszyn, N., Wiśniowska-Szurlej, A., Grzegorczyk, J., \u0026amp; Kwolek, A. (2021). The impact of physical exercises with elements of dance movement therapy on the upper limb grip strength and functional performance of elderly wheelchair users living in nursing homes\u0026mdash;A randomized control trial. \u003cem\u003eBMC Geriatrics\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e(1), 423. https://doi.org/10.1186/s12877-021-02368-7\u003c/li\u003e\n\u003cli\u003eWu, C.-C., Xiong, H.-Y., Zheng, J.-J., \u0026amp; Wang, X.-Q. (2022). Dance movement therapy for neurodegenerative diseases: A systematic review. \u003cem\u003eFrontiers in Aging Neuroscience\u003c/em\u003e, \u003cem\u003e14\u003c/em\u003e, 975711. https://doi.org/10.3389/fnagi.2022.975711\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Dance, Movement, Therapy, Survey","lastPublishedDoi":"10.21203/rs.3.rs-7829291/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7829291/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eDance/movement therapy is a psychotherapeutic approach that uses movement, body awareness, and embodied communication to support healing and wellness across different populations. In dance/movement therapy treatment, movement serves not only as a primary mode of intervention but also as a tool for assessment. There is growing interest in quantifying internal and external variables within dance/movement therapy. However, the specific movement components most relevant for clinical assessment remain unclear. This study aimed to generate a framework of quantifiable components of movement and physiological function and examine how dance/movement therapists rate the importance of aspects of motor fitness, spatial engagement, and breath quality. Thirty-three therapists anonymously rated the importance of patient improvement in items defining speed/reaction time, balance, coordination, movement accuracy, agility, available space. A one-way analysis of variance revealed significant differences in importance ratings across components, \u003cem\u003eF (6, 86.90)\u0026thinsp;=\u0026thinsp;221.38, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e. Notably, spatial engagement was rated as \u0026ldquo;not at all important\u0026rdquo; and was rated significantly lower than all other components \u003cem\u003e(all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/em\u003e Although breath and all aspects of motor fitness were rated as important, post hoc analyses indicated that breath was rated significantly more important than speed/reaction time \u003cem\u003e(p\u0026thinsp;=\u0026thinsp;0.029)\u003c/em\u003e and movement accuracy \u003cem\u003e(p\u0026thinsp;=\u0026thinsp;0.025).\u003c/em\u003e These findings lay the groundwork for understanding which components of internal and external movement are clinically meaningful and emphasize the potential to integrate objective physical and physiological data into embodied therapeutic practice.\u003c/p\u003e","manuscriptTitle":"Breath Quality and Aspects of Motor Fitness are Key Indicators in Dance/Movement Therapy Assessment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 16:16:54","doi":"10.21203/rs.3.rs-7829291/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6a1a5670-a480-4d64-bdf7-813839cd3bf4","owner":[],"postedDate":"October 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-14T23:08:58+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-15 16:16:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7829291","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7829291","identity":"rs-7829291","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}