Physiological and Emotional Responses of Disabled Children to Therapeutic Clowns: A Pilot Study

Abstract

This pilot study examined the effects of Therapeutic Clowning on inpatients in a pediatric rehabilitation hospital. Ten disabled children with varied physical and verbal expressive abilities participated in all or portions of the data collection protocol. Employing a mixed-method, single-subject ABAB study design, measures of physiological arousal, emotion and behavior were obtained from eight children under two conditions—television exposure and therapeutic clown interventions. Four peripheral autonomic nervous system (ANS) signals were recorded as measures of physiological arousal; these signals were analyzed with respect to measures of emotion (verbal self reports of mood) and behavior (facial expressions and vocalizations). Semistructured interviews were completed with verbally expressive children (n = 7) and nurses of participating children (n = 13). Significant differences among children were found in response to the clown intervention relative to television exposure. Physiologically, changes in ANS signals occurred either more frequently or in different patterns. Emotionally, children's (self) and nurses' (observed) reports of mood were elevated positively. Behaviorally, children exhibited more positive and fewer negative facial expressions and vocalizations of emotion during the clown intervention. Content and themes extracted from the interviews corroborated these findings. The results suggest that this popular psychosocial intervention has a direct and positive impact on hospitalized children. This pilot study contributes to the current understanding of the importance of alternative approaches in promoting well-being within healthcare settings.

Palhaços de hospital como estratégia de amenização da experiência de hospitalização infantil

“…(2009) e Fernandes e Arriaga (2010) verificaram que a presença dos PH no período pré-operatório diminui os níveis de ansiedade da criança e de seus pais, como também no pós-operatório (menor ansiedade, afetos mais positivos). Adicionalmente, salientam-se os efeitos positivos da intervenção dos PH na comunicação verbal e não verbal da criança; na atitude face a si própria, à doença e à hospitalização; o aumento da expressão de emoções como o riso, a alegria e o humor; ou o aumento de sua percepção de controle, autoconfiança e vitalidade, bem como uma maior abstração da doença e dos problemas vividos em volta da mesma (Garcia e cols., 2009;Gryski, 2003;Kingsnorth, Blain, & McKeever, 2010;Linge, 2011Linge, , 2012Masetti, 1998Masetti, , 2011Motta & Enumo, 2004). Linge (2011), por seu lado, afirma que o palhaço "infecta" a criança com afetos positivos, assim como todos aqueles que estão envolvidos na atividade.…”

Palhaços: uma revisão acerca do uso dessa máscara no ambiente hospitalarPayasos: una revisiónsobre el uso de esa máscara en el ambiente hospitalario

“…In this perspective, the clowns, in general, have as objective the ressignification of the hospital environment with resulting improvment in the emotional wellbeing as much of the patients as of companions and staff [3][4][5][6][7][8] .…”

“…It is considered that as much the illness as the internment configure stress generating situations, fear and anxiety, context on which the clowns interventions are based 4,6,[9][10][11][12][13] .Therefore, we propose a short discussion on the physiology of stress for understanding the effect of obtaining better responses to the patients' and companions treatments, the ones who were in contact with the clowns 4,6,14,15 .…”

“…On the other hand, they can unchain anxiety, appetite loss, increase of allergic reaction and aggravation of conditions as hypertension and diabetes 9 . Common signs of these reactions to stress are alterations of the pulse, breathing frequency and skin temperature, that in some studies are used as parameters for evaluation of emotional well-being 4,6,14 . Like this, interventions that aim to reduce the stress levels provoked by the illness and by the internment, for clinical treatment, surgical procedure, anaesthetic 13 or sedative 16 , can contribute to avoid the onset of complications and associated pathologies, promoting even the patients response to the treatment 10,12 .…”

Feeling happy and carefree: a qualitative study on the experiences of parents, medical clowns and healthcare professionals with medical clowns

“…Whether medical clowns can be of value in other care settings and for other groups of children is largely unknown. To our knowledge, there is only one study that explored the response of children with mental disabilities to therapeutic clowns (Kingsnorth, Blain, & McKeever, 2011). Furthermore, there are only a few studies on how clowns themselves value their work (Linge, 2008) and the experiences of healthcare professionals (Barkmann, Siem, Wessolowski, & Schulte-Markwort, 2013; Blain, Kingsnorth, Stephens, & McKeever, 2012; Ford et al, 2014; Linge, 2011).…”