Dohsa-hou

A Japanese Psycho-rehabilitative
program for individuals with motor
disorders and other disabilities
Asghar Dadkhah and Susumu Harizuka

Department of Clinical Psychology Center for Clinical Psychology and

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

Paper presented at the British Educational Research Association Annual

Conference
(September 11-14 1997: University of York)

What is Dohsa-hou ?

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

Dohsa means a holistic process of motor action which consists of the inner
psychic activities of a bodily movement and Hou means method. "When we
intend to move some parts of our body, we make striving to realize the bodily
movement according to our own intention. If the striving is appropriate to the
movement, the intended movement can be realized" (Naruse, 1973). The
method of Dohsa-hou is based upon such concept.
The process of Dohsa can be divided into two: one is psychological, (for
example, intention and striving), and the other is physiological (for example,
body movement, body posture). It is schematized as a process of "intention-
striving-body movement" (Naruse, 1973). In the process of client's goal-
directed striving, 'the trainer is able to activate the client's mind and facilitate
the activity of his self through his experiencing of goal
directed Dohsa' (Naruse, 1985, 1992).

The utility of Dohsa-hou for counseling as a supplementary technique is

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

Has any research undertaken on this method ?

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

Dadkhah (1996, 1997) applied Dohsa-hou to disabled sportsmen and disabled

students in elementary school in Iran, as a result of training, their public aspect
of their body-consciousness changed the most by experiencing a new mode of
motor action which was different from the one they experienced before the
training, they gained a better balance on their body while walking and running,
and they improved their sports record time. The results indicated that this
training is a useful method for helping disabled sportsmen to improve their
body-consciousness, to gain control over both their own bodies and minds, and,
in addition, that it maybe useful in making training programs for them.
In the field of Sports in Japan , Since Rome Olympic to Tokyo Olympic,
some Dohsa-hou techniques such as relaxation, mental rehearsal and mental
training was introduced to champion athletes for treatment of stage flight and
training for game strengthening by Naruse (1975).

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

What is the mechanism of the treatment ?

Dohsa-hou is a new Psycho-rehabilitation training method in Japan developed

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

What is specific about this method ?

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

Dohsa Hou is different from physiotherapy and other psychotherapeutic

methods. In the traditional psychotherapeutic methods, the motivation or
striving is there but no program is undertaken by motoric way. In
physiotherapy, clients' psychological aspects are not given due attention.
Who can benefit from Dohsa-hou ?

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

It also applies to mentally retarded children, down syndrome children and

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

What are the changes after the therapy?

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

Brief description of the method

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

Ban 1 : neck

Ban 2 : two parts of scapula joint in back

Ban 3 : the upper part of the back between scapulas

Ban 4 : the middle part of back around the chest

Ban 5 : the lower part of back around waist

Ban 6 : hip joints

Ban 7 : knees

Ban 8 : ankles.

Ban 9 : feet fingers.

Ban 10 : shoulder joints.

Ban 11 : elbows.

Ban 12 : wrists.

Ban 13 : hands fingers

Basic ideas in Dohsa training

The basic ideas in Dohsa training are: 1) Relaxation, 2) Movement of arms,

hands and legs - tan-i Dohsa, 3) 'Tate method'.

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

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

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

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

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

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

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

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

1. Zai training (sitting with crossed legs training)

2. Hizatachi training (standing on knees training)

3. Kata Hizatachi (standing on one knee training)

4. Litsui training (standing posture training)

5. Hokou training (gait training)

Zai training - Sitting posture on the floor is the primary posture for human
being to keep his body vertical against gravitation. In child development, it is
the first posture when an infant makes his body vertical by himself. The sitting
posture has quite different physiological and psychological meaning other than
a state in which the body is lying on the floor. The posture is one of active
motor actions that a person operates for his own body to be vertical against
gravitation. To make the upper part of the body to stand vertical is not only to
set it on the lower parts, but to operate the whole of body (neck, shoulders,
waist, hips and legs) in order to keep the upper parts vertical. So the main task
in this position is making 1,3,4,5 "Ban" straight in one line towards the ground
and to enable trainees to support themselves on their buttocks.

Hizatachi training - The importance of the kneeling posture has not been
emphasized in rehabilitation medicine and developmental psychology. In the
techniques of neuro developmental treatments (Bobath 1966), this posture has
not usually been used. The only exemption is an unimportant technique in
which a child maintains a kneeling position by holding onto some stable object.
In the Dohsa-hou, however, kneeling has always been a very important posture.
The term "kneeling" generally includes all the positions in which a person's
knees touch the floor. The kneeling posture used in the Dohsa-hou means the
position in which a child is supporting himself/herself upright on his/her knees
with a trunk and the thighs erect. So the aim of Hizatachi training is to enable
them to support themselves on their knees. As in Zai (sitting) training the main
task was working on 1,3,4,5 "ban", in Hizatachi training 6 "ban" will be added
to the task.

Kata Hizatachi training - After Hizatachi training, in order to make balance on

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

Litusi training - The training of Litsui (standing on feet) is as important as the

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

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

Who is Dr. Gosaku Naruse?

In 1967, Gosaku Naruse, a professor of Kyushu university in Japan, proposed a

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

How to get more information about Dohsa-hou?

In Kyushu University, Center for Clinical Psychology and Human

Development is responsible for Dohsa training. The information contact are:

Director & professor: Susumu, Harizuka Ph.D.

Center for Clinical Psychology and Human Development
Faculty of Education, Kyushu university,
6-19-1 Hakozaki, Higashi-ku, Fukuoka 812-81, Japan

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

Web (Homepage):

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

References

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Harizuka, S. (1988). The technique of vertically straightening in dohsa-hou for

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