COMMUNITY AND COLLABORATIVE PROGRAMS

The ADAM Center has a long history of involvement with the dance community. The Center has relationships with many dance companies, dancers, and their medical practitioners including, but not limited to, Alvin Ailey American Dance Theatre, Bill T. Jones Dance Company, Elisa Monte Dance, Boston Ballet, Dance Theatre of Harlem, Joffrey Ballet, Lar Lubovitch Dance Company. The ADAM Center has developed and introduced programs related to:

         In-house injury prevention and management

         Outcome tools

         Dance pre-participation screening

         Injury surveillance

In-house Injury Prevention and Management

At the professional level, sports teams assemble a medical team of orthopedists, athletic trainers, physical therapists, and coaches to assure timely triage, and implementation of preventative and rehabilitative programs to assure the optimal fitness of the athlete. In the workplace, comprehensive safety and managed care occupational initiatives have demonstrated both health and financial cost-effectiveness. Traditionally, most dance companies rely on the workers compensation system of treatment following injury. There are no preventative measures implemented to emphasize wellness. 

In 1998, ADAM Center Director, Shaw Bronner, created an injury prevention and treatment clinic at the Alvin Ailey American Dance Center. The clinic, open to all levels of dancers: from the elite dancers of the Alvin Ailey American Dance Company to students studying at the Ailey School and Ailey-Fordham University BFA program, provides services to approximately 1,000 dancers annually. Ms. Bronner provides screening and prevention workshops; coordinates therapy coverage for the two Ailey dance companies when they are on tour, and trains physical therapists in dance medicine. ADAM Center Research Associate, Sheyi Ojofeitimi, works closely with Ms. Bronner to run the Ailey program, provide coverage, and develop new prevention and treatment programs for dancers. The ADAM Center also maintains a network of physical therapists, who are available to travel with the main company and treat other touring groups on the road. The in-house comprehensive management of injuries in this dance company achieved a 64% reduction of new workers compensation cases and time-loss savings of 60% in three years.1

Outcome Tools

Comprehensive managed care initiatives focus on financial and time-loss outcomes. While these measures are important to organizations, it is also important to measure outcomes at the individual worker level. Adequate measurement of the recovery of an individual following injury requires objective assessment of functional status and general health. Traditional measures of strength and range of motion are inadequate because they do not directly correlate with task performance.2 To be objective, a functional outcome measure should accurately reflect long-term changes in functional level, not merely short-term improvement as a result of clinical or surgical intervention.3

To fill a gap in evaluating performance and function of ballet and modern dance populations following lower extremity injury, the ADAM Center has developed the Dance Functional Outcome System (DFOS).4 The objective of the DFOS is to ascertain functional status in professional and student dancers as it relates to their ability to dance and work, the length of time to recover from injury, and their pre-morbid status. The DFOS consists of two components: a self-administered questionnaire with activities of daily living and dance-specific questions, and a quantitative performance measure. The DFOS has been examined for content validity, reliability, and sensitivity in adult modern and ballet.5 Preliminary analysis of the DFOS suggests that this instrument is responsive to musculoskeletal injury and recovery in this dance population.  This tool will allow clinical researchers to compare the efficacy and effectiveness of medical interventions, to determine performance readiness as discharge criteria, and as one aspect of preseason screening.

 
Dance Pre-participation Screening 

Dance screens are the equivalent of pre-season screens in sports. They provide healthy baseline data, uncover pathology, and help define population characteristics at a given level of performance. Screens in both dance and sports are designed to detect “red flags,” medical conditions that warrant further investigation. Every college athlete undergoes a mandatory physical for this reason. Shaw Bronner of the ADAM Center developed a dance screen, variations of which are currently being used to screen students at Ailey-Fordham, Long Island University, Case Western Reserve University, and Ithaca College. The annual dance screens have become a cornerstone of the Dance Departments of Long Island University and Case Western Reserve’s Dance Wellness Programs.

While there are various versions, the typical dance screen is comprised of structural alignment assessment (to ascertain asymmetries), muscular, joint, and ligamentous testing (to ascertain weakness, excessive laxity, or tightness), aerobic capacity measurement, and dance technique evaluation. Screening results provide each student with an objective profile of their physical strengths and weaknesses and relate these issues to problems in dance technique. In post-screening workshops, information can be provided on the structure of joints and relationship to proper anatomical alignment. Based on the individual profiles, each student receives recommendations for a cross training program: exercises to improve strength, stretching to improve flexibility, aerobic training to improve aerobic capacity. Other topics can include a review of dancers’ dietary needs with guidelines for good nutritional habits. The screen has become an important tool for teaching student dancers about technique errors and anatomy-kinesiology.

In addition, ADAM Center physical therapists have an ongoing dialog about healthcare concerns with Dance USA and Dance UK, organizations that support dance companies, administrators, and dancers. The ADAM Center provides assistance to dance companies, schools, and departments seeking to establish screening, wellness, and prevention programs of their own. Ms. Bronner is on the advisory board of Dance Teacher magazine, consults with Dance Teacher and Pointe magazines on articles, and has been invited to present workshops on dance wellness at their conferences.


Injury Surveillance

An important development in both occupational and sports medicine research was the creation of surveillance systems to document incidence, magnitude and patterns of injury; thus identifying high-risk groups and generating hypotheses of injury risk factors. This was a first step toward implementing effective change.

One of the strengths in both sports and dance medicine research is the description of patterns of injury. However, lack of standardized and clearly defined terminology has complicated comparison of injury rates within sports and dance medicine literature. Adopting a commonly accepted definition of injury is the first of many criteria necessary to develop standardized systems for surveillance. Other criteria include description of the population, exposure, and injury severity, type, and anatomic region. The definition of severity and type of injury are also important in any discussion of injury patterns. Several time-based definitions of severity exist including: minor (less than one week), moderate (1 to 4 weeks), and severe (more than 4 weeks).6 Definition of injury type: overuse v. traumatic, and anatomic region permits analysis of patterns of injury.        

Reporting exposure duration to the activity is an important way to relate injury to time on task. Dance medicine researchers must begin to calculate annual dance exposure by recording the number of contracted employment weeks, hours of dancing per week, number of performance or rehearsal weeks, total number of performances, and number of touring weeks. To allow comparison of injury rates between populations, exposure measures are incorporated into incidence calculations. In sports, this is defined as the number of injuries per 1000 hours of sports participation.7           

In any surveillance system it is also important to include contextual information about the injury, including venue (in or outdoors, raked or non-raked stage), choreography, and activity (class, rehearsal, or performance). This information helps to explain the relationship of exposure and type of workload to injury. Implementation of standards of definition and reporting will permit comparison of one dance population to another, or dance to various sports or occupational injuries.

Based on the dance screening and surveillance programs developed in their work with Alvin Ailey, the ADAM Center is currently developing software to serve as a dance injury surveillance, screening database and analysis tool.


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