Therapeutic Clowning Research Articles

Resonance: A Brain-Computer Interface Assemblage of EEG, Sound, and Therapeutic Clowns for the Detection of Consciousness

Abstract A growing number of individuals live with medical conditions and injuries that render them minimally communicative. Assessing their level of consciousness and awareness is a major challenge that has profound implications for care decisions and their relationships. Resonance: a novel brain-computer interface assemblage, is designed to detect and augment expressions of consciousness in minimally communicative individuals. Resonance consists of (1) high-density EEG features that vary with states of consciousness; (2) sound; and (3) therapeutic clowns. Seven EEG features of consciousness are calculated in real time and mapped to sonic output. Therapeutic clowns use multisensory improvisational play to interact with these sonified brain features to create interpersonal connections with minimally communicative individuals. Resonance has the potential to reveal real-time variations in an individual’s level of consciousness, which may create an entirely new form of interpersonal interaction with minimally communicative persons.

The Clown and His Therapeutic Play. Le Rire Médecin

The clown, often referred to as the "perfect actor," possesses a remarkable ability to improvise, a crucial skill in communicating with the audience. The evolution of the clown has been long and complex, culminating in excellent theater therapy within medical settings. Thanks to a scholarship obtained through the European Erasmus Program, I had the opportunity to participate in meetings with therapeutic clowns in Nancy, France, through the welcoming organization Le Rire Médecin. Observing the activities of these clowns at the Children's Hospital in Nancy, their interactions with patients, their families, medical staff, and all hospital personnel, was an astonishing experience for me as an artist and educator. Theater therapy employs improvisation and other theatrical techniques to explore and address personal issues, develop self-confidence, and even address some cases of depression and anxiety. Clown therapy can bring joy, having a positive impact on mental and emotional health, offering individuals a break from the worries and pressures of daily life.

“I made you a small room in my heart”: how therapeutic clowns meet the needs of older adults in nursing homes

ABSTRACT Therapeutic clowns are increasingly common in nursing homes, where residents often encounter factors that can undermine their quality of life and dignity. We aimed to understand the strategies of successful therapeutic clowning with a diverse older adult population, and the unique contributions of elder-clowning to the nursing home experience. Using an interpretivist descriptive methodology, twenty-three (n=23) experienced therapeutic clowns from eight countries were interviewed to understand the needs of nursing home residents met by elder-clowns, and strategies and techniques the clowns use to address them. Participants identified five major needs: to escape routine; for reassurance of worth; for meaningful, personalized social interaction unrestricted by communication barriers; to have culturally meaningful opportunities for reminiscence; and to have a space where residents could be unapologetically themselves. The artistic and emotional strategies used by the therapeutic clowns to address these needs illustrate how creativity, imagination and relational presence can provide nursing home residents with a sense of being known and belonging. Elder-clowns also positively affect the nursing home staff and enrich the interpersonal interactions in the residence. Through their focus on the social and emotional needs of residents, elder-clowns can play an important and distinct role in creating an optimal nursing home experience.

From Laughter to Medicine, from Clowning to Therapy

“Laughter is the best medicine,” was just a saying up until, therapeutic clowning started using humour and play to bring about emotional healing and psychological recovery. This article attempts to review 27research based articles in a thematic fashion, to develop a comprehensive understanding about therapeutic clowning, its effects across different conditions and specific populations, and how it could be established as a profession. The review not only adds to the existing literature on medical clowning, but also tries to highlight the therapeutic nature of it, and how it lends itself in maintaining the holistic well-being of the diseased or disabled. After close examination, it was found out that therapeutic clowning has positive and sustainable consequences for community well-being. This also expands further scope for future researches to measure the effects of therapeutic clowning so that it could be accepted as an intervention model or a psycho-socio-emotional rehabilitation model.

“We are still doing some magic”: Exploring the effectiveness of online therapeutic clowning

ABSTRACT Background Therapeutic clowns use embodied practices to engage with clients, their families and healthcare staff to empower patients and create therapeutic relationships. This study explored the effectiveness of a virtual therapeutic clown initiative. Methods Thirteen therapeutic clowns participated in a semi-structured interview to discuss their experiences with online clowning; additionally, four dyads consisting of a clown duo and a client explored multiple perspectives of a shared online clowning experience. Data were analyzed according to the six core competencies of therapeutic clowning. Results Although all therapeutic clowns and caregivers reported challenges and limitations with the medium, virtual therapeutic clowning was effective for empowering clients and forming therapeutic relationships. Clowns successfully used many strategies to maintain their core clowning competencies in the virtual environment. Conclusions Virtual clowning may be more beneficial for some clients than in-person clowning and has the potential to extend therapeutic clowning beyond its traditional domains of practice.

Effects of therapeutic clowning on pain and anxiety during venous blood sampling in Turkey: Randomised controlled trial.

The research aim was to investigate the effects of therapeutic clowning on pain and fear during the process of venous blood sampling in children. This study was conducted in a randomised controlled trial from January to March 2020. The study population consisted of children from 7 to 12 years of age who came to the research centre for blood sampling. The research sample consisted of 166 children (83 in the intervention group and 83 in the control group) who met the research criteria and came to the research centre on a specific date through probable sampling. For the data collection, a questionnaire form, the Visual Analogue Scaleand the Children's Fear Scalewere used. Therapeutic clowning was used in this process for the intervention group. There was no intervention for children who were in the control group. The calculation of percentage distribution and means, χ2 test, analysis of variance analysis in repeated measures and least significant difference and independent t-test were used to analyse the data. The results of the research indicated that children in the intervention group had significantly lower pain and fear than children in the control group (p < .001). Therapeutic clowning seems to effectively reduce pain and fear during venous blood sampling for children from 7 to 12 years of age. Our results support using therapeutic clowns which is an inexpensive, safe, and effective method for lowering children's pain and fear during venous blood sampling. The use of therapeutic clowns could become the standard of care in blood sampling for children from 7 to 12 years of age in hospitals. Therapeutic clowning, which is an easy-to-use, low-cost and practical method to provide better communication and cooperation with the family and the child, can be used as a complementary therapy in all nursing areas, especially in the field of paediatrics. Nurses could be encouraged to be trained on the use of therapeutic humour based upon a standardised approach and offered guidance on how to apply entertaining methods such as clowns. Therapeutic clowning can be examined in other applications in nursing care in light of these results.

Designing a paediatric hospital information tool with children, parents, and healthcare staff: a UX study

BackgroundThe hospital patient pathway for having treatment procedures can be daunting for younger patients and their family members, especially when they are about to undergo a complex intervention. Opportunities to mentally prepare young patients for their hospital treatments, e.g. for surgical procedures, include tools such as therapeutic clowns, medical dolls, or books and board games. However, while promising in reducing pre-operative anxiety and negative behaviours, they may be resource intensive, costly, and not always readily available. In this study, we co-designed a digital hospital information system with children, parents and clinicians, in order to prepare children undergoing medical treatment.MethodThe study took place in the UK and consisted of two parts: In part 1, we purposively sampled 37 participants (n=22 parents, and n=15 clinicians) to understand perceptions and concerns of an hospital information platform specifically design for and addressed to children. In part 2, 14 children and 11 parents attended an audio and video recorded co-design workshop alongside a graphic designer and the research team to have their ideas explored and reflected on for the design of such information technology. Consequently, we used collected data to conduct thematic analysis and narrative synthesis.ResultsFindings from the survey were categorised into four themes: (1) the prospect of a hospital information system (parents’ inputs); (2) content-specific information needed for the information system (parents’ and clinicians’ inputs); (3) using the virtual information system to connect young patients and parents (parents’ inputs); and (4) how to use the virtual hospital information system from a clinician’s perspective (clinicians’ inputs). In contrast, the workshop highlighted points in times children were most distressed/relaxed, and derived the ideal hospital visit in both their and their parents’ perspectives.ConclusionsThe findings support the use of virtual information systems for children, in particular to explore and learn about the hospital, its facilities, and the responsibilities of healthcare professionals. Our findings call for further investigations and experiments in developing safer and more adequate delivery of care for specific age groups of healthcare users. Practical and theoretical implications for improving the quality and safety in healthcare delivery are discussed.

Therapeutic Clowning in Pediatric Practice: A Novel Concept to Think About in India

Therapeutic Clowning in Pediatric Practice: A Novel Concept to Think About in India

The Evolution of a Clown in Service: Reflections on Therapeutic Clowning in Canada

Drawing on their experience as therapeutic clown practitioners, reflective practice facilitators, and trainers, the authors reflect thoughtfully on three key questions: What is the deeper nature of this relational practice called therapeutic clowning? Why are seasoned professional performers increasingly being drawn to this practice? What kinds of adaptations and considerations does a clown artist undertake to move from the world of theatre and performance to the world of health care and compassionate service? Beginning with a brief look at the evolution of therapeutic clowning in Canada and abroad, the authors turn to a deeper consideration of practices in pediatric, adult, and dementia-care settings. Child life and clown doctor pediatric models of therapeutic clown are delineated, as is the Elder-clown approach used by many practitioners working with older people in long-term care and community care. The authors emphasize the importance of reciprocity and co-created play between practitioner(s) and the people they serve and consider the role these play in bolstering resilience, vitality, and a sense of agency in the lives of vulnerable people in hospital and institutionalized care settings. The article also emphasizes that foundational clown training and performance experience alongside specialized training are crucial for therapeutic clown practitioners. Throughout, poignant vignettes illustrate and illuminate the complex, challenging, and rewarding dimensions of therapeutic clown practice.

Clowning but Not: A Clown’s Approach to Drama for People with Intellectual and Physical Disabilities

Even without the red nose and costume, clowning has much to offer when used as an approach to teaching creative drama to people with intellectual and physical disabilities. Clown humour and animated play encourage creativity, movement, and self-expression. With a clown-like approach, markers for success change and become more relevant to the level at which participants are working. Using a clown approach allows participants to expand their capacities by releasing the fear of not accomplishing their goals. In fact, slipping up and failing at tasks are good reasons for the group to laugh and relax. In my experience in setting up drama programs at the Manitoba Developmental Centre, I discovered the value of the clown’s flop. By embracing failure, participants were more able to enjoy taking risks. Non-verbal communication skills and object transformation, common to clown play, also created new possibilities for the participants’ creativity and expression. As a result, they were able to move, play, and communicate in unexpected ways and put on a performance for 300 people. The community of therapeutic clowns—including Karen Ridd, Joan Barrington, and organizations like the Dr. Clown Foundation—engages a similar approach to working with the public. They embrace failure and succeed at bringing joy through humour, clown antics, and play.

Effects of Therapeutic Clowning on Pain and Anxiety During Intrathecal Chemotherapy in Turkey

PurposeThe aim of the present study was to explore the effect of therapeutic clowning on pain and anxiety during intrathecal chemotherapy. Design & methodsThe study was conducted using a quasi-experimental method with a pretest-posttest control group design. The study sample was composed of children between 7 and 12 years old (N = 78) who had been diagnosed with acute myeloid leukaemia and acute lymphoblastic leukaemia and were undergoing intrathecal chemotherapy in a hospital in Turkey. The study was conducted with children who received services at this hospital. The results were obtained from 74 children (i.e. 36 in the control group, 38 in the clown group). The data were collected with a questionnaire developed by the researchers, the Visual Analogue Scale (VAS) and the Faces Pain Rating Scale (FACES). VAS and FACES were used to measure pain and anxiety levels. Therapeutic clowning was applied to children in the intervention group. Analyses included percentage distributions, mean, chi-square, t-test, variance, and correlation analysis. ResultsResults showed that children in the clown group had significantly lower pain and anxiety than children in the control group (p < .001). ConclusionsAccording to the results, therapeutic clowning was effective in relieving the pain and anxiety of children between the ages of 7 and 12 years who undergone intrathecal chemotherapy. Practice implicationsDue to its positive effects, therapeutic clowning could be explore for use in other areas of paediatric nursing for the children between the ages of 7 and 12 years as a complementary treatment.

Being a therapeutic clown- an exploration of their lived experiences and well-being

Therapeutic clowning uses humor and play to minimize the stress for patients and their families during hospitalization. This study aims to explore the subjective meaning of therapeutic clowning through clowns’ perspective, understand why they continue clowning and interpret how it has impacted them. The research design takes a qualitative approach using phenomenological paradigm. Nine therapeutic clowns between 20 and 60 years with clowning experience of 6 months-4 years from Compassionate Clowns, located at Bangalore were interviewed. The results reflected that the journey of being a therapeutic clown has been equally therapeutic for the clowns. Based on the thematic data analysis network, it was found that clowning has instilled many values in the way they think. It has given them a platform to learn new things from the children they clown. Therefore, looking at these results it could be said that therapeutic clowning serves as a medium for community service and in maintaining personal wellbeing.

Do You Have a Place for Therapeutic Clowning?

Do You Have a Place for Therapeutic Clowning?

Intervention of Medical (Therapeutic) Clowns in a Kindergarten for Children with Intellectual Disability: A Case Study

ABSTRACTIn recent years, there is growing evidence for the efficacy of medical clowning as a para-medical profession. In the present study, we explored the possibility of expanding the work of medical clowns into the special education system, hypothesising that medical clowns can contribute to the development of socio-emotional abilities of children with intellectual disability (ID). Two medical clowns worked with 50 children in a kindergarten cluster for children aged 3–7 with ID for 6 months. All clowning sessions were videotaped and coded using the Test of Playfulness (ToP) observation instrument. Parents and the clowns were interviewed about the children’s participation. This preliminary report presents a case study of one of the children who participated in the study. The level of playfulness after the intervention increased compared to the baseline, including social skills, use of humour and pretend play, flexibility and engagement. The mother’s interview indicates the unique gains of the clown’s intervention. The preliminary results point to the importance of clowning and free-play for children with ID, and expand the possibilities for interacting with children with ID to enhance their socio-emotional abilities.

Acute Procedural Pain in Children: Intervention With the Hospital Clown.

Hospitalized children often describe needle-related procedures as the worst pain possible and such procedures may be emotionally traumatic. The use of hospital clowns (HCs) related to painful medical procedures in children may offer pain relief, but this has not been systematically evaluated. The objective of this study was to assess the effect of a therapeutic clown in comparison with standard care on the experience of pain in children receiving venipuncture. A sample of 116 children aged 4 to 15 years consecutively admitted to the hospital was allocated to either the experimental (presence of HC) or control group (standard care) before venipuncture. Self-reported pain after the procedure was assessed using the Faces Pain Scale combined with a 0 to 10 Numerical Rating Scale. Separate analysis was conducted in age groups from 4 to 6 (N=37) and 7 to 15 (N=74) years. Without the clown present, the mean pain score (2.7±2.8) was not significantly different between the 2 age groups. Children aged 7 to 15 years had lower pain scores when the clown was present compared with the control group (P=0.025). Children aged 4 to 6 years had higher pain scores with the clown present, although the difference was not statistically significant (P=0.054). Children with pain (N=49) or previous experiences with venipuncture (N=56) did not score pain significantly differently. Assessing the pain experience of children receiving venipuncture with the presence of an HC indicates a pain relieving effect for children older than 6 years. However, future studies should carefully study the effects on younger children where mixed effects may be present.

The Effect of Therapeutic Clowning on Handwashing Technique and Microbial Colonization in Preschool Children

This study aimed to determine the effect of therapeutic clowning on handwashing technique and microbial colonization in preschool children. This randomized controlled trial was conducted using pre-test and post-test experimental and control groups. The study was conducted between March and June 2016 in two kindergartens in eastern Turkey. The study was completed with a total of 195 students, including 90 students in the experimental group and 105 students in the control group. A questionnaire was used for data collection. This questionnaire included sections about the subjects' descriptive characteristics and the results of the bacterial cultures of their hand swabs. For the collection of these swabs, the subjects were informed in advance, and samples were collected at predetermined times. The swabs were analyzed to determine the bacterial colonization of the subjects' hands. Clowns and video activities were used as intervention tools in the study. In the post-test, the microbial growth was ≤103 in 68.9% and >103 in 31.1% of the subjects in the experimental group. In contrast, the growth was ≤103 in 34.3% and >103 in 65.7% of the control group subjects. The difference in the post-test microbial growths of the two groups was statistically significant (p < .000). The hygienic handwashing technique taught in the therapeutic clowning and videos reduced the bacterial colonization on the preschool children's hands by 50%. Moreover, this method was effective in reducing the growth rate of coliform bacteria that indicate undesirable, poor hygiene of the hands. Considering these results, we recommend that pediatric healthcare professionals use entertaining methods such as those involving clowns to teach and guide children regarding hygienic handwashing techniques.

Erratum to: Therapeutic clowns in pediatrics: a systematic review and meta-analysis of randomized controlled trials.

Children and/or their parents are in fear and anxiety when admitted to hospitals or undergo invasive surgeries or investigations. Clown therapy has been shown as an effective measure in reducing this hospital fear and anxiety. Hence, we carried out a systematic compilation of the existing evidence on the clinical utility of hospital clowns in pediatric population. Electronic databases were searched with an appropriate search strategy, and only randomized controlled trials comparing the effect of clown therapy with standard care in children were included. The key outcome measures were as follows: extent of anxiety and pain felt by children and extent of state and trait parental anxiety. Random effect model was applied when moderate to severe heterogeneity was observed. Forest plot, I2 statistics and risk of bias were evaluated using RevMan 5.3 software. A total of 19 studies were found eligible to be included in the systematic review and 16 for meta-analysis. The pooled SMD [95 % CI] for child anxiety score was −0.83 [−1.16, −0.51] favoring clown therapy. Similarly, a statistically significant reduction {SMD [95 % CI] −0.46 [−0.7, −0.21]} in the state anxiety was observed amongst parents. Conclusion: We found that hospital clowns play a significant role in reducing stress and anxiety levels in children admitted to hospitals as well as their parents.

Therapeutic clowns in pediatrics: a systematic review and meta-analysis of randomized controlled trials.

Children and/or their parents are in fear and anxiety when admitted to hospitals or undergo invasive surgeries or investigations. Clown therapy has been shown as an effective measure in reducing this hospital fear and anxiety. Hence, we carried out a systematic compilation of the existing evidence on the clinical utility of hospital clowns in pediatric population. Electronic databases were searched with an appropriate search strategy, and only randomized controlled trials comparing the effect of clown therapy with standard care in children were included. The key outcome measures were as follows: extent of anxiety and pain felt by children and extent of state and trait parental anxiety. Random effect model was applied when moderate to severe heterogeneity was observed. Forest plot, I(2) statistics and risk of bias were evaluated using RevMan 5.3 software. A total of 19 studies were found eligible to be included in the systematic review and 16 for meta-analysis. The pooled SMD [95% CI] for child anxiety score was -0.83 [-1.16, -0.51] favoring clown therapy. Similarly, a statistically significant reduction {SMD [95% CI] -0.46 [-0.7, -0.21]} in the state anxiety was observed amongst parents. We found that hospital clowns play a significant role in reducing stress and anxiety levels in children admitted to hospitals as well as their parents. • Trials with clown doctors in pediatric population have shown conflicting results in allaying anxiety amongst children undergoing either hospitalization or invasive procedures What is new: • This is the first systematic review and meta-analysis on hospital clowns • We found out that hospital clowns reduce anxiety amongst children before undergoing either hospitalization or invasive procedures.

A clown most serious: Patch Adams

Patch Adams is profiled, based on an interview in his home conducted in December 2012. Adams' contribution to therapeutic clowning is discussed and analyzed.

The Effect of a Medical Clown on Pain During Intravenous Access in the Pediatric Emergency Department

We report the effect of the presence of a medical clown during insertion of an intravenous catheter during their emergency department visit. Prospectively randomized to either the presence or absence of a male medical clown during the procedure. Pain was assessed using the Faces Pain Scale-Revised in children 4 to 7 years old, and visual analog scales in children 8 years and older. Parental situational anxiety was recorded using the State-Trait Anxiety Inventory after the procedure. The presence of a medical clown during a painful procedure in the pediatric emergency department tended to improve pain scores in children younger than 7 years. Parental situational anxiety was significantly reduced in parents of children older than 8 years (P = .02). Therapeutic clowns are useful for diminishing pain and anxiety during painful procedures being performed on children in the emergency department.