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 spatial engagement 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 (Fisher & 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. Together, these findings indicate that aspects of motor fitness and breath may warrant future objective evaluation and standardized measurement.

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 definition, 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 (Doll et al., 2016; Gerbarg et al., 2019). In DMT breath is a therapeutic tool that can be consciously modulated to support grounding (De Tord & Bräuninger, 2015), self-awareness (Mehling et al., 2011), and nervous system regulation (Barbera, 2024; Berrol, 1992). 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 (Fisher & Freeman, 2022). Physiologically, breath is a central component of the cardiorespiratory system, directly influencing heart rate, oxygen exchange, and autonomic nervous system balance (Russo et al., 2017). Slow, diaphragmatic breathing activates the parasympathetic branch of the autonomic nervous system, promoting relaxation and reducing sympathetic arousal – key mechanisms in trauma-informed care (Zaccaro et al., 2018). Consequently, breathwork offers a non-invasive accessible strategy for regulating internal states (Giorgi & Tedeschi, 2025), especially for individuals experiencing hypervigilance or chronic stress (Banushi et al., 2023; Fincham et al., 2023). In DMT, the clinicians 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 spatial engagement (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 use 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(e) [sic] 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 treatment—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). This study found that respondents rated speed and reaction time 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., 1997). 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 disorders 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 [sic] 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 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). Synchrony is a core element of DMT practice, whether it is the ability to synchronize with the self or others. The ability to synchronize movement requires coordination and it is used to improve the ability to understand and share the feelings of others through physical attunement (Behrends et al., 2012; Manders et al., 2021). This research team selected coordination as the overarching concept for synchrony, phrasing, and body integration for the purposes of this study. 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. To try to capture this, recent studies have rated movement-based mirroring tasks during DMT and used 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, 2025). 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. Future assessment frameworks should consider that accuracy in DMT is grounded in authenticity, expressive clarity, and interpersonal attunement, rather than external performance outcomes, to ensure that objective measures align with the clinical meaning of this construct.

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 should focus on creating and validating standardized movement-based assessment tools that integrate components of motor fitness and physiological signals such as breath quality. Leveraging wearable technologies including accelerometers, heart rate monitors, and respiration sensors may offer non-invasive ways to track movement and autonomic regulation across a range of therapeutic sessions. Longitudinal and observational designs would clarify how changes in breath, motor fitness and spatial engagement relate to therapeutic outcomes. For dance/movement therapists and other clinicians, these current findings provide a refined framework that can support clearer goal setting, documentation and interdisciplinary communication. By clarifying which movement components practitioners view as most clinically meaningful, this study establishes a clear direction for future research and the development of clinically useful assessment strategies. As part of these future directions, our research team is developing protocols to evaluate the use of wearable technologies in DMT and exploring their application in studies designed to assess therapeutic outcomes. These efforts aim to operationalize the constructs identified in this study and further integrate objective physiological and kinematic data into DMT assessment and research. Together, these directions highlight the potential for more precise, embodied, and evidence‑informed approaches to assessment in dance/movement therapy.

This study has several limitations. Participant selection was non-random. 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. Some constructs, such as Movement Accuracy, draw from both fitness and DMT terminology, which may be understood differently across disciplines. This variability may have influenced how respondents interpreted and rated these items. Another limitation is that the construct originally labeled “Available Space” may not have been interpreted consistently by respondents. Although the items reflected spatial engagement, the category title could have suggested either the amount of physical space or the mover’s dynamic use of space, potentially contributing to varied interpretations and influencing responses. Future studies could incorporate observational or longitudinal methods to examine how movement and breath patterns change over time and relate to therapeutic outcomes.