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Project Pulse: A Dance Research Experience (Published Paper)

Casey Lee Thorne (2021): Project Pulse: A Dance Research Experience, Journal of Dance Education, DOI: 10.1080/15290824.2020.1846741

Publication Date: January 25, 2021

ABSTRACT
The research outlined in this article offers a systematic training methodology for students and licensed Traditional Chinese Medicine (TCM) practitioners to learn the clinical art and science of pulsology through dance. One of the greatest hurdles in learning pulse palpation is a TCM practitioner’s inability to feel the pulse with a degree of certainty that adds value in a clinical setting. Through inter-operator reliability testing, our research indicates that if practitioners learn and repeat pre-choreographed movements that represent pulse imagery, there is increased agreement amongst the group as to what pulses are being expressed in the bodies of patients. The implications of our research are that TCM practitioners are able to increase their ability to feel pulses in their patients by dancing the pulses, thus making more informed diagnoses in a clinical setting.

INTRODUCTION
Traditional Chinese Medicine (TCM) training in pulsology, or pulse palpation training, was through apprenticeship, which typically consisted of ten years of persistent training with a master practitioner (Broffman 2018). In modern times, pulsology is taught as part of the curriculum in TCM schools, largely by way of didactic theory (Flaws 1995). Students learn the names of pulses, their distinguishing characteristics, and what they indicate about the body through reading, lectures, and seminars (Porkert 1983). The problem with didactic teaching methodologies in relationship to pulse palpation training is that they ignore feeling the movement as primary and rush the student to meaning. This would be akin to learning a dance by reading about what the steps are and how they feel versus embodying and experiencing them first-hand. Although hands-on training is also a part of TCM schools, in order for modern TCM practitioners to achieve enough competency in pulse palpation to use in a clinical setting, new educational methodologies that focus on how to feel the pulse are required. Our hypothesis for Project Pulse: A Dance Research Experience is that by dancing the pulses, TCM practitioners will create neuro muscular brain pathways that will activate when feeling the same qualitative movements in the pulses of patients, helping them to identify pulses better, and thus make more informed diagnoses in a clinical setting.

BACKGROUND
Pulse examination in modern Traditional Chinese Medicine primarily entails a TCM practitioner using their index, middle, and ring fingertips to palpate the pulse of a patient at the radial arteries of both wrists (Flaws 1995). The traditional Chinese pattern of pulse taking is based on touching the wrist with three levels of pressure: superficial palpation (almost no pressure, to feel the bounding of the pulse up to the skin surface); intermediate palpation (light pressure, to feel the basic pulse form); and deep palpation (somewhat heavy pressure, to feel how the pulse is able to emerge from the physical constraint) (Broffman 2018). In addition, the changes in pulse feeling as one moves from less to more pressure, and again from more to less pressure, can also give some information about the resilience of the pulse (Fang, Wu, and Cheng 2013). There are nine pulse takings on each wrist: one for each of the three pulse taking fingers at each of the three levels of pressure (Broffman 2018).

It is believed that the pulses felt at the radial arteries indicate the balance and/or imbalance of qi, blood, and the bodily fluids of the entire body (Flaws 1995). The aim of pulse diagnosis is to obtain useful information about what goes on inside the body, what has caused disease, what might be done to rectify the problem, and what the chances of success are (Broffman 2018). According to TCM, the pulse can identify whether a syndrome is of a hot or cold nature, whether it is of excess or deficiency type, which of the humors (qi, moisture, or blood) are affected, and which organ systems suffer from deficiency or excess (Ching and Halpin 2017). A pulse reading can be an invaluable diagnostic tool that informs how a TCM practitioner may administer acupuncture and/or prescribe herbal remedies for the patient, among other integrated methods (Micozzi and Repeti 2011). However, for pulse palpation to be a beneficial diagnostic tool, the TCM practitioner must be able to feel and differentiate up to thirty different pulses.

Sensory Based Learning
Recent studies at the intersection of neuroscience and cognition have shown strong correlations between bodily movement, or dance, and brain development (Borhan et al. 2018). In a 2015 Harvard Mahoney Neuroscience Institute article entitled Dancing and the Brain, Scott Edwards outlines the parts of the brain that contribute to dance learning and performance:

Studies using PET imaging have identified regions of the brain that contribute to dance learning and performance. These regions include the motor cortex, somatosensory cortex, basal ganglia, and cerebellum. The motor cortex is involved in the planning, control, and execution of voluntary movement. The somatosensory cortex, located in the mid-region of the brain, is responsible for motor control and also plays a role in eye-hand coordination. The basal ganglia, a group of structures deep in the brain, work with other brain regions to smoothly coordinate movement, while the cerebellum integrates input from the brain and spinal cord and helps in the planning of fine and complex motor actions. (Edwards 2015)

Not only does dancing activate parts of the brain, bodily movement actually builds brains, too. As affirmed in Rodolfo Llinás’s 2001 book I of the Vortex, Llinás asserts that the nervous system evolved to allow active movement in animals, movement that keeps them alive by enabling them to anticipate the consequences of their movements. The implications of this research offer an argument in favor of the efficacy of movement-based learning modalities like Project Pulse, if movement in fact predicates brain development, and thus cognition (Llinás 2008).

Further studies have discovered that dancing is associated with a reduced risk of dementia (Verghese et al. 2003), and that synchronizing music and movement (dance) constitutes a “pleasure double-play” where music stimulates the brain’s reward centers and dance activates its sensory and motor circuits (Krakauer 2008). It has also been shown that dancing releases mood boosting endorphins and aids in the development of social interactions (Redcay and Warnell 2018).

Recent studies on mirror neurons reveal that identical sets of neurons can be activated in an individual who is simply witnessing another person performing a movement as the one actually engaged in the action or expression, functionally building empathy (Berrol 2006). Essentially, watching, or witnessing dance is a way to learn dance beyond doing dance. In our workshop, practitioners do the pulse choreography and also watch their teacher and watch each other perform the pulse movements. Theoretically, watching, as well as doing, stimulates learning. We can take this one step farther if we imagine feeling the pulse with our fingertips as a process of seeing the pulse choreography. In other words, pulse palpation becomes a process of image association, or drawing connections between the fingertip sensation and a moving image (the pulse choreography). In a clinical setting, when “watching” or palpating the pulse movement of a patient, a practitioner who has engaged in Project Pulse training can theoretically become more effective in drawing connections between the image (choreography) and the sensation of the pulse in a patient, augmenting their ability to identify what the pulse is.

The Creative Process: Choreographic Thinking
Project Pulse began with an immersive educational experience between licensed acupuncturist Michael Broffman and myself. I had very little knowledge of TCM when we began working together. Broffman intentionally communicated minimal information to me about each of the thirty pulses when we began, in order to see if the choreographic methodology I would develop would successfully teach me how to take an accurate pulse reading in a patient without having any prior didactic learning experience. We discussed chapters in Nan Jing, one of the main books of TCM, and engaged in philosophical dialogue about the nature of knowledge, perception, language, location, correctness, and movement. My movement research began instinctually and intuitively, the logic being that I would be the first site of our research. In other words, my being a novice offered us an opportunity to test our hypothesis: if you can feel the pulse movement in your own body as dance, you will be able to accurately feel and then identify the pulse movement in others. After a few months, I successfully identified pulses in others with 85% accuracy, as determined by Broffman, without having any prior training in TCM. Our method seemed to be working, at least with me.

The ultimate goal of Project Pulse was to create a workshop that would teach pulsology through dance. We set a cap of twenty practitioners per workshop to ensure individualized attention. TCM students and practitioners would be awarded Continued Education Units (CEUs) for successfully completing our workshop, creating incentive to attend since it is required by state law, at least in California, that all licensed TCM practitioners achieve fifty CEUs every two years to renew their license (State of California Acupuncture Board 2014). To date we have completed one beta test to gauge the efficacy of our work, and two full workshops.

We had two primary goals in setting the choreography. The first was to ensure that the choreographed movement represented each pulse accurately and efficiently. Each movement needed to feel like what the pulse feels like sensorially. Second, every movement needed to be accessible for bodies of mixed ability, physical fitness, and limited (if any) exposure to dance. The chosen strategy was to minimize movement into and out of the floor and to keep the lower body stationary with the exception of pedestrian movements like walking and running and shallow knee bends. The movements can also be successfully modified sitting in a chair. It is important to acknowledge that there will likely be challenges around accessibility as our workshops unfold. We are dedicated to ongoing improvement.

Each choreographed pulse movement is initiated by an idea. Teaching begins with a spoken prompt communicating an idea via sensory-based imagery. The prompt calls upon a specific sensorial quality or image that corresponds with the pulse at hand. The idea initiates the movement, followed by corresponding arm gestures and movements of the head and torso with subtle bending and straightening of the knees (if done standing). The information lies in the energetics of the movement. What can be communicated about pulsology via movement is communicated by way of the level, tempo, force, scale, quality, elasticity, rhythm, and trajectory (both traveling and stationary) of that movement. The movements are the pulses.

The Thirty Pulses
The choreographed flow of dancing the thirty pulses follows the order of eight characteristics: depth, rate, strength, volume, texture, pliability, rhythm, and length in three continuous sequences. By organizing the thirty pulses into three passes, we offered practitioners a process of elimination to help them deduce what pulses they might feel in a clinical setting (see Figure 1). In other words, practitioners are encouraged to ask the following series of questions to help them determine what pulse they are feeling:

(1) First, is the pulse superficial or deep?
(2) If deep, then is the pulse large or small?
(3) If small, then is the pulse strong or weak?
(4) If weak, then is the pulse hard or soft?
(5) If soft, then this is the Fine Pulse (for example)

The choreographed flow of all thirty pulses follows the same format as the three passes. The first pass includes seventeen pulses organized in order of the eight characteristics as oppositional pairs. These seventeen pulses are taught on day two of the workshop:

(1) Normal
(2) Simple Floating (Characteristic: Depth)
(3) Simple Deep (Characteristic: Depth)
(4) Simple Fast (Characteristic: Rate)
(5) Simple Slow (Characteristic: Rate)
(6) Qi Excess (Characteristic: Strength)
(7) Qi Deficient (Characteristic: Strength)
(8) Large (Characteristic: Volume)
(9) Fine (Characteristic: Volume)
(10) Slippery (Characteristic: Texture)
(11) Rough (Characteristic: Texture)
(12) Taut Bowstring (Characteristic: Pliability)
(13) Simple Bowstring (Characteristic: Pliability)
(14) Fast Irregularly Interrupted (Characteristic: Rhythm)
(15) Slow Irregularly Interrupted (Characteristic: Rhythm)
(16) Long (Characteristic: Length)
(17) Short (Characteristic: Length)

The second pass includes eight pulses, following the order of the eight characteristics with the exception that rate and strength were flipped to accommodate for choreographic fluidity, and texture, pliability, and length are absent. The second pass is not organized in oppositional pairs. These eight pulses are taught on day three of the workshop:

(18) Hidden (Characteristic: Depth)
(19) Firm (Characteristic: Depth)
(20) Simple Weak (Characteristic: Strength)
(21) Faint (Characteristic: Volume)
(22) Extremely Fast (Characteristic: Rate)
(23) Moderate (Characteristic: Rate)
(24) Flooding (Characteristic: Volume)
(25) Regularly Interrupted (Characteristic: Rhythm)

The third pass includes five pulses, following the order of the eight characteristics, not including strength, texture, rhythm, or length. These five pulses are also taught on day three of the workshop:

(26) Weak Floating (Characteristic: Depth)
(27) Scattered (Characteristic: Depth)
(28) Stirred (Characteristic: Rate)
(29) Scallion Stalk (Characteristic: Volume)
(30) Drumskin (Characteristic: Pliability)

Figure 1

Going into our workshop, we understood that practitioners may have learned pulses by different names based on where they had studied, with whom, and what Chinese translations they had learned (Broffman 2018). To help minimize confusion, we created a glossary to define the terms used in our workshop. The glossary was given to each participant at the start of the workshop as part of their welcome packet. For easy reference during workshop time, we printed large scale posters with the same information which are hung on the walls of the dance studio where our workshops take place.

The names of the pulses are needed to help us accomplish our pedagogical goals, i.e. to be able to guide participants to feel different qualities of movement in their own bodies. As such, some of the names we used do not match up with what is taught in TCM schools today (Broffman 2018). One example of this is our use of the term “simple” to describe a pulse. These simple pulses never actually occur in the body. Pedagogically, they help us to distinguish the aforementioned eight characteristics that define a pulse. For example, the “simple floating” and “simple deep” pulses, when choreographed into movement, function to demonstrate the characteristic of depth. The “simple fast” and “simple slow” pulses, when choreographed into movement, function to demonstrate the characteristic of speed. Practitioners move at high and low levels when doing “simple floating” and “simple deep,” thus feeling depth. Practitioners move quickly and slowly when doing “simple fast” and “simple slow,” thus feeling speed, etc. Although the simple pulses do not exist in the body, they help practitioners determine a dominant distinguishing characteristic of a pulse which can lead them one step closer to identification, and then diagnosis, when taking pulses in a clinical setting. This methodology is based in a foundational compare and contrast rationale, highlighting opposites as a way toward differentiation. It is important to note, however, that many pulses have composite characteristics. We used a choreographic game of charades, outlined later in this article, to explain pulse composites.

The Workshop—Day One
The beta test and our first two workshops were three days long. The first day began with introductions and ice breaker exercises, such as the enactment of a theatrical play written by Broffman (See Figure 2). The play explains differing viewpoints of Chinese philosophy in an effort to highlight that the underlying belief systems of a TCM practitioner may sway or influence how they listen to and interpret a patient’s ailments. In the context of our project, inherent biases may lead to inaccurate pulse readings (Flaws 1995).

Figure 2

After the play, we explained the inter-operator reliability test. In order to gauge the effectiveness of our workshop, we needed to measure the accuracy of a participant’s pulse taking skills before and after our workshop. Our hope was that we could prove quantitatively that by dancing the pulses, a TCM practitioner would be able to feel and identify the pulses more accurately. We invited six volunteers to the dance studio on the morning of the second day of the workshop so that they could have their pulses taken by the workshop participants. Our workshop participants would break into groups of three and would alternate between three jobs: 1) pulse taker, 2) pulse transcriber, and 3) timekeeper. Each participant would take the pulse of the volunteer for five minutes and transcribe their answers on a form (see Figure 1 above) we designed specifically for this project that follows a process of elimination. The workshop participants repeat this process on day three of the workshop with the same volunteer and group of three after they have danced and learned the pulse choreography. We then compare the before and after results.

Rather than have our expert, Broffman, take the pulse of each volunteer, establish his readings as accurate and true, and then measure the accuracy of the workshop participants’ answers against Broffman’s, we decided to use inter-operator reliability to measure our data and determine the effectiveness of our workshop. Interoperator reliability is the degree of agreement among raters (Gwet 2008). It is a score of how much homogeneity or consensus exists in the ratings given by various judges. Since pulses can vary based on the time of day, season, and whether or not someone has eaten recently, among other things, there can be variation in a pulse reading from one moment to the next. The group consensus offered more valuable data for this project.

The Workshop—Day Two
Day two of the workshop began with the inter-operator reliability test (see Figure 3), followed by a full day of dancing. Our workshops were held in dance studios with covered mirrors and marley floors. We felt it was important for workshop participants to practice in a dance studio in order to get them out of their habitual comfort zones and reinforce our attention to movement. If there was music or sound in our workshops, it consisted of prerecorded tracks of Tibetan bells and singing bowls to provide ambiance and atmosphere, with no percussive beat. We did not move with a goal of staying in time with music or sound. The intention of the workshop is to sense the movements from the inside out, in tandem with examining the lines and shapes of the movements based on what they look like from the outside. However, we covered the studio mirrors to diffuse any self-consciousness. Once the students get the hang of the choreography, they are encouraged to focus on the feelings of the movements they are making as opposed to solely copying or mimicking the teacher.

Figure 3

The day two morning session included a two-hour warm-up designed to incrementally expose the participants to the pulse characteristics and choreography without them knowing it. Verbal directions were kept to a minimum so as not to distract from the experience of sensation. An improvisation-based warm-up led participants through tasks such as walking an imaginary grid that only allows right angle changes of direction and forward walking. The option of walking backwards is introduced, and we begin layering more tasks/possibilities for movement based on the eight primary pulse characteristics: depth, rate, strength, volume, texture, pliability, rhythm, and length. The pace of the walking then opens up, as well as how much distance is traveled, until eventually the walking itself starts to morph by making the body as large or as small as it can be, as bound or as free, as even or uneven tempo, etc.

In between the introduction of each new warm-up idea, the participants make their way to a tactile box, fifteen of which are laid out in a line on one side of the studio (see Figure 4). The tactile boxes are designed for tactile discrimination. Whether the contents are rough, soft, squishy, stringy, or bumpy, the participant becomes more aware of and associates different textures around them. This is part of our attempt at training fingertip sensitivity based on the idea of the homunculus, which represents the motor or sensory distribution along the cerebral cortex of the brain (Nguyen and Duong 2020).

Figure 4

The warm-up ends with the participants following me as I lead them through the entire flow of the thirty choreographed pulse movements without speaking. The participants are forced into a space of doing and listening to movement without prior knowledge or experience, and thus without judgment, which is the highest aim of our workshop: to sense the movement (pulse) first, then draw conclusions.

Charades and Performance
Once we established the name and choreographed movement of each pulse and its dominant characteristic in our morning sessions, we moved toward instruction of composite characteristics in the afternoons. In our study, a composite is when more than one of the eight groups characterize the pulse (Broffman 2018). The majority of pulse readings are composites. This is a reality that mirrors the truth of movement in the body: pulses reflect the movement of and thus livelihood of bodily systems that, when considered as a relational whole, express the well-being of the body (Flaws 1995). For example, the dominant characteristic of the Fine Pulse is volume; it is small and thin. The Fine Pulse is also thready (pliable), weak (strength), and deep (depth) (Broffman 2018). Beyond composite characteristics in individual pulses, we must remember that there are also eighteen possible pulse readings, nine from each wrist, that a TCM practitioner takes in one sitting. This means that a TCM practitioner must be able to differentiate eighteen different pulses in one setting, each of which may express a composite. In other words, composite characteristics exist in individual pulses, and there are multiple pulses at play in the body at all times. A pulse reading is truly dynamic, just like well-choreographed movement.

In order to learn to feel qualities as distinct from others, our challenge was to find a way to differentiate each quality, through movement, in contrast to the others, as a way to learn to feel, and then introduce composites from there. We did this through games of choreographic pulse charades, watching pulse performances, drawing pulses, birding, and having the participants choreograph and perform their own pulse reading.

The choreographic charades included five to ten rounds of group collaboration. Day two charades dealt with the first pass of seventeen pulses, and day three charades examined passes two and three with the remaining thirteen pulses. We created index cards which contained either the names of two or three pulses, or a description of a condition/illness/imbalance in the body that is commonly found in TCM practice and the corresponding pulse expressions. Each round of charades offered a new challenge as the tasks became increasingly complex and the groups grew in numbers from two, to three, four, and finally five. The groups were tasked with dancing the composite of pulses outlined on the index cards they were given. Beyond simply standing side by side and performing the pulse choreography they had learned for each pulse one after the other, the participants were tasked with becoming choreographers. They had to find ways to combine the pulse choreography of two or more pulses to clearly depict a composite. This required them to venture into touch, weight-sharing, levels, and direction changes (See Figure 5). After they completed the task, they would perform their work for the rest of the class. The class would then try to guess what pulses they were assigned based on their performance, mimicking a classic game of charades. This offered everyone an opportunity to review the distinctive details of the pulse choreography they had learned, while taking ownership of the material. For some, building on pulse choreography was stressful due to difficulty with memorization; others had conflicts with group dynamics. The tasks required that participants developed collegiality and discourse around how they would represent the pulse composites visually and choreographically as a group, and braved new, and for some uncomfortable, territories of dancing in front of others.

Figure 5

Charades were followed by a short performance where Broffman read aloud a clinical narrative telling the story of a patient’s health over time. Composed as a structured improvisation, I would incrementally change my movements to match the clinical narrative in real time as Broffman read. The performance offered participants an opportunity to see how a professional dancer could express pulse composites based in the learned pulse choreography. Further, the performance depicted an example of what their final task would be at the end of the three-day workshop: to choreograph and perform their own pulse reading based in the movement vocabulary they had learned throughout the workshop.

Pulse Drawing
On the evening of the second day of the workshop, everyone gathered at the Pine Street Clinic for dinner and a pulse drawing activity. Any participant who wanted to volunteer could have their pulse read by up to three other participants. Those three participants would then draw the pulses they had felt on a large piece of paper organized as a three by three grid (see Figure 6). The grid represents the nine quadrants of palpation along the radial artery of one wrist. Colored markers, pencils, and crayons were provided for the drawings. After the activity was completed, we considered each drawing as a group and engaged in group discussion.

One challenge in this activity was that the drawings were largely two-dimensional and thus did not visually represent the three-dimensional nature of the pulses. There were some fascinating overlaps in the drawings where all three participants felt the same pulses and represented them in similar locations with similar coloration and shape, while other drawings had discrepancies and sparked debates. The benefit of this activity was to provide another outlet for taking something felt (the pulses) and creating visual representations of them. The creative process of drawing the pulses mirrors the creative process of choreographing the pulses. Participants were given autonomy over their tactile knowledge and an opportunity to express and discuss that knowledge through another creative medium.

Figure 6

The Workshop—Day Three
On the morning of the third and final day of the workshop, we took everyone birding at Las Galinas Wildlife Ponds in San Rafael, California, lead by bird guide Jack Gedney. There are numerous bird species on earth. Birds are exceptionally variable in plumage, size, habits, beaks, tails, song, diet, and habitat choices. Traditional Chinese Medicine pulses are also numerous. Pulses have exceptional variability organized by depth, rate, strength, volume, texture, pliability, rhythm, length, and also gender, age, weight, season, and climate. As a birder, identification of some birds can be difficult to differentiate from a similar species. For instance, trying to identify a Scaup from fifty yards away to determine whether it is a “Lesser Scaup” or a “Greater Scaup” is quite difficult (Broffman 2018). A TCM pulse taker experiences the same issues. The difference between a Hidden Pulse and a Firm Pulse is very subtle. For the birder and the TCM pulse taker, the goal to achieve expertise is to simultaneously “see gestalt” (an organized whole that is perceived as more than the sum of its parts), and observe small details. For the birder this means taking in tertial patterns and under tail coverts while comparing size, shape, and overall “feel” to what you already know about the surrounding foliage and other birds present. To the TCM pulse taker, it means connecting their fingertips to the sensory strip in the brain that allows us to feel gross and subtle sensations to a great level of refinement, in addition to considering the patient’s breathing, skin texture, gender, age, the current season, and the times we are living in (Broffman 2018).

Dancers use the term “feel” for that natural, almost indescribable ability to “become the movement” rather than being independent of that movement. This is similar to birding. In both cases we study the subject matter in order to become so familiar and comfortable with the content that eventually the content does not have to be picked out, but instead reveals itself. Our workshop aims to achieve this by familiarizing participants with the movements of the pulses so that they may reveal themselves in practice.

Research Findings
To assess the level of agreement between different raters of a specific diagnostic test, we used statistical analysis to measure inter-operator reliability. A newer version of inter-rater reliability (IRR) is Gwet’s AC, which has been updated to capably handle the problem of missing data, which often occurs in diagnostic studies (Gwet 2008). Among the seven pulse takers, in comparing IRR before and after dance training, we observed improvements in IRR in twelve of seventeen individual pulse assessment criteria. In Level One of Pulse Assessment, we found increased agreement between pulse takers in their assessments of pulse depth, rate, rhythm, texture, and volume (five of eight pulse criteria). In Level Two of Pulse Assessment, we found increased agreement between pulse takers in their assessments of depth, pliability, rhythm, strength, and volume (five of six pulse criteria). In Level Three of Pulse Assessment, we found increased agreement between pulse takers in their assessments of rate and volume (two of three pulse criteria) (see Table 1). 

Table 1

Among these twelve improvements seen in IRR, comparing before vs. after dance training, in one pulse criterion (Assessment Level Two, pulse volume) we saw that the IRR was lower after dance training than before, but that the IRR had reached a level of statistical significance, meaning that even though the IRR was lower, it was a more precise answer and not likely to have happened by chance alone. In only two of the twelve improvements seen in IRR, was the IRR level reached not of statistical significance (Assessment Level One, pulse texture and pulse volume).

By creating a set of choreographed movements based on how the pulse actually feels in the whole body, Project Pulse has taken the subjective to the objective. Our beta testing using the inter-rater reliability test before and after a dance workshop training has verified that practitioners can collectively agree that the movement they feel with their fingertips at the radial artery is the same as the feeling of the whole body movement that they have been trained to feel.

Participant Feedback
Participant feedback was largely positive and reflected benefits to taking the workshop. The games, performance, and tactile boxes were crowd favorites. The biggest criticism was that the workshop required a lot of stamina and endurance from the participants and many grew fatigued and cranky by the end. We noticed that fifteen-minute breaks would run much longer and encouragement to push through was met with push back. Since the majority of participants were not practiced movers, did not have regular workout regimens, and were over fifty years old, more consideration must be made to reduce the amount of time spent on physical exertion while maintaining the integrity of the work.

Some possible solutions to this problem are to set expectations around physical exertion in preliminary e-mail correspondence by encouraging a minimum two-week pre-training for participants to get into shape prior to taking our workshop. Since this may be unrealistic for some, we also need to shorten the length of our warm-ups and pull back on demanding more exertion when energy is low. The issue with this is that in order to offer CEUs for our workshop, we must fulfill a certain number of hours of training. As such, we need to reimagine how those hours can be filled without student burn out. Our goal was to have the participants immersed in movement for the majority of the workshop, however mixed ability groups require sensitivity and creative problem-solving to counter fatigue-based resistance. Adding in more focused discussions about TCM theory, philosophy, and pulsology will help us fulfill time, however we do not want the workshop to become too heavily based in language. Likely the best solution to this problem is to develop new movement games that correspond with group discussion and do a better job of setting expectations at the start of each new activity. For instance, we thought to create time limits for the charade games and clearly explain how many rounds there will be. Another idea is to target a younger, more active audience by having workshops for TCM students instead of seasoned practitioners.

Other feedback included that the performance was largely based in movement outside of the pulse vocabulary learned, which was hard for participants to decipher. It was an intentional choice to put an abstract twist on the codified movements, however this was hard for some to understand without a clear explanation of intent. Students were also interested in gaining access to the inter-operator reliability test results to see how they did.

Lastly, students wanted access to recordings of the pulse choreography so they could practice after the workshop was over. In response, we created filmed, instructional recordings where I performed each of the thirty pulses and also the flow of all thirty back to back. These videos became available on the Pine Street Clinic website. Any student who has taken the workshop has access to the videos thereafter. We encourage daily practice in the mornings, before a full day of patients, to awaken the senses.

Conclusion and Future Considerations
By dancing the choreographed pulse movements, practitioners are strengthening the patterns of mind-body coordination that making the movements requires, and thus, in a sense, becoming the movements of the pulses (LaMothe 2020). By witnessing the choreographed pulse movements by way of watching performance and by way of watching others practice the choreographed pulse movements, practitioners are able to empathetically recognize the patterns of pulse movements in others. Recognizing the movement in others as moving images that you have made yourself reflects the process of embodied learning.

We have completed two beta tests and two iterations of our workshop over the span of two and a half years. Our long-term vision for Project Pulse: A Dance Research Experience is to create at least a four-part progression to our program, the first of which being the workshop we have already developed, as outlined in this article. Each progression will require successful completion of the workshop leading up to it. For instance, pulse workshop one must be completed before taking pulse workshop two, and pulse workshops one and two must be completed before taking pulse workshop three, etc.

The first iterations of pulse workshops two and three were scheduled to take place summer 2020, however due to the global COVID-19 pandemic we have canceled them until further notice. Pulse two will consist of a three-day road trip to the Kam Wah Chung State Heritage Site in John Day, Oregon. The museum was built in 1865, led by Ing “Doc” Hay, a formidable practitioner of herbal medicine. For over sixty years the museum housed a social, medical, and religious center for Oregon’s Chinese community (Oregon State Parks 2020). Participants will consider pulsology through a historic lens and participate in movement activities that correspond to the legacy of Doc Hay.

Pulse three will consist of a twenty-four-hour pulse reading. Six TCM practitioners who have already completed pulse one and two will be invited to stay in a rented home along with six volunteers. They will take pulse readings of the volunteers every hour for twenty-four hours, draw each pulse reading, and dance each pulse reading, creating twenty-four sketches each. The final assignment will be to dance the changing tide of the pulse that they recognized over the twenty-four-hour span. Since this workshop will require someone to stay awake for a long period of time and be able to handle the strain of mental and physical fatigue, we will have a special selection process to determine who can take the first iteration of pulse workshop three, and will consider our findings and clarify workshop attendance and pre-requisites from there.

Beyond orchestrating and analyzing the effectiveness of pulse two and three, we hope to bring our research to China. We seek collaboration with TCM practitioners in China to increase the validity, effectiveness, and visibility of our work. Video links with clips of our beta tests and workshops and of the full pulse choreography are available upon request.

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