Dance as Complementary Therapy for Parkinson Disease
p align="justify">Parkinson disease (PD) is the second most common neurodegenerative disorder, affecting 1-2% of individuals over 65 years of age, 3-5% of those 85 or older, and approximately 6 million people worldwide. There are four cardinal features of PD: rest tremor, rigidity, bradykinesia, and postural instability, all of which are motor symptoms. However, PD also may include any combination of a myriad of non-motor symptoms including cognitive changes, sleep disorders, fatigue, loss of motivation, anxiety, and depression.
PD is most commonly treated with pharmacological approaches, sometimes in combination with surgical procedures such as deep brain stimulation. Unfortunately, these approaches do not fully address many of the problems associated with PD, such as difficulty with balance and walking. As such, additional complementary approaches to the management of PD are needed. Exercise is one such approach, and accumulating evidence from animal models of parkinsonism suggests that exercise can enhance physical function and may also slow neuronal degeneration. Based on this animal work, there has been a veritable explosion of studies examining exercise in people with PD. The work in our lab has focused in particular on the effects of dance as a form of exercise for people with PD.
Why choose dance to treat people with Parkinson Disease?
We chose to examine dance, and in particular Argentine tango, as a form of exercise for people with PD for several reasons. First, the basic step of tango is walking and depending on whether one is dancing the leader or follower role, this walking is primarily in the forward or the backward direction, respectively. Given the particular difficulty that many with PD experience with balancing and moving in the backward direction, tango is a means of teaching specific strategies for moving backward and then practicing them repeatedly within the context of the dance. Other aspects of tango also seemed particularly suited to dealing with PD, such as practicing moving at different speeds to address the slowness of movement associated with PD, practicing turning and moving in tight spaces which are situations known to trigger freezing of gait in PD, and moving to music as an external cue to facilitate movement.
How is dance beneficial to people with Parkinson disease?
In the past 5 years we have published several studies regarding the specific benefits of tango. Our most recent study (1) examined the long-term effects of participating in tango dancing. Participants with PD danced twice a week for a full year and were compared to another group with PD who did not dance. We assessed participants’ disease severity at the beginning of the study and again at 3, 6, and 12 months using the Unified Parkinson Disease Rating Scale and all participants were assessed off their normal anti-PD medications. After just three months, the people who were dancing tango had lower disease severity than people who were not dancing, despite the fact that the two groups started out with equal levels of disease severity. Differences between the two groups got larger as time went on, with the tango group continuing to improve and show reduced disease severity over the full year. By the end of the study the tango group showed a 25% reduction in disease severity. This suggests that dancing may be able to modify the progression of disability over time and that the benefits of dancing tango are cumulative, as larger gains were noted with longer participation in a tango program. In addition to these exciting improvements in overall disease severity, we also noted significant improvements in balance and walking. These were in keeping with our prior work showing that short-term participation in tango can convey significant improvements in balance, walking, and quality of life for individuals with PD (2).
In addition to our numerous tango studies, we have also studied the effects of modern dance, specifically contact improvisation (CI). CI is an improvised duet that integrates tactile, visual, and vestibular feedback generated by both partners simultaneously and by the forces of motion and gravity. CI does not focus on execution of specific movement sequences but rather directs the dancer’s attention to sensation and non-verbal communication, challenging dancers to continually adapt to unpredictable movement (i.e. weight shifts and mutual support) generated during spontaneous tactile interaction with the dance partner. Because it is improvisational and does not require learning of specific movements, CI is quickly accessible and allows dancers of varied size, age, ability and skill level to be quickly immersed in the movement experience. Our study compared CI to tango dancing, noting similar improvements in balance and disease severity with the two dance forms. For more information on CI for PD please see Marchant, Sylvester, and Earhart (3).
How does a class work?
Our dance classes for people with PD pair the individual with PD with a dance partner who does not have PD. This partner may be a spouse or caregiver or a volunteer. Both members of the dance partnership should have the opportunity to dance the leader and follower roles, ignoring the tradition that men typically lead so that all dancers get practice moving in different directions. Throughout the class, dancers rotate so that each person works with a new partner every 10-15 minutes. Classes typically last for one hour and involve a brief warm-up followed by introduction of a new step or technique, practice of this new concept, and integration of the new material with previous knowledge. For more specifics on how classes are implemented please refer to Hackney & Earhart (4).
Could dance be beneficial to people with other conditions?
Dance has the potential to benefit groups other than those with PD, as it is a socially engaging and motivating form of physical activity. Dance has the potential to convey benefits not only in the realms of balance and walking, but also with respect to aerobic fitness and cardiovascular health if the dance exercise is of sufficient intensity. Dance may also convey benefits with respect to mood and cognitive function. The therapeutic potential of dance is promising and more research is clearly warranted to better understand the benefits of dance for different groups, the relative merits of different forms of dance, and the mechanisms by which dance conveys benefits.
|Author :||Gammon M. Earhart, Ph.D., P.T.
Physical Therapy, Anatomy & Neurobiology, Neurology
Washington University School of Medecine in St Louis
Duncan, R.P., Earhart, G.M. Randomized Controlled Trial of Community-Based Dancing to Modify Disease Progression in Parkinson Disease. Neurorehab Neural Repair, in press, DOI: 10.1177/1545968311421614
Earhart, G.M. (2009) Dance as therapy for individuals with Parkinson disease. Eur J Phys Med Rehabil, 45(2): 231-238. PMC2780534
Marchant, D., Sylvester, J.L., Earhart, G.M. (2010) Effects of a short duration, high dose contact improvisation dance workshop on Parkinson disease: A pilot study. Comp Ther Med, 18(5): 184-190.
Hackney, M.E., Earhart, G.M. (2010) Recommendations for implementing partnered tango classes for persons with Parkinson disease. Amer J Dance Ther, 32(1): 41.