Peer reviewed: Dance for PD: a preliminary investigation of effects on motor function and quality of life among persons with Parkinson’s disease
This preliminary uncontrolled study investigated the effects of a dance intervention on several motor and quality of life aspects of PD following 16 sessions (8 weeks; 20 h) taught by professional dancers/teachers. A mixed methods design was used to determine the effects of the class. Assessment instruments administered at baseline and post-intervention included the Hoehn and Yahr, UPDRS (part III), Berg Balance Scale, Beck Depression Inventory, and PDQ-39 and individual interviews after the last class. Hoehn and Yahr scores ranged from 1 to 4. UPDRS III total scores and sub scores of gait and tremor improved following the intervention (P < 0.05). During interviews participants reported physical, emotional, and social benefits. Despite the diversity of baseline measures post-class interview results were consistently positive across the sample. Twelve of 14 subjects (mean age 66.2) with idiopathic PD completed the sessions. After 4 years, four participants regularly attended DfPD® classes. The low attrition rate and continued attendance suggest notable adherence to the DfPD® class. The importance of the results is both clinical and conceptual, highlighting the value of using both quantitative and qualitative data to evaluate the benefits of dance with PD.
Peer reviewed: Impact of a weekly dance class on the functional mobility and on the quality of life of individuals with Parkinson’s disease.
Lisa Heiberger, with a team from the Cortical Motor Control Laboratory at University Hospital of Freiburg, Germany under the direction of Dr. Rumyana Kristeva, investigated the short-term effects of dance on motor control in individuals with PD and the long-term effects of 8 months of participation in the weekly dance class on the quality of life of the PD patients and their caregivers. The class was modeled after the Mark Morris Dance Group/Brooklyn Parkinson Group class. Eleven people with moderate to severe PD (58–85 years old) were subjected to a motor and quality of life assessments. The team found a signiﬁcant beneﬁcial short-term effect for the total score of the UPDRS motor score. The strongest improvements were in rigidity scores followed by signiﬁcant improvements in hand movements, ﬁnger taps, and facial expression. The results of the questionnaires showed positive effects of the dance class on social life, health, body-feeling and mobility, and on everyday life competences of the PD patients. Beneﬁcial effect was also found for the caregivers.
Peer reviewed: A mixed-methods study into ballet for people living with Parkinson’s
English National Ballet and University of Roehampton have published the peer-reviewed findings of a groundbreaking research project that reveals that dance benefits people with Parkinson’s by relieving debilitating symptoms, aiding short-term mobility and significantly improving stability, as well as contributing to social inclusion and artistic expression. In the light of the excellent adherence to the dance sessions, this initial research project indicates that dancing would be an appropriate and enjoyable way of encouraging exercise and creative activity for people with Parkinson’s.
Peer reviewed: Why Dance for Parkinson’s Disease
Brooklyn Parkinson Group (BPG) in collaboration with Mark Morris Dance Group (MMDG) developed dance classes for persons with Parkinson’s disease (PD), friends, and family. Over 5 years, classes increased from 2 to 9 participants once a month, to weekly classes of 20 to over 30 participants. This article explains the rationale of dance for PD, describes teaching methods, and includes participants’ observations. Also discussed are perceived benefits noted by 15 participants with PD to a validated questionnaire are discussed.
Peer reviewed: Effects of tango on functional mobility in Parkinson’s disease: a preliminary study.
The purpose of this study was to compare the effects of two movement programs: tango classes or exercise classes. Nineteen subjects with PD were randomly assigned to a tango group or a group exercise class representative of the current classes offered in our geographical area for individuals with PD. Subjects completed a total of 20 tango or exercise classes and were evaluated the week before and the week following the intervention. Both groups showed significant improvements in overall Unified Parkinson’s Disease Rating Scale (UPDRS) score and nonsignificant improvements in self-reported Freezing of Gait. In addition, the tango group showed significant improvements on the Berg Balance Scale. The exercise group did not improve on this measure. Finally, the tango group showed a trend toward improvement on the Timed Up and Go test that was not observed in the exercise group. Future studies with a larger sample are needed to confirm and extend our observation that tango may be an effective intervention to target functional mobility deficits in individuals with PD.
Peer reviewed: Feasibility of an Intensive Trial of Modern Dance for Adults with Parkinson Disease
This study assesses the feasibility and benefits of modern dance classes for a group of 11 adults with early-to-middle stage Parkinson’s Disease in North Carolina. The three-week trial suggests that modern dance may be a desirable alternative to other modes of exercise because it is cost-effective, simple to administer, and offers social as well as potentially functional benefits.
Meta Analysis: Dance for People With Parkinson Disease: What Is the Evidence Telling Us?
This meta-analysis suggests that participation in dance classes may be beneficial for some individuals with mild-to-moderate PD. This review provides preliminary guidance regarding an optimum FITT principle. It has highlighted methodological limitations and gaps in the current literature to help inform future research development. The results of this review found evidence to suggest that two 1-hour dance classes per week, for at least 10 weeks, can have positive effects. Greater benefit might also be seen with longer duration interventions. More high level, multicenter RCTs with robust methodology are needed to determine the effect of different types of dance and their long-term benefit for people with PD. In addition, the safety of dance programs needs to be adequately reported to ensure the safe and appropriate implementation of dance interventions.
Effects of dance on movement control in Parkinson's disease: a comparison of Argentine tango and American ballroom.
The purpose of this study was to compare the effects of tango, waltz/foxtrot and no intervention on functional motor control in individuals with Parkinson's disease. This study employed a randomized, between- notsubject, prospective, repeated measures design. Fifty-eight people with mild-moderate Parkinson's disease participated. Participants were randomly assigned to tango, waltz/foxtrot or no intervention (control) groups. Those in the dance groups attended 1-h classes twice a week, completing 20 lessons in 13 weeks. Balance, functional mobility, forward and backward walking were evaluated before and after the intervention. Both dance groups improved more than the control group, which did not improve. The tango and waltz/foxtrot groups improved significantly on the Berg Balance Scale, 6-minute walk distance, and backward stride length. The tango group improved as much or more than those in the waltz/foxtrot group on several measures.Tango may target deficits associated with Parkinson's disease more than waltz/foxtrot, but both dances may benefit balance and locomotion.
Active music therapy and Parkinson's disease: methods.
Music therapy (MT) is an unconventional, multisensorial therapy poorly assessed in medical care but widely used to different ends in a variety of settings. MT has two branches: active and passive. In active MT the utilisation of instruments is structured to correspond to all sensory organs so as to obtain suitable motor and emotional responses. We conducted a prospective study to evaluate the effects of MT in the neurorehabilitation of patients with Parkinson's Disease (PD), a common degenerative disorder involving movement and emotional impairment. Sixteen PD patients took part in 13 weekly sessions of MT each lasting 2 hours. At the beginning and at the end of the session, every 2 weeks, the patients were evaluated by a neurologist, who assessed PD severity with UPDRS, emotional functions with Happiness Measures (HM) and quality of life using the Parkinson's Disease Quality of Life Questionnaire (PDQL). After every session a significant improvement in motor function, particularly in relation to hypokinesia, was observed both in the overall and in the pre-post session evaluations. HM, UPDRS-ADL and PDQL changes confirmed an improving effect of MT on emotional functions, activities of daily living and quality of life. In conclusion, active MT, operating at a multisensorial level, stimulates motor, affective and behavioural functions. Finally, we propose active MT as new method to include in PD rehabilitation programmes. This article describes the methods adopted during MT sessions with PD patients.
Active music therapy in Parkinson's disease: an integrative method for motor and emotional rehabilitation.
Modern management of Parkinson's disease (PD) aims to obtain symptom control, to reduce clinical disability, and to improve quality of life. Music acts as a specific stimulus to obtain motor and emotional responses by combining movement and stimulation of different sensory pathways. We explored the efficacy of active music therapy (MT) on motor and emotional functions in patients with PD. This prospective, randomized, controlled, single-blinded study lasted 3 months. It consisted of weekly sessions of MT and physical therapy (PT). Thirty-two patients with PD, all stable responders to levodopa and in Hoehn and Yahr stage 2 or 3, were randomly assigned to two groups of 16 patients each. We assessed severity of PD with the Unified Parkinson's Disease Rating Scale, emotional functions with the Happiness Measure, and quality of life using the Parkinson's Disease Quality of Life Questionnaire. MT sessions consisted of choral singing, voice exercise, rhythmic and free body movements, and active music involving collective invention. PT sessions included a series of passive stretching exercises, specific motor tasks, and strategies to improve balance and gait. MT had a significant overall effect on bradykinesia as measured by the Unified Parkinson's Disease Rating Scale (p < .034). Post-MT session findings were consistent with motor improvement, especially in bradykinesia items (p < .0001). Over time, changes on the Happiness Measure confirmed a beneficial effect of MT on emotional functions (p < .0001). Improvements in activities of daily living and in quality of life were also documented in the MT group (p < .0001). PT improved rigidity (p < .0001). MT is effective on motor, affective, and behavioral functions. We propose active MT as a new method for inclusion in PD rehabilitation programs.
Stimulating music increases motor coordination in patients afflicted with Morbus Parkinson.
The present study measured the short-term effect of special stimulating music on motor coordination in Parkinson patients. Eleven patients with a dominant akinetic Parkinson syndrome as well as ten healthy persons (age-matched control group) participated in this study. In the Parkinson group, the measurement of fine motor coordination with the 'Vienna Test System' showed an improvement in two (aiming, line tracking) of the four subtests after listening to the music. The patients improved their performance with the right arm significantly in the subtest aiming-error-time. No statistical differences were found in the other two subtests (steadiness, tapping) in both groups. There was also no improvement in frequency of tapping movement on the power-force-working-plate. Accordingly, music effects more the precision of a movement than the speediness. The measurements on the power-force-working-plate showed a significant improvement in two of five measured parameters: contact time, variability coefficient for total step and impact maximum changed significantly. This study gives evidence that specific music can improve the precision of arm and finger movements.
The effects of two different auditory stimuli on functional arm movement in persons with Parkinson's disease: a dual-task paradigm.
The objective is to examine, in a dual-task paradigm, the effect of auditory stimuli on people with Parkinson's disease in a counterbalanced repeated-measures design. The study includes twenty individuals with Parkinson's disease. Each participant did two experiments (marching music experiment and weather forecast experiment). In each experiment, the participant performed an upper extremity functional task as the primary task and listened to an auditory stimulus (marching music or weather forecast) as the concurrent task. Each experiment had three conditions: listening to the auditory stimulus, ignoring the auditory stimulus and no auditory stimulus. The mail measures were kinematic variables of arm movement, including movement time, peak velocity, deceleration time and number of movement units. We found that performances of the participants were similar across the three conditions for the marching music experiment, but were significantly different for the weather forecast experiment. The comparison of condition effects between the two experiments indicated that the effect of weather forecast was (marginally) significantly greater than that of marching music. The results suggest that the type of auditory stimulus is important to the degree of interference with upper extremity performance in people with Parkinson's disease. Auditory stimuli that require semantic processing (e.g. weather forecast) may distract attention from the primary task, and thus cause a decline in performance.
Into the groove: can rhythm influence Parkinson's disease?
Previous research has noted that music can improve gait in several pathological conditions, including Parkinson's disease, Huntington's disease and stroke. Current research into auditory-motor interactions and the neural bases of musical rhythm perception has provided important insights for developing potential movement therapies. Specifically, neuroimaging studies show that rhythm perception activates structures within key motor networks, such as premotor and supplementary motor areas, basal ganglia and the cerebellum - many of which are compromised to varying degrees in Parkinson's disease. It thus seems likely that automatic engagement of motor areas during rhythm perception may be the connecting link between music and motor improvements in Parkinson's disease. This review seeks to describe the link, address core questions about its underlying mechanisms, and examine whether it can be utilized as a compensatory mechanism.
Rehabilitation, exercise therapy and music in patients with Parkinson's disease: a meta-analysis of the effects of music-based movement therapy on walking ability, balance and quality of life.
Recent evidence suggests that music-based movement (MbM) therapy may be a promising intervention to improve gait and gait-related activities in Parkinson's disease (PD) patients, because it naturally combines cognitive movement strategies, cueing techniques, balance exercises and physical activity while focussing on the enjoyment of moving on music instead of the current mobility limitations of the patient. A meta-analysis of RCTs on the efficacy of MbM-therapy, including individual rhythmic music training and partnered dance classes, was performed. Identified studies (K = 6) were evaluated on methodological quality, and summary effect sizes (SES) were calculated. Studies were generally small (total N= 168). Significant homogeneous SESs were found for the Berg Balance Scale, Timed Up and Go test and stride length (SESs: 4.1,2.2,0.11; P-values <0.01; I(2) 0,0,7%, respectively). A sensitivity analysis on type of MbM-therapy (dance- or gait-related interventions) revealed a significant improvement in walking velocity for gait-related MbM-therapy, but not for dance-related MbM-therapy. No significant effects were found for UPDRS-motor score, Freezing of Gait and Quality of Life. Overall, MbM-therapy appears promising for the improvement of gait and gait-related activities in PD. Future studies should incorporate larger groups and focus on long-term compliance and follow-up.
The future of music in therapy and medicine.
The understanding of music's role and function in therapy and medicine is undergoing a rapid transformation, based on neuroscientific research showing the reciprocal relationship between studying the neurobiological foundations of music in the brain and how musical behavior through learning and experience changes brain and behavior function. Through this research the theory and clinical practice of music therapy is changing more and more from a social science model, based on cultural roles and general well-being concepts, to a neuroscience-guided model based on brain function and music perception. This paradigm shift has the potential to move music therapy from an adjunct modality to a central treatment modality in rehabilitation and therapy.
To find the rhythm. Therapist, doctor and author Audun Myskja describes the use of rhythm and music in treatment of for example Parkinson, arthritis, mental illness, dementia or multiple sclerosis.
Studies of gait in patients with Parkinson's disease have shown that stimulation by external rhythm provides increased symmetry, balance, step length and walking speed. This improvement will often disappear shortly after the rhythmic stimulation ceases. The technique “rhythmic auditory stimulation” (RAS) systematize external stimulation by metronome or rhythmic music to enhance internal regulation of rhythmic processor and provides lasting recovery of gait. It is based on patients’ step rhythm and provides stimulation with the same rhythm as patients’ walking speed (measured as the number of steps per minute). When the patient has gotten used to this rhythm, the external frequency changed to a different optimal speed – an average of five to ten percent higher than the current rhythm. When you find the optimal rhythm, this will in most cases lead to a visible and noticeable improvement in walking function. Systematic studies have shown that RAS has not just an immediate effect, but also can develop a more functional gait through regular training over time. RAS has provided significant improvements in gait under controlled conditions in the rehabilitation of patients with stroke, Parkinson's disease, Huntington's disease, traumatic brain injury and cerebral palsy.
Rhythmic auditory stimulation in gait training for Parkinson's disease patients.
Rhythmic auditory stimulation (RAS) was used as a pacemaker during a 3-week home-based gait-training program for Parkinson's disease (PD) patients (n = 15). Electromyogram (EMG) patterns and stride parameters were assessed before and after the test without RAS to evaluate changes in gait patterns. Data were compared with those of two control groups (n = 11), who either did not participate in any gait training or who participated in an internally self-paced training program. RAS consisted of audiotapes with metronome-pulse patterns embedded into the on/off beat structure of rhythmically accentuated instrumental music. Patients who trained with RAS significantly (p < 0.05) improved their gait velocity by 25%, stride length by 12%, and step cadence by 10% more than self-paced subjects who improved their velocity by 7% and no-training subjects whose velocity decreased by 7%. In the RAS-group, timing of EMG patterns changed significantly (p < 0.05) in the anterior tibialis and vastus lateralis muscles. Evidence for rhythmic entrainment of gait patterns was shown by the ability of the RAS group to reproduce the speed of the last training tape within a 2% margin of error without RAS.
Metronome therapy in patients with Parkinson disease.
We studied 10 patients with Parkinson's disease and 12 patients with Parkinson-plus-syndrome, trying to improve patients' gait by application of various external rhythmic stimuli, including metronome stimulation (96 beats per minute = middle andante). The test course of the patients was 4 x 10 meters and 3 U-turns. The patients' gait quality under stimulation was compared with their free walk (velocity, number of steps, number of freezing episodes). Metronome stimulation significantly reduced the time and number of steps needed for the test course and also diminished the number of freezing episodes. March music stimulation was less effective and tactile stimulation (rhythmically tapping on the patient's shoulder) even produced negative results. The positive effect of metronome stimulation was also found, when the tests were not performed inside the hospital building, but outside in the hospital parc. Metronome stimulation was comparably effective in both patient sub-groups examined in this study (M. Parkinson, Parkinson-plus-syndrome) and seems to be an important additional help in the treatment of these patients. Electronical metronomes are not expensive, easy in handling, and portable. A theoretical explanation of metronome stimulation effectivity in patients with Parkinson's disease still needs to be elucidated.