Madeleine E. Hackney

Effects of Dance on Movement Control in Parkinson’s Disease: A Comparison of Argentine Tango and American Ballroom

OBJECTIVE The basal ganglia may be selectively activated during rhythmic, metered movement such as tango dancing, which may improve motor control in individuals with Parkinsons disease. Other partner dances may be more suitable and preferable for those with Parkinsons disease. The purpose of this study was to compare the effects of tango, waltz/foxtrot and no intervention on functional motor control in individuals with Parkinsons disease. DESIGN This study employed a randomized, between- notsubject, prospective, repeated measures design. SUBJECTS/PATIENTS Fifty-eight people with mild-moderate Parkinsons disease participated. METHODS 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. RESULTS 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. CONCLUSION Tango may target deficits associated with Parkinsons disease more than waltz/foxtrot, but both dances may benefit balance and locomotion.

Effects of tango on functional mobility in Parkinson's disease: a preliminary study.

Recent research has shown that dance, specifically tango, may be an appropriate and effective strategy for ameliorating functional mobility deficits in people who are frail and elderly. Individuals with Parkinsons disease (PD) experience declines in functional mobility that may be even more pronounced than those experienced by frail elderly individuals without PD. 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 Parkinsons 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.

Tai Chi improves balance and mobility in people with Parkinson disease

This pilot study examines the effects of Tai Chi on balance, gait and mobility in people with Parkinson disease (PD). Thirty-three people with PD were randomly assigned to either a Tai Chi group or a control group. The Tai Chi group participated in 20 1-h long training sessions completed within 10-13 weeks; whereas, the control group had two testing sessions between 10 and 13 weeks apart without interposed training. The Tai Chi group improved more than the control group on the Berg Balance Scale, UPDRS, Timed Up and Go, tandem stance test, six-minute walk, and backward walking. Neither group improved in forward walking or the one leg stance test. All Tai Chi participants reported satisfaction with the program and improvements in well-being. Tai Chi appears to be an appropriate, safe and effective form of exercise for some individuals with mild-moderately severe PD.

Effects of dance on gait and balance in Parkinson's disease: a comparison of partnered and nonpartnered dance movement.

Partnered tango dance can improve balance and gait in individuals with Parkinson’s disease (PD). Partnered dance may allow these individuals to challenge balance more than nonpartnered dance. Alternatively, partnered practice could reduce balance gains because the participant may rely on the partner as a balance aid when challenged. The authors compared the effects of partnered and nonpartnered dance on balance and mobility in 39 people (11 women) with mild-moderate PD (Hoehn and Yahr stages I-III). Participants were randomly assigned to partnered or nonpartnered tango and attended 1-hour classes twice per week, completing 20 lessons within 10 weeks. Balance and gait were evaluated in the weeks immediately before, immediately after, and 1 month after the intervention. Both groups significantly improved on the Berg Balance Scale, comfortable and fast-as-possible walking velocity, and cadence. Improvements were maintained at the 1-month follow-up. The nonpartnered class improved as much as the partnered class; however, partnered participants expressed more enjoyment and interest in continuing.

Health-related quality of life and alternative forms of exercise in Parkinson disease

Parkinson disease (PD) reduces health-related quality of life (HRQoL), but exercise may improve HRQoL. This pilot study compared the effects of Tango, Waltz/Foxtrot, Tai Chi and No Intervention on HRQoL in individuals with PD. Seventy-five persons with PD (Hoehn and Yahr I-III) were assigned to 20 lessons of Tango, Waltz/Foxtrot, Tai Chi, or an untreated No Intervention group. Participants completed the PDQ-39 before and after participation in 20 classes or within 13 weeks in the case of the No Intervention group. Two-way repeated measures ANOVAs determined differences between interventions. Tango significantly improved on mobility (p=0.03), social support (p=0.05) and the PDQ-39 SI (p<0.01) at post-testing. No significant changes in HRQoL were noted in the Waltz/Foxtrot, Tai Chi or No Intervention. Tango may be helpful for improving HRQoL in PD because it addresses balance and gait deficits in the context of a social interaction that requires working closely with a partner.

The Effects of Adapted Tango on Spatial Cognition and Disease Severity in Parkinson's Disease

ABSTRACT The authors determined effects of community-based adapted tango on spatial cognition and disease severity in Parkinsons disease (PD) while controlling for the effects of social interaction. Thirty-three individuals with mild-to-moderate PD (stage I–III) were assigned to twenty 90-min tango (n = 24) or education (n = 9) lessons over 12 weeks. Disease severity, spatial cognition, balance, and fall incidence were evaluated pre-, post-, and 10–12 weeks postintervention. The authors evaluated differences using t tests and analyses of variance. Twenty-three tango and 8 education participants finished. Tango participants improved on disease severity (p = .008), and spatial cognition (p = .021) compared with education participants. Tango participants also improved in balance (p = .038), and executive function (p = .012). Gains were maintained 10–12 weeks postintervention. Multimodal exercise with structured syllabi may improve disease severity and spatial cognition in PD.

Short duration, intensive tango dancing for Parkinson disease: An uncontrolled pilot study

OBJECTIVE The goal of this pilot study was to determine the effects of short duration, intensive tango lessons on functional mobility in people with Parkinson disease. DESIGN This study employed a within-subject, prospective, repeated measures design. SUBJECTS/PATIENTS Fourteen people with idiopathic Parkinson disease participated. SETTING All balance and gait assessments were performed in a laboratory, but dance classes took place in a large, open classroom. INTERVENTIONS Participants completed ten 1.5-h long Argentine tango dance lessons within 2 weeks. Their balance, gait and mobility were assessed before and after the training sessions. MAIN OUTCOME MEASURES Measures included the Berg Balance Scale, the Unified Parkinson Disease Rating Scale, gait velocity, functional ambulation profile, step length, stance and single support percent of gait, Timed Up and Go, and the 6 min walk. RESULTS Participants significantly improved on the Berg Balance Scale (effect size (ES)=0.83, p=0.021), Unified Parkinson Disease Rating Scale Motor Subscale III (ES=-0.64, p=0.029), and percent of time spent in stance during forward walking (ES=0.97, p=0.015). Non-significant improvements were noted on the Timed Up and Go (ES=-0.38, p=0.220) and 6 min walk (ES=0.35, p=0.170). CONCLUSIONS Frequent social dance lessons completed within a short time period appear to be appropriate and effective for these individuals with mild-moderately severe Parkinson disease.

Effects of dance on balance and gait in severe Parkinson disease: a case study.

Purpose. Dance may improve functional mobility in individuals with mild-to-moderate Parkinson disease (PD), yet dance effects in severe PD remain unexamined. This studys purpose was to evaluate the feasibility and effects of partnered tango classes on balance, endurance and quality of life in an individual with severe PD. Design. Over 10 weeks, the participant attended 20, 1-h tango classes for individuals with PD. Balance, walking, and quality of life were evaluated before and after the intervention and at a 1-month follow-up in this single case design. Caregiver burden was also assessed at all time points. Results. The participant improved on the Berg Balance Scale, 6-min walk test, and functional reach. He reported increased balance confidence and improved quality of life as measured by the Parkinson Disease Questionnaire-39 summary index. Gains were maintained at the 1-month follow-up. Caregiver burden increased from baseline immediately post-intervention and at follow-up. Conclusion. Twenty partnered tango lessons improved balance, endurance, balance confidence, and quality of life in a participant with severe PD. This is the first report of the use of dance as rehabilitation for an individual with advanced disease who primarily used a wheelchair for transportation.

The Effects of a Secondary Task on Forward and Backward Walking in Parkinson's Disease

BACKGROUND People with Parkinsons disease (PD) often fall while multitasking or walking backward, unavoidable activities in daily living. Dual tasks involving cognitive demand during gait and unfamiliar motor skills, such as backward walking, could identify those with fall risk, but dual tasking while walking backward has not been examined in those with PD, those who experience freezing of gait (FOG), or healthy older controls. METHODS A total of 78 people with PD (mean age = 65.1 +/-9.5 years; female, 28%) and 74 age-matched and sex-matched controls (mean age = 65.0 +/-10.0 years; female, 23%) participated. A computerized walkway measured gait velocity, stride length, swing percent, stance percent, cadence, heel to heel base of support, functional ambulation profile, and gait asymmetry during forward and backward walking with and without a secondary cognitive task. RESULTS Direction and task effects on walking performance were similar between healthy controls and those with PD. However, those with PD were more affected than controls, and freezers were more affected than nonfreezers, by backward walking and dual tasking. Walking backward seemed to affect gait more than dual tasking in those with PD,although the subset of freezers appeared particularly affected by both challenges. CONCLUSION People with PD are impaired while performing complex motor and mental tasks simultaneously,which may put them at risk for falling. Those with FOG are more adversely affected by both motor and mental challenges than those without. Evaluation of backward walking while performing a secondary task might be an effective clinical tool to identify locomotor difficulties.

Backward walking in Parkinson's disease.

We walk backward on a daily basis, such as when backing away from the kitchen sink or stepping back from a curb as a swiftly moving bus passes. This task may be particularly difficult for individuals with Parkinsons disease (PD) who often fall as a result of moving or being perturbed in the backward direction. The aim of this study was to assess backward walking (BW) in individuals with PD. Both forward walking (FW) and BW were assessed in 78 people with idiopathic PD (H&Y range: 0.5–3) in the ON state, and 74 age‐ and sex‐matched controls. In FW, those with PD had significantly shorter strides, lower swing percents, higher stance percents, and lower functional ambulation profiles than controls. Both groups walked significantly slower and with a wider base of support during BW than FW. Additionally, in BW those with PD walked significantly slower with shorter strides, lower swing percents, and higher double support and stance percents, and lower functional ambulation profiles compared with controls. Those with mild to moderate PD have impaired FW and BW, but differences between those with and without PD are more pronounced in BW.