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Monday February 15, 2010

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Maybe, as the bumper sticker says, the “Hokey Pokey” really is what it’s all about. At least when it comes to helping senior patients. Because dances like the old party standby can help improve balance, muscle strength and confidence.

“I look at it from the point of view of, ‘How does dance help a person’s balance, motor planning and strength?’” says Robyn Gisbert, DPT, an instructor in the Physical Therapy Program at the University of Colorado Denver. “And at the end of the day, if they’re having fun in therapy and building a rapport with the therapist, that has power.”

Most of the patients Karen Rusin, PT, sees at Holy Redeemer Home Care in New Jersey are seniors, many frail and most with balance issues. “I’m always trying to improve balance to make patients safer at home. Some people are fearful of falling, and music makes them less fearful. Some patients have cognitive issues. But I put on music and ask them to teach me how to dance. Pretty much anyone can do that.” Rusin uses dance to work on weight shifting, turning and other traditional aspects, and her patients think less about having therapy and more about just having fun.

One key is finding music patients like. Rusin doesn’t use specific dances, though, focusing instead on movement. “I’ve identified the patient’s impairments, know what they can and can’t do, and what I need to accomplish from a therapeutic standpoint,” Rusin says. “Then I facilitate those movements through dance.”

Dancing helps patients with pain issues, she adds, taking their minds off the pain. “If I’m working on weight shifting and the patient has joint pain, they might not want to do it,” Rusin says. “The music distracts them.”

Rusin’s colleague Karen Robilotta, PT, has worked at Holy Redeemer Home Care for 37 years and also uses music with her patients. “Using rhythm to do exercises helps patients concentrate more on music and fun, and not on repetitions. I don’t like counting out loud. Patients get to number 10 and think they’re supposed to be tired and quit. When they’re doing it to music, they aren’t paying attention to how many times they’re doing a motion.”

Robilotta finds that music also creates a rapport with the patient. “It’s a fun activity instead of, ‘Oh no, she’s here again to make me do exercises.’”

Music can involve the patient’s family, making it easier for them to reinforce the activity. Robilotta also taps into a patient’s culture, selecting familiar music and body movements.

Music and dance work well for dementia patients because they are so ingrained in our culture, says Gisbert. “Songs like the ‘Hokey Pokey,’ ‘Happy Birthday,’ and the ‘Alphabet Song’ are deep in our memory and work even for people who have lost most of theirs,” Gisbert says. Patients with difficulty following verbal commands sometimes naturally move to music.

Rusin stresses that although the method may be slightly unconventional, it still is standard therapy. “I do evaluation using all the usual measures and tests, all the standard work-ups and techniques throughout,” Rusin says. “I get results that are objective, measurable, documented and evidence-based.”

There is a body of literature on dance medicine, Gisbert says, but questions still need to be answered. “To put on music and get people moving is a beginning, but there is the potential for it to be more skilled and technical.” Until more research is done into types of music and the best ways to use it, there is room for therapists to improvise, using, for example, the “Hokey Pokey” to bring back fun memories and get patients to move their bodies and participate in therapy with more enthusiasm.

Gisbert stresses keeping this therapy patient centered. “Instead of putting any music on, go back to the patient, or their family if they can’t communicate, to choose the type of music or dancing,” she says. “A patient may say, ‘I used to waltz with my wife.’ So the waltz would be a good choice for that person.”

Music and dancing can work in many kinds of therapy. “Occupational therapists could use the same ideas,” Robilotta says. “Using your arms and trunk moving to music is a real-life skill. Recreational therapists do functional activities of a more recreational nature and dance would certainly fall under that.”

For Robilotta, dancing is a great introduction to a client, something fun for a first visit. It’s also good at discharge. “It’s like icing on the cake,” Robilotta says. “I say, ‘All the hard work you’ve been doing and look how much better you can move now.’” •

Melissa Gaskill is a contributing writer for Today in PT.


To comment, e-mail pteditor@todayinpt.com.


Monday February 15, 2010
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