Shall we dance?
Monday May 14, 2012
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When patients with Parkinson’s disease stop coming to physical therapy, Valerie Carter, PT, DPT, NCS, knows the effects of the disease will continue to debilitate her patients — both physically and emotionally.
This was the case for a woman in her 60s who stopped attending therapy because she was discouraged about her condition and afraid of injuring herself. Over time, the woman lost muscle control to the point that she moved around by shuffling rapidly. Often unable to stop herself, she would deliberately run into furniture to stop the forward momentum. Other times, she would freeze while walking, paralyzed in that position until she could muster the courage to lean precariously forward in hopes of triggering her legs to move to catch her fall.
Carter had not seen the woman for five years, so she was shocked and thrilled when the woman recently showed up for a new tango class for people with Parkinson’s that would be taught by physical therapy students from Northern Arizona University in Flagstaff. Each of the participants partnered with a student, and then something amazing happened: They began to move their bodies in ways that had previously seemed lost to the disease.
"For PD patients, the signal in the basal ganglia gets muddled, so that is why they start taking smaller steps and leaning forward," said Carter, an associate clinical professor at NAU. "The tango brings them upright and requires large backward and side steps, and this is exactly what PD patients need. I am seeing people dancing who I haven’t seen in the clinic in years because they are having fun and enjoying themselves."
Proof that it works
Gammon Earhart, PT, PhD, associate professor of physical therapy at Washington University in St. Louis, first considered the potential benefits of the tango for PD patients several years ago, and has since conducted several studies that have supported its therapeutic value. In the February issue of Neurorehabilitation and Neural Repair, she published the results of a study involving 52 patients in a 12-month study. Even Earhart was surprised by what she found.
She compared a control group of patients who continued their usual routine with a group who started participating in one-hour tango classes twice a week. She used a rating system for PD motor severity (known as MDS-UPDRS-3) that tested levels of impairment in areas such as balance, walking, leg and foot movement, facial expressions, and hand and finger movement. "I expected to see improvements during the first three or six months, but the improvement continued at nearly the same rate for the full 12 months," Earhart said.
By the end of the study, the tango group experienced a reduction of 28.7% impairment on the motor severity scale, while the control group experienced no significant change. Also, she found that the tango group experienced a 40% improvement in bradykinesia, compared to no change for the control group.
Although other forms of dance, such as the waltz and foxtrot, can benefit PD patients, Earhart suggested that the tango is particularly advantageous for these patients. "The backward steps, the change of pace, and the less predictable and more improvisational style of the tango require patients to do things that are particularly challenging for people with Parkinson’s," Gammon said. "This can help them to improve their motor function and potentially slow the progression of their disability."
Becky Farley, PT, MS, PhD, CEO and founder of Parkinson Wellness Recovery in Tucson, Ariz., has worked with Parkinson’s patients for more than a decade, and she believes that the social aspect of dance is just as therapeutic as the physical challenge.
"People with Parkinson’s have a neurodegenerative disease that affects not only motor function, but also emotional and cognitive functions that are essential for learning," she said. "The changes in their brains can lead to anxiety, depression, loss of self-efficacy, attentional deficits and reduced body awareness. The social networking, touch, and sense of doing something enjoyable during dance can create positive changes in the brain to help these patients."
Farley said she believes PD patients will experience the most benefit if they are not only vigorous when they dance, but also thoughtful about diversifying their exercise regime throughout the week. "To slow the motor deterioration, these patients need a variety of exercise options that require them to work more vigorously than they would self-elect," she said. "Dance is one option, and others include the treadmill, pole walking, high intensity spinning and strength training."
Changing the future
Although the steps in the tango are somewhat universal, understanding the symptoms of the disease is important for anyone who attempts to teach the dance to this patient population.
"The biggest difference is that we are more careful with guarding them from falling," said Malia Walker, a physical therapy student at NAU who started the tango class in September 2011. "For participants at higher risk for falls, we pair two students with one patient and also use a gait belt for added safety. Also, people with Parkinson’s do not have as much motivation to do things, so I do a lot of encouragement and I challenge them to make big, powerful movements."
Walker knows also that people with PD may notice their voice becomes increasingly quiet over time, so she asks the students to yell "T-A-N-G-O" to the beat of the steps.
As for whether the challenges in class translate to changes at home, Walker has heard caregivers of the patients comment that their loved ones are walking faster, talking louder and able to get out of bed on the first attempt, rather than the third or fourth.
For the woman in her 60s who had stopped going to physical therapy, the tango classes had a significant affect on her life at home. When she froze while walking one day, she decided to recite "T-A-N-G-O" to the beat of the music from class, and amazingly this mental trick helped her brain to safely move her legs out of the frozen position.
"My hope is that we can actually slow or reverse the disease progression and eventually stop seeing the detrimental end stages of Parkinson’s disease," Carter said. "Music is very motivating to people, and after these patients see the changes they are making, it gives them a new lease on life. They realize for the first time that they are not dying, and PTs are the people who can tell them that with exercise they can get better." •
Heather Stringer is a freelance writer.
This was the case for a woman in her 60s who stopped attending therapy because she was discouraged about her condition and afraid of injuring herself. Over time, the woman lost muscle control to the point that she moved around by shuffling rapidly. Often unable to stop herself, she would deliberately run into furniture to stop the forward momentum. Other times, she would freeze while walking, paralyzed in that position until she could muster the courage to lean precariously forward in hopes of triggering her legs to move to catch her fall.
Carter had not seen the woman for five years, so she was shocked and thrilled when the woman recently showed up for a new tango class for people with Parkinson’s that would be taught by physical therapy students from Northern Arizona University in Flagstaff. Each of the participants partnered with a student, and then something amazing happened: They began to move their bodies in ways that had previously seemed lost to the disease.
"For PD patients, the signal in the basal ganglia gets muddled, so that is why they start taking smaller steps and leaning forward," said Carter, an associate clinical professor at NAU. "The tango brings them upright and requires large backward and side steps, and this is exactly what PD patients need. I am seeing people dancing who I haven’t seen in the clinic in years because they are having fun and enjoying themselves."
Proof that it works
Gammon Earhart, PT, PhD, associate professor of physical therapy at Washington University in St. Louis, first considered the potential benefits of the tango for PD patients several years ago, and has since conducted several studies that have supported its therapeutic value. In the February issue of Neurorehabilitation and Neural Repair, she published the results of a study involving 52 patients in a 12-month study. Even Earhart was surprised by what she found.
She compared a control group of patients who continued their usual routine with a group who started participating in one-hour tango classes twice a week. She used a rating system for PD motor severity (known as MDS-UPDRS-3) that tested levels of impairment in areas such as balance, walking, leg and foot movement, facial expressions, and hand and finger movement. "I expected to see improvements during the first three or six months, but the improvement continued at nearly the same rate for the full 12 months," Earhart said.
By the end of the study, the tango group experienced a reduction of 28.7% impairment on the motor severity scale, while the control group experienced no significant change. Also, she found that the tango group experienced a 40% improvement in bradykinesia, compared to no change for the control group.
Although other forms of dance, such as the waltz and foxtrot, can benefit PD patients, Earhart suggested that the tango is particularly advantageous for these patients. "The backward steps, the change of pace, and the less predictable and more improvisational style of the tango require patients to do things that are particularly challenging for people with Parkinson’s," Gammon said. "This can help them to improve their motor function and potentially slow the progression of their disability."
Becky Farley, PT, MS, PhD, CEO and founder of Parkinson Wellness Recovery in Tucson, Ariz., has worked with Parkinson’s patients for more than a decade, and she believes that the social aspect of dance is just as therapeutic as the physical challenge.
"People with Parkinson’s have a neurodegenerative disease that affects not only motor function, but also emotional and cognitive functions that are essential for learning," she said. "The changes in their brains can lead to anxiety, depression, loss of self-efficacy, attentional deficits and reduced body awareness. The social networking, touch, and sense of doing something enjoyable during dance can create positive changes in the brain to help these patients."
Farley said she believes PD patients will experience the most benefit if they are not only vigorous when they dance, but also thoughtful about diversifying their exercise regime throughout the week. "To slow the motor deterioration, these patients need a variety of exercise options that require them to work more vigorously than they would self-elect," she said. "Dance is one option, and others include the treadmill, pole walking, high intensity spinning and strength training."
Changing the future
Although the steps in the tango are somewhat universal, understanding the symptoms of the disease is important for anyone who attempts to teach the dance to this patient population.
"The biggest difference is that we are more careful with guarding them from falling," said Malia Walker, a physical therapy student at NAU who started the tango class in September 2011. "For participants at higher risk for falls, we pair two students with one patient and also use a gait belt for added safety. Also, people with Parkinson’s do not have as much motivation to do things, so I do a lot of encouragement and I challenge them to make big, powerful movements."
Walker knows also that people with PD may notice their voice becomes increasingly quiet over time, so she asks the students to yell "T-A-N-G-O" to the beat of the steps.
As for whether the challenges in class translate to changes at home, Walker has heard caregivers of the patients comment that their loved ones are walking faster, talking louder and able to get out of bed on the first attempt, rather than the third or fourth.
For the woman in her 60s who had stopped going to physical therapy, the tango classes had a significant affect on her life at home. When she froze while walking one day, she decided to recite "T-A-N-G-O" to the beat of the music from class, and amazingly this mental trick helped her brain to safely move her legs out of the frozen position.
"My hope is that we can actually slow or reverse the disease progression and eventually stop seeing the detrimental end stages of Parkinson’s disease," Carter said. "Music is very motivating to people, and after these patients see the changes they are making, it gives them a new lease on life. They realize for the first time that they are not dying, and PTs are the people who can tell them that with exercise they can get better." •
Heather Stringer is a freelance writer.
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Monday May 14, 2012