World Parkinson’s Day is celebrated on April 11, on the birthday of English physician Sir James Parkinson, who was the first to describe this disease. The purpose of marking this day is to raise awareness of the causes, symptoms and treatment options for this important public health problem. In this article, we are bringing you answers to why dance is being increasingly researched today as a potential best form of non-pharmacological therapy in the treatment of Parkinson’s disease.
Parkinson’s disease (PB) is the second most common neurodegenerative disease with progressive impairment of motor functions and other accompanying symptoms such as autonomic and cognitive impairment, sleep disturbances, and impulse control. People with PB often show postural instability (tendency to lose balance), difficulty walking, bradykinesia (slowness of movement), stiffness, and tremor at rest. As a result, they have limited mobility and a higher risk of falls, which significantly reduces their quality of life. 70% of patients with PB experience a fall within one year, and of that percentage, 50% experience another fall in the following year. Falls are especially problematic for people with PD because they have a 3,2 times higher risk of hip fractures compared to people without PD. 1
Various studies have shown that in the advanced stages of the disease, in addition to standard pharmacotherapy, additional supportive therapies are useful to alleviate symptoms, which most often include physiotherapy, aerobic training, water gymnastics or strength exercises. However, although the effectiveness and positive effects of these approaches have been proven to alleviate motor symptoms, in such activities the patients’ motivation is often lacking, and there is also a fear of falling. That is why some other forms of physiotherapy, which connect the mind and body, such as Qi Gong and Tai Chi, and dance, are being increasingly considered today.
Dance as a movement therapy with music for people with PB naturally combines cognitive movement strategies, posture techniques, balance exercises and physical activity. The focus is on enjoying movement with music, rather than on current mobility limitations. This may encourage longer-term patient motivation to participate compared to conventional exercise training. 3 Older people find dancing more enjoyable than traditional exercises and show improved balance and functional mobility. Argentine tango has proven to be particularly effective because various studies have shown that it has led to more improvements in balance and complex walk.
Argentine tango involves frequent changes of movement and interruption of movement, spontaneous changes of direction and a wide range of movement speeds, requires postural control, monitoring rhythmic variations of music, and movement in close proximity to another person. It is these features that can affect difficulty in initiating movement, turning, lack of stride length, and bradykinesia that are the main symptoms of PB. This distinguishes tango from other standard dances (waltz, foxtrot) which do not have as many rhythmic variations and improvisational patterns. In Argentine tango, dancers do not have to learn a complex sequence of steps that would be too difficult to remember or physically follow, but it is important that they learn to improvise with spontaneous reactions, steps and movements to the music. Additionally, patients should focus on the partner’s movements, whole-body coordination, and aesthetics of their movements.
Brain and dance
PET studies have shown that the basal ganglia can be intensified during measured rhythmic movement such as that in the Argentine tango, and these patterns can improve motor control in people with Parkinson’s disease.
Visible improvements in dance therapy may be the result of external signals generated by the music and/or partner, but also of specific movements characteristic to a particular form of dance.
Individuals with PB often move slowly but can achieve movements of almost normal speed and amplitude by focusing attention on critical aspects of movement, especially with the help of external signals. These signals can reach the cortical region, bypassing the dysfunctional basal ganglia. Audible signals reach the additional motor area via the thalamus or the premotor cortex via the cerebellum. 1 This may explain the improvement in walk speed, movement, and rhythm in patients on therapy. On the other hand, the partner is there to facilitate step coordination, serve to support balance, and guide the step.
Specific movement patterns
One study 1 compared the influence of different dances and found that although waltz and foxtrot also lead to improved motor skills in PB, they are not identical to those caused by tango. This depends not only on the previously mentioned different rhythms and variations in movement patterns but also on the preferences of the patients themselves or their socio-cultural differences.
What makes tango special is that it includes movements that are similar to those used in conventional therapy, the so-called “Frozen walk”, which are crossing your partner’s foot, tapping your partner’s feet or crossing one foot over the other. It also involves rhythmic rocking and alternating movement of the centre of gravity of the mass from foot to foot. Tango can also help improve walk speed and stride length as it involves controlling the speed and magnitude of movement, i.e. changing slow and fast steps of different lengths and requires their constant adjustment. What makes tango stand out in particular from other dances and physical therapies is its special effectiveness in improving walking backwards. Given that tango is the dance in which the most movement is backwards (other dances have equal movement backwards, sideways and forwards), this is one of the very important exercises that should be mastered because the falls in patients with PB are mostly in that direction, backwards.
More than dancing
Argentine tango can improve the quality of life of people with PB not only by alleviating physical symptoms but also by boosting self-confidence and increasing enjoyment in life. Dancing allows them social interaction, nonverbal communication, and restoring a sense of usefulness. This points to the multiple benefits of dance in PB therapy, both in addressing the physical challenges and the cognitive and emotional challenges associated with PB.
In honour of people suffering from PB, let’s dance t-a-n-g-o (spelling words in English is often used for the purpose of teaching rhythm/steps in Argentine tango).
Translated by: Ines Jurak
2 Lötzke D et al. Argentine tango in Parkinson disease – a systematic review and meta-analysis. BMC Neur. 2015, 15:226
3 of Dreu MJ et al. 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. Parkinsonism Relat Disord. 2012, 18 Suppl 1:S114-9
4 Berti A, Pini M, Ferrarello F, Argentine tango in the care of Parkinson’s disease: a systematic review and analysis of the intervention, Complementary Therapies in Medicine, 2020
5 Bognar S et al. More than just dancing: experiences of people with Parkinson’s disease in a therapeutic dance program, Disability and Rehabilitation, 2016, 17:37
6 World Parkinson’s Day, https://www.hzjz.hr/, accessed 2.4.2021.
7 World Parkinson’s Day, https://stampar.hr/, accessed 2.4.2021.