Social dancing: a way to support intellectual, emotional and motor functions in persons with dementia

The Neuroscience of Dance: A Conceptual Framework and Systematic Review

Ancient and culturally universal, dance pervades many areas of life and has multiple benefits. In this article, we provide a conceptual framework and systematic review, as a guide for researching the neuroscience of dance. We identified relevant articles following PRISMA guidelines, and summarised and evaluated all original results. We identified avenues for future research in: the interactive and collective aspects of dance; groove; dance performance; dance observation; and dance therapy. Furthermore, the interactive and collective aspects of dance constitute a vital part of the field but have received almost no attention from a neuroscientific perspective so far. Dance and music engage overlapping brain networks, including common regions involved in perception, action, and emotion. In music and dance, rhythm, melody, and harmony are processed in an active, sustained pleasure cycle giving rise to action, emotion, and learning, led by activity in specific hedonic brain networks. The neuroscience of dance is an exciting field, which may yield information concerning links between psychological processes and behaviour, human flourishing, and the concept of eudaimonia.

Benefits of Tango Therapy in Alleviating the Motor and Non-Motor Symptoms of Parkinson’s Disease Patients—A Narrative Review

The present study examines the efficacy of tango therapy on motor and non-motor symptomatology in Parkinson’s disease, as detailed in articles published over the previous four decades (1980–2022). All data was collected using PubMed, Google Scholar, Web of Science, and Science Direct. The present descriptive study outlines the advantages of tango in the rehabilitation of Parkinson’s disease’s motor and non-motor symptoms. Numerous studies have been conducted to determine the usefulness of tango for people with PD. Information from various research is critical for determining if tango is a useful supplementary therapy for the variety of symptoms related to Parkinson’s disease. The purpose of this review was to describe the present state of research on this subject. Thus, the objective of this review is to promote awareness of tango therapy’s therapeutic benefits for Parkinson’s disease.

Culture and mental health resilience in times of COVID-19

This paper aims to clarify the role of culture as a public good that serves to preserve mental health. It tests the evolutionary hypothesis that cultural consumption triggers a microeconomic mechanism for the self-defense of mental health from uncertainty. The COVID-19 pandemic offers a natural experiment of cultural consumption under increased uncertainty. Using primary data from a pilot survey conducted online during the pandemic and applying Probit and Heckman selection models, the study analyzes levels of happiness and propensity to help others. The results suggest that past consumption of culture is associated with higher happiness levels during crises. Moreover, spontaneous cultural practices (such as group singing) during times of uncertainty are associated with an increase in the pro-social propensity to help others. These findings highlight culture as a tool for promoting mental health at the micro level and social capital resilience at the aggregate level.

Impacts of dance on agitation and anxiety among persons living with dementia: An integrative review

INTRODUCTION

Individuals living with dementia are likely to experience one or more neuropsychiatric symptoms on a daily basis. Dance has the potential to positively impact and reduce these symptoms. This integrative review was conducted to identify the impacts of dance on agitation and anxiety among those living with dementia.

METHODS

An integrative review methodology guided the literature search and evaluation. Thirty-Nine papers were retrieved from the initial search. Five studies were included in the review. The Mixed Methods Appraisal Tool was used to assess the quality of relevant articles.

RESULTS

Three quantitative and 2 qualitative studies were reviewed. Three out of 4 studies found dance positively impacted agitation. While 1 out of 2 studies reported improvements in anxiety.

DISCUSSION

This review suggests that dance has the potential to impact anxiety and agitation symptoms of persons living with dementia. However, the evidence is weak and further research is warranted.

Improving mental health and reducing antipsychotic use in people with dementia in care homes: the WHELD research programme including two RCTs

Background

The effective management of agitation and other neuropsychiatric and behavioural symptoms in people with dementia is a major challenge, particularly in care home settings, where dementia severity is higher and there is limited training and support for care staff. There is evidence for the value of staff training and the use of psychosocial approaches; however, no intervention currently exists that combines these elements into an intervention that is fit for purpose and effective in these settings based on evidence from a randomised controlled trial.

Objective

The objective was to develop and evaluate a complex intervention to improve well-being, reduce antipsychotic use and improve quality of life in people with dementia in care homes through person-centred care, management of agitation and non-drug approaches.

Design

This was a 5-year programme that consisted of six work packages. Work package 1 consisted of two systematic reviews of personalised psychosocial interventions for behavioural and psychological symptoms for people with dementia in care homes. Work package 2 consisted of a metasynthesis of studies examining implementation of psychosocial interventions, in addition to developing a draft Well-being and Health for people with Dementia (WHELD) programme. Work package 3 consisted of a factorial study of elements of the draft WHELD programme in 16 care homes. Work package 4 involved optimisation of the WHELD programme based on work package 3 data. Work package 5 involved a multicentre randomised controlled trial in 69 care homes, which evaluated the impact of the optimised WHELD programme on quality of life, agitation and overall neuropsychiatric symptoms in people with dementia. Work package 6 focused on dissemination of the programme.

Setting

This programme was carried out in care homes in the UK.

Participants

Participants of this programme were people with dementia living in care homes, and the health and care professionals providing treatment and care in these settings.

Results

Work package 1: reviews identified randomised controlled trials and qualitative evidence supporting the use of psychosocial approaches to manage behavioural symptoms, but highlighted a concerning lack of evidence-based training manuals in current use. Work package 2: the meta-analysis identified key issues in promoting the use of interventions in care homes. The WHELD programme was developed through adaptation of published approaches. Work package 3: the factorial trial showed that antipsychotic review alone significantly reduced antipsychotic use by 50% (odds ratio 0.17, 95% confidence interval 0.05 to 0.60). Antipsychotic review plus social interaction significantly reduced mortality (odds ratio 0.36, 95% confidence interval 0.23 to 0.57), but this group showed significantly worse outcomes in behavioural and psychological symptoms of dementia than the group receiving neither antipsychotic review nor social interaction (mean difference 7.37 symptoms, 95% confidence interval 1.53 to 13.22 symptoms). This detrimental impact was reduced when combined with social interaction (mean difference –0.44 points, 95% confidence interval –4.39 to 3.52 points), but with no significant benefits for agitation. The exercise intervention significantly improved neuropsychiatric symptoms (mean difference –3.58 symptoms, 95% confidence interval –7.08 to –0.09 symptoms) but not depression (mean difference –1.21 points, 95% confidence interval –4.35 to 1.93 points). Qualitative work with care staff provided additional insights into the acceptability and feasibility of the intervention. Work package 4: optimisation of the WHELD programme led to a final version that combined person-centred care training with social interaction and pleasant activities. The intervention was adapted for delivery through a ‘champion’ model. Work package 5: a large-scale, multicentre randomised controlled trial in 69 care homes showed significant benefit to quality of life, agitation and overall neuropsychiatric symptoms, at reduced overall cost compared with treatment as usual. The intervention conferred a statistically significant improvement in quality of life (Dementia Quality of Life Scale – Proxy z-score of 2.82, mean difference 2.54, standard error of measurement 0.88, 95% confidence interval 0.81 to 4.28, Cohen’s d effect size of 0.24; p = 0.0042). There were also statistically significant benefits in agitation (Cohen-Mansfield Agitation Inventory z-score of 2.68, mean difference –4.27, standard error of measurement 1.59, 95% confidence interval –7.39 to –1.15, Cohen’s d effect size of 0.23; p = 0.0076) and overall neuropsychiatric symptoms (Neuropsychiatric Inventory – Nursing Home version z-score of 3.52, mean difference –4.55, standard error of measurement 1.28, 95% confidence interval –7.07 to –2.02, Cohen’s d of 0.30; p < 0.001). The WHELD programme contributed to significantly lower health and social care costs than treatment as usual (cost difference –£4740, 95% confidence interval –£6129 to –£3156). Focus groups were conducted with 47 staff up to 12 months after the end of work package 5, which demonstrated sustained benefits. Work package 6: the outputs of the programme were translated into general practitioner workshops and a British Medical Journal e-learning module, an updated national best practice guideline and a portfolio of lay and care home outreach activities.

Limitations

Residents with dementia were not involved in the qualitative work.

Conclusions

The WHELD programme is effective in improving quality of life and reducing both agitation and overall neuropsychiatric symptoms in people with dementia in care homes. It provides a structured training and support intervention for care staff, with lower overall costs for resident care than treatment as usual.

Future work

It will be important to consider the long-term sustainability of the WHELD programme and cost-effective means of long-term implementation.

Trial registration

Current Controlled Trials ISRCTN40313497 and ISRCTN62237498.

Funding

This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 6. See the NIHR Journals Library website for further project information.

Contemporary Dance Practice Improves Motor Function and Body Representation in Huntington's Disease: A Pilot Study

BACKGROUND

Physical exercise improves neurological conditions, but adherence is hard to establish. Dance might be a promising alternative; however, since patients with Huntington's disease (HD) suffer from rhythmic movement execution deficits, any metric dance practice must be avoided.

OBJECTIVE

Here we asked, if contemporary dance, a lyrical dance form, practiced for two hours per week over five months, might improve motor function, neuropsychiatric variables, cognition and brain volume of HD patients.

METHODS

Nineteen patients aged between 43 and 78 years with mild to moderate HD (TFC range 7-13, UHDRS motor score range 3-58) participated in this randomized, controlled pilot study (NCT 01842919). The primary outcome measure was total motor score. Secondary outcome measures were differences in brain structure, cognitive function, neuropsychiatric variables, apathy and quality of life. A semi-structured interview assessed participants' experiences.

RESULTS

Adherence to dance classes was very good. All participants completed 5 months of dance practice. Motor impairment (median [IQR] decreased from 28[6-51] to 27[7-33] for the dance group compared to an increase of 19[13-35] - 25[14-42] for usual care, Z = -2.44, p = 0.015). No other behavioral measures showed any changes.Brain volume increased in the medial superior parietal and paracentral lobule, in line with compensatory structural brain changes in areas supporting spatial and somatosensory processing. These changes were also reflected in patients' reports that contemporary dance altered the way they "felt and lived in their bodies".

CONCLUSIONS

Contemporary dance practice, through work on spatial and bodily representations, helps improve motor function in HD patients.

Effects of Dance Movement Therapy and Dance on Health-Related Psychological Outcomes. A Meta-Analysis Update

Background: Dance is an embodied activity and, when applied therapeutically, can have several specific and unspecific health benefits. In this meta-analysis, we evaluated the effectiveness of dance movement therapy(DMT) and dance interventions for psychological health outcomes. Research in this area grew considerably from 1.3 detected studies/year in 1996-2012 to 6.8 detected studies/year in 2012-2018. Method: We synthesized 41 controlled intervention studies (N = 2,374; from 01/2012 to 03/2018), 21 from DMT, and 20 from dance, investigating the outcome clusters of quality of life, clinical outcomes (with sub-analyses of depression and anxiety), interpersonal skills, cognitive skills, and (psycho-)motor skills. We included recent randomized controlled trials (RCTs) in areas such as depression, anxiety, schizophrenia, autism, elderly patients, oncology, neurology, chronic heart failure, and cardiovascular disease, including follow-up data in eight studies. Results: Analyses yielded a medium overall effect (d = 0.60), with high heterogeneity of results (I 2 = 72.62%). Sorted by outcome clusters, the effects were medium to large (d = 0.53 to d = 0.85). All effects, except the one for (psycho-)motor skills, showed high inconsistency of results. Sensitivity analyses revealed that type of intervention (DMT or dance) was a significant moderator of results. In the DMT cluster, the overall medium effect was small, significant, and homogeneous/consistent (d = 0.30, p < 0.001, I 2 = 3.47). In the dance intervention cluster, the overall medium effect was large, significant, yet heterogeneous/non-consistent (d = 0.81, p < 0.001, I 2 = 77.96). Results suggest that DMT decreases depression and anxiety and increases quality of life and interpersonal and cognitive skills, whereas dance interventions increase (psycho-)motor skills. Larger effect sizes resulted from observational measures, possibly indicating bias. Follow-up data showed that on 22 weeks after the intervention, most effects remained stable or slightly increased. Discussion: Consistent effects of DMT coincide with findings from former meta-analyses. Most dance intervention studies came from preventive contexts and most DMT studies came from institutional healthcare contexts with more severely impaired clinical patients, where we found smaller effects, yet with higher clinical relevance. Methodological shortcomings of many included studies and heterogeneity of outcome measures limit results. Initial findings on long-term effects are promising.

Using technology to enhance and encourage dance-based exercise

This study investigated the role of Self-Service Technologies (SSTs) in dance-based exercise in order to begin exploring the motivations behind the use (or not) of SSTs by ordinary men and women in this context. The research approach employed interviews to gain insights into participants' use of SSTs and their exercise practices, in order to start establishing ways in which dance can be re/incorporated into people's lives through the design of appropriate SSTs. Findings from this study highlight the significant opportunity to further explore how the properties of music and dance can be integrated into the design of new SSTs. Literature suggests dance could be a beneficial exercise format for many people and self-service technology abounds for exercise but is often not used consistently. Our interviews asked participants about dance-based exercise and SSTs for exercise and showed that there is an opportunity to design SSTs to help people access dance-based exercise. SSTs should help people learn dance, build confidence, and dance alone or with others. SSTs could facilitate movement and increase engagement with physical activity whilst addressing issues around logistics, confidence and dance knowledge and experience.

Ballroom dance for persons with multiple sclerosis: a pilot feasibility study

Purpose: The purpose of this study was to evaluate the exercise intensity and feasibility of recreational ballroom dance for persons with multiple sclerosis (MS).Methods: Seven persons with MS participated in 2 one-hour dance sessions per week for 6 weeks. Dance types included rumba, foxtrot, waltz, and push-pull. Six other persons with MS comprised a control group that did not dance. Heart rate and ratings of perceived exertion (RPE) were monitored during the sessions. Outcomes included: quality of life, fatigue, depression, self-efficacy, timed up and go, Berg Balance Scale, Dynamic Gait Index and the Multiple Sclerosis Functional Composite comprising 9-hole peg test, 25-ft walk test, and Paced Auditory Serial Addition Test (PASAT), a cognitive test.Results: Heart rates and RPE indicated that ballroom dance for persons with MS can provide a light to moderate exercise intensity. After the dance program, quality of life and PASAT improved as did the MS Functional Composite Score. No changes were noted in the control group.Conclusions: Recreational ballroom dance is feasible and can provide an exercise stimulus sufficient to help meet exercise recommendations for persons with multiple sclerosis as well as improve quality of life and cognition in persons with MS.Implications for rehabilitationExercise or physical activity is important for the health and wellness of persons with multiple sclerosis.Persons with multiple sclerosis often seek information about non-traditional low-impact physical activity.In a small controlled sample, partnered recreational ballroom or social dance for persons with multiple sclerosis has been shown to be feasible and of recommended exercise intensity.Further, partnered recreational ballroom dance for persons with multiple sclerosis can improve measures of quality of life and cognitive function.

Systematic review of the impact of arts for health activities on health, wellbeing and quality of life of older people living in care homes

Care home populations frequently feature older people who often experience poor physical health and cognitive difficulties, along with vulnerability to psychological and social stressors. To date there has been no systematic review which focuses on the impact of arts for health activities to the care home population. Evidence was sourced from several databases and 71 studies were deemed eligible for inclusion in this review. These studies underwent data extraction and quality appraisal and the findings associated with health, wellbeing and quality of life are presented within this paper.

It takes time: Building relationships and understanding through an intergenerational ballet programme

Individuals living in long-term residential care homes are often viewed through a negative lens. These residents have increasingly complex care needs, and their functional, communication and cognitive challenges can support conceptualizations of difference and disability perpetuating negative stereotypes of age and dementia. However, engaging in meaningful activities and relationships with older adults, including those with dementia, has been shown to promote positive attitudes. Specifically, intergenerational programming that provides opportunities for meaningful engagement between children and older adults has been shown to support positive emotional experiences through socializing and building relationships. This qualitative study explored the development of relationships between school-aged children and older adults with dementia living in a long-term residential care home. Residents in long-term care homes and children typically have limited opportunities to interact with each other; in this study, participating in an intergenerational dance programme provided an opportunity for meaningful relationships to develop. This paper focuses on the development of the children’s attitudes and understandings of their much older dance partners. Seven girls between the ages of seven and nine participated in ballet classes with residents in a long-term care home for one hour each week over a six-month period. All of the residents had a diagnosis of moderate to advanced dementia. Further, all of the residents also had other chronic health issues such as cardiac, respiratory and/or neurological diseases. The children were interviewed at the baseline, three- and six-month intervals. Prior to beginning the dance programme, the children anticipated their dance partners to be unwell and unable. However, by the end of six months, the children described the residents much more positively highlighting their abilities and strengths. Over time, through participating in a structured intergenerational programme, the children’s views of disability and difference disappeared as they formed dance partnerships and developed meaningful relationships.

International Ballroom Dancing Against Neurodegeneration: A Randomized Controlled Trial in Greek Community-Dwelling Elders With Mild Cognitive impairment

BACKGROUND

Many studies have highlighted the positive effects of dance in people with neurodegenerative diseases.

OBJECTIVES

To explore the effects of International Ballroom Dancing on cognitive function in elders with amnestic mild cognitive impairment (aMCI).

METHODS

One-hundred twenty-nine elderly patients with aMCI diagnosis (mean age 66.8 ± 10.1 years) were randomly assigned into 2 groups: intervention group (IG, n = 66) and control group (CG, n = 63). The IG exercised systematically for 10 months, and both groups were submitted to extensive neuropsychological assessment prior and after the 10-month period.

RESULTS

According to the independent sample t test at the follow-up, significant differences between groups were found in benefit of the IG while the CG showed worse performance in the majority of neuropsychological tests. According to the Student t test, better performance is detected in IG in contrast with CG, which had worse performance almost in all scales.

CONCLUSION

Dance may be an important nonpharmacological approach that can benefit cognitive functions.

A process evaluation of a Psychomotor Dance Therapy Intervention (DANCIN) for behavior change in dementia: attitudes and beliefs of participating residents and staff

BACKGROUND

In a previous paper, we presented results from a 12-week study of a Psychomotor DANCe Therapy INtervention (DANCIN) based on Danzón Latin Ballroom that involves motor, emotional-affective, and cognitive domains, using a multiple-baseline single-case design in three care homes. This paper reports the results of a complementary process evaluation to elicit the attitudes and beliefs of home care staff, participating residents, and family members with the aim of refining the content of DANCIN in dementia care.

METHODS

An external researcher collected bespoke questionnaires from ten participating residents, 32 care home staff, and three participants' family members who provided impromptu feedback in one of the care homes. The Behavior Change Technique Taxonomy v1 (BCTTv1) provided a methodological tool for identifying active components of the DANCIN approach warranting further exploration, development, and implementation.

RESULTS

Ten residents found DANCIN beneficial in terms of mood and socialization in the care home. Overall, 78% of the staff thought DANCIN led to improvements in residents' mood; 75% agreed that there were improvements in behavior; 56% reported increased job satisfaction; 78% of staff were enthusiastic about receiving further training. Based on participants' responses, four BCTTv1 labels-Social support (emotional), Focus on past success and verbal persuasion to boost self-efficacy, Restructuring the social environment and Habit formation-were identified to describe the intervention. Residents and staff recommended including additional musical genres and extending the session length. Discussions of implementing a supervision system to sustain DANCIN regularly regardless of management or staff turnover were suggested.

CONCLUSIONS

Care home residents with mild to moderate dementia wanted to continue DANCIN as part of their routine care and staff and family members were largely supportive of this approach. This study argues in favor of further dissemination of DANCIN in care homes. We provide recommendations for the future development of DANCIN based on the views of key stakeholder groups.

We think you can dance! A pilot randomised controlled trial of dance for nursing home residents with moderate to severe dementia

OBJECTIVES

To evaluate the feasibility of a dance program for people with moderate to severe dementia living in nursing homeswith regards to recruitment and retention, assessment tools, intervention safety, attendance and engagement.

DESIGN

Pilot randomised controlled trial with assessments at weeks 0, 16 and 32.

SETTING

A nursing home in Sydney, Australia.

INTERVENTIONS

Experienced dance teachers conducted dance groups (intervention) or music appreciation and socialisation groups (control) for 45min, three times a week for 16 weeks.

MAIN OUTCOME MEASURES

Descriptive statistics for recruitment and retention, adverse events and attendance and engagement.

RESULTS

Recruitment was smooth, attrition was17% over 32 weeks. Engagement during the sessions was high, and no serious falls or behavioural incidents occurred. Average attendance was poorer than anticipated for dance groups (67%) in comparison to music groups (89%). A ceiling effect on the Severe Impairment Battery and the logistical challenges of the Clinical Global Impression of Change meant they may not be optimal tools.

CONCLUSIONS

It is feasible to conduct a study of group dance for people with moderate to severe dementia in residential care. Choice of attention control condition should be reconsidered.

Embodied selfhood in Alzheimer's disease

Dementia care practices are premised on a model of Alzheimer's disease that denies the body an agential role in the constitution and manifestation of selfhood. As a consequence, despite advances in person-centred care, the body, which is a substantive means by which persons with advancing dementia engage with the world, is treated as passive rather than active and intentional. My central argument is that dementia care practices must embrace the idea that the body is a fundamental source of selfhood that does not derive its agency from a cognitive form of knowledge. With an interest in bringing the body into a theoretical re-visioning of selfhood in Alzheimer's disease, I advance this idea with the notion of embodied selfhood. I suggest ways that the notion of embodied selfhood could enhance person-centred dementia care; however, further research is required in order to fully conceptualize this notion in the context of dementia care.

Perspectives of People with Dementia About Meaningful Activities: A Synthesis

Qualitative studies were synthesized to describe perspectives of people with dementia regarding meaningful activities. Themes of connectedness were identified using a meta-ethnography approach. The theme of being connected with self encompasses engagement for continuity, health promotion, and personal time. The theme of being connected with others includes being with others not to feel alone, doing an activity with others, and meaningful relationships. The theme of being connected with the environment encompasses being connected to one’s familiar environment, community, and nature. This synthesis suggests that connectedness is an important motivation for engagement in daily activities. Findings indicate that identifying the underlying motivation for an individual with dementia to engage in different activities is important for matching a person with activities that will be satisfying. This review may inform the development of interventions for engaging people with dementia in meaningful, daily activities and creating connectedness to self, others, and the environment.

Improving quality of life for people with dementia in care homes: making psychosocial interventions work

BACKGROUND

Psychosocial interventions can improve behaviour and mood in people with dementia, but it is unclear how to maximise their effectiveness or acceptability in residential settings.

AIMS

To understand what underlies the successful implementation of psychosocial interventions in care homes.

METHOD

Systematic review and meta-synthesis of qualitative research.

RESULTS

The synthesis of 39 qualitative papers revealed that beneficial psychosocial interventions met the needs of people with dementia to connect with others, make a meaningful contribution and reminisce. Successful implementation rested on the active engagement of staff and family and the continuing provision of tailored interventions and support. This necessitated staff time, and raised issues around priorities and risk, but ultimately helped redefine staff attitudes towards residents and the caregiving role.

CONCLUSIONS

The findings from the meta-synthesis can help to inform the development and evaluation of psychosocial interventions in care homes and support their widespread implementation in clinical settings.

Nonpharmacological management of apathy in dementia: a systematic review

Apathy is one of the most challenging and prevalent behavioral symptoms of dementia. It is associated with increased disability and caregiver frustration as well as reduced quality of life, rehabilitation outcomes and survival after nursing home admission. A literature search to set criteria yielded 56 nonpharmacological intervention studies with outcomes relevant to apathy in dementia. Studies were rated according to quality and categorized into 7 groups: exercise, music, multisensory, animals, special care programming, therapeutic activities and miscellaneous. Despite a lack of methodological rigor, it is apparent that nonpharmacological interventions have the potential to reduce apathy. This review indicates that therapeutic activities, particularly those provided individually, have the best available evidence for effectiveness in dementia. Recommendations are provided for quality research.

Impact of a weekly dance class on the functional mobility and on the quality of life of individuals with Parkinson's disease

Individuals with Parkinson’s disease (PD) mainly suffer from motor impairments which increase the risk of falls and lead to a decline of quality of life. Several studies investigated the long-term effect of dance for people with PD. The aims of the present study were to investigate (i) the short-term effects of dance (i.e., the effect immediately after the dance class) on motor control in individuals with PD and (ii) 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 dance lessons took place in a ballet studio and were led by a professional dancer. Eleven people with moderate to severe PD (58–85 years old) were subjected to a motor and quality of life assessments. With respect to the motor assessments the unified Parkinson disease rating scale III (UPDRS III), the timed up and go test (TUG), and the Semitandem test (SeTa) before and after the dance class were used. With respect to the quality of life and well-being we applied quality of life scale (QOLS) as well as the Westheimer questionnaire. Additionally, we asked the caregivers to fill out the Questionnaire for caregivers. We 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. No significant changes were found for TUG and for SeTa. 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. The findings demonstrate that dance has beneficial effect on the functional mobility of individuals with PD. Further, dance improves the quality of life of the patients and their caregivers. Dance may lead to better therapeutic strategies as it is engaging and enjoyable.

Recommendations for Implementing Tango Classes for Persons with Parkinson Disease

Several studies have recently been published regarding the physical and emotional benefits of Argentine tango dance for individuals with Parkinson disease (PD). These papers focused on the effects of tango interventions rather than methods used to implement and deliver the interventions. The focus of the present paper is on methods for implementing PD-specific tango programs, to facilitate safe and appropriate implementation of community-based partnered dance programs for this population. We report successful methods for an Argentine Tango-based class, but these recommendations could be applicable to other partnered dances.

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 study's 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.

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.

Greek traditional dances and quality of old people's life

The aim of the present study was to examine the effect of Greek traditional dances on the improvement of old people's quality of life. A hundred and eleven subjects (75 women and 36 men) 60-91 years old, were divided into an experimental group (n=76) which participated in Greek traditional dances and a control group (n=35) which was discussing and watching television, both for 1h. The Subjective Exercise Experiences Scale [McAuley, E., Courneya, K., 1994. The Subjective Exercise Experiences Scale (SEES): development and preliminary validation. Journal of Sport and Exercise Psychology 16, 163-177] was used to measure positive well-being, psychological distress, and fatigue and the State-Trait Anxiety Inventory [Spielberger, C.D., Gorsuch, R., Lushene, R., 1970. Manual for the State-trait Anxiety Inventory. Consulting Psychologists, Palo Alto] to measure state and trait anxiety respectively. Correlational analyses, between the various measures taken postdance, showed that the overall set of relations between the SEES subscales and the SAI-Y1 subscale supports the criterion-related validity of this measure of exercise-induced psychological responses. The independent groups t-tests showed that the control group in comparison to experimental group, at rest as well as on the second measurement, has significantly higher levels of state anxiety (t=-4.45, p<0.001 &t=-6.56, p<0.001), psychological distress (t=-4.30, p<0.001 &t=-5.46, p<0.001), and fatigue (t=-3.16, p<0.01 &t=-3.46, p<0.001), while it has significantly lower levels of positive well-being (t=4.23, p<0.001 &t=6.90, p<0.001). After dancing approximately 63% of maximum heart rate of experimental group was activated, while from paired t-tests significant decreases in state anxiety (t=5.02, p<0.001) and psychological distress (t=3.14, p<0.01) were observed, as well as significant increases in positive well-being (t=-4.44, p<0.001) and fatigue (t=-2.15, p<0.05). On the other hand, no significant difference in control group was observed. Consequently, Greek traditional dances may be used as a functional psycho-physical activity, to produce both physical and mental benefits for elderly individuals.

Does partnered dance promote health? The case of tango Argentino

AIMS

Cultural activities, including music, singing and dance, have often been conceptualised as enhancing well-being as well as promoting mental and physical health. This paper focuses on partnered dance in the context of 'cultures of fitness'. Its purpose was to investigate the dancers of tango Argentino, and to explore potential health benefits in this group.

METHODS

Participants (N=110) completed a self-developed inventory, which was, in part, based on interviews and observations as a participant observer. The inventory addresses educational, musical, and socio-economic background, motivation for and investment in dancing tango, and other leisure activities.

RESULTS

Dancers are characterized by high-level education and socio-economic status. Motivation appears to be predominantly driven by both hedonistic and social factors, accounting altogether for nearly 60% of the variance. The majority of individuals started dancing tango only in their 30s. Physical investment in terms of time and money indicate tango dancing as a highly important activity that seems to involve substantial opportunity of moderate physical exercise, social interaction and emotional reward. In consequence, tango dance was identified as the primary leisure activity.

CONCLUSIONS

Tango dancers were identified as highly educated individuals, who are dedicated to the practice in many respects, including physical and emotional. They draw from similar motivations as compared to participants of other musical activities such as singing and listening to music. Notably, aspects of physical fitness are more prominent in this group. The intensity with which tango is practised seems to depend to some degree on individual lifestyles. Taken together, the results suggest a high degree of personal involvement in tango dance as a primary leisure activity. Implications of partnered dance for social, emotional, and physical well-being and health promotion demand further research.

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 Parkinson's 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 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.

Dance in mental health nursing: a hybrid concept analysis

The aim of this concept analysis is to describe the defining attributes and consequences of the concept of dance and to define it in a mental health nursing context using hybrid concept analysis. Dance is a human resource learned from culture. Dance implies body movements, steps, expression, and interaction. The outcomes of dance are mostly functional, including a client's physical and emotional health, well-being, ability to cooperate with other people in activities of daily life, and meeting role expectations within family and community. Based on the findings of this concept analysis, dance can be used as a nursing intervention.

Dementia -- involving patients and their caregivers in a drama programme: the caregivers' experiences

A cultural drama programme was designed for patients with dementia and was led by teachers trained in drama in education and storytelling. The focus was on dance, rhythm, song, storytelling and conversations. The aim of this study was to describe how a drama programme for patients with dementia and their caregivers was experienced by the caregivers. Twelve strategically selected patients, 10 women and two men, with moderate and severe dementia, and their seven female caregivers participated in the programme. Sessions were held for one and a half hour, weekly once for 2 months. A focus group interview was held with the caregivers 1 month after the programme had ended. The interview and analysis of data were carried out according to the principles of phenomenography. Two categories, 'interaction' and 'professional growth', and five subcategories emerged in the analysis. In these, the caregivers described how fellowship developed between the participants and how they shared joy and sorrow. The patients communicated with each other and the leaders, and the programme seemed to help the patients to remember and make associations with situations experienced earlier in their lives. The patients also showed knowledge and ability in things about which the caregivers were unaware until the time of the drama programme. In other daily life situations, the patients showed their feelings, both joy and sorrow, more openly, their self-confidence grew and they showed greater interest in their surroundings. The caregivers furthermore expressed that they felt confirmed in their roles as caregivers. The programme prompted them to reflect upon their roles as caregivers. In conclusion, a drama programme with cultural features seems to increase the quality of life in patients with dementia and strengthen the caregivers in their profession.

Emotional response to social dancing and walks in persons with dementia

The emotional response to social dancing and walks in persons with dementia was studied to better understand the feasibility, popularity, and meaning of these activities from the perspective of the patient. Social dance events and walks were videotaped and analyzed using Husserl's philosophy as a basis for the analysis. Six persons with dementia participated in the study. The results are described in terms of four interrelated themes: 1) the engaged body; 2) the caregivers' understanding, encouragement, and response to patients during the activity; 3) mutual tenderness and communion; and 4) environmental conditions. Results were then synthesized into a general assessment of the emotional states observed and reported in relation to the activities.