Dance therapy improves motor and cognitive functions in patients with Parkinson's disease

Assessing the factors that influence the utilization and delivery of rehabilitation services among persons with Parkinson's disease: A scoping review

RATIONALE

Rehabilitation has the potential to significantly improve the lives of people and, most importantly, for persons with Parkinson's disease (PD). Although numerous studies have reported the benefits of rehabilitation for persons with PD (PwPD), these services are still limited and underutilized even when patients exhibit problems that require rehabilitation.

AIMS AND OBJECTIVES

This review aims to describe the (a) indication for referral for rehabilitation services, (b) patterns of referral for rehabilitation and (c) factors that facilitate or hinder the utilization and delivery of rehabilitation services among PwPD.

METHODS

A comprehensive literature search was conducted across selected databases, African Journals Online, EBSCOhost (CINAHL, Africa-wide), PubMed, SCOPUS and Web of Science. Studies published in English from January 2002 until December 2022 were applied as limiters. Reference and grey data sources tracking were also conducted. Two reviewers conducted the study selection, screening of titles, abstracts and full text and data charting. A descriptive analysis was performed. Findings were narratively presented and illustrated with tables, diagrams and descriptive formats as appropriate.

RESULTS

Twelve studies were included in the review; however, none were from Africa. Impairments and activity limitations were the key functioning problems indicated for rehabilitation. Age, gender, income, race, disease stage, specific functioning problems, quality of life and care by a neurologist were the main predictors for referral to rehabilitation. Physiotherapy, occupational therapy and speech and language therapy were the most utilized rehabilitation services and were sometimes utilized together. The rate of rehabilitation service utilization among PwPD ranged from 0.9% to 62.5%. Lack of referrals and limited rehabilitation units/professionals were the common barriers to rehabilitation service utilization.

CONCLUSION

Per the studies reviewed, utilization of rehabilitation services is generally low among PwPD. Lack of referral and nonavailability of professionals are cited as barriers to access. Adequate measures are needed to improve rehabilitation services for all PwPD.

Moving Towards a Medicine of Dance: A Scoping Review of Characteristics of Dance Interventions Targeting Older Adults and a Theoretical Framework

Background

Dance combines cultural and aesthetic elements with behaviors important for brain health, including physical activity, social engagement, and cognitive challenge. Therefore, dance could positively impact public health given the rapidly aging population, increasing incidence of Alzheimer's disease and related dementias, and lack of uptake of exercise in many older adults. Despite a high volume of literature, existing literature does not support evidence-based guidelines for dance to support healthy aging.

Objective

To conduct a scoping review of the dance intervention literature in older adults and provide information to facilitate a more consistent approach among scientists in designing dance interventions for older adults that stimulate physical and neurocognitive health adaptations.

Methods

Study characteristics (sample size, population, study design, outcomes, intervention details) were ascertained from 112 separate studies of dance reported in 127 papers that reported outcomes important for brain health (cardiorespiratory fitness, balance and mobility, cognition, mood, and quality of life).

Results

High heterogeneity across studies was evident. Class frequency ranged from < 1 to 5 classes per week, class length from 30-120 minutes, and intervention duration from 2 weeks to 18 months. Studies often did not randomize participants, had small (< 30) sample sizes, and used varied comparator conditions. Over 50 tests of cognition, 40 dance forms, and 30 tests of mobility were identified.

Conclusions

Based on these results, important future directions are establishing common data elements, developing intervention mapping and mechanistic modeling, and testing dosing parameters to strengthen and focus trial design of future studies and generate evidence-based guidelines for dance.

Tango and physiotherapy interventions in Parkinson's disease: a pilot study on efficacy outcomes on motor and cognitive skills

Pharmacological treatments in Parkinson's disease (PD), albeit effective in alleviating many motor symptoms, have limited effects in non-motor signatures as cognitive impairment, as well as in other aspects included postural instability. Consequently, complementary interventions are nowadays a prerogative of clinical practice managing PD symptomatology. In this pilot longitudinal study, we recruited twenty-four PD patients participating in one of two interventions: adapted Argentine Tango or group-based physiotherapy. Participants underwent a motor and neuropsychological evaluation before and after four months of activities, carried out twice a week. We found a general stabilization of motor and cognitive abilities, with significant improvements in several motor skills, mainly pertaining to static and dynamic balance, similarly in both groups. At cognitive level, we measured a significant improvement in both groups in the Action Naming task. Interestingly, only PD patients in the Tango group improved their performance in the test measuring facial emotion recognition. These findings highlight the crucial role that physical activities have in the stabilization and slowdown of disease's progression in PD. They further highlight the beneficial effects of a group-based physical intervention, which, especially in the case of Tango, could lead to behavioral ameliorations in domains other than the motor, such as emotion recognition.

Self-Guided DMT: Exploring a Novel Paradigm of Dance Movement Therapy in Mixed Reality for Children with ASD

Children diagnosed with Autism Spectrum Disorder (ASD) often exhibit motor disorders. Dance Movement Therapy (DMT) has shown great potential for improving the motor control ability of children with ASD. However, traditional DMT methods often lack vividness and are difficult to implement effectively. To address this issue, we propose a Mixed Reality DMT approach, utilizing interactive virtual agents. This approach offers immersive training content and multi-sensory feedback. To improve the training performance of children with ASD, we introduce a novel training paradigm featuring a self-guided mode. This paradigm enables the rapid creation of a virtual twin agent of the child with ASD using a single photo to embody oneself, which can then guide oneself during training. We conducted an experiment with the participation of 24 children diagnosed with ASD (or ASD propensity), recording their training performance under various experimental conditions. Through expert rating, behavior coding of training sessions, and statistical analysis, our findings revealed that the use of the twin agent for self-guidance resulted in noticeable improvements in the training performance of children with ASD. These improvements were particularly evident in terms of enhancing movement quality and refining overall target-related responses. Our study holds clinical potential in the field of medical treatment and rehabilitation for children with ASD.

Effectiveness of dance interventions for falls prevention in older adults: systematic review and meta-analysis

INTRODUCTION

Fall prevention is a global health priority. Strength and balance exercise programmes are effective at reducing falls. Emerging literature suggests dance is an enjoyable and sociable form of exercise. However, there is little evidence that dance reduces fall incidence.

METHODS

Systematic review and meta-analysis examining effectiveness and cost-effectiveness of dance for falls prevention in older adults. Five databases were searched with no restrictions on publication date or intervention settings. Risk of bias was assessed using variants of Cochrane Risk of bias tools, Mixed-Methods Appraisal and Drummond checklist as appropriate. Certainty of evidence was assessed using GRADE.

RESULTS

Forty-one studies were included (19 RCTs, 13 quasi-experimental, two mixed-method, seven observational studies, 2,451 participants). Five types of dance interventions were identified: ballroom and Latin dance, dance exercise, cultural dance, dance therapy, and low-impact dance. Meta-analysis was only possible for functional outcome measures: Timed-Up-and-Go (dance versus usual care, mean difference (MD) = 1.36; 95% CI -3.57 to 0.85), Sit-to-Stand (dance versus exercise MD = -0.85; 95% CI -2.64 to 0.93: dance versus education MD = -1.64; 95% CI -4.12 to 0.85), Berg Balance Scale (dance versus usual care MD = 0.61; 95% CI -4.26 to 5.47). There was unexplained variance in effects and no significant differences between intervention and control groups. Overall, certainty of evidence was very low; we are uncertain about the effect of dance interventions in reducing falls.

CONCLUSIONS

There is very low certainty evidence for dance as an alternative to strength and balance training if the aim is to prevent falls. No robust evidence on the cost-effectiveness of dance interventions for the prevention of falls was found.

PROSPERO REGISTRATION

CRD42022382908.

Effect of Rhythmically Cued Exercise Interventions on Functions in Patients With Parkinson Disease: A Meta-Analysis

OBJECTIVE

The purpose of this review was to investigate the efficacy of rhythmically cued exercise interventions on motor function, cognition, and mental state in patients with Parkinson disease.

METHODS

PubMed, Cochrane Database, Web of Science, Embase, and CINAHL were searched June 15, 2023. Original studies investigating the efficacy of rhythmically cued exercise interventions on the functions of patients with Parkinson disease were included. The Cochrane risk-of-bias assessment tool was used to evaluate the risk of bias. The protocol was registered in PROSPERO (CRD42022371203).

RESULTS

A total of 38 original studies involving 1486 participants were included. Rhythmically cued exercise interventions demonstrated superior effects on motor function compared to exercise therapy without rhythm (standardized mean difference [SMD] = -0.31). However, no significant improvements were observed in cognition and mental state. Overall, significant improvements were observed in motor examination (SMD = -0.61), Timed "Up & Go" Test (mean difference [MD] = -0.91), activities of daily living (SMD = -0.49), balance (SMD = 0.59), walking velocity (MD = 0.06), step length (MD = 2.65), and stride length (MD = 0.04) following rhythmically cued exercise interventions. No significant improvements were observed in freezing of gait and cadence. Assessment of publication bias showed no significant evidence of publication bias. Meta-regression analyses revealed a significant association between treatment duration and improvement in motor function. Furthermore, adverse events and dropout rates did not significantly differ between the 2 groups.

CONCLUSION

Rhythmically cued exercise interventions are effective in improving motor function in the early to middle stages of Parkinson disease. More than 10 weeks of intervention yielded better results. However, these interventions do not have a significant impact on cognition and mental states. Importantly, rhythmically cued exercise interventions are safe and well tolerated. Large-scale trials are needed for further confirmation.

IMPACT

This study contributes to the development of safe and reliable home rehabilitation programs, aiming to enhance the quality of life for patients with Parkinson disease.

Qualitative inquiry of a community dance program for older adults in Singapore

Dance programs promote physical and psychosocial well-being. However, studies focusing on the experiences of older adults in dancing are limited. This study aims to develop a community dance program (CDP) for older adults at senior activity centers in Singapore, as well as to explore the older adults' and student instructors' experiences of the CDP. A qualitative inquiry of semi-structured and in-depth focus group discussions was conducted. In total, 20 older adults and 10 student dance instructors participated in the study. Student instructors who were undergraduate students from a dance society were trained in how to provide step-by-step instructions for the older adults. An inductive approach of thematic analysis was undertaken. Three main themes were identified: (i) promotion of physical, cognitive, and psychosocial health with dance; (ii) imagination is power-travel through dance; and (iii) further enhancement of the dance program. The themes highlighted the prominence of CDP in improving memory, physical health, mood, and social interactions-thus mitigating the risk of social isolation. The findings illustrated the benefits of CDP in cultivating intergenerational bonds amongst older adults and student instructors.

Adapted Portuguese folk dance intervention for subacute rehabilitation post-stroke: study protocol

Dance can be an innovative, well-accepted, and effective therapy for stroke survivors. The present protocol aims to assess the feasibility of adapted Portuguese folk dance as a post stroke rehabilitative activity. We will use a mixed-methods pilot study convenience sampling to recruit 16 stroke survivors with mild-moderate lower limb paresis from a rehabilitation center in Lisbon and Tagus Valley. In addition to usual care, participants will attend 3 days per week 1-h dance exercise for 8 weeks. The dance style used for this intervention will be an adaptation of the Portuguese folk dance. Assessment will be conducted before and immediately after the program intervention. Acceptability will be assessed by four key domains (enrollment, retention, satisfaction, and recommendation to others). Safety will be assessed based on the number and type of adverse events. Feasibility will be assessed based on balance performance and functional mobility. Quantitative data will be analyzed through descriptive statistics for sample characterization, followed by inferential statistics to evaluate differences in the balance recovery and functional mobility scores between the initial and final assessment. Qualitative data will be analyzed using an inductive process of content analysis. The Portuguese folk dance program has the potential to improve balance outcomes and functional mobility. Our results will help validate Portuguese folk dance as a tool for rehabilitation settings for stroke survivors. The potential of our program to enhance balance outcomes and functional mobility among stroke survivors bears implications for aging and public health initiatives. Positive results from this study could pave the way for integrating dance-based rehabilitative activities into standard stroke rehabilitation protocols, catering to older stroke survivors' specific needs and preferences.

Physical activity based on dance movements as complementary therapy for Parkinson's disease: Effects on movement, executive functions, depressive symptoms, and quality of life

BACKGROUND

Parkinson's disease (PD) is a progressive, neurodegenerative disease with motor symptoms that are well understood, but non-motor symptoms may be present and appear at different temporal stages of the disease. Physical activity based on dance movements is emerging as a complementary therapeutic approach to a range of PD symptoms as a multidimensional activity that requires rhythmic synchronization and more neuromuscular functions.

OBJECTIVE

To evaluate the effects of physical activity based on dance movements on the movement, executive functions, depressive symptoms, quality of life, and severity of PD in individuals diagnosed with PD.

METHODS

13 individuals with PD (Hoehn & Yahr I-III, MDS-UPDRS 67.62 ± 20.83), underwent physical activity based on dance movements (2x week for 6 months). Participants were assessed at baseline and after 6 months on movement (POMA, TUG and MDS-UPDRS Part III), executive function (FAB), depressive symptoms (MADRS), quality of life (PDQ-39), and severity of PD (MDS-UPDRS TOTAL). Student's t-test was used to compare pre and post-intervention results.

RESULTS

We observed a significant improvement in the movement (balance and gait) by the POMA test, p = 0.0207, executive function by the FAB test, p = 0.0074, abstract reasoning and inhibitory control by the FAB, Conceptualization test, p = 0.0062, and Inhibitory Control, p = 0.0064, depressive symptoms assessed by the MADRS test significantly reduced, p = 0.0214, and the quality of life by the PDQ-39 had a significant increase after the intervention, p = 0.0006, showed significant improvements between the pre-and post-intervention periods of physical activity based on dance movements.

CONCLUSION

Physical activity based on dance movements contributed to significant improvements in movement (balance and gait), executive functions, especially in cognitive flexibility and inhibitory control, and the quality of life too. Sensorimotor integration, most cognitive processing and social skills may have contributed to the results.

TRIAL REGISTRATION

The study was registered in the Brazilian registry of clinical trials: RBR-3bhbrb5.

Dancing out for a voice; a narrative review of the literature exploring autism, physical activity, and dance

Autism Spectrum Disorder is characterised by profound challenges with social communication and social interaction. Currently, there are few therapeutic interventions that successfully target some of the functionally impairing traits associated with autism. Furthermore, many of these interventions comprise a variety of limitations; including, limited accessibility, extensive durations, or the requirement of a trained professional to deliver the intervention. New research suggests that instead of targeting all traits associated with Autism Spectrum Disorder with a single solution, scientific research should focus on providing therapeutic tools that alleviate functionally impairing facets specific to the individual. Owing to the nature of physical activity, sports, and dance (coordinated movement) these activities could provide opportunities to enhance communication skills and social development in autistic children. Therefore, this paper gives a narrative overview of the literature surrounding communication and coordinated movement; outlining what is meant by communication challenges, exploring the benefits of coordinated movement for traits associated with Autism Spectrum Disorder, and delineating how coordinated movement elicits positive outcomes for autistic children.

Do dance style and intervention duration matter in improving balance among people with Parkinson's disease? A systematic review with meta-analysis

INTRODUCTION

Impaired balance is a common symptom that increases fall risk in people with Parkinson's disease (PwPD). Although previous meta-analyses concluded that dance-based interventions could improve balance in PwPD, they have limitations, such as small samples and low rigor. Another overlooked issue is whether the effects of dance-based interventions depend on dance style and training duration. The primary purpose of this meta-analysis was to further examine the efficacy of dance-based interventions in improving balance in PwPD. The secondary goals were to compare the intervention efficacy of different dance styles and durations.

METHODS

Fourteen randomized controlled trials (RCT) examining the effect of dance-based treatment on improving balance among 612 PwPD were included. Effect size (ES) was calculated as the standardized mean difference. Meta-analyses (one primary analysis and three subgroup analyses) were completed using random-effects models.

RESULTS

Results showed a medium overall ES of 0.57 (95% confidence interval or CI: [0.29,0.84], p < 0.0001) in favor of dance versus control on improving balance in PwPD. The subgroup analysis of six dance styles revealed various ES ranging 0.40-2.00. Balance was significantly improved with dance compared to control group for 12+ week interventions (ES = 0.72, 95%CI: [0.37,1.08], p < 0.0001). Interventions with 60- and 90-min classes produced similar ES for improving PwPD's balance (60-min ES = 0.54; 90-min ES = 0.68).

CONCLUSION

Dance-based interventions (particularly of 12+ weeks) could effectively improve balance among PwPD. More high-quality RCT are needed to determine the most beneficial dance styles and session lengths. These findings could inform future studies for designing/deploying effective dance-based balance training and fall prevention programs for PwPD.

Dance activity interventions targeting cognitive functioning in older adults with mild cognitive impairment: A meta-analysis

Objectives

To comprehensively determine the effect of dance activities on the cognitive functions and its sub-domains of older adults with mild cognitive impairment (MCI).

Methods

We obtained data from PubMed, Web of Science, EBSCO, China national knowledge infrastructure, Wanfang data, and VIP databases from 2017/01/01 to 2022/03/01. We included trials of older adults with MCI that underwent dance activity intervention and fulfilled the inclusion criteria. Two researchers independently assessed the quality of the study using the Cochrane risk of the bias assessment tool. Meta-analysis was performed when data were available, with further subgroup analysis, using Review Manager 5.4, and sensitivity analysis was performed using Stata software 15.1.

Results

Search terms yielded 183 articles, of which 12 fulfilled the inclusion criteria. This included 7 high-quality studies and 5 medium-quality studies. A total of 820 older adults were analyzed. Results showed that dance activity had beneficial effects for global cognition [SMD_MMSE = 0.65, 95% CI_MMSE (0.20, 1.09), p_MMSE = 0.004; SMD_MoCA = 0.87, 95% CI_MoCA (0.44, 1.29), p_MoCA < 0.0001], memory [SMD = 0.61, 95% CI (0.35, 0.88), p < 0.00001], visuospatial function [SMD = −0.39, 95% CI (−0.60, −0.19), p = 0.0002], cognitive flexibility [SMD = −0.31, 95% CI (−0.52, −0.11), p = 0.003], attention [SMD = 0.34, 95% CI (0.07, 0.61), p = 0.01], and balance [SMD = 1.25, 95% CI (0.06, 2.44), p = 0.04]. Further subgroup analysis showed that open-skill dance activity (OSDA) was more effective in promoting global cognition in older adults with MCI than closed-skill dance activity (CSDA) because of the different stimulation provided by the two types of dance activities in the brain regions of the older adults (p = 0.0002). It could be speculated that dance activity improved cognitive function mainly by affecting the microstructure and function of the cingulate tract, hippocampus, cardiovascular function, and other brain areas of older adults with MCI.

Conclusion

Dance activities can significantly improve global cognition, memory, visuospatial function, cognitive flexibility, attention, and balance in older adults with MCI. However, more trials with rigorous study designs are necessary to provide more concrete evidence in the future.

The association between ballroom dance training and empathic concern: Behavioral and brain evidence

Dance is unique in that it is a sport and an art simultaneously. Beyond improving sensorimotor functions, dance training could benefit high-level emotional and cognitive functions. Duo dances also confer the possibility for dancers to develop the abilities to recognize, understand, and share the thoughts and feelings of their dance partners during the long-term dance training. To test this possibility, we collected high-resolution structural and resting-state functional magnetic resonance imaging (MRI) data from 43 expert-level ballroom dancers (a model of long-term exposure to duo dance training) and 40 age-matched and sex-matched nondancers, and measured their empathic ability using a self-report trait empathy scale. We found that ballroom dancers showed higher scores of empathic concern (EC) than controls. The EC scores were positively correlated with years with dance partners but negatively correlated with the number of dance partners for ballroom dancers. These behavioral results were supported by the structural and functional MRI data. Structurally, we observed that the gray matter volumes in the subgenual anterior cingulate cortex (ACC) and EC scores were positively correlated. Functionally, the connectivity between ACC and occipital gyrus was positively correlated with both EC scores and years with dance partners. In addition, the relationship between years with dance partners and EC scores was indirect-only mediated by the ACC-occipital gyrus functional connectivity. Therefore, our findings provided solid evidence for the close link between long-term ballroom dance training and empathy, which deepens our understanding of the neural mechanisms underlying this phenomenon.

Detection and assessment of Parkinson's disease based on gait analysis: A survey

Neurological disorders represent one of the leading causes of disability and mortality in the world. Parkinson's Disease (PD), for example, affecting millions of people worldwide is often manifested as impaired posture and gait. These impairments have been used as a clinical sign for the early detection of PD, as well as an objective index for pervasive monitoring of the PD patients in daily life. This review presents the evidence that demonstrates the relationship between human gait and PD, and illustrates the role of different gait analysis systems based on vision or wearable sensors. It also provides a comprehensive overview of the available automatic recognition systems for the detection and management of PD. The intervening measures for improving gait performance are summarized, in which the smart devices for gait intervention are emphasized. Finally, this review highlights some of the new opportunities in detecting, monitoring, and treating of PD based on gait, which could facilitate the development of objective gait-based biomarkers for personalized support and treatment of PD.

Interventions for preventing falls in Parkinson's disease

BACKGROUND

Most people with Parkinson's disease (PD) experience at least one fall during the course of their disease. Several interventions designed to reduce falls have been studied. An up-to-date synthesis of evidence for interventions to reduce falls in people with PD will assist with informed decisions regarding fall-prevention interventions for people with PD.

OBJECTIVES

To assess the effects of interventions designed to reduce falls in people with PD.

SEARCH METHODS

CENTRAL, MEDLINE, Embase, four other databases and two trials registers were searched on 16 July 2020, together with reference checking, citation searching and contact with study authors to identify additional studies. We also conducted a top-up search on 13 October 2021.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of interventions that aimed to reduce falls in people with PD and reported the effect on falls. We excluded interventions that aimed to reduce falls due to syncope.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane Review procedures. Primary outcomes were rate of falls and number of people who fell at least once. Secondary outcomes were the number of people sustaining one or more fall-related fractures, quality of life, adverse events and economic outcomes. The certainty of the evidence was assessed using GRADE.

MAIN RESULTS

This review includes 32 studies with 3370 participants randomised. We included 25 studies of exercise interventions (2700 participants), three studies of medication interventions (242 participants), one study of fall-prevention education (53 participants) and three studies of exercise plus education (375 participants). Overall, participants in the exercise trials and the exercise plus education trials had mild to moderate PD, while participants in the medication trials included those with more advanced disease. All studies had a high or unclear risk of bias in one or more items. Illustrative risks demonstrating the absolute impact of each intervention are presented in the summary of findings tables. Twelve studies compared exercise (all types) with a control intervention (an intervention not thought to reduce falls, such as usual care or sham exercise) in people with mild to moderate PD. Exercise probably reduces the rate of falls by 26% (rate ratio (RaR) 0.74, 95% confidence interval (CI) 0.63 to 0.87; 1456 participants, 12 studies; moderate-certainty evidence). Exercise probably slightly reduces the number of people experiencing one or more falls by 10% (risk ratio (RR) 0.90, 95% CI 0.80 to 1.00; 932 participants, 9 studies; moderate-certainty evidence).  We are uncertain whether exercise makes little or no difference to the number of people experiencing one or more fall-related fractures (RR 0.57, 95% CI 0.28 to 1.17; 989 participants, 5 studies; very low-certainty evidence). Exercise may slightly improve health-related quality of life immediately following the intervention (standardised mean difference (SMD) -0.17, 95% CI -0.36 to 0.01; 951 participants, 5 studies; low-certainty evidence). We are uncertain whether exercise has an effect on adverse events or whether exercise is a cost-effective intervention for fall prevention. Three studies trialled a cholinesterase inhibitor (rivastigmine or donepezil). Cholinesterase inhibitors may reduce the rate of falls by 50% (RaR 0.50, 95% CI 0.44 to 0.58; 229 participants, 3 studies; low-certainty evidence). However, we are uncertain if this medication makes little or no difference to the number of people experiencing one or more falls (RR 1.01, 95% CI 0.90 to 1.14230 participants, 3 studies) and to health-related quality of life (EQ5D Thermometer mean difference (MD) 3.00, 95% CI -3.06 to 9.06; very low-certainty evidence). Cholinesterase inhibitors may increase the rate of non fall-related adverse events by 60% (RaR 1.60, 95% CI 1.28 to 2.01; 175 participants, 2 studies; low-certainty evidence). Most adverse events were mild and transient in nature.  No data was available regarding the cost-effectiveness of medication for fall prevention. We are uncertain of the effect of education compared to a control intervention on the number of people who fell at least once (RR 10.89, 95% CI 1.26 to 94.03; 53 participants, 1 study; very low-certainty evidence), and no data were available for the other outcomes of interest for this comparisonWe are also uncertain (very low-certainty evidence) whether exercise combined with education makes little or no difference to the number of falls (RaR 0.46, 95% CI 0.12 to 1.85; 320 participants, 2 studies), the number of people sustaining fall-related fractures (RR 1.45, 95% CI 0.40 to 5.32,320 participants, 2 studies), or health-related quality of life (PDQ39 MD 0.05, 95% CI -3.12 to 3.23, 305 participants, 2 studies). Exercise plus education may make little or no difference to the number of people experiencing one or more falls (RR 0.89, 95% CI 0.75 to 1.07; 352 participants, 3 studies; low-certainty evidence). We are uncertain whether exercise combined with education has an effect on adverse events or is a cost-effective intervention for fall prevention.  AUTHORS' CONCLUSIONS: Exercise interventions probably reduce the rate of falls, and probably slightly reduce the number of people falling in people with mild to moderate PD.  Cholinesterase inhibitors may reduce the rate of falls, but we are uncertain if they have an effect on the number of people falling. The decision to use these medications needs to be balanced against the risk of non fall-related adverse events, though these adverse events were predominantly mild or transient in nature. Further research in the form of large, high-quality RCTs are required to determine the relative impact of different types of exercise and different levels of supervision on falls, and how this could be influenced by disease severity. Further work is also needed to increase the certainty of the effects of medication and further explore falls prevention education interventions both delivered alone and in combination with exercise.

Including Arts in Rehabilitation Enhances Outcomes in the Psychomotor, Cognitive, and Affective Domains: A Scoping Review

OBJECTIVE

The purpose of this scoping review was to analyze the published literature regarding the use of art in the context of rehabilitation for consideration in physical therapy.

METHODS

The CINAHL, PsycArticles, APA PsycInfo, Art Index, Music Index, Cochrane Reviews, and PubMed electronic databases were accessed. Inclusion and exclusion criteria were established and utilized to determine study eligibility. Study details were extracted from each article by researchers using a systematic format. Summation of journal type, participants, dosing and type of intervention, setting and interventionist, outcome domains, and study results were included.

RESULTS

Out of 1452 studies, 76 were included for extraction. Of these studies, most had outcome measures aligned with the psychomotor and affective domains of learning (n = 66). Very few studies had outcome measures with psychomotor and cognitive domains (n = 2) or psychomotor, affective, and cognitive outcome measures (n = 8). Regarding the arts used, music, dance, or both were used in 77 instances. Fewer studies reported using creative arts therapy, singing, theater, writing, and rhythm (n = 17). Of the 76 studies analyzed, 74 reported a within-group treatment effect.

CONCLUSION

The arts effectively enhance physical therapist practice; therefore, it is recommended that physical therapists continue to seek collaboration with art professionals and explore the use of arts in practice.

IMPACT

Findings demonstrate that combining the arts with physical therapist practice amplifies not only psychomotor but affective and cognitive outcomes as well. The arts have applicability across broad populations (eg, chronic pain, neurologic dysfunction, respiratory conditions). This study supports that physical therapist education and practice should embrace the arts as a collaborative modality to promote enhanced psychomotor, affective, and cognitive outcomes.

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.

The neuropalliative multidisciplinary team-Members and their roles

Neurodegenerative conditions are prominent contributors to both morbidity and mortality worldwide. They pose a significant challenge to health professionals, health systems, and the often unpaid, untrained family members and carers. The many and varied challenges encountered are best managed by a multidisciplinary neuropalliative team, as it is impossible for a single clinician to possess and deliver the wide range of skills and services required to optimally care for these patients. This chapter discusses the assembly, maintenance, and care of such a team, as well as potential difficulties and solutions in domains such as funding, training, geographical remoteness, as well as the potential lack of awareness and acceptance by colleagues. A comprehensive description of the role of all possible team members is discussed. The chapter outlines the concept, content, and potential benefits of a multidisciplinary team in neuropalliative care. Its thesis is twofold: that multidisciplinary care is vital and, second, that the sum of the whole of a team can be greater than the individual parts with respect to organization, planning, experience, and creativity of approach. With all these factors considered, and implemented wherever possible, we may all move closer to optimizing the comfort and care of our shared neuropalliative patients.

Benefits of Cultural Activities on People With Cognitive Impairment: A Systematic Review

Museums and cultural institutions are increasingly striving to respond to the interests and needs of the society that hosts them. This means, apart from other actions, that these institutions must be involved in the health and wellbeing of society, and the creation of cultural activities aimed at people with cognitive impairment, a group of individuals that is growing worldwide due to the aging of society and the increasing prevalence of dementia. The involved sectors are aware of the potential and benefits of activities for this population, even though there is much research to be conducted. To date, no systematic review has focused on the benefits of cultural activities for cognitively impaired people. This study aimed to explore the benefits of different modalities of cultural activities with evidence from 145 studies from various databases, which met the inclusion criteria. Significant improvements in general cognition, quality of life (QoL), emotional wellbeing, socialization, and communication were generally reported after interventions, with a reduction in depression symptoms. There was not enough evidence to prove memory, language, or daily functioning improvements attributable to cultural interventions. There were no significant reductions reported in apathy, sadness, agitation, or anxiety.

The Effect of Physical Exercise on Cognitive Impairment in Neurodegenerative Disease: From Pathophysiology to Clinical and Rehabilitative Aspects

Neurodegenerative diseases are a group of pathologies that cause severe disability due to motor and cognitive limitations. In particular, cognitive impairment is a growing health and socioeconomic problem which is still difficult to deal with today. As there are no pharmacologically effective treatments for cognitive deficits, scientific interest is growing regarding the possible impacts of healthy lifestyles on them. In this context, physical activity is gaining more and more evidence as a primary prevention intervention, a nonpharmacological therapy and a rehabilitation tool for improving cognitive functions in neurodegenerative diseases. In this descriptive overview we highlight the neurobiological effects of physical exercise, which is able to promote neuroplasticity and neuroprotection by acting at the cytokine and hormonal level, and the consequent positive clinical effects on patients suffering from cognitive impairment.

The Proper Diet and Regular Physical Activity Slow Down the Development of Parkinson Disease

From year to year, we know more about neurodegeneration and Parkinson’s disease (PD). A positive influence of various types of physical activity is more often described in the context of neuroprotection and prevention as well as the form of rehabilitation in Parkinson’s patients. Moreover, when we look at supplementation, clinical nutrition and dietetics, we will see that balancing consumed products and supplementing the vitamins or minerals is necessary. Considering the biochemical pathways in skeletal muscle, we may see that many researchers desire to identify molecular mediators that have an impact through exercise and balanced diet on human health or development of the neurodegenerative disease. Therefore, it is mandatory to study the potential mechanism(s) related to diet and factors resulted from physical activity as molecular mediators, which play a therapeutic role in PD. This review summarizes the available literature on mechanisms and specific pathways involved in diet-exercise relationship and discusses how therapy, including appropriate exercises and diet that influence molecular mediators, may significantly slow down the progress of neurodegenerative processes. We suggest that a proper diet combined with physical activity will be a good solution for psycho-muscle BALANCE not only in PD but also in other neurodegenerative diseases.

I Feel Like I Am Flying and Full of Life: Contemporary Dance for Parkinson's Patients

Parkinson’s is a neurodegenerative disease characterized by motor and non-motor symptoms which are strongly associated with patients’ quality of life, affecting social skills and support. It strikes not only the motor abilities but may harm cognitive and emotional functioning. For the past 15 years, contemporary dance has been employed as an intervention to help people diagnosed with Parkinson’s disease cope physically and mentally by way of motor, vestibular, and sensory stimulation as well as social interaction. In this study we aimed to examine psychological flexibility, creative self-efficacy and quality of life of Parkinson’s patients participating in contemporary dance sessions. To obtain this goal we conducted a cross-sectional comparative study of 50 Parkinson’s patients aged 50–87 years, half of which had been participating for at least 3 months once a week, in contemporary dance classes, and the matched controls participated in a verbal support group. Study participants completed questionnaires after participating in a dance class (Intervention) or in a support group (control). Participants in the intervention group were also asked to answer three open-ended questions that examined the experience of participating in contemporary dance classes. We found that psychological flexibility and quality of life were significantly higher in the dance class participants. Participants reported positive changes that occur in their overall feeling and quality of life following their participation in dance classes. Since PD patients’ experiences are deeply embedded in the body, it is significant to explore the use of movement in treatment. The importance of the study is in its potential to highlight the relationship between psychological flexibility and quality of life and to increase awareness of clinicians treating Parkinson’s patients to the importance of incorporating dance as an inherent part of a multidisciplinary team effort.

The effect of dance interventions on cognition, neuroplasticity, physical function, depression, and quality of life for older adults with mild cognitive impairment: A systematic review and meta-analysis

BACKGROUND

Mild cognitive impairment is an age-related cognitive disorder which is associated with frequent memory lapses, impaired judgement, and progressive functional decline. If untreated early, 39.2% of people with mild cognitive impairment could progress to develop dementia. However, there are currently no approved pharmacological interventions to treat the condition, which lead researchers to explore non-pharmacological options, such as dance therapy.

OBJECTIVES

This systematic review aimed to examine the effectiveness of dance interventions on cognition, neuroplasticity, physical function, depression, and quality of life in older adults with mild cognitive impairment.

METHODS

Seven databases were systematically searched from their respective inception dates to 31 March 2020. Relevant randomized controlled trials (RCTs) were screened and assessed for risk of bias. Eight RCTs evaluating dance interventions were included.

RESULTS

Results showed that dance interventions had a significant moderate effect on global cognition (SMD=0.54, Z = 3.55, p<0.001), significantly improved memory (SMD=0.33, Z = 3.97, p<0.001), visuospatial function (SMD=0.42, Z = 2.41, p = 0.02), and language (SMD=0.39, Z = 2.69, p = 0.007). We found that dance interventions produced a significant moderate effect on physical function (SMD=0.55, Z = 3.43, p<0.001), and a significant effect on quality of life (SMD=0.93, Z = 5.04, p<0.0.001).

CONCLUSION

Dance is a non-pharmacological and inexpensive intervention that can be implemented for older adults on a large scale. It can slow down the cognitive deterioration of older adults with mild cognitive impairment. However, the findings should be interpreted with caution due to the heterogeneity in intervention designs. Rigorous design studies with long-term follow-ups, neuroimaging, biological markers, and comprehensive neuropsychological assessment are required to understand the mechanism of dance interventions and demonstrate its efficacy for older adults with mild cognitive impairment. The protocol was registered on PROSPERO (CRD42020173659).

Dance Improves Motor, Cognitive, and Social Skills in Children With Developmental Cerebellar Anomalies

In this multiple single-cases study, we used dance to train sensorimotor synchronization (SMS), motor, and cognitive functions in children with developmental cerebellar anomalies (DCA). DCA are rare dysfunctions of the cerebellum that affect motor and cognitive skills. The cerebellum plays an important role in temporal cognition, including SMS, which is critical for motor and cognitive development. Dancing engages the SMS neuronal circuitry, composed of the cerebellum, the basal ganglia, and the motor cortices. Thus, we hypothesized that dance has a beneficial effect on SMS skills and associated motor and cognitive functions in children with DCA. Seven children (aged 7-11) with DCA participated in a 2-month dance training protocol (3 h/week). A test-retest design protocol with multiple baselines was used to assess children's SMS skills as well as motor, cognitive, and social abilities. SMS skills were impaired in DCA before the training. The training led to improvements in SMS (reduced variability in paced tapping), balance, and executive functioning (cognitive flexibility), as well as in social skills (social cognition). The beneficial effects of the dance training were visible in all participants. Notably, gains were maintained 2 months after the intervention. These effects are likely to be sustained by enhanced activity in SMS brain networks due to the dance training protocol.

Rhythm and groove as cognitive mechanisms of dance intervention in Parkinson's disease

Parkinson's disease (PD) is associated with a loss of internal cueing systems, affecting rhythmic motor tasks such as walking and speech production. Music and dance encourage spontaneous rhythmic coupling between sensory and motor systems; this has inspired the development of dance programs for PD. Here we assessed the therapeutic outcome and some underlying cognitive mechanisms of dance classes for PD, as measured by neuropsychological assessments of disease severity as well as quantitative assessments of rhythmic ability and sensorimotor experience. We assessed prior music and dance experience, beat perception (Beat Alignment Test), sensorimotor coupling (tapping to high- and low-groove songs), and disease severity (Unified Parkinson's Disease Rating Scale in PD individuals) before and after four months of weekly dance classes. PD individuals performed better on UPDRS after four months of weekly dance classes, suggesting efficacy of dance intervention. Greater post-intervention improvements in UPDRS were associated with the presence of prior dance experience and with more accurate sensorimotor coupling. Prior dance experience was additionally associated with enhanced sensorimotor coupling during tapping to both high-groove and low-groove songs. These results show that dance classes for PD improve both qualitative and quantitative assessments of disease symptoms. The association between these improvements and dance experience suggests that rhythmic motor training, a mechanism underlying dance training, impacts improvements in parkinsonian symptoms following a dance intervention.

Frequent Sports Dance May Serve as a Protective Factor for Depression Among College Students: A Real-World Data Analysis in China

Purpose

This study aims to investigate the role of frequent sports dance in preventing mental disorders, including anxiety and depression, among college students using real-world data, and to further analyze potential risk factors associated with anxiety and depression.

Methods

We investigated 921 college students from eight universities in China. A survey was completed by 901 students and they were included in the analysis. The anxiety score was evaluated by the Generalized Anxiety Disorder 7-item (GAD-7) scale and the depression score was evaluated by the Patient Health Questionnaire-9 (PHQ-9). Subgroup comparisons were performed among frequent sports dance students and non-frequent sports dance students.

Results

Of all the students, 9.98% had moderate-to-severe anxiety and 14.65% students suffered from moderate-to-severe depression. Compared with non-frequent sports dance students, frequent sports dance students had significantly lower depression scores (P=0.04). According to the multiple logistic regression models, when potential confounding factors were all adjusted, frequent sports dance was also significantly associated with less depression (OR=0.55, 95% CI: 0.36–0.84, P<0.01). We also found that higher college grade levels (P<0.01), non-physical education students (P=0.02), higher body mass index (P=0.02), lower exercise frequency per week (P<0.01), addiction to drinking (P=0.02), and previous diagnosis of anxiety or depression in hospital (P<0.01) were significantly associated with more anxiety; higher college grade levels (P<0.01), addiction to drinking (P<0.01), preference for eating fried food (P=0.02), soda as the main source of drinking water (P=0.01), and previous diagnosis of anxiety or depression (P=0.03) were significantly associated with more depression, while higher exercise frequency per week (P<0.01), only-child status (P<0.01), and preference for eating vegetables (P=0.02) were significantly associated with less depression.

Conclusion

Anxiety and depression are common among college students. Frequent sports dance may serve as a protective factor for preventing depression and it can be recommended for college students.

Binary dance rhythm or Quaternary dance rhythm which has the greatest effect on non-motor symptoms of individuals with Parkinson's disease?

This study aimed to compare the effect of a binary and quaternary rhythm protocol on cognition, mental activity, daily life, and quality of life among individuals with Parkinson's Disease. A two-arm randomized clinical trial with 31 individuals diagnosed with Parkinson's disease, who were allocated to the binary group or quaternary group. Both groups underwent a 12-week intervention. The following variables were analyzed: personal and clinical information; MoCA; UPDRSI and II; PDQ-39. Both intervention groups improved cognition, mental activity, activities of daily living, and quality of life. In addition, there were intergroup differences in total UPDRSII, writing, and hygiene where the quaternary group was superior to the binary group. It concludes that the binary and quaternary rhythm positively influenced and presented similar effects on the complementary treatment of individuals with Parkinson's disease on the studied variables. Thus, it is believed that both interventions are possible and feasible for the health professionals involved in the area.

Beauty That Moves: Dance for Parkinson's Effects on Affect, Self-Efficacy, Gait Symmetry, and Dual Task Performance

Background: Previous studies have investigated the effects of dance interventions on Parkinson’s motor and non-motor symptoms in an effort to develop an integrated view of dance as a therapeutic intervention. This within-subject study questions whether dance can be simply considered a form of exercise by comparing a Dance for Parkinson’s class with a matched-intensity exercise session lacking dance elements like music, metaphorical language, and social reality of art-partaking.

Methods: In this repeated-measure design, 7 adults with Parkinson’s were tested four times; (i) before and (ii) after a Dance for Parkinson’s class, as well as (iii) before and (iv) after a matched-intensity exercise session. Physiological measures included heart rate and electrodermal activity. Self-reported affect and body self-efficacy were collected. Gait symmetry and dual task cost were analyzed using the 6 min walking test (6MWT) and Timed-Up-and-Go test (TUG), respectively.

Results: Average heart rate was the same for both conditions, while electrodermal activity was higher during Dance for Parkinson’s. Significant differences were found in body self-efficacy, beauty subscale, symmetry of gait, and dual task performance.

Conclusion: Dance, compared to an exercise intervention of matched intensity, yields different outcomes through the means of intrinsic artistic elements, which may influence affective responses, the experience of beauty, self-efficacy, and gait performance.

Table tennis for patients with Parkinson's disease: A single-center, prospective pilot study

INTRODUCTION

Table tennis is a popular sport worldwide. However, no study has examined whether it is an effective exercise for patients with Parkinson's disease (PD). The efficacy and safety of table tennis exercise for PD patients was examined.

METHODS

This 6-month prospective study investigated if our table tennis exercise program could improve parkinsonian motor symptoms, cognition and psychiatric symptoms. Twelve PD patients with Hoehn & Yahr stage ≤4 were recruited. Patients participated in a 6-hour exercise session once weekly. All patients were assessed with the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) parts I-IV, Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), Self-Rating Depression Scale (SDS), and Starkstein Apathy Scale (SAS) at baseline, 3 months, and 6 months.

RESULTS

Nine of 12 PD patients were analyzed, except for three patients for which data was missing. MDS-UPDRS parts II and III were improved at 3 months (median -4.0, p = 0.012 and median -10.0, p = 0.012) and 6 months (median -7.0, p = 0.015 and median -12.0, p = 0.008), whereas MDS-UPDRS total parts I scores and total IV scores, MoCA, FAB, SDS, and SAS were unchanged. Adverse events included fall and backache in one patient each.

CONCLUSION

A table tennis exercise program is relatively safe and may improve activities of daily living and motor symptoms in patients with PD.

PasoDoble, a Proposed Dance/Music for People With Parkinson's Disease and Their Caregivers

Managing the heterogeneity of Parkinson's disease symptoms and its progressive nature demands strategies targeting the hallmark disrupted neurotransmission but also the comorbid derangements and bolstering neuroprotection and regeneration. Strong efforts are done to find disease-modifying strategies, since slowing disease progression is not enough to hamper its burden and some motor symptoms are resistant to dopamine-replacement therapy. The inclusion of non-pharmacological strategies can provide such a multitarget umbrella approach. The silent long-term biological process that precedes the clinical onset of disease is a challenge but also an opportunity to reinforce healthy lifestyle known to exert preventive/therapeutic effects. These non-pharmacological strategies are foreseen as able to reduce the prevalence and the global impact of long-term diseases demanding strong management of patient-caregiver quality of life. In this regard, European guidelines for Parkinson's disease recommend physical-related activities such as aerobic exercise and dancing known to improve functional mobility and balance in patients. Here, we propose “PasoDoble,” a novel dance/music patient-caregiver intervention with additional preventive value. The rationale is founded on evidence-based therapeutic benefits of dance/music therapy and the singular features of this widely extended Hispanic dance/music targeting motor symptoms, mood/cognition, and socialization: (i) As a dance, an easy and simple double-step pattern (back-and-forward and lateral movements) that evolves from a spontaneous individual dance to a partnered dancing, performed in social groups and involving dancing-figures of increasing complexity; (ii) “PasoDoble,” as a music that can be sung, has musical rhythmicity with high groove and familiarity that will help to synchronize the steps to the rhythm of music; (iii) Widely extended (Spain, Mexico, Puerto Rico, Colombia, and USA) and easy-to-learn for others. As a regular dancing “PasoDoble” can improve and preserve function, mood and socialization, as an intervention the method is structured to improve gait and balance; facilitate movement, reaching and grasping; muscle power and joint mobility; reduce of risk of falls, and increase of aerobic capacity. Finally, this easy-to-implement into patient care and free-living environments (elderly social centers, home care) rehabilitation programs can promote positive emotions and self-esteem, with added general improvement of social attachment and recognition, thus improving the quality of life of patient-caregiver.

A systematic review of active group-based dance, singing, music therapy and theatrical interventions for quality of life, functional communication, speech, motor function and cognitive status in people with Parkinson's disease

BACKGROUND

Parkinson's disease (PD) is a common neurodegenerative condition associated with a wide range of motor and non-motor symptoms. There has been increasing interest in the potential benefit of performing arts as a therapeutic medium in PD. While there have been previous reviews, none have considered all performing arts modalities and most have focused on dance. This systematic review examined the potential benefit of all active group-based performing arts interventions for quality of life, functional communication, speech, motor function and cognitive status.

METHODS

Searches were conducted in February 2020 on five scholarly databases. Supplementary searches were conducted. Included studies were quantitative in design, and assessed the potential benefit of any active group-based performing arts intervention for quality of life, functional communication, speech, motor function or cognitive status in people with PD. Full text papers were eligible for inclusion, as were conference abstracts since January 2018. Screening, data extraction, narrative synthesis and quality assessment were conducted independently by two reviewers. Quality assessment used the SURE checklists.

RESULTS

Fifty-six studies were eligible for inclusion in this systematic review, reported in 67 publications. Published from 1989 to 2020, these studies included a total of 1531 people with PD from 12 countries, and covered four broad performing arts modalities: dance, singing, music therapy and theatre. Dance remains the most commonly studied performing arts modality for PD (38 studies), while there were 12 studies on singing interventions, four on music therapy, and only two on theatrical interventions. There was evidence for a beneficial effect of all four performing arts modalities on at least some outcome domains.

CONCLUSIONS

This is the first systematic review to assess the potential benefit of all active group-based performing arts interventions in PD. The evidence suggests that performing arts may be a useful therapeutic medium in PD. However, a substantial limitation of the evidence base is that no studies compared interventions from different performing arts modalities. Moreover, not all performing arts modalities were assessed for all outcome domains. Therefore it is not currently possible to determine which performing arts modalities are most beneficial for which specific outcomes.

The efficacy of dance for improving motor impairments, non-motor symptoms, and quality of life in Parkinson's disease: A systematic review and meta-analysis

Dance may help individuals living with Parkinson's disease (PD) improve motor and non-motor symptoms that impact quality of life (QOL). The primary aim of this systematic review of randomized controlled trials (RCTs) was to evaluate the efficacy of dance in improving motor and non-motor symptoms of PD and QOL. The secondary aims of this review were to evaluate the methodological quality of included studies by assessing risk of bias across nine categories and to inform the direction of future research. Peer-reviewed RCTs that included people living with PD at all disease stages and ages and measured the effects of a dance intervention longer than one day were included. Sixteen RCTs involving 636 participants with mild to moderate PD were eligible for inclusion in the qualitative synthesis and nine in the meta-analysis. Overall, the reviewed evidence demonstrated that dance can improve motor impairments, specifically balance and motor symptom severity in individuals with mild to moderate PD, and that more research is needed to determine its effects on non-motor symptoms and QOL. RCTs that use a mixed-methods approach and include larger sample sizes will be beneficial in fully characterizing effects and in determining which program elements are most important in bringing about positive, clinically meaningful changes in people with PD.

The Effect of Different Exercise Modes on Domain-Specific Cognitive Function in Patients Suffering from Parkinson's Disease: A Systematic Review of Randomized Controlled Trials

BACKGROUND

Supervised exercise training alleviates motor symptoms in people with Parkinson's disease (PD). However, the efficacy of exercise to improve nonmotor symptoms such as cognitive function is less well known.

OBJECTIVE

To systematically review evidence on the efficacy of different exercise modes (coordination exercise, resistance exercise, aerobic exercise) on domain-specific cognitive function in patients with PD.

METHODS

Parallel-group randomized controlled trials published before March 2018 were included. Primary outcome measures included global cognitive function and its subdomains, and the Unified Parkinson's Disease Rating Scale was included as a secondary outcome. Methodological quality was assessed using the Physiotherapy Evidence Database scale.

RESULTS

The literature search yielded 2,000 articles, of which 11 met inclusion criteria. 508 patients (mean age 68±4 years) were included with a disease severity from 1 to 4 on the Hoehn & Yahr stage scale. Overall study quality was modest (mean 6±2, range 3-8/10). In 5 trials a significant between-group effect size (ES) was identified for tests of specific cognitive domains, including a positive effect of aerobic exercise on memory (ES = 2.42) and executive function (ES = 1.54), and of combined resistance and coordination exercise on global cognitive function (ES = 1.54). Two trials found a significant ES for coordination exercise (ES = 0.84-1.88), which led to improved executive function compared with that of non-exercising control subjects.

CONCLUSION

All modes of exercise are associated with improved cognitive function in individuals with PD. Aerobic exercise tended to best improve memory; however, a clear effect of exercise mode was not identified.

Nordic walking influence on biomechanical parameters: a systematic review

INTRODUCTION

Nordic walking (NW) as a form of physical activity has been shown to have benefits in various domains, but little is known about the effect of NW on more specific biomechanical parameters. The purpose is to determine the impact of NW on the following parameters: walking speed/distance, muscle activation, spatiotemporal parameters, kinematics and ground reaction force.

EVIDENCE ACQUISITION

A literature search was carried out in different databases from October 2008 to October 2018. This review was conducted and reported in accordance with the PRISMA statement. Finally, 42 studies with a median PEDro Score of 5.5/10 were included.

EVIDENCE SYNTHESIS

The included studies reported increased walking distance (+14.8%, P<0.05), walking speed (+25.5%, P<0.05), and stride length (+10.4%, P<0.05), but decreased cadence (-6.2%, P<0.05). NW generally increased: muscle activation and strength for upper limbs; upper and lower limb range of motion, and ground reaction force.

CONCLUSIONS

NW has beneficial effects on many biomechanical parameters. It appears to be an effective way of doing physical activity and could be used in physical rehabilitation or in daily life.

Dance improves symptoms, functional mobility and fine manual dexterity in people with Parkinson disease: a quasi-experimental controlled efficacy study

BACKGROUND

Clinically, individuals diagnosed with Parkinson disease (PD) present several symptoms that impact on their functional independence and quality of life. While there is accumulating evidence supporting dance as an effective symptom management option, few studies have objectively assessed these benefits, particularly related to the Dance for Parkinson's Disease^® (DfPD^®) program.

AIM

The aim of this study was to explore the effects of DfPD^®-based dance classes on disease-related symptoms, fine-manual dexterity and functional mobility in people with PD.

DESIGN

A quasi-experimental controlled efficacy study, with pre and post testing of two parallel groups (dance versus control).

SETTING

Community.

POPULATION

Thirty-three participants with PD allocated to one of two groups: dance group (DG; N.=17; age=65.8±11.7 years) or control group (CG: N.=16; age=67.0±7.7 years). They were cognitively intact (Addenbrooke's Score: DG=93.2±3.6, CG=92.6±4.3) and in early-stage of disease (Hoehn & Yahr: DG=1.6±0.7, CG=1.5±0.8).

METHODS

The DG undertook a one-hour DfPD^®-based class, twice weekly for 12 weeks. The CG had treatment as usual. Both groups were assessed at baseline and after 12 weeks on disease-related symptom severity (MDS-Unified Parkinson Disease Rating Scale: MDS-UPDRS), fine-manual dexterity (Perdue Peg Board), measures of functional mobility (Timed Up & Go: single & dual task, Tinetti, Berg, Mini-BESTest) and self-rated balance and gait questionnaires (Activities Balance Confidence Scale: ABC-S; Gait and Falls: G&F-Q; Freezing of Gait: FOG).

RESULTS

Compared to the CG, there was significantly greater improvement in the DG pre-post change scores on measures of symptom severity MDS-UPDRS, dexterity, six measures of functional mobility, and the ABC-S, G&F-Q, FOG questionnaires.

CONCLUSIONS

DfPD^®-based dance classes improved disease-related symptom severity, fine-manual dexterity, and functional mobility. Feasibility of the approach for a large scale RCT was also confirmed.

CLINICAL REHABILITATION IMPACT

DfPD^® could be an effective supportive therapy for the management of symptoms and functional abilities in PD.

Effects of Dance on Gait, Cognition, and Dual-Tasking in Parkinson's Disease: A Systematic Review and Meta-Analysis

Dance-based interventions have been proposed for the management of Parkinson's disease (PD) symptoms. This review critically appraises and synthesises the research on the effects of dance interventions on gait, cognition and dual-tasking in PD, through a meta-analysis of peer-reviewed literature from seven databases. Eligible studies included people with PD, used a parallel-group or cohort design with a dance-based intervention, reported outcome measures of gait, cognition or dual-tasking, and were published in English up until September 2017. Of the initial 1079 articles, 677 articles were reviewed for eligibility, and 25 articles were retained. Only 12 articles had sufficient common assessment items for meta-analysis. Two independent reviewers extracted the data and assessed the risk of bias of each study using the Cochrane risk-of-bias tool. Based on pre-post change scores, gait speed, Timed Up and Go (TUG) test performance, freezing of gait questionnaire, and six-minute walk test times significantly improved after a dance intervention compared to controls. Global cognition assessed with Montreal Cognitive Assessment, and cognitive dual-tasking measured using dual-task TUG, also exhibited greater improvement in dance groups. There was limited evidence to determine the most effective intensity, frequency, duration of dance interventions or the most beneficial music. Findings must be interpreted cautiously because of the lack of randomised control trials, and the moderate to high risk of bias of studies. However, the results of papers with level-I and level-II.1 evidence suggest that dance may have the potential to ameliorate PD symptoms, particularly gait, global cognition and cognitive dual-tasking.

Cognitive Rehabilitation for Individuals With Parkinson's Disease: Developing and Piloting an External Aids Treatment Program

Purpose Cognitive deficits are common in Parkinson's disease (PD) and can have a detrimental effect on daily activities. To date, most cognitive treatments have had an impairment-based focus with primary outcome measures of formal neuropsychological test scores. Few, if any, studies have focused on functional improvement or patient-centered goals. Method Three individuals with idiopathic PD participated in an 8-week pilot treatment program to train for the use of compensatory external aids to achieve personalized goals. Goal attainment scaling was the primary outcome measure, which was independently judged by multiple raters at baseline, postintervention, and 1 month posttreatment and analyzed via T-score analysis. Descriptive measures, including self-report and spouse-report rating scales of cognitive functioning, were employed. Results All 3 participants improved in the majority of their laboratory and home goals posttreatment, as measured by goal attainment scaling, and maintained gains for the majority of goals 1 month posttreatment. Conclusions This is the 1st known study to implement an external aids treatment program with patient-centered goals for individuals with cognitive deficits from PD. Positive outcomes were likely influenced by 3 factors: (a) a theoretically motivated focus on external aids; (b) a well-documented, systematic approach to instruction; and (c) the personalization of goals. Supplemental Material https://doi.org/10.23641/asha.10093493.

Perceived effects of Tango Argentino on body experience in persons with Parkinson's disease (PD)-A qualitative study with affected persons and their partners

BACKGROUND

Persons with Parkinson's disease (PD) experience somatic and psycho-emotional limitations. As a neurodegenerative disease with increasing motor symptoms, PD changes the body experience. Embodied activities like dancing are beneficial to individuals with PD regarding mobility, balance and body feeling. The objective of this study was to assess the impact of Tango Argentino (TA) on body experience in individuals with PD.

METHODS

This qualitative study was conducted among 12 individuals with PD and their dance partners participating in TA courses for persons with PD and uses semi-standardized interviews. The heterogeneity of the sample was mainly based on the number of TA classes, so that participants were distinguished in participants with 10 h (beginners) and participants with more than 10 h (advanced). Further variance was due to different age groups and duration of disease.

RESULTS

Participants reported change on five categories of body experiences: body awareness, motor symptoms and movement, general feelings, body sensations and disease-related feelings. Participants cited a shift in body awareness and improved stability, walking safety, enhanced mobility and amelioration in gestures and facial expressions. In general, participants described reduced body fatigue, anxiety, shame and frustration and increase in joy, pride, curiosity as well as reinforcement of partnership. With regard to perception, positive and negative feelings, ease, relaxation and increase of inner congruence were reported. The experience of normality and health helped to generate greater acceptance of disease burdens and to develop self-confidence and self-assurance. Dance partners confirmed the perceptions of the dancers with PD.

CONCLUSION

The perceived effects of TA courses may be linked to a positive body awareness and body control which may be related improved motor symptoms, social and everyday life. These perceived effects should be controlled in relation to the long time change in embodied activity and body experience in persons with PD.

Structuring community-based adapted dance programs for persons post-stroke: a qualitative study

PURPOSE

Dance improves physical, psychosocial, and cognitive function, while increasing community participation among community-dwelling individuals post-stroke. Yet little is known about how to structure community-based dance classes to optimize benefits and participation. This study aims to gain stakeholders' perspectives about how to optimally structure community-based dance classes for individuals with chronic stroke.

METHODS

A qualitative descriptive approach utilizing focus group methods was implemented. Two focus groups were undertaken with each of three stakeholder groups: persons post-stroke (n = 9), rehabilitation therapists (n = 6), and dance instructors (n = 8). Focus groups were audio-recorded and transcribed verbatim, providing the raw data. Analysis of the focus group transcripts were completed using the DEPICT model of collaborative qualitative analysis.

RESULTS

This study identified three main themes/topics requiring consideration when structuring community-based dance programs: the environment, flow of the class, and qualities of the dance instructor. The study findings highlight that the pedagogical skills and teaching philosophy of the dance instructor are integral for a successful dance program, as the dance instructor directly mediates both the environment and flow of classes.

CONCLUSION

Recommendations generated from our study can inform the development of community-based dance programs that are practical, optimize health benefits, and meet the needs and interests of people post-stroke.IMPLICATIONS FOR REHABILITATIONDance is an effective way to improve physical, psychosocial, and cognitive function for persons post-stroke while also promoting meaningful social relationships within the community.A dance instructor who is a skilled communicator and is willing to adapt to the needs of the class, is the most important factor for a successful dance class.Creating a safe and inviting environment for a dance program, includes both the physical and emotional aspects of environment facilitating individuals to create connections with others and feel more confident in themselves.The structure of a dance class, based on the abilities, interests, and goals of dancers, should include elements of predictability and variability to keep dancers progressing and motivated, and be two times a week for 3 months lasting 1-2 h.

Comparison of virtual reality rehabilitation and conventional rehabilitation in Parkinson's disease: a randomised controlled trial

OBJECTIVE

To compare a 6-week virtual reality (VR) rehabilitation programme with a conventional rehabilitation programme in patients with Parkinson's disease.

DESIGN

Prospective, single-blinded, randomised controlled trial.

SETTING

Outpatients.

PARTICIPANTS

Fifty-one patients with Parkinson's disease were assigned at random to a VR rehabilitation programme or a conventional rehabilitation programme.

INTERVENTIONS

Both programmes ran for 6 consecutive weeks, with a 40-minute session three times per week.

MAIN OUTCOME MEASURES

The Balance Berg Scale (BBS) was used to measure balance. Secondary outcome measures were: Dynamic Gait Index (DGI) to evaluate ability to adapt gait to complex walking tasks; Disabilities of the Arm, Shoulder and Hand (DASH) scale to measure performance of the upper limb; and Short Form 36 (SF-36) to evaluate quality of life.

RESULTS

The VR rehabilitation programme led to an increase in BBS score {45.6 [standard deviation (SD) 7.9] vs 49.2 (SD 8.1), mean difference 3.6, 95% confidence interval (CI) 1.3 to 5.9; P=0.003}, DGI score [18.7 (SD 4.7) vs 20.2 (SD 4.2), mean difference 1.6, 95% CI 0.6 to 2.5; P=0.003] and SF-36 mental composite score [37.7 (SD 11.4) vs 43.5 (SD 9.2), mean difference 5.8, 95% CI 0.4 to 11.3; P=0.037], and a decrease in DASH scale score [29.6 (SD 17.5) vs 21.6 (SD 15.1), mean difference -7.9, 95% CI -13.7 to -2.2; P=0.009]. In contrast, the conventional rehabilitation programme only led to a decrease in DASH scale score [30.3 (SD 18.1) vs 25.1 (SD 15.8), mean difference -5.2, 95% CI -8.8 to -1.5; P=0.007].

CONCLUSION

These findings suggest that rehabilitation is useful in Parkinson's disease, and the VR rehabilitation programme was more effective in determining overall improvement than the conventional rehabilitation programme.

CLINICAL TRIAL REGISTRATION NUMBER

NCT02807740.

Dance and Parkinson's: A review and exploration of the role of cognitive representations of action

Parkinson's disease (PD) is a neurodegenerative condition that causes both sensorimotor and non-motor impairments, and there is a clear need for non-medical approaches to improve quality of life. Dance is an increasingly popular activity among people with PD, which demonstrates potential therapeutic benefits. However, findings to date have been inconsistent, and little is known about the mechanisms underlying benefits of dance in PD. In this review, we provide an overview of research into dance for people with PD. The majority of quantitative evidence is in the sensorimotor domain, but cognitive, psychological and social effects have also been reported. We consider the role of cognitive representations of action within dance through observation, imitation and imagery, which may contribute to both sensorimotor and non-motor outcomes for people with PD. Moreover, we discuss how these processes may be enhanced through dance to provide further benefits in everyday life. Finally, we propose avenues for future research to increase understanding of action representation in dance for PD, which has the potential to inform practice and maximize benefits.

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.

Person-centered home-based rehabilitation for persons with Parkinson's disease: A scoping review

BACKGROUND

Due to vague, initial symptoms, persons with Parkinson's disease (PD) usually receive a definitive diagnosis after a prolonged period of time. At the time of diagnosis, they have already experienced limitations in activities of daily living and quality of life and are thus in need of immediate rehabilitation.

OBJECTIVE

To describe the existing knowledge on the rehabilitation of persons with PD suitable to a home environment and to describe the person-centeredness, interprofessionality and clinical effectiveness of existing rehabilitation activities.

SOURCES OF EVIDENCE

67 full-text papers from the EBSCO, CINAHL, Medline, Google and Google Scholar databases, published in English, Swedish or Finnish between January 2010 and October 2018, were charted (type of rehabilitation, sample, instrumentation, reported effects) and summarized.

RESULTS

Rehabilitation through physical activities still appears to be the most common form of rehabilitation, varying from walking to individually tailored exercise programs. The majority of physical rehabilitation activities were conducted outside the home even though they were suitable for a home setting. Physical activities not only improved several physical outcomes but also quality of life, well-being and activities of daily living functions, especially when digital devices were used. Cognitive and psychosocial rehabilitation were much less researched but seen to be an emerging area of research. The focus of rehabilitation seems to lie on persons with PD, not their near-ones. The majority of interventions were planned without discussing in advance with the persons with PD about their preferences, needs or values. Very few interventions were individually tailored or conducted in a home setting, and many studies included patient-recorded outcome measures, but only as secondary to clinical measures. Only a few studies focused on an interprofessional approach to PD rehabilitation, despite the approach being found effective in regard to quality of life for persons with PD.

CONCLUSIONS

There appears to be a focus on physical outcomes and symptom management in the rehabilitation of persons with PD, even though cognitive and psychosocial well-being are often explored as secondary outcomes. Very few rehabilitation interventions were planned with persons or conducted in a home setting, and no interventions were seen that included near-ones. The majority of interventions were planned without the involvement of persons with PD. Still, many of the studies included patient-recorded outcome measures. Digital devices that assist in physical rehabilitation and an interprofessional approach to rehabilitation yield positive clinical outcomes, which in turn promotes a person-centered and holistic approach to rehabilitation.