A series that seeks to peer into the future of the dance studio.

I believe we may be at an interesting turning point, on the cusp of an exciting time in dance, the full pivot of which may not be recognised for perhaps another decade or more.

Many dance studios are poised to undergo a fascinating re-structure, gradually transforming from having a largely singular emphasis on engaging young students wanting to dance as a recreational activity, or for vocational studies. Instead they will find a new balance, one that continues to cater to the young recreational or vocational dancer, but that also develops the dance studio to be understood and valued as a place for cognitive development for toddlers, a locus for young people to bond and learn vital life skills adaptable to the creatively challenging, collaborative job opportunities of the future; spaces where people with trauma, both emotional and physical, come to be guided through their obstacles using dance as a therapeutic tool, and engaging spaces where older adults come to ward off neurological decline, slowing or even eliminating the potentially devasting effects of Dementia, Alzheimer’s and Parkinson’s Disease.

Some studios are already fast moving in these directions, while others are dabbling at the fringes, experimenting with both their business model and with the new research findings to discover what works for them. For those doing so, they already understand that the successful dance studio of the future will be a multi-generational, multi-purpose facility, catering to people from diverse walks of life and with diverse needs, with the love and understanding of the great value of dance threading through as the common bond.

In this article, part of an ongoing series MDM has undertaken to better understand the changing nature of our dance studios, I’ve interviewed physiotherapist, Dr. Nadeesha Kaylani Hewa Haputhanthirige from the Queensland University of Technology (QUT) discussing her research on dance for Parkinson’s Disease.

Dr. Nadeesha is a Physiotherapist from Sri Lanka and a Lecturer in Physiotherapy attached to the University of Colombo and has recently completed her PhD via QUT titled: The Effects of Dance on Gait, Cognition and Dual Tasking in Parkinson’s Disease.

Q: Dr. Nadeesha, what first led you to want to research a link between dance and Parkinson’s Disease?

A: I was highly interested in neurological physiotherapy and I was initially working on research with spinal cord injuries. Then I was thinking of extending my research to either stroke or Parkinson’s Disease. Those were two conditions I was interested in, and then I found this area; dance for Parkinson’s Disease.

Q: How did you come across dance for Parkinson’s Disease?

A: I become exposed to the work of dance for Parkinson’s Disease when I came to Queensland and started working as a volunteer with the existing class for Parkinson’s Disease run at the Queensland Ballet. They have an ongoing class that started in 2013. The pilot research that helped form this class involved my supervisory team. This was a collaborative project between QUT, University of Queensland, Queensland Ballet and the organisation, Dance for Parkinson’s Australia.

Q: Is that where dance research into Parkinson’s started?

A: Dance for PD® originated in Brooklyn, New York as a collaboration between the Mark Morris Dance Group and the Brooklyn Parkinson’s Group in 2001, which motivated the program in Australia. Dance for PD is now delivered in more than 250 other communities in 25 countries.

From the Queensland Ballet website:

Research suggests dance can improve cognitive performance and reaction times, making it a useful treatment for a number of conditions, including arthritis, dementia, depression and Parkinson’s Disease (PD).

As part of the pilot program, which ran from October 2013 – July 2014, QB partnered with the Queensland University of Technology – Creative Industries (Dance) and Health (Movement Neuroscience), and the University of Queensland – Health and Behavioural Sciences (Physiotherapy) faculties to conduct initial research into the effects of these dance classes.

This was the first study of its kind in Australia with the results concluding the QB Dance for Parkinson’s pilot program classes affected people living with Parkinson’s in multiple ways including valuable physical, emotional, social, and cognitive benefits.

Q: What was your specific research looking at?

A: My entry areas were gait, cognition and dual tasking. Patients with Parkinson’s disease have problems with walking, and problems with certain cognitive skills mainly related to executive function*.

They also find dual tasking difficult, which is doing two things at the same time, such as: walking and holding a conversation, walking while subtracting numbers, or something more manual like, walking and carrying a glass of water.

 *NOTE on Executive Function

Executive functions (collectively referred to as executive function and cognitive control) are a set of cognitive processes that are necessary for the cognitive control of behaviour: selecting and successfully monitoring behaviours that facilitate the attainment of chosen goals. Executive functions include basic cognitive processes such as attentional control, cognitive inhibition, inhibitory control, working memory, and cognitive flexibility. Higher order executive functions require the simultaneous use of multiple basic executive functions and include planning and fluid intelligence (e.g., reasoning and problem solving).

https://en.wikipedia.org/wiki/Executive_functions

Q: Can you explain why Parkinson’s patients have these specific challenges with gait, dual tasking and executive functions such as memory?

A: Basically, the main reason for Parkinson’s is the lack of dopamine secretion – a neurotransmitter – in a specific part of the midbrain called the Substantia nigra, and this leads to problems with cognitive and motor skills.

Reduced dopamine leads to more inhibitory output* from the brain, which causes slowness in walking.

*NOTE Dopamine reduction causes problems in basal ganglia-thalamo-cortical loop in the brain. This involves 2 pathways direct pathway and indirect pathway, which connects basal ganglia, thalamus and the motor cortex. Usually, if the direct pathway is activated the inhibitory neurons are inactivated and the movement occurs. If the indirect pathway is activated the inhibitory neurons are activated and the movement is prevented. What happens in Parkinson’s disease is due to a lack of dopamine, the direct pathway becomes inactivated and the indirect pathway gets activated, resulting in a decrease in motor function, including gait problems.

The exact causes of cognitive impairment in Parkinson’s Disease is not fully understood yet. However, researchers argue that there can be changes in the neurochemical signals that the brain uses to pass along information to different regions of the brain and these can be disrupted due to a lack of Dopamine causing cognitive impairment. Due to that, several cognitive domains can be affected; however, executive functions may be particularly vulnerable.

Dual-task performance depends on executive function and the ability to divide attention. Both of these are affected in Parkinson’s disease. Therefore, people with PD tend to have problems in dual tasking.

Q: Excuse my ignorance, but isn’t it possible to simply provide a pill, or an injection that supplies the dopamine?

A: That does happen and currently there are medical and surgical treatments for PD. For example; people can take the drug Levadopa, which stimulates dopamine secretion in the brain. Deep brain stimulation is a surgical procedure commonly used. But full recovery is highly unlikely even in patients who receive best medical/surgical care. Research findings show that these treatments don’t reasonably address all of the symptoms of Parkinson’s, which is why alternative therapies, such as physical therapy, different types of dance etc. have been introduced.

Q: If dance is an “alternative therapy”; is it exercise generally that helps and if so, how?

A: Broadly, physical activity is important for motor and non-motor functions of Parkinson’s Disease, as it’s been found to have a neuro-protective effect against the signs of cognitive ageing: decline and impairment.

Q: How does exercise help?

A: Neuroimaging studies show there’s an age-related natural decline that happens in any person, but this age-related atrophy of the brain slows down when people engage in physical activity regularly. This happens because dopamine is secreted more when people engage in physical activity.

That is partly why the WHO (World Health Organisation) recommends at least 150 minutes of moderate activity per week, or 75 minutes of vigorous activity for older adults.

Q. And more specifically, what kind of activity would you give to someone with Parkinson’s Disease?

A: Strengthening or aerobic exercise, balance training, gait training programs and different dance types; it really depends on their particular issues.

Q: How does dance help more specifically?

A: The problem with most exercise programs is the lack of long-term adherence. People simply don’t keep doing it. Studies have shown that long term adherence is poor for traditional exercise. That is why people are moving to more community-based treatments that facilitate the uptake and enjoyment of the patients. So that is how dance came into the field.

Dance involves a lot of range of motion and mobility movements, balance training both alone and with a partner, as the person has to control balance dynamically responding to the perturbations within the environment. And dance can also be a strengthening and an aerobic activity. Dance has the features required within a traditional exercise program, plus dance has some other unique skills as well.

For example, dance uses different cues, some visual, auditory and somatosensory*. So, a person with poor gait i.e. walking, might have problems initiating movement, attaining movement and terminating movement. When there is a cue such as music, which is an auditory cue, it helps facilitate the movement. Research hypothesizes that these cues bypass the Basal ganglia pathways, and the smaller Substantia nigra that is embedded within that part of the brain, those areas specifically effected by Parkinson’s, by using alternative pathways which helps facilitate movement. There are also tactile cues such as holding hands, partner work, or physical touches from the teacher. Also dancing in a group with a teacher becomes a visual cue that also assists.

These cues are more obvious in dance than in traditional exercise programs. Dance also has functional movement patterns. People with Parkinson’s have problems with walking forward, backward and turning and these are embedded in dance patterns.

Dance also involves training in the executive skills such as, motor planning and memory through learning and remembering movement sequences.

Regards dual tasking, the dancer has to move across the floor while attending to music and other people in the shared space.

*Somatosensory: relating to or denoting a sensation (such as pressure, pain, or warmth) which can occur anywhere in the body, in contrast to one localized at a sense organ (such as sight, balance, or taste).

Q: Does any dance help?

A: Yes, there are different types of dance used as an intervention for PD such as Argentine Tango, contact improvisation and ballroom dancing. There is also a lot of cultural dance that is performed in different countries. All these dance types integrate complex motor skill learning patterns, dynamic balance practice, different musical rhythms, tempos and socialisation.

One of the big benefits is that dance is a pleasurable experience. Beyond the joy of moving to music, they are in a group and so have the possibility for socialization, meeting the other people in the group with the same condition. It can become a support group. Also, this provides the person with the identity of a dancer, rather than a patient.

Also, music used in dance is a pleasurable stimulus: music-induced states of mind increases the release of dopamine from certain areas of the brain. So simply being happy helps. Therefore, there are benefits from almost any kind of dance.

However, we used the Dance for PD® programme in our study as it uses different dance styles within it, aiming at a greater diversity of movement types and a range of music. We therefore anticipated that the improvement would be higher.

I’m not sure if it’s related to dance specifically, but when you look at the world there are some regions that have a higher prevalence of PD. Part of that is due to Parkinson’s being associated with complex interactions between multiple environmental and genetic factors. As it currently stands, we’re not sure whether the prevalence also can be related to the type of movement people are involved in, or something else.

Prevalence of Parkinson’s by Country

https://viartis.net/parkinsons.disease/prevalence.htm

Q: Dance challenges our musicality, our balance, our memory for patterns and sequences, plus the regular social inclusion and connectedness means we’re happier doing it, as opposed to, I’m just going for a run to stay fit.

A: Yes. While there were many improvements in gait, balance and executive functioning such as memory, there were also improvements in quality of life, and psychological symptoms such as depression and anxiety. That is, patients recorded feeling better and enjoying life more.

And dance is not only positive for Parkinson’s. I read a systematic review that shows that dance is also effective for stroke, Multiple Sclerosis and spinal cord injuries as well. While there’s a lot of research done on Parkinson’s Disease, as people have been studying dance for about 30 years and its effects since 1989, yet there’s been only limited research on other neurological and cognitive problems. That is expanding now. There’s now more research being done, and the early evidence is suggesting that dance is very helpful.

Dance and its therapeutic effects or as a therapeutic intervention has a longer history, with an initial use going back to around 1947, where it was used for people with psychiatric problems.

Summary

We really should dance for life.

One of the key points is that the earlier we start participating in dance, and the longer we keep it up, the better. While Parkinson’s symptoms might slow in mild to moderate cases, if we reached people earlier then perhaps fewer people would succumb to this, and many other neurodegenerative diseases.

The dance studio of today is primed to lead the way in offering these classes for older members of our society.

A huge thank you to Dr. Nadeesha for sharing her thoughts and fascinating research.

Article written by Josef Brown

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