Dance for Parkinson s disease. Laurie King, PT, PhD Dept. of Neurology Oregon Health & Science University Portland, OR

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1 Dance for Parkinson s disease Laurie King, PT, PhD Dept. of Neurology Oregon Health & Science University Portland, OR

2 Studies of effects of exercise in PD on are on the rise sell lag behind other types of interveneon

3 Why is it especially important for people with PD to exercise? Avoid falls and fractures (5X age- matched!) Meta- analysis: 46% fell during 3 month period and 21% of non- fallers fell. (Pickering et al., Mov Disord 2007) Women with PD have 7.3 % lower bone mineral density and 2.6 X higher incidence for hip fracture (turning). (Schneider JL et al Osteop Int 2008) Deep Brain SEmulaEon and medicaeons do not improve balance! (St. George, et al J Neurosurgery 2012)

4 Constraints limieng mobility in PD; could dance help? Rigidity: seffness, flexed posture Bradykinesia: slow, small movements Freezing: small weight shies Poor Sequen7al Coordina7on: difficulty turning, rolling, quick switching Execu3ve func3on: cognieve processes such as working memory, planning and execueon, task flexibility

5 Postural Alignment- Stooping worsens Upright Control balance Stooped Control Parkinson's disease

6 Stooped inieal posture reduces balance in response to perturbaeons, especially backwards (like PD subjects). Stability Margin (peak CoP - peak CoM) FL F 5 cm FR L R BL BR B Upright Controls Parkinson s Disease (PD) Stooped Controls

7 Levodopa does NOT always improve balance in Parkinson s Disease OFF Dopa Pull Test ON Dopa Pull Test

8 Could dance help postural alignment and pracecing stepping in different direceons, especially backwards

9 Could dance help bradykinesia (small Small steps Small weight shies Small preparaeon for stepping movements?

10 Video of dance showing big steps in mule direceons

11 Turning is harder than straight walking, esp. for PD cm PD Control cm

12 We make over 1,000 turns a day

13 QuanEty of acevity is similar in PD and controls, but quality of turning is diﬀerent

14 Dance naturally incorporates turns

15 Same parts of brain for thinking and balance

16 Dual Tasking Dual- Task Interference Walking slows when talk Thinking slows when walk More difficult with Parkinson s Disease: Need more aleneon to walk and balance Reduced working memory Difficult to switch between tasks Make not priorieze balance Owen et al., 1997; Lewis et al 2005

Balance and walking require more AlenEon in PD 90 80 70 60 Stride Velocity (% height/sec) Gait

17 Balance and walking require more AlenEon in PD Stride Velocity (% height/sec) Gait Velocity Controls PD Patient Control Patient - Cog Control - Cog Month 0 Month 3 Month 6 Month 9 Month 12

18 Dance requires cognieon AlenEon Learning new skills Switching motor plans Planning Memory Conflict resolueon

19 Dance is a cognieve task

20 Six months of dance interveneon enhances postural, sensorimotor, and cognieve performance in elderly without affeceng cardio- respiratory funceons Jan- Christoph Kalenstroth 1, Tobias Kalisch 1,2, Stephan Holt 3, MarEn Tegenthoff 2 and Hubert R. Dinse 1* 1 Neural PlasEcity Lab, InsEtute for NeuroinformaEcs, Ruhr- University Bochum, Bochum, Germany 2 Department of Neurology, BG- Kliniken Bergmannsheil, Ruhr- University Bochum, Bochum, Germany 3 Department of Cardiology, BG- Kliniken Bergmannsheil, Ruhr- University Bochum, Bochum, Germany

21 Randomized Controlled Trial of Community- Based Dancing to Modify Disease Progression in Parkinson Disease Ryan P. Duncan, MPT and Gammon M. Earhart, PhD

24 Why dance may be helpful for PD Naturally uses cues (i.e. music for Eming and partner for alignment and big steps) Backwards and sideways walking CogniEve challenge Requires motor learning No current medical treatment for balance problems

Start early to preserve funceon Rigidity: stiffness, flexed posture Bradykinesia: slow, small movements Freezing: small weight shifts Poor Sequential

25 Start early to preserve funceon Rigidity: stiffness, flexed posture Bradykinesia: slow, small movements Freezing: small weight shifts Poor Sequential Coordination: difficulty turning, rolling, quick switching Executive function: cognitive processes such as working memory, planning and execution, task flexibility

What goes wrong with balance in Parkinson s Disease? Fay B Horak, PhD, PT Professor of Neurology Oregon Health and Science. CoM

What goes wrong with balance in Parkinson s Disease? Fay B Horak, PhD, PT Professor of Neurology Oregon Health and Science CoM CoM Course Objectives Understand different types of balance systems affected