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An NSERC-funded project, where patients with Parkinson’s participated in three-month dance classes, has led to the patients’ improvements in balance and gait speed.

Highly collaborative research led by 91��ɫ’s Centre for Vision Research, alongside the National Ballet of Canada and Ryerson University, offers new hope to those with Parkinson’s disease (PD). The project, funded by the National Science and Engineering Research Council (NSERC), the Parkinson’s Society Canada and donation from the Irpinia Club of Toronto, looked at the benefits of a 12-week dance intervention for patients with Parkinson’s.

This ground-breaking research, led by Professor Joseph DeSouza (with PhD student Karolina Bearss and honours student Katherine McDonald) wove together the insights of many departments, including Biology, Psychology, the Neuroscience Graduate Diploma Program and Interdisciplinary Studies, as the 91��ɫ team worked with Rachel Bar of Canada’s National Ballet School and Ryerson University.

“This research shows, for the very first time, long-term changes related to participation in a 12-week dance program,” DeSouza explains. “The results indicate motor improvements for both balance and gait in short-term – one day – and long-term – 12 weeks,” he adds.

Roughly 70,000 Canadians living with Parkinson’s

The second-most common neurodegenerative disease after Alzheimer’s, Parkinson’s is a progressive degenerative disease that affects mainly those over 60 years of age (Statistics Canada). Diagnosed by symptoms alone, common signs are tremor, slowness of movement and stiffness, impaired balance and coordination, and rigidity of the muscles (Parkinson Canada).

Just under 70,000 Canadians are living with Parkinson’s today (55,000 adults in addition to 12,500 residents of long-term care facilities), according to Statistics Canada.

The rate of progression of this disease varies greatly among patients. As there is no cure, several therapies have proven beneficial to help manage the symptoms. Interestingly, research in this field has shifted its attention away from drug therapies – in part, due to negative side effects – to forms of interventions, such as dance, intended to improve daily functioning and quality of life, DeSouza notes.

Successful forms of interventions or therapies include:

• Physical therapy for aiding mobility, flexibility and balance;
• Occupational therapy with daily activities;
• Speech therapy to assist with voice control; and
• Exercises that help joints and muscles, and improve the overall health and well-being of patients (Parkinson Canada).

Existing research already proved that exercising and dancing benefits those with Parkinson’s – hence, the suggested therapies, noted above – but DeSouza’s team wanted to delve deeper into the longer-term benefits of dance.

Research in this field has shifted its attention away from drug therapies to forms of interventions, such as dance, intended to improve daily functioning and quality of life.

Researchers wanted to know minimal amount of time needed to see improvements

The team decided upon a pilot study, a small-scale preliminary study executed to figure out the feasibility, time, costs etc. of doing a larger and more comprehensive study. A pilot study is intended to improve upon the design of the study before actually undertaking a full-scale research project.

Earlier research had shown motor and quality of life improvements after dance therapy at eight- and 17-months. DeSouza’s team aimed to replicate previous findings, but in a shorter time frame; his study looked at the effects of a dance program that was on average 34 per cent shorter in dance intervention duration than previous studies.

Simply put: The 91��ɫ researchers wanted to determine the minimal amount of time/intervention, the shortest dance session, needed to see improvements. “This research adds an extension to the existing literature on the required length of time necessary to see these beneficial impacts,” DeSouza explains.

DeSouza’s team wanted to determine the minimal amount of time/intervention, the shortest dance session, needed to see improvements in patients with Parkinson’s.

Nine participants from new “Dancing with Parkinson’s” Program at National Ballet

Over 12 weeks, the researchers studied nine participants with Parkinson’s who volunteered from a new Dancing with Parkinson’s Program at Canada’s National Ballet School. The participants used the “Dance for PD” model, which targets Parkinson’s -specific symptoms related to balance, cognition, motor skill, depression and physical confidence. (See table with select sample exercises.)

Table: Sample exercises featured in the dance class at National Ballet School

Exercise	Description	Purpose
Danced name introduction	Stating your name with a corresponding dance movement. The rest of the class first watches before repeating the participants name and movement. Standing or seated.	Feeling welcomed and welcoming everyone in the class. Practicing skills of choreographing on the spot.
Magic dance	Dancing with an imaginary ball and scarf, while exploring a range of motion. Seated.	An opportunity for vivid imagery and creative interpretation.
Winning the poker game	Rising slowing from a chair while moving in a celebratory manner.	Practicing rising from a seated position in a safe manner.
Shy to confident shuffle dance	A standing variation of the seated shuffle dance, where the movements are done first in a demur and small manner, but gradually increase in confidence until they are gregariously expressed.	A fun way of practicing moving with confidence and with clear intention.

The researchers gained information about the potential beneficial impacts of the dance therapy via questionnaires: Study participants completed two motor and quality of life questionnaires before and after the second and twelfth “Dance for PD” class.

To measure motor performance, the research team used the Berg Balance Scale and the Timed Up and Go test. The former is comprised of 14 tasks, measuring different everyday functions of balance and posture. Each task is rated on a scale of 0 to 4, and evaluated in terms of how long it took to complete or the quality of execution.  The latter is a timed measurement of movement sequencing, gait and balance control. Here, a participant rises from a seated position, walks three meters, turns around, returns to the seat and sits back down.

Two quality of life questionnaires were administered, also at weeks two and 12: the Quality of Life Scale from Oregon Health and Sciences University and a post-dance class questionnaire of wellbeing developed by European researchers in this field, Olie Westheimer and Lisa Heiberger.

Results showed motor improvements in balance and gait, set stage for future research

Although no improvements were seen in terms of the study participants’ quality of life, results indicated, for the first time, motor improvements for both balance and gait in short-term (1-day) and long-term (12-weeks).

This pilot study clearly sets the stage for future research. “What remains unknown in the literature on this topic, is the specific length of dance intervention that is needed, measured in weeks and hours, until initial improvements are seen in both motor and quality of life in Parkinson’s,” says DeSouza.

He also suggests that quality of life may have already increased after just two weeks of dance class. “What is more important for future studies is to uncover the mechanisms that underlie these behavioural changes,” says DeSouza.

The article, ,” was published in Advances in Integrative Medicine (February, 2017).  To learn more about 91��ɫ’s , visit the website. To learn more about DeSouza’s research, visit his .

To learn more about Research & Innovation at 91��ɫ, watch the , see the or visit the .

By Megan Mueller, manager, research communications, Office of the Vice-President Research & Innovation, 91��ɫ, muellerm@yorku.ca