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People with Parkinson’s Disease Discover the Joy of Dance
By Rachel Cox, AARP
February 20, 2009
Grace, the physical kind at least, is a quality not often ascribed to people with Parkinson’s disease (PD), a neurological disorder that gradually robs patients of the ability to perform even the most basic movements without great difficulty.
But on Tuesday afternoons in a spacious studio of the Maryland Youth Ballet in Bethesda, Anne Davis, diagnosed with Parkinson’s eight years ago, recaptures a feeling she once knew well during a girlhood of horseback riding and ballet lessons. Urged on by choreographer and teacher Lucy Bowen McCauley, buoyed by the rhythms of familiar piano tunes, Davis dances, and afterward her pleasure and gratitude are palpable. The dance classes give her, she says, “a chance to really feel graceful again.”
PD patients have long recognized the power of music to liberate them, at least temporarily, from the disease’s debilitating constraints. Now a growing number of dance studios across the United States, including some of America’s most renowned, are offering classes on a regular basis for people with PD. Students and teachers alike report marked improvements not only in physical symptoms but also in dancers’ and caregivers’ states of mind. And the first controlled studies of dance and Parkinson’s disease—part of an ever-growing body of evidence that supports the therapeutic value of exercise for people with PD—bear out the empirical evidence.
Still, it seems an improbable coupling—dance, the realm of exquisite, extraordinary movement, and Parkinson’s, which results from the dying of brain cells that produce dopamine, a chemical messenger or neurotransmitter, critical to the initiation of movement. About 1 million Americans have the disease, according to the Parkinson's Disease Foundation, and roughly 60,000 new cases are diagnosed annually.
As the disease progresses, patients experience varying degrees of tremor, stiffness, slowness of movement, difficulty of speech, and impairment of balance and coordination. The standard medication, levodopa, is administered in combination with other drugs and alleviates symptoms but loses effectiveness over time. And levodopa can cause side effects called dyskinesias, involuntary movements like those sometimes displayed during public appearances by one of the most famous people with PD, actor Michael J. Fox.
But to David Leventhal, a dancer with the Mark Morris Dance Group (MMDG) who teaches Dance for PD classes in Brooklyn, the pairing is not at all paradoxical. Dancers and people with PD “really have a lot in common,” he says. “We share the challenge of bringing superconsciousness to movement. Neither can take a movement for granted.”
It was her intuitive recognition of this similarity that in 2001 led Olie Westheimer, a professionally trained dancer and now the executive director of the Brooklyn Parkinson Group, to approach MMDG about starting the first artist-taught dance classes for patients, their families and caregivers. “Dancers train their bodies, but they dance with their minds,” Westheimer says. “When dancers are given a complicated series of movements, they use cognitive methods and strategies to get it. Dancers have been doing it for hundreds of years. That’s useful. [And they know that] the purpose of teaching is to help people enjoy moving.”
Dance for PD classes have spread, through dancer-to-dancer training, to California, Massachusetts, Tennessee, Chicago, Toronto and the Washington, D.C., area. Financing and organizing generally comes from local nonprofits such as the Parkinson Foundation of the National Capital Area, which supports the Bethesda, Md., classes. MMDG will offer another teacher training workshop in March. Increasingly now, Westheimer works to educate the scientific community about the ability of dance and music to improve mobility and lift spirits. Last November Leventhal led a group of McCauley’s Parkinson’s dancers in a closed-circuit demonstration for neuroscientists at their annual convention in Washington.
Neurologist Kathleen Shannon, M.D., a Parkinson’s specialist at Rush University Medical Center in Chicago who strongly supports the benefits of dance, is designing a randomized, controlled study to compare changes in two groups of Parkinson’s patients. One group takes regular dance classes with artists from Chicago’s Hubbard Street Dance Group, and the other practices another form of exercise such as Pilates.
The first controlled study to examine the effects of dance classes on people with Parkinson’s, published in December 2007 in the Journal of Neurologic Physical Therapy, focused on the Argentine tango, a dance form that researchers at Washington University School of Medicine in St. Louis say targets problems specific to PD patients, such as balance, multitasking, moving backward, initiating movement and moving at a variety of speeds. In the results, patients who took part in regular tango dance classes showed significant improvements in balance and mobility when compared with patients who did conventional exercise.
Lead researcher Gammon Earhart, assistant professor of physical therapy, points to another, peripheral result of the study that she feels is nevertheless also very important. After the study ended, half of the participants in the tango lessons continued to attend classes, while all those engaged in conventional exercise classes dropped out. The key to maintaining healthy movement, Earhart says, “is to remain as active as possible. If they enjoy it, find it engaging, they’re motivated to do it.”
“PD is not a life-and-death disorder, it’s a quality-of-life disorder,” says Mahlon R. DeLong, M.D., a neurologist and PD expert at Emory University School of Medicine in Atlanta. “PD is initially and predominantly a movement disorder, but [it is] associated with behavioral, nonmotor aspects that become more and more prominent” as the motor aspects are addressed. Depression, for instance, is as common to PD as tremor is, he says, especially as the disease progresses and patients become increasingly self-conscious and isolated.
As a result, DeLong says, an alternative therapy like dance, which gets patients “engaged, moving, socializing, feeling their bodies, gets them out,” has tremendous value. “I’m very supportive,” he says. “I think it’s a wonderful thing for patients.”
To observe one of McCauley’s Dance for PD classes in Bethesda is to sense why this must be so. Preparing for class in the mirrored, yellow-walled studio, she unfolds metal chairs in a large circle, where her students will do their warm-up routines. The pianist settles herself at the piano. As students arrive, one parks her cane on the barre on the wall. The most debilitated is a thin, gray-haired man who wants to be identified as Ed. He hunches in his wheelchair, his arms and legs rising and falling spasmodically, as a helper rolls him into place in the circle, then sits down in the chair beside him.
Class progresses, like all dance classes, from small, supported movements—think of a ballet dancer at the barre—to larger, unsupported movements across the floor. McCauley and her assistant, company dancer Alison Crosby, use the language of ballet as students stretch out their legs in tendu and rond de jambe, first seated in their chairs, then standing by the barre, which Ed uses to pull himself out of his wheelchair, McCauley hovering nearby to help with balance.
Teachers enjoin students to “pull up” their posture to improve freedom of movement, deploy imagery to engage their imaginations and improvise movements of their own. In one favorite opening exercise, each PD dancer and care-partner says his or her name and demonstrates a gesture to go with it. On this January afternoon not long before Inauguration Day, Ed chooses to be the new president-elect. “Obama!” he shouts exuberantly and throws his arms in the air in a classic victory pose.
By the second part of class, when the piano breaks into a familiar tango and McCauley directs the dancers to walk in rhythm across the floor, faces are animated, smiles are spreading, cheeks are flushed and all but Ed swing their arms as they strut. Ed is deeply, and remarkably successfully, engaged otherwise. He is making his wheelchair dance.
What’s New in Parkinson’s Research
Parkinson’s experts concede that recent research results have not always met expectations, especially in the area of new drugs. “After a string of interesting developments in the 1990s, there have been several years of disappointments,” says Robin Elliott, executive director of the Parkinson’s Disease Foundation. Promising medications have failed or been withdrawn in the last stages of clinical trials. But, he adds, more research is going on now than ever before, both in terms of dollars invested and universities and doctors participating, and both basic research and new approaches continue to develop apace.
Drugs
While trials continue on new drugs that may offer symptomatic relief for PD patients, researchers increasingly are studying substances that may prove neuroprotective—that is, they may prevent or slow progress of the disease. Several are fairly commonplace, including the nutritional supplement creatine, the blood-pressure drug isradipine, and even vitamin D.
Deep brain stimulation
Introduced in the mid-1990s, deep brain stimulation works something like a heart pacemaker: A device implanted near the breastbone delivers an electrical current to the brain that helps control movement. It is “now in the area of existing, proven treatments” for patients who no longer respond satisfactorily to drugs, says Elliott. A large study published in the Journal of the American Medical Association on Jan. 7 found the treatment beneficial, but not without problematic effects. Plus, Elliott says, “It is brain surgery. You need a case-by-case evaluation” to determine its potential effectiveness.
Exercise
“Exercise is looking like one of the very, very important things people can do to reduce their symptoms and perhaps even slow the progression” of Parkinson’s, says DeLong of Emory University. “There clearly are changes in the brain that protect against toxins.” Scientists have long known that exercise benefits PD patients in the same ways it benefits the population at large, improving aerobic functioning, strength, flexibility and range of motion. But recent studies suggest that it may have neuroprotective effects as well.
One such study, published in the January issue of Neurorehabilitation and Neural Repair, grew out of an experience that neuroscientist Jay Alberts of the Cleveland Clinic had while riding a tandem bicycle across Iowa with a friend who had PD. During the week of 50- and 60-mile rides, his friend’s symptoms all but disappeared. Intrigued and excited, Alberts designed a study that compared results when two groups exercised regularly for eight weeks; one group's members rode stationary bikes at whatever rate they chose, the others on tandem bicycles were forced to exercise well above their comfort level.
While both groups showed improved overall fitness, only the forced-exercise group showed a major improvement in motor function. What’s more, participants in the forced group continued to show functional improvements a month after they stopped bike riding.
Gene therapy
Genetic research is “racing ahead,” Elliott says, and much has been learned about the genetic variations associated with PD. Only about 5 percent of Parkinson’s cases are considered to be genetic in origin, but the discoveries will contribute to understanding causal mechanisms on the cellular level and may help in tailoring medications to fit individuals. Techniques for delivering beneficial new genetic material are under study, but still highly experimental.
Stem cell research
Recent advances in reprogramming cells from adults, rather than embryonic stem cells, have boosted hopes that political issues will no longer prevent progress in using engineered cells to rescue the neurons of people with PD. But researchers see the biggest value of this technique in its implications for drug development. Some of the pioneering techniques that get the most press are “still quite a way away,” Elliott says.
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