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Kalyani, Nadeesha, Sullivan, Karen A., Moyle, Gene Margaret, Brauer,Sandra, Jeffrey, Erica Rose, & Kerr, Graham K.(2018)Effects of dance for Parkinson’s on gait, dual-tasking and quality of life inParkinson’s disease. InDANscienCE Moving Well Conference, 2018-06-02 - 2018-06-02. (Unpub-lished)

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Effects of Dance for Parkinson’s on gait, dual-tasking and quality of life in Parkinson's disease

Supervisory Team

Prof. Graham Kerr: Program Leader, Injury Prevention, Faculty of Health, QUT (Principal Supervisor)

Prof. Karen Sullivan: School of Psychology and Counselling, Faculty of Health, QUT

Prof. Gene Moyle: Head of School, School of Creative Practice, Faculty of Creative Industries, QUT

Prof. Sandy Brauer: Head of Physiotherapy, University of Queensland

Dr. Erica Rose Jeffrey: Program Coordinator, Dance for Parkinson's Australia

Outline

Introduction

Knowledge gap

Methodology

Results

Conclusion

02.06.2018 2

Chronic, progressive, incurable, neuro degenerative condition (Andrew, 2009)

Reduction of Dopamine synthesis

10 million or more

Approximately 70,000

Parkinson’s disease

(“Deloitte Access Economics Report” 2015)

02.06.2018 3

Parkinson’s disease clinical features

Motor Non-motor

• Walking impairment

• Bradykinesia • Rigidity• Rest tremor• Postural problems

• Cognitive dysfunction

• Autonomic dysfunction

• Sleep disorders• Sensory

abnormalities

4

Dual task

Parkinson’s disease treatment Drug Therapy

• Dopamine replacement therapy : Levodopa

Neurosurgical Interventions

• Ablative surgery, stimulation surgery or deep brain stimulation (DBS), and transplantation or restorative surgery

Allied Health Treatments

• PT, OT, ST, Exercise therapy, External cue therapy etc.

02.06.2018 5

Dance for Parkinson’s

02.06.2018 6Photo credit: Erik De Wit

Cultural dance

Tango

Contact Improvisation

DfPD®

Dance for Parkinson’s (DfPD®)

• Began = 2001 • Brooklyn Parkinson Group & Mark

Morris Dance Group, in New York. • Dance for Parkinson’s Australia in QB

= 2013• 1st pilot study = 2014

(Westheimer, 2008)

02.06.2018 7

Photo credit: Christian Tiger

Techniques

Internal imagery

Mirroring

Improvisation

Tactile input

02.06.2018 8

• Music : external cue • Balance exercise• Strengthening exercise • Mobilization exercise • Aerobic exercise

(Earhart, 2009)

What is the knowledge gap?

Limited parallel group designs

Small sample size

No detailed gait analysis

No detailed cognitive assessment

Limited dual task gait

No activity monitoring

02.06.2018 9

Aims

02.06.2018 10

To evaluate the effectiveness of the dance classes based on DfPD® model on:1. walking speed and other spatio temporal variables during normal

walking, and during dual tasking,2. cognition (executive function),3. anxiety and depression, 4. the activity (limb acceleration) in class,5. the daily activity involved,6. the QoL,7. caregiver burden.

MethodsQuasi-experimental, parallel group pretest-posttest study

Study design

17 – Dance group16 - Control group

Sample size

QUTStudy

setting

• Engaged in DfP program during past 6 months• Addenbrooke’s < 82• Medical, neurologic, musculoskeletal, cardiovascular

or respiratory abnormalities

• Idiopathic PD• Aged 40 to 85 years• I-III on Hoehn and Yahr: Mild to moderate PD • Addenbrooke’s > 82: No dimentia

Inclusion criteria

Exclusion criteria

Participant recruitment

• PD support groups • Parkinson’s Queensland Incorporated (PQI) • Distributing recruitment flyers • Existing DfP class at QB• Emailing to the QUT classifieds distribution • QUT alumni newsletter • ‘IHBI Participate in Research’ site

02.06.2018 11

Participant participation

02.06.2018 12

Assessed for eligibility (n = 49)

Allocated to dance group (n = 20)

Allocated to control group (n = 21)

Analysed (n = 17) Analysed (n = 16)

Allocation

Not meeting inclusion criteria (n = 8)

Discontinued (n = 5)Discontinued (n = 3)

Intervention: QUT DfP class• Commenced on 21st Aug 2017• Twice a week, 3 months• Six DfPD® trained instructors from QB• 15 volunteers• 1 hour class

1. 30 mins seated warm up2. 15 mins standing dance3. 15 mins moving across the floor

• Family member, friend, or caregivers

02.06.2018 13

Assessment

Baseline assessment

Post assessment

Screening

02.06.2018 14

Dance Control

Allocation

1 hour dance for PD classes twice a week for 12 weeks

• Timed up and Go test (TUG)• Dual task - TUG• Vicon 3D motion analysis system • FoG questionnaire

Gait: preferred pace & dual tasking

• Addenbrooke’s Cognitive Examination• MMSE• Trail making test • National Institutes of Health tool box (NIH TB)

Cognition: executive function

• Mini-BEST test• Tinetti Mobility test•ABC scale

Balance

• ActivPALs• Activity diary

Activity monitoring

• PDQ-39• Depression and Anxiety Stress scale

Quality of life, Anxiety and Depression

• Caregiver burden scale

Caregiver burden

Timed Up and Go test

• Measures Walking speed Static/dynamic balance Mobility

• Stand – walk 3m – turn – come back – sit down• Normal walking & dual-tasking

02.06.2018 15

Demographic details

02.06.2018 16

Demographic Dance group(n = 16)

Control group(n = 17)

P value

Age (years) 65.8 ± 11.7 67.0 ± 7.7 0.73

Hoehn and Yahr 1.6 ± 0.7 1.5 ± 0.8 0.76

Addenbrooke's examination

93.2 ± 3.6 92.6 ± 4.3 0.69

Results : TUG

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Results : Dual task - TUG

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Results – PDQ 39

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Qualitative assessment

• “joyful”• “fun”• “inclusive” • “challenging”.

02.06.2018 20

Conclusion

Compared to the controls the dance group had• significantly improved walking speed during normal walking • significantly improved walking speed during dual tasking• significantly improved quality of life• Improved emotional wellbeing

02.06.2018 21

����Effects of Dance for Parkinson’s on gait, dual-tasking and quality of life in Parkinson's diseaseOutline Slide Number 3Parkinson’s disease clinical features Parkinson’s disease treatment Dance for Parkinson’sDance for Parkinson’s (DfPD®) Techniques What is the knowledge gap?Aims MethodsParticipant participation Intervention: QUT DfP classAssessmentTimed Up and Go test Demographic details Results : TUGResults : Dual task - TUGResults – PDQ 39Qualitative assessmentConclusion