Balance, Body Motion, and Muscle Activity After High-Volume Short-Term Dance-Based Rehabilitation in Persons With Parkinson Disease: A Pilot Study

Abstract

BACKGROUND AND PURPOSE The objectives of this pilot study were to 1) evaluate the feasibility and investigate the efficacy of a 3-week, high volume (450 minutes/week) Adapted Tango intervention for community dwelling individuals with mild-moderate PD, and to 2) investigate the potential efficacy of Adapted Tango in modifying electromyographic (EMG) activity and center of body mass (CoM) displacement during automatic postural responses to support surface perturbations. METHODS Individuals with PD (n=26) were recruited for high volume Adapted Tango (15 lessons, 1.5 hour each over 3 weeks). Twenty participants were assessed with clinical balance and gait measures before and after the intervention. Nine participants were also assessed with support-surface translation perturbations. RESULTS Overall adherence to the intervention was 77%. At posttest, peak forward CoM displacement was reduced (4.0±0.9 cm, pretest, vs. 3.7±1.1 cm, posttest; P=0.03; Cohen’s d=0.30) and correlated to improvements on Berg Balance Scale (BBS; rho=−0.68; P=0.04) and Dynamic Gait Index (rho=−0.75; P=0.03). Overall antagonist onset time was delayed (27 ms; P=0.02; d=0.90) and duration was reduced (56 ms, ≈39%, P=0.02; d=0.45). Reductions in EMG magnitude were also observed (P<0.05). DISCUSSION AND CONCLUSIONS Adherence was acceptable and improvements on clinical measures of balance and gait were comparable to that obtained with lower volume, 12-week programs. Following participation in Adapted Tango, changes in kinematic and some EMG measures of perturbation responses were observed in addition to improvements in clinical measures. We conclude that 3-week, high volume Adapted Tango is feasible and represents a viable alternative to longer duration adapted dance programs. Video Abstract available for more insights from the authors (see Supplemental Digital Content 1)

Do sensorimotor perturbations to standing balance elicit an error‐related negativity?

“…Many populations with altered error responses also display differences in balance behavior, including frequent comorbidities between anxiety disorders and balance disorders (Balaban, 2002;Balaban & Thayer, 2001;Bolmont, Gangloff, Vouriot, & Perrin, 2002;Yardley & Redfern, 2001), and substantially reduced postural sway in individuals with obsessive-compulsive disorder (Kemoun et al, 2008). Further, balance impairment is strongly associated with cognitive impairment in older adults with (Allcock et al, 2009;Mak, Wong, & Pang, 2014;McKay, Lang, Ting, & Hackney, 2018) and without (Camicioli & Majumdar, 2010;Gleason, Gangnon, Fischer, & Mahoney, 2009;Herman et al, 2010;Mirelman et al, 2012) Parkinson's disease, and rehabilitation interventions that simultaneously target cognitive engagement show greater improvement in motor function in healthy aging (Kraft, 2012;Wu, Chan, & Yan, 2016) and in Parkinson's disease (McKay, Ting, & Hackney, 2016;Petzinger et al, 2013) than interventions that target motor function alone. Collaboration across fields could provide new insight into these synergistic benefits of combined interventions and may help explain counterintuitive findings that balance training can ameliorate anxiety disorders (Bart et al, 2009) or that cognitive training can improve balance and gait (Smith-Ray et al, 2015), leading to the development of more integrated treatment strategies for comorbid motor, cognitive, and psychiatric disorders.…”

Lower Limb Rigidity Is Associated with Frequent Falls in Parkinson's Disease

“…For most of the participants (143 of 216), these were the following: advanced stage dementia in which patients were unable to perform activities of daily living independently, presence of cerebrovascular disease or extensive white matter disease, findings suggestive of atypical parkinsonism (extraocular movement abnormalities, pyramidal tract signs, ataxia), past neuroleptic use, or past history of multiple head injuries . For the remaining participants (73 of 216), the exclusion criteria were a history of neurological insult other than PD, inability to walk ≥3 meters with or without assistance, or other significant musculoskeletal, cognitive, or neurological impairment other than PD as determined by the investigators . Beginning with 220 records, 4 records were excluded because of incomplete Freezing of Gait Questionnaire or UPDRS‐III scores.…”

“…22 For the remaining participants (73 of 216), the exclusion criteria were a history of neurological insult other than PD, inability to walk ≥3 meters with or without assistance, or other significant musculoskeletal, cognitive, or neurological impairment other than PD as determined by the investigators. [23][24][25] Beginning with 220 records, 4 records were excluded because of incomplete Freezing of Gait Questionnaire 26 or UPDRS-III 4 scores.…”

Perception of whole-body motion during balance perturbations is impaired in Parkinson’s disease and is associated with balance impairment

“…Participants stood barefoot on a custom perturbation platform that translated in the horizontal plane, wore a harness attached to the ceiling, and were attended by staff [17,38]. Stance width between the feet was standardized to inter-anterior superior iliac spine (ASIS) distance.…”

“…Participants were blindfolded and wore headphones that played white noise to eliminate visual and auditory feedback during testing. All testing was performed while participants were instrumented with electromyography electrodes on the legs and reflective motion capture markers [17,38].…”