Dance Therapy in Parkinson’s Disease: Can the Argentine Tango Improve Motor Function?

December 2, 2011

By Neha Jindal

Faculty Peer Reviewed

Parkinson’s disease (PD) is a progressive neurodegenerative movement disorder that affects over 1 million people in the United States. People with PD often demonstrate postural instability, gait difficulties, and impaired functional mobility, which can lead to falls and decreased quality of life.[1] Medical treatments for PD do not fully address gait and balance issues and, consequently, additional approaches are needed.[2] One approach that has recently emerged in clinical studies is the use of dance, particularly the Argentine tango, as therapy to improve motor function in Parkinson’s patients. Can this social partner dance rooted in the early nineteenth century brothels of Buenos Aires really help improve the motor disturbances of Parkinson’s disease?

In PD, there is an imbalance in neurotransmitters such as dopamine, gamma-aminobutyric acid (GABA), and acetylcholine in the basal ganglia, which compromises their role in the motor control of skilled voluntary movements.[3,4] As a result, patients develop bradykinesia with short, shuffling steps and flexed posture, and may have freezing of gait. Patients also have difficulties with balance, and dual tasking while walking, turning, and walking backwards.[5] Traditionally, physical therapy is prescribed along with medical treatment to address these symptoms. In 2007, Keus and colleagues made evidence-based recommendations regarding the four key components of physical therapy design for PD patients: 1) cueing strategies to improve gait; 2) cognitive movement strategies to improve transfers of weight; 3) exercises to improve balance; and 4) training of joint mobility and muscle power to improve physical capacity.[6] Based on these recommendations, it is clear why the Argentine tango may be an effective form of therapy in PD.

The Argentine tango is a partner dance in which the couple is embraced in each other’s arms, and the leader guides the follower, creating synchronized walking and body movement to the music. This form of dance uniquely addresses each of Keus’s recommendations.[7] First, all movement is done to music. Rhythmic auditory cues have been shown to be beneficial in gait training for PD patients.[8] Similarly, music in Argentine tango may act as an external cue to facilitate movement. Secondly, the Argentine tango teaches specific movement strategies for walking patterns that are particularly difficult for PD patients, like walking backwards. To walk backwards in the Argentine tango, dancers are taught to “keep the trunk over the supporting foot while reaching backward with the other foot, keeping the toe of that rear foot in contact with the floor as it slides back and shifting weight backward over the rear foot only after it is firmly planted.”[7] Balance, the third recommendation, is addressed though the partnered nature of the Argentine tango; the dancers must work to maintain balance dynamically while turning and in the midst of random external perturbation. Finally, similar to other forms of dance, if the Argentine tango is done with sufficient amount of intensity, it can be an aerobic workout and result in improved cardiovascular function and physical capacity.[7]

The benefits of Argentine tango in mild-to-moderate idiopathic PD were demonstrated by Hackney and colleagues in 2007.[9] Their study found significant improvements in balance based on an average improvement of 4 points on the Berg Balance Scale after patients completed 20 one-hour Argentine tango classes over 13 weeks. Interestingly, this improvement was only seen in the tango group and not the control group, who only participated in traditional exercise class. This finding of improved balance in PD patients after Argentine tango classes was also supported by two later studies, both showing comparable improvements in the average Berg Balance Scale.[1,10] Furthermore, a 2009 study by Madeleine and colleagues comparing effects of Argentine tango in PD to American Ballroom (waltz/foxtrot) demonstrated not only an improvement in balance after Argentine tango classes, but also a significant improvement in backward walking velocity, backward stride strength, and physical capacity. The study went on to show superiority of Argentine tango over American ballroom in improving forward walking velocity and functional motor control function, as evidenced by a 0.08 meter per second increase in forward walking velocity and 2 second decrease in the Timed Up & Go test.[1]

Based on this information, the Argentine tango appears to contain the four recommended components of physical therapy for individuals with PD and to be an effective form of movement therapy as well. Not only has Argentine tango proven to be beneficial for the motor function of patients with PD, it has also demonstrated superiority to exercise and American ballroom dance. The Argentine tango demands postural control, movement initiation, turning, and moving in close proximity to another individual. These fundamentals of Argentine dance can improve balance, difficulties in movement initiation, directional changes, and overall functional motor control. While there is currently a small number of studies looking at the Argentine tango and its effects in PD, the research to date is highly suggestive of a potential benefit for patients with mild-to-moderate PD with movement disturbances. If research continues in this direction, it may not be long before we see Parkinson’s patients practicing the Argentine tango up and down the halls of Neurology Clinic.

Neha Jindal is a 4th year medical student at NYU School of Medicine

Peer reviewed by Damara Gutnick, MD, Medicine, NYU Langone Medical Center

Image courtesy of Wikimedia Commons

References:

1. Hackney ME, Earhart G. Effects of dance on movement control in Parkinson’s Disease: a comparison of Argentine tango and American ballroom. J Rehabil Med. 2009;41(6):475-481.

2. Gage H, Storey L. Rehabilitation for Parkinson’s disease: a systematic review of available evidence. Clin Rehabil. 2004;18(5):463-482.  http://cre.sagepub.com/content/18/5/463.abstract

3. Marsden CD, Parkes JD. “On-off effects” in patients with Parkinson’s disease on chronic levodopa therapy. Lancet. 1976;1(7954):292-296. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(76)91416-1/abstract

4. Benecke R, Rothwell JC, Dick JP, Day BL, Marsden CD. Disturbance of sequential movements in patients with Parkinson’s disease. Brain. 1987;110(Pt 2):361-379.

5. Hackney ME, Earhart GM. Backward walking in Parkinson’s disease. Mov Disord. 2008;24(2):218-223.

6. Keus SH, Bloem BR, Hendriks EJ, Bredero-Cohen AB, Munneke M; Practice Recommendations Development Group. Evidence-based analysis of physical therapy in Parkinson’s disease with recommendations for practice and research. Mov Disord. 2007;22(4):451-460.

7. Earhart GM. Dance as therapy for individuals with Parkinson’s disease. Eur J Phys Rehabil Med. 2009;45(2):231-238.  http://www.mendeley.com/research/dance-as-therapy-for-individuals-with-parkinson-disease/

8. Thaut MH, McIntosh GC, Rice RR, Miller RA, Rathbun J, Brault JM. Rhythmic auditory stimulation in gait training for Parkinson’s disease patients. Mov Disord. 1996;11(2):193-200.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC486690/

9. Hackney ME, Kantorovich S, Levin R, Earhart GM. Effects of tango on functional mobility in Parkinson’s disease: a preliminary study. J Neurol Phys Ther. 2007;31(4):173-179.  http://nnr.sagepub.com/content/24/4/384.refs

10. Hackney ME, Kantorovich S, Earhart GM. A study on the effects of Argentine tango as a form of partnered dance for those with Parkinson’s disease and healthy elderly. Am J Dance Ther. 2007;29:109-127.

One Response to Dance Therapy in Parkinson’s Disease: Can the Argentine Tango Improve Motor Function?

  1. A True Story « Positively Ballroom on September 11, 2012 at 10:44 pm

    [...] The reason why I am telling you this story is due to an article that I read just this week.  The article, titled “Dance Therapy in Parkinson’s disease: Can the Argentine Tango Improve Motor Function?” was written by Neha Jinda, a 4th year medical student at NYU School of Medicine.  The article gives some great research data on how dancing has proving to help people with Parkinson’s disease.  Please take a moment to read it in full here: http://www.clinicalcorrelations.org/?p=5035 [...]

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