Introduction

Welcome to my blog, my name is Madison Chilton and I am currently a third year student, studying occupational therapy at Otago Polytechnic. Through this blog I am going to explore one of my passions, dance and apply it to another of my passions, occupational therapy.  

The purpose for this blog is to not only pass my transition to practice paper, but to also provide information around the benefits of dance for those who live with Parkinson’s disease. Within this blog I aim to provide my personal reflections and opinions, sound literature and evidence as well as links and videos around this topic, to inform others, develop new perspectives and even to inspire.

I am not an expert in this area and I am developing my knowledge throughout this blog, it is a great learning experience. I encourage you to read the blog and add your own opinions and perspectives, I also value feedback and any advice that you may have.  Thank you and enjoy reading.

What is Parkinson's disease?

Parkinson’s disease is a progressive neurodegenerative condition that is caused by a deficiency of a chemical in the brain called dopamine. When we have sufficient levels of dopamine our movements are coordinated and quick, however for someone with Parkinson’s their movements become slow and awkward.  It is common for Parkinson’s to occur in older age groups, the average age of diagnosis is 59 and many people have different symptoms and degrees of severity. There is no known reason for why the levels of dopamine change or what triggers the development of Parkinson’s, it can’t be cured but it can be treated. (The Parkinsonism Society of New Zealand Inc., n.d).

Click here to veiw a short video that explains what Parkinson’s disease is, how it is caused and the types of symptoms people can experience. (Parkinsonsworm, 2013).
Those who live with Parkinson’s disease can have a range of symptoms including motor and non-motor. Below is a table of symptoms that can appear with the disease. (Browner & Pagan, 2013).



MOTOR SYMPTOMS

Bradykinesia (slowness of movement)

Rigidity (stiffness of movement)

Tremor (involuntary shaking of the hands, feet, arms, legs, jaw, or tongue, usually more prominent at rest)

Postural Instability (tendency to fall without explanation, usually when pivoting)

NON-MOTOR SYMPTOMS


Mood (depression, anxiety, irritability)

Cognitive changes (attention, visuo-spatial problems, memory problems, personality changes, psychosis/hallucinations)

Orthostatic hypotension (lightheaded and low blood pressure upon standing)

Constipation and early satiety (a feeling of fullness after eating small amounts)

Hyperhidrosis (excessive sweating), especially of hands and feet

Seborrhea dermatitis (dry skin) dandruff

Urinary urgency, frequency and incontinence

Loss of sense of smell (Anosmia)

Sleep disorders

Insomnia, Excessive Daytime Sleepiness (EDS), Rapid Eye Movement Behavioral Disorder (RBD) or active dreaming, dream enactment, involuntary movements and vocalizations during sleep, Restless Legs Syndrome (RLS)/Periodic Leg Movements Disorder (PLMD)

Sensory (pain, tightness, tingling, burning)


MIXED MOTOR AND NON-MOTOR SYMPTOMS

Drooling due to slowed swallowing (Sialorrhea)

Speech and swallowing problem

There is no cure for Parkinson’s disease; however there are treatments available for the management of symptoms. Treatments can include medications, surgery and alternative treatments such as lifestyle changes, exercise, sleep, diet, massage and herbal remedies to name a few. (Healthcare Group, n.d.).

References:
Browner, N., & Pagan, F. (2013). National Parkinson Foundation. Retrieved from http://www.parkinson.org/Parkinson-s-Disease/PD-101/How-do-you-know-if-you-have-PD-

Parkinsonsworm. (2013). What is Parkinson’s? Retrieved from htp://www.youtube.com/watch?v=X9NsJoNThAk
The Parkinsonism Society of New Zealand Inc. (n.d.). Parkinson’s New Zealand. Retrieved from http://www.parkinsons.org.nz/

The significant role of occupations and what it means for people who have Parkinson's disease

Participation in occupations is an important component to health and is vital for all humans. Through the things we participate in everyday, we learn skills, socialize, gain satisfaction and most of all they add a sense of purpose and meaning to our lives. (Law, 2002).  But what happens when the things we once enjoyed and valued in our lives, gets taken away by something out of our control?

Occupational deprivation refers to conditions or situations that are out of a person’s control that inhibits the person participating in occupations. (Christiansen & Townsend, 2010). When we can’t participate in things that are important and meaningful to us, it is damaging to our health. The meaning we tie to our occupations, impacts our meaning to our lives which in turn affects our quality of life, our purpose and our self-worth (Hammell, 2004). Reduced participation in occupations has many adverse effects such as isolation, reduced or no active recreation, depression, that loss of purpose of meaning to life can be detrimental to your physical and mental wellbeing. (Law, 2002).  Loss of occupations can also bring about a change in life roles, it may be that roles are lost such as being the provider for the family and the new roles may needed to be learned or adapted. (Parkinson’s Society, British Columbia, 2013).

Having Parkinson’s disease affects the occupations they can carry out, depending on the stage the disease is and what degree their symptoms are at, it can heavily influences what occupations they can do. Parkinson’s can impact transfers making difficult to begin an occupation, driving and all activities of daily living due to stiffness and reduced trunk flexibility. (Aragon & King, 2010). Due to gait and balance problems difficulties such as taking that initial step for walking, fear of falling and balance, can affect the type of occupation they can carry out. (Aragon & King, 2010).  Fatigue can Affect a person’s endurance and even motivation to carry out occupations. Fatigue can lead to reduced participation in occupations that are meaningful and purposeful for a person. (Aragon & King, 2010).  A cognition change affects the type of occupations they can engage in, speech can even be lost, affecting communication and leading to isolation of social occupations and interactions. (Aragon & King, 2010).


Having Parkinson’s disease dramatically changes the occupations that can be carried out and participated in. This change in occupations that can be carried out, due to the disease causes loss, occupational deprivation, and change of life roles.
References:

Aragon, A., & King, J. (2010). Occupational therapy for people with Parkinson’s: Best practice guidelines. London: College of Occupational therapists.


Christiansen, C., & Townsend, E. (2010). Introduction to occupation: The art and science of living. (2ed). New Jersey, United States of America: Pearson Education Inc.
Hammell, K. W. (2004). Dimensions of meaning in the occupations of daily life. Canadian Journal of Occupational Therapy, 71(5), 296-305

Law, M. (2002). Participation in the occupations of everyday life, 2002 Distinguished Scholar Lecture. American Journal of Occupational Therapy, 56, 640–649.
Parkinson’s Society, British Columbia. (2013). Parkinson’s disease. Retrieved from http://www.parkinson.bc.ca/Living-with-Parkinsons
 

Using Dance as an intervention technique for people living with Parkinson's disease

“Remarkably effective therapies for movement disorders, is dance.” (Hogan, 2010. Pg 1). There are many different interventions that can be applied to address the different aspects of Parkinson’s disease. Dance however, can be used in conjunction to these interventions and more and more are being seen as an effective addition to traditional intervention strategies. Dance can help to address areas of concern to an individual, living with Parkinson’s disease. (Earhart, 2010).

There are many reasons that dance can benefit a client living with Parkinson’s disease. One area in particular that Parkinson’s clients have difficulty with is ‘freezing’ a term that refers to when a person literally is stuck in place, when trying to initiate movement such as walking. (Browner & Pagan, 2013). The music that accompanies dance can act like an external cue, which is a recommended component for Parkinson’s patient’s functioning, the music cues facilitation of movement. (Earhart, 2010). The music paired with dance can help trigger voluntary movements and can assist in management of movements that are difficult. (Aragon & King, 2010).

Motor and non-motor impairments that are associated with Parkinson’s disease make it difficult to carry out occupations. Decline in cognitive functioning especially reduced executive functioning and impaired attention makes it difficult when trying to complete meaningful occupations. (Aragon & King, 2010). Dance is usually low impact and repetitive when learning steps which enables for easier retention of steps while engaging the mind and body. (Hogan, 2010).  Studies show the importance exercise has on functional independence and improving mobility for neurological disorders, in particular Parkinson’s disease. (Rodrigues-de-Paula & Oliveira Lima, 2013). Using dance for people living with Parkinson’s is such a good way to combine social interaction, improve motor skills and influence quality of life. Dance has the ability to provide strength, flexibility, balance and cardiovascular improvements in a fun and social environment. (Hogan, 2010).

Improvements from participating in dance may branch from increased confidence and enhanced motor control, which can enable the client to lead a more active lifestyle. (Hackney & Earhart, 2010). The reduced participation in occupations that are meaningful for Parkinson’s clients, because of their disease affects their quality of life. Dance can foster interest in increased participation and carry over into other areas of their lives. (Hogan, 2010). It is important that these clients participate in occupations that are meaningful to them and keep up with an active lifestyle to help not only their physical but mental wellbeing. Recent studies show that tango dancing can improve mobility and increase the quality of life for those living with Parkinson’s disease. (Hackney et al, 2007).

There are many benefits when using dance as an alternative intervention for clients who live with Parkinson’s. Benefits can are not limited to, but can include gait and balance improvements, social interaction, engagement of the brain, external cues that help with initiation of movement, increased motivation and cardiovascular improvements, engagement in physical activity and improved quality of life.
References:


Aragon, A., & King, J. (2010). Occupational therapy for people with Parkinson’s: Best practice guidelines. London: College of Occupational therapists.

Browner, N., & Pagan, F. (2013). National Parkinson Foundation. Retrieved from http://www.parkinson.org/Parkinson-s-Disease/PD-101/How-do-you-know-if-you-have-PD-

Hogan, P. (2010). More evidence on the value of dance. Running & Fitnews, 28(1), 9-10.

Hackney ME, Kantorovich S, Levin R, Earhart GM (2007) Effects of tango on functional mobility in Parkinson’s disease: a preliminary study. Journal of Neurologic Physical Therapy, 31(4), 173–179.

Earhart, G. M. (2010). Dance as therapy for individuals with Parkinson’s disease. European journal of physical and rehabilitation med. 45 2) 231-238.

 
Hackney, M., & Earhart, G. (2010). Effects of dance on balance and gait in severe Parkinson disease: a case study. Disability & Rehabilitation, 32(8), 679-684.

Rodrigues-de-Paula, F., &  Oliveira Lima, L.( 2013). Physical Therapy - Exercise and Parkinson's Disease. In: International Encyclopedia of Rehabilitation.  

Social interaction is enhanced through dance

Dance can be enjoyable and socially engaging; the settings dance can be carried out in can enhance social support, and therefore increase motivation and prolonged engagement in exercise related activities. (Earhart, 2010). For those with Parkinson’s disease relationship goals are amongst the many they hold important, any activity that can nurture social interactions is vital. Obtaining these goals can be imperative for their mood function and therefore carry over to their quality of life. (Hackney & Earhart, 2010).

One non-motor symptom that can occur during the course of Parkinson’s is apathy, this reduced interest and motivation can lead to isolation. (Aragon & King, 2010). This seclusion impacts and reduces participation in occupations and social interaction which is vital for wellbeing and quality of life. Dance helps to reduce isolation and increase confidence. (Widdecombe & Beke, 2011).
Dance can increase social interactions, develop personal development, self-expression and fosters further community involvement. (Earhart, 2010). Dance groups for those living with Parkinson’s can mean they are involved with people who are like minded, a place where they can relate to others and feel as though they belong. Dance is a social activity that creates and strengthens relationships and assistances in those living with the disease from withdrawing from the community. (Bernstein, 2013).The connections they make with others through dance can help them share and express feelings and gain support. The environment creates a place where they can feel safe and have purpose.

References:
Aragon, A., & King, J. (2010). Occupational therapy for people with Parkinson’s: Best practice guidelines. London: College of Occupational therapists.

Berstein, L. (2013). Dance for Parkinson’s Disease: Movement as medicine. Retrieved from http://articles.washingtonpost.com/2013-07-02/lifestyle/40324316_1_dance-class-parkinson-s-tremors
Earhart, G. M. (2010). Dance as therapy for individuals with Parkinson’s disease. European journal of physical and rehabilitation med. 45 2) 231-238.

Hackney, M., & Earhart, G. (2010). Effects of dance on balance and gait in severe Parkinson disease: a case study. Disability & Rehabilitation, 32(8), 679-684.
Widdecombe, A., & Beke, A. (2011). Bupa. Retrieved from http://www.bupa.co.uk/individuals/care-homes/care-homes-news-2011/june-2011/dance-your-way-to-a-healthy-old-age

Occupational therapy perspective, dance as an intervention technique.

Most studies around the benefits of dance for people living with Parkinson’s, focus on the effects and improvements on gait, balance, quality of life, social interaction and functional mobility. The article ‘We’re fools whether we dance or not, so we may as well dance’ highlighted the fact that particular research studies lacked an Occupational therapists perspective at this stage. The article outlines that the amount of praise is high, when viewing the difference dance has made to this particular client group. (Gendle, 2012). Occupational therapists need to get more involved with this potential positive treatment intervention, for people who live with Parkinson’s.

Occupational therapists have a vast scope of practice and knowledge specific to occupations, this enables them to bring an occupational perspective to any situation and address occupational issues. (Christian & Townsend, 2010). As addressed in the earlier posts Parkinson’s disease effects the occupations that people can carry out and participate in, so therefore an occupational therapist should be involved in finding solutions to these occupational issues.
Occupational therapists aim to empower people with Parkinson’s to participate in everyday tasks, and adapt those tasks to reduce barriers and enhance their quality of life. (EPDA,2013). Using dance for people living with Parkinson’s is a way to enhance physical wellbeing by improving motor skills, strength, balance and cardiovascular fitness; it also influences quality of life due to its fun and social environment. (Hogan, 2010). Occupational therapists should also focus on promoting mobility and present opportunities to participate in community life. (Aragon & King, 2010).

Providing intrinsic and extrinsic cues for those living with Parkinson’s is vital when promoting functional abilities from an occupational therapy perspective, such as visualisation, mental rehearsal, music and movement and verbal commands. (Aragon & King, 2010). These intrinsic and extrinsic cues occur throughout a dance class, promoting the use of dance within an intervention programme for people living with Parkinson’s.
It is also important for occupational therapists to explore social, recreational and leisure activities that promote physical and mental well-being. (Aragon & King, 2010).  Dance can be utilised to help a person express difficulties of the disease and gain support from others in similar situations to them, in a relaxed environment while keeping physically active. (EPDA ,2013).

References:

Aragon, A., & King, J. (2010). Occupational therapy for people with Parkinson’s: Best practice guidelines. London: College of Occupational therapists.

Christiansen, C., & Townsend, E. (2010). Introduction to occupation: The art and science of living. (2ed). New Jersey, United States of America: Pearson Education Inc.

Gendle, E. (2012). We’re fools whether we dance or not, so we may as well dance. International Journal of Therapy and Rehabilitation, 19 (3), 127.

Hogan, P. (2010). More evidence on the value of dance. Running & Fitnews, 28(1), 9-10.

Videos that promote the use of dance as an intervention tool for people living with Parkinson's

Click here to view a video that briefly explains what Parkinson's is, and then explains how dance can benefit the clients who live with Parkinson's disease. The video shows the clients sitting at first looking stiff and rigid and then towards the end on the video shows them carrying out more complex moves, standing up and mobilising freely.

Click here to view a video that shows perspectives of people living with Parkinson's who participate in dance as an intervention tool.

Click here to view a video that shows clients sitting very stiff and shaking and towards the end of the dance class they are tiptoeing, hopping, balancing without falling and you can clearly see the benefits and joy they receive from participating in the dance class.

Click here to view a video that explains how people with Parkinson's feel during a dance class and the benefits they feel they gain through participating and performing.

References:

Majesticediting. (2010). If I can’t dance – Dancing with Parkinson’s. [Video file]. Retrieved from http://www.youtube.com/watch?v=ErYUDvqwUD4

 Argue, J. (2011). Parkinson's Dance: People with Parkinson's Can't Do That...Can They? [Video file]. Retrieved from http://www.youtube.com/watch?v=pL_LZgAEsnM

 Apworldny. (2010). Why ‘Dance for PD’. [Video file]. Retrieved from http://www.youtube.com/watch?v=brHD72djUjg

 BrainlinkVideos. (2010). Dancing helps manage Parkinson’s disease. [Video file]. Retrieved from http://www.youtube.com/watch?v=q9FgS65JkYs

Conclusion/ Personal reflection

In the beginning before I had started this blog I wanted to choose a topic that was meaningful to me and something I was passionate about. Dance to me is my way of expressing myself, it makes me happy, and it gives me a sense of belonging, belonging to a community of dancers. It not only provides me an environment for social interaction but also keeps me fit and healthy, engages my mind and gives me a feeling of satisfaction and purpose. But how could I integrate something I love into something that was therapeutically beneficial for someone else? I knew from literature that dance had been used to help elderly reduce falls, dance could help with balance. I also knew that for those living with Parkinson’s’ disease it is important to exercise and keep active.

Parkinson’s clients have difficulty with gait, mobility, balance, isolation, reduced participation, cognitive difficulties and other symptoms depending on the individual. People living with Parkinson’s disease have many obstacles to face and barriers that can inhibit them from participating in activities of daily living and meaningful occupations.  Occupational therapy can help people living with Parkinson’s disease to engage in occupations that are important to them and therapeutically beneficial. Finding interventions that can enable them to carry out the occupations that are important to them, is vital. This is where I began to source literature supporting many positive effects when utilizing dance as an intervention tool for those living with Parkinson’s disease.
‘Dance to express not to impress’ is the title I chose to represent my topic and blog. It is so important to me that people see how dance can be used as something positive, a way to express yourself, a way to connect with others, a way to improve functional mobility and lose yourself within the music. It is not about the way you look doing the movements, it’s not to impress. Dance can allow your mind and body to focus so much on the music and movement that you leave your disability, disease and worries at the door. The confidence someone living with Parkinson’s can gain from improving gait, improving muscle strength, participate in something beneficial to them, can increase self-efficacy, engage them in something meaningful and incorporate active body, active mind.

I have learnt so much from doing this blog and linking the use of dance for Parkinson’s disease with an Occupational therapy perspective. I didn’t realise that dance could have so many benefits for those living with Parkinson’s. I hope that this blog has encouraged people to think about how dance can be utilised as a meaningful intervention tool to positively influence those living with Parkinson’s.
Thank you for reading my blog I really appreciate any comments, questions or feedback you have to offer.