Dancing with Parkinson's – the effects on whole body co-ordination during turning

Background: Turning is considered the single most injurious fall-related activity in people with Parkinson's disease, with difficulty in turning being a sensitive predictor of freezing, falling and quality of life, highlighting the physical and psychosocial importance of improving turning performance for people with Parkinson's. A growing body of literature, including the 2014 European Guidelines for physiotherapy in Parkinson's, recommends the use of dance (which includes turning) as a form of treatment and management however, its effect on turning ability in people with Parkinson's has not been investigated. Purpose: The purpose of this research study was to investigate the effects of a ballroom and Latin American dancing on turning in people with Parkinson's. Methods: Twenty-four people with Parkinson's were randomly allocated to receive either twenty, one-hour dancing classes over 10 weeks (n = 12), or usual care (n = 12). Using 3-D movement analysis, data were collected before and after the intervention period on twelve, 180° on-the-spot turns in either a preferred/unpreferred and predicted/unpredicted direction. Measures of (1) latency and (2) horizontal movement of the eyes, head, thorax, shoulders, pelvis and feet were taken from a light cue to the point of first foot movement, alongside (3) the centre of mass displacement, and (4) the total time. The standing start 180 degrees turn test (SS180) was also completed. Statistical analysis (4-way ANOVA) investigated pre-assessment versus post-assessment, and the influence of dancing or usual care, as well as the interaction of the preferred and predicted turn direction. Results: Groups were comparable for all baseline demographics. A significant 4-way interaction (preference*prediction*time*group*) was found for head latency (p = 0.008), with mean values showing a longer latency in the usual care group during predicted/preferred turn directions. Similar trends were also shown in pelvis latency (p = 0.077), first (p = 0.063) and second (p = 0.081) foot movement, with mean values suggesting longer pelvis latency in predicted/un-preferred turning and slower foot movement in un-predicted/un-preferred turning in the usual care group. Significant between-group differences were also found for pelvis rotation (p = 0.036), with the usual care group showing greater rotation, with similar results in other body segments. No differences were found in the centre of mass displacement, turn time, or the SS180. Conclusion(s): Movement of the head, pelvis, and feet during turning in people with Parkinson's are affected by dancing, with body segments appearing more co-ordinated in time and sequence, however the nature and extent of the effect depends on the type of turn completed, showing an influence of preference and prediction. Implications: Results suggest ballroom and Latin American dancing may influence turning ability for people with Parkinson's, which surprisingly indicates a more ‘en bloc’ turning pattern. In rehabilitation, physiotherapists should consider the implications of encouraging the ‘en bloc’ turning pattern in people with Parkinson's, to improve turning performance, although further research is warranted.