Introduction

Parkinson's disease is a neurological disorder that is progressive in nature, affecting movement and impacting various aspects of a person's daily life and routine. The disease is named after Dr. James Parkinson, who first described and recognized the condition in 1817, and is characterised by the gradual loss of special chemicals called dopamine. 

Dance therapy, which is also known as dance movement therapy (DMT), is a form of expressive and holistic therapy that utilises dance and movement to promote emotional, physical, and mental well-being. Dance therapy has shown promise as a complementary intervention for individuals living with Parkinson's disease by enhancing mobility and coordination while also contributing to emotional release, reducing anxiety and improving mood. 

Understanding Parkinson's disease

Parkinson's disease is due to the gradual loss of a special brain cell neurotransmitter that produces chemical messengers called dopamine or the “happy hormone”. This chemical messenger works on part of our brain that gives us feelings; mainly satisfaction, happiness, and motivation. At the same time, it also triggers certain receptors that can cause skeletal muscle tone to be activated and contracted.¹ Having too much of dopamine can result in aggression and difficulty in controlling the impulses, while having low amounts of it can cause depression and Parkinson’s disease.² 

Due to the gradual loss of dopamine-producing brain cells, it results in the change of the muscles and mood. Characteristic symptoms of Parkinson’s disease are exhibited such as tremors, bradykinesia (slowness of movement), muscle rigidity, facial masking, and postural instability. Parkinson’s disease non-movement symptoms include cognitive changes, mood disorders, and sleep disturbances. 

According to John Hopkins Medicine, 10-20% of Parkinson’s disease cases are due to a genetic cause but the cause of the majority of cases remains idiopathic or unknown.³ Other major risk factors include age, gender, environmental factors such as exposure to certain pesticides or chemicals, and repeated head trauma.³ Since this is a progressive disease that affects not only the body but also the mind it causes inhibition of day-to-day activities and changes in the lifestyle. Individuals with Parkinson’s disease are more prone to mental health deterioration, with 60% of patients with Parkinson’s disease exhibiting anxiety while 35% exhibit depression.⁴ 

Although there is no cure for Parkinson's disease, various treatments, including medications, physical therapy, and in some cases, surgery, aim to manage symptoms and improve the quality of life of individuals affected by the condition. 

Introduction to dance therapy

Dance therapy utilises the therapeutic approach to engage individuals in structured dance and movement activities. While guided by professionals such as trained dance therapists and physiotherapists, they may explore and express their emotions, thoughts, and experiences. These sessions occur in safe and supportive environments that allow the mind-body connection to strengthen in order to create a positive impact of movement on emotions, and physical and mental health.

Benefits of dance therapy for parkinson's

In the context of Parkinson's disease, where muscular-related symptoms like tremors and muscle stiffness can significantly impact movement, dance therapy offers an unorthodox approach to improving physical, emotional, and social well-being. Any form of regular movement and/or exercise provides numerous benefits to muscles, overall health and well-being to all individuals. These benefits include:

• Strengthening bone and muscles
• Reduction of risk of diseases
• Weight management⁵

Consistent exercise plays a crucial role in maintaining joint health, strength and flexibility and preventing muscle atrophy, particularly as individuals age or are more prone to being immobilised. Thus with dance therapy, it allows patients to move and maintain muscle strength in an entertaining and safe activity. 

Oftentimes due to the nature of the disease, patients with Parkinon’s disease are more likely to go through memory loss and gradual decline of regular activities. This can cause loneliness and depression. Dance therapy for Parkinson's disease often incorporates music, rhythm, and social interaction, fostering a supportive community for participants to connect and share their experiences. Based on a 2019 study, it showed that dance therapy can be an effective treatment for depression due to the release of hormones called endorphins through exercise, providing a sense of belonging in a community, and giving channels of expression.⁶

While the creative and joyful nature of dance therapy can empower individuals with Parkinson's disease, promoting a sense of control and vitality over a condition that is debilitating on the actions of the body and mind. Dance therapy emphasises the use of the body as a medium of expression, allowing individuals to convey emotions and experiences which can be particularly beneficial for those who find it challenging to express themselves verbally. The benefit of dance therapy with Parkinson’s disease is supplemented by evidence as a 2021 study showed that dance therapy improved the overall cognition and quality of life in patients with mild to moderate Parkinson’s.⁷

Structure for dance therapy 

For patients with Parkinson's disease in dance therapy, various dance styles and approaches are used to address specific muscle and emotional challenges associated with the condition. The choice of dance forms is often tailored to the individual needs and preferences of the participants but may include tango, ballroom, ballet, Turkish folklore dances amongst others.⁸ 

The general structure of the dance therapy follows:

Warm-up

A gentle warm-up through stretches, breathing exercises and relaxation techniques to prepare the body for movement.

Introduction and check-in

The therapist sets the tone for the session and explains the activities planned.

Participants may share how they are feeling or any specific requirements for the session.

Theme or focus

Establish a theme or focus for the session, which may be based on therapeutic goals or individual needs.

Guided movement exploration

Participants engage in guided movement activities tailored to the therapeutic goals.

The therapist may use specific prompts, imagery, or music to facilitate the participant's expression.

Free movement and improvisation

Allow time for participants to engage in free movement and improvisation to encourage them to explore their unique movement styles.

Reflective and processing phase

Participants reflect on their experiences and emotions during the movement activities through therapist-led discussions.

Cool down

Gradually transition into a cool-down using stretches and relaxation exercises to bring the session to a close.

Closing and integration

Provide a space for participants to share their thoughts or reflections on the session, while providing methods of integrating the movements into everyday life.⁹

Practical considerations

Due to the nature of the therapy and its involvement with physical movement, safety and practical considerations need to be implemented, especially with Parkinson’s disease patients. 

Qualified dance therapists need to lead the dance therapy sessions, especially with expertise in working with individuals with Parkinson's disease. And as the dance therapist is involved in the activity, healthcare workers such as physicians and physiotherapists need to be routinely updated to make sure the activity is safe and to see the effects. Furthermore, an accessible and safe environment needs to be ensured, free of obstacles with appropriate flooring to prevent injuries in the event of a fall as patients with Parkinson’s disease are at a higher 45-68% risk of one.¹⁰

On the social aspects, with the leadership of the dance therapist, a sense of community during group dance therapy sessions needs to be formed. Encouragement of social interaction and socialising can enhance the overall well-being of participants. Encouragement of family members or caregivers can be given to participate in sessions or support participants outside of therapy, promoting continuity of care.

Future directions and research

Medication and other pharmaceutical treatments do not fully address motor, cognitive, and psychosocial symptoms. Therefore, adjunctive therapies such as dance therapy have been researched and implemented for their efficacy in addressing these issues.

Continued research efforts on a larger scale will likely yield more insights into the specific benefits of dance therapy for Parkinson's disease. Different research in various settings has already yielded positive results. Exploring and implementing a diverse range of dance styles into therapy programs can make dance therapy more inclusive and appealing to a broader audience.

During the COVID-19 pandemic, strict social limitations were imposed, and thus dance therapies were shifted to online sessions in each participant's home. Despite that, almost 95% of the participants acknowledged benefit from the online sessions and 70.8% had a strong desire to continue the sessions.¹¹ Further improvements in technology and facilities can allow regular dance therapy sessions to be conducted from safe and comfortable spaces such as homes, hospitals and care homes. 

FAQs

Is dance therapy suitable for individuals at different stages of Parkinson's, including those with mobility issues?

It has shown to benefit individuals of various stages of Parkinson’s disease, due to its approach of having an individualistic therapy plan. Consultation with healthcare professionals and qualified therapy instructors should be done to curate a realistic and safe plan. 

Does dance therapy need any special equipment or location?

Due to its simple approach, it does not need any special equipment or environment and can be done at home. However emphasis on safety needs to be considered for individuals with Parkinson’s disease, moreover going to a specialised location may provide a social environment.

Are there specific dance styles or techniques used in dance therapy for Parkinson's?

Dance therapy for Parkinson's incorporates a variety of dance styles. The choice of dance styles depends on the goals of the therapy and the preferences of participants. 

Do participants need prior dance experience?

No prior dance experience is necessary, as dance therapy is designed to be accessible to individuals of all skill levels.

Summary

Dance therapy for Parkinson's disease is a different but promising form of therapy that can be used in conjunction with the medical approach. Due to the structure and involvement of both the physical and emotional aspects, dance therapy has shown numerous benefits for patients with Parkinson's disease. Each individual case is different, so consultation with healthcare professionals needs to be done in order to procure a personalised therapy plan to maximise benefits. Further advancements and research can broaden the market and offer more positives for this holistic and creative means of therapy.