A new study explores the evolving therapeutic landscape for Parkinson's disease (PD), emphasizing the growing interest in complementary therapies, particularly dance. While it's specific to one culture, I think we could use it in any culture, as long as physical therapy is done in a pleasant social setting. Here the authors report that the enjoyment factor associated with Garba dance likely contributed to better adherence to the treatment. Patients reported having fun, which is crucial for long-term engagement with any form of physical therapy.
Overview of Parkinson's Disease Treatment The primary treatment for Parkinson's disease is dopamine replacement therapy, which targets motor symptoms. However, as the disease progresses, the effectiveness of these medications diminishes, and patients often experience more pronounced nonmotor symptoms, including cognitive decline, mood disorders, and sleep disturbances. These nonmotor symptoms are particularly resistant to pharmacological treatments and negatively impact quality of life. In addition, dopamine replacement therapies create new mental (hallucinations) and physical challenges (cardiac fibrosis).
To address these challenges, a multidisciplinary approach involving surgery, physical therapy, occupational therapy, and cognitive interventions is often necessary. Yet, adherence to such therapies can be challenging, particularly among older adults.
Complementary Therapies for Parkinson's Disease Various complementary activities like dance, music, theatre, art, and Tai Chi have been studied as potential therapeutic options in recent years. Though evidence supporting these therapies is still in its early stages, initial findings suggest that they may positively affect nonmotor symptoms, psychological well-being, and overall quality of life. For example, music therapy has been reported to benefit motor and nonmotor symptoms, cognition, and emotional health. Similarly, active theatre therapy may help patients develop social and emotional skills in a supportive environment, potentially reducing depression and social stigma. Tai Chi has shown promise in improving balance and reducing the frequency of falls in patients.
Dance Therapy in Parkinson's Disease Among complementary therapies, dance has garnered significant attention for its potential to manage both motor and nonmotor symptoms of Parkinson's disease. Studies suggest that dance may enhance cognitive function, improve motor skills, and even increase dopamine release in the brain. Furthermore, the enjoyment and social aspects of dance make it an appealing form of physical activity, potentially enhancing treatment adherence. Various dance forms, including Irish set dancing, Argentine tango, and ballroom dances like the Waltz and Foxtrot, have been shown to improve balance, gait, and locomotion in Parkinson's patients, particularly in Western contexts. In India, traditional dances like Bharatnatyam and Kathak have been explored for their therapeutic potential, although their complexity makes them less accessible to all patients.
Pilot Study: Garba Dance as a Therapy for Parkinson's Disease The pilot study evaluated Garba, a popular Indian dance form, as a therapeutic intervention for Parkinson's disease. Garba involves relatively simple movements, making it more accessible than other Indian dance forms. The study assessed the effects of Garba dance on motor and nonmotor symptoms, cognitive functions, and mood. The results were promising, particularly in terms of improvements in motor symptoms, as measured by the Unified Parkinson's Disease Rating Scale (UPDRS). To say it in a few words, symptoms went from severe to moderate in 12 weeks. There were three groups, one practicing Garba dance, the other physical therapy, and the last one was the control. All groups took their medications. Obviously, it was not possible to make a fully blinded test where patients ignore which drug they are administrated. Still, UPDRS raters were blinded to treatment allocations at all time points in the study.
The UPDRS encompasses different aspects of the disease, it ranges from 0 to 260 but a value below 30 usually means a mild disease. All patients had a score of 35 at the beginning of the study, indeed severely disabled patients would not be able to participate in this study.
Motor Symptom Improvement: Patients in the Garba dance group experienced significant improvements in UPDRS scores after 12 weeks (going from ~35 to ~20), surpassing those in the physical therapy and control groups. The physical therapy group went from ~36 to ~30, while the situation worsened for the control group (~35 to ~37).
Mood and Sleep Benefits: Although the study found no significant improvement in nonmotor symptoms like activities of daily living (ADL) or cognition, it did observe improvements in mood and sleep. This is consistent with other studies that have linked dance therapy to enhanced emotional well-being and reduced depressive symptoms in Parkinson’s patients.
Limitations of the Study While the study results are encouraging, the authors acknowledge several limitations. The small sample size and short duration of the study prevent definitive conclusions. Additionally, there was no follow-up after the study to assess the persistence of the observed effects. The study also did not capture differences in motor symptoms during the "on" and "off" medication states, which could have provided more nuanced insights. Another concern was the incidence of near falls, though no actual falls were reported, likely due to the close monitoring of participants.
Implications for Future Research and Practice Despite its limitations, this pilot study suggests that Garba dance may be a viable complementary therapy for Parkinson's disease, particularly for patients with a cultural affinity for dance. The noticeable improvements in motor symptoms, mood, and sleep warrant further investigation in larger, more rigorous trials. The study supports the idea that enjoyable, culturally relevant therapies can enhance treatment adherence and improve the quality of life for Parkinson’s patients.
In conclusion, while Garba dance should not replace traditional physical therapies in India, it presents an additional option within a multidisciplinary treatment plan for managing mild-to-moderate Parkinson's disease.