Parkinson’s disease and dance therapy—An Indian scenario: An initial experience

Dear Editor, Parkinson's disease (PD) is a neurological condition that is rapidly increasing worldwideand is associated with motor and non-motor symptoms. Together, these symptoms can considerably impact the activities of daily living and independence of patients.[1] A Hoehn and Yahr (H & Y) scale, designed to be the descriptive staging scale, evaluates both disability and impairment-related progression. It originally included stages 1 to 5 but was recently modified and stages 1.5 and 2.5 were added.[2] PD patients are usually managed with conventional medical and surgical therapies. However, dance can now be used as a complementary therapy due to its emergence as a practical tool. Our study aimed at working with PD patients to understand the benefits of movement therapy using Garba dance. This concept was built on the existing insights from research on movement therapy for PD. Restoring the dopaminergic nigrostriatal pathway is the primary strategy for controlling movement. Furthermore, the most efficient pharmacological treatment, Levodopa can have treatment-limiting side effects from long-term use. Therefore, non-pharmacological management is essential to address some specific symptoms and broader quality of life (QoL) issues.[3] The international data have verified the potential of dance to improve the function and QoL in progressive disorders such as PD. However, the available data is more in context with the European, American, and Latin American forms of dance such as Tango, Irish dance, ballroom dance, and native folk dances that are not relevant to the Indian context. Therefore, there is a need to develop intervention-based dance therapy with Indian forms of dance. Judging by its country-wide popularity of the music and the dance form, Garba, a folk-dance form originating from Gujarat, proved to be a good fit. It is a lively dance style, in which dancers follow a circular formation moving counterclockwise with sweeping actions.[4] An initial study (quasirandomized) was conducted in September 2019, involving four patients (two cases and two controls) with idiopathic PD (H & Y stage 2.5) who were on medications and were followed-up for 5 years. A trial session was conducted with a dance professional in the preliminary week to test the patient's acceptance rate, from which two patients were enrolled in the dance therapy after positive feedback. These sessions lasted for 1 hour every day for 5 days a week for a total of 12 weeks. Various scales such as the Unified Parkinson Disease Rating Scale Motor scale part III, nonmotor symptom scale, Mini BESTest Balance scale, freezing of gait questionnaire, Fatigue Severity Scale, Activities of daily living scale by Katz, SCOPA-COG for cognition, PD sleep questionnaire, and Geriatric Depression Scale were used for the objective assessment at a 6-week random interval [Table 1]. All these scales showed improvement in their scores from the baseline to 12 weeks in the dance group vs controls [Figure 1].Table 1: General characteristicsFigure 1:: The scales showed remarkable improvement in their scores from the baseline to 12 weeks in group 1 (dance group) compared to the controls (group 2)Therefore, since dance is an energetic, engaging, and pleasurable pursuit, the participants reported improvement in all parameters, including motor and non-motor symptoms, gait, balance, and cognitive functions, which enhanced their QoL. The results comprising the study were substantial when compared to the results of the controls. The success of this case study encourages the extrapolation of a more extensive sampling to confirm the above results and compare them with other physical therapies. Despite the successful findings, the limitation of our study is that it is a pilot study with small sample size; therefore, the possibility of a placebo effect/bias cannot be ruled out. In addition, caution against unsupervised therapy in patients with postural instability is advised. This study calls for further investigation to derive the promising benefits of Garba dance as therapy. Acknowledgments I'd like to acknowledge Dr. Monika Vempadapu (Pharm D), Research Associate, Division of Research and Patents at Ramaiah Medical College, for her support in preparing the manuscript. Authors Contributions Dr. Anish – Has made contribution to the concept, design, manuscript writing, acquisition and interpretation of data. Ethical compliance statement All the procedures performed in studies involving human participants were under the ethical standards of the institutional Ethics Committee. Informed consent was obtained from all the patients included in the study. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.