Singing, music and dance in Parkinson’s disease
Three research articles of interest to nurses of older people
Parkinson’s disease (PD) is a long-term neurological condition that can have a profound effect on physical, psychological and social function.
It becomes more prevalent with age, affecting 1.6% of the population over the age of 65. Motor symptoms can include slowness, tremor, stiffness and impaired balance; non-motor symptoms can include changed mood, cognition, and a wide range of physical, emotional and social functions. While medical treatments offer effective management of many symptoms, there is emerging research into the value of non-pharmacological approaches, such as music, singing and dance.
Three reviews of the evidence are summarised. Overall, the evidence demonstrates the potential for relief of physical, social and emotional symptoms of PD through engagement with singing, dance and music-related activities. The strongest evidence supports engagement with Argentine tango, but further research into this and singing, and engagement with other forms of music, is needed.
The Sidney De Haan Research Centre for Arts and Health published an overview of evidence that group singing can benefit people with PD.
The paper challenges the relevance of the medical model of illness to people’s day-to-day experience of PD. It cites evidence that people who engage in creative activities can cope with their health conditions and deal with stress more effectively.
The paper reviews evidence that singing can lead to improvements in lung capacity, posture, and emotional and social well-being. Group singing offers opportunities for emotional expression and a sense of achievement, which can also benefit the carers of frail, older people with PD.
While the strength of evidence is limited by lack of high-quality randomised trials, this paper takes a pragmatic approach, citing examples of community singing groups and offering application to practice. It includes guidance on setting up and running singing groups for people with PD and their carers.
Vella-Burrows T, Hancox G (2012) Singing and people with Parkinson’s (Last accessed: 7 October 2016.)
This review paper summarises the evidence to support the use of music in rehabilitation interventions for people with PD.
Many studies have found that rhythmic cue-based training enhances connections between the motor and auditory systems, which can improve gait speed, step length, synchronisation and timing.
The benefits of these techniques when applied to music therapy studies are less certain, but they may increase the chances of synchronising movement while helping to build therapeutic relationships between therapists and patients.
Music therapy studies concern mainly techniques such as free improvisation, which involves melody, rhythmic instruments and singing.
The review found fewer studies into the effects of music on non-motor symptoms, such as anxiety and depression. While it recommends that further research with stronger methodology is needed, it concludes that music can act effectively on motor and non-motor symptoms of PD.
Raglio A (2015) Frontiers in Neurology. 6, 185.
This article reports on a meta-analysis of 13 studies of the effects of Argentine tango (AT) as a music-based movement therapy for people with PD. Nine studies involved randomised controlled trials.
In the studies reviewed, participants attended community tango classes of at least 1 hour’s duration for at least 10 weeks. AT involves rhythmic variation, and requires participants to learn spatial postures and simple paths, but they do not have to learn complex step sequences.
The studies found that AT had a significant effect on balance, with a lesser non-significant effect on gait. There was no significant effect on freezing of gait, a common motor problem in people with PD.
There is a social dimension to AT, which is a partnered dance, and many people in the studies increased their participation in leisure activities as a result of their engagement with AT. The social and psychological effects of participation in AT could not be analysed further due to the small scale of the studies and the breadth of their inclusion criteria.
The meta-analysis concludes that AT can be a supportive approach for individuals with PD and has the potential to improve balance.
Lötzke D, Ostermann T, Büssing A (2015) BMC Neurology. 15:226. doi: 10.1186/s12883-015-0484-0
Compiled by Nicky Hayes, nurse consultant for older people, King’s College Hospital NHS Foundation Trust, and Dawne Garrett, RCN professional lead for older people