

May 25, 2016

Music and Dance v. Parkinson's

I recently attended "Update on Parkinson's Disease" by an eminent neurology professor. From his purely medical point of view "nothing new" has happened since discovery of the response to L-Dopa in the 1960's and probably nothing will for years to come. You start L-Dopa when the patient needs medicine for tremor and reduced mobility, the medicine helps for awhile but then becomes less and less effective as the disease relentlessly progresses. We can't do anything to slow the progression.

There can be no better illustration of the 1) inadequacy of a purely medical approach and, 2) truth that any person's (and their family's) experience with Parkinson's depends mainly on what they can learn about the condition in order to help themselves.

Almost 80% of people with Parkinson's initially consult their doctor for one of four kinds of symptoms, the 'motor' symptoms of Parkinson's: 

  1. Tremor
  2. Clumsy, weak limb
  3. Stiff, aching limb
  4. Gait disturbance
Correct diagnosis may be delayed among patients in the last three categories, especially by primary care physicians who care for half of all patients in the US with the condition.

The professor barely touched on the 'non-motor' manifestations of Parkinson's, probably because they don't respond well to his purely medical treatment. But they increase the distress--and risk of falls--of Parkinson patients: 

  • anosmia (loss of sense of smell)
  • micrographia (smaller and smaller writing)
  • sweating, salivation, dysphagia (poor swallowing)
  • bladder disturbance and constipation
  • sleep disturbance including sleep apnea
  • heart rhythm and blood pressure increase and/or decrease
  • postural and balance disturbance (lightheadedness and problems remaining upright)
  • depression (often limiting necessary mobility)
  • dementia (a late complication)
  • falls (cause often misinterpreted, "I tripped," but a serious complication)

Responsibilities of people with Parkinson's are many, ranging from discovering precisely how and when the medicine acts in his/her case in order to determine the dose levels and intervals, to finding how to mitigate all the manifestations, medically and in other ways. 

One of the other ways is exercise. A stringent Cochrane review of 16 studies in 2015 concluded: 
treadmill training in patients with PD may improve . . .gait speed and stride length. . . . The results must be interpreted with caution . . . and it is not known how long improvements last. . . .
It seems reasonable to extend those results, 1) to all kinds of exercise -- from Tai Chi to tango -- whatever each individual can do regularly and, 2) to the assumption that benefits will probably continue so long as the exercise continues.

Oliver Sacks and others have emphasized that Parkinson patients tend to synchronize with a rhythmic beat. For example, their small rapid steps, called "marche a petit pas," will lengthen and slow when they march to a real march, like Stars and Sripes Forever, that bandmasters customarily conduct at 120 beats/minute, twice each second. Watch David Leventhal do that in the dance studio: (if you don't see the video below, click here then return to this page)

Note how Leventhal and his class synchronize their arms, legs, and torsos to the beat.

Walking, of course, is great exercise partly because it is available to almost everyone at home without a treadmill and also can be done in company of (and synchrony with) others. Walkers with Parkinson's could play a march on a smartphone and split the music into two pairs of earbuds.

Or they could use a walking stick or staff. Rhythmic placing of the staff ahead along the path creates the beat. When the staff is held loosely, a heavier expanded crown swings forward (like a metronome) and the tip backwards then forward again as the walker takes 3-4 steps past it. The walker can thus coordinate a march to a steady full metronomic cycle.

The neurologist-inventor of the "Neurostaff" claims furthermore that:
"The incorporation of the arms and legs in a whole body motion creates a synergy of proprioceptive sensations providing the brain with additional posture information to deliver better balance and hence psychological confidence."

Thus the tip of a staff on the ground or floor provides not only a beat but also a third source of proprioceptive (position sense) signals to the the sensorimotor regions of cerebral cortex that program walking. Once Parkinson patients accustom themselves to the walking stick, their small steps may become longer (as seen on neurostaff.com). Balance becomes more stable with three points of contact, falls less frequent, and confidence increases. (I find that to be true for myself and I don't have Parkinson's.)

Of course you can also use the neurostaff as a baton to conduct a band playing a Sousa march (probably the original purpose of now-twirled batons in front of bands)! Or to ward off animals or small children.

Exercise is just one method people with Parkinson's can help themselves. Singing in a choir is another and perhaps a discussion in another post. The hypothesis that Parkinson's relates to environmental toxins entering the body through the gastrointestinal or olfactory system and then moving through the nervous system like infectious agents was also not mentioned in the Update.  Another fascinating question.