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Animated Edition - Autumn 2011
Researching dance for Parkinson's
Danielle Jones and Dr Sara Houston describe the groundbreaking research into the benefits of dance for people with Parkinson's disease

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Image: Dance for Parkinson's participants with Jennie Harrington, English National Ballet artist. Photo: Belinda Lawley
Dance for Parkinson's participants with Jennie Harrington, English National Ballet artist. Photo: Be
Danielle Jones, Learning and Participation Officer, English National Ballet
In 2008, Dance Umbrella presented Mark Morris Dance Group's Dance for PD® model of leading dance for people with Parkinson's disease, in a seminar hosted by English National Ballet. Motivated by this innovative work, English National Ballet has developed its own Dance for Parkinson's model to reflect the artistic focus of the company. Weekly sessions are inspired by company repertoire and are routed in the fundamental principles of ballet technique: grace, alignment, expression and fluidity. Exercises are designed with Parkinson's symptoms in mind, however the strength of these sessions is an artistic focus: creativity and expression are highlighted as some of the most valuable assets of the dance experience. Visits to see the company perform and the opportunity to dance alongside company dancers enhance the cultural and social connections for the group to one another and to English National Ballet.

In order to evidence benefits of dancing for people with Parkinson's, English National Ballet commissioned University of Roehampton to conduct research into a 12 week Dance for Parkinson's programme focussing on the ballet Romeo & Juliet. These sessions were based on characters and scenarios from the ballet and were inspired by the Prokofiev score. With a remit to engage with partners regionally, English National Ballet now plans to extend opportunities to people with Parkinson's in our touring regions whilst maintaining the success of the London programme.

Dr Sara Houston, Senior Lecturer, Department of Dance, University of Roehampton
Parkinson's is a neurodegenerative disease, which can curtail the implementation of everyday tasks and actions. Symptoms can vary greatly from one person to another. Some of the more common symptoms include: Tremor, stiffness in muscles, slowness of movement, hurried shuffling walk, lack of coordination, freezing (where people suddenly cannot move despite wanting to), increased curvature of the spine, quieter voice, lack of facial expression and depression.

Many people with Parkinson's loose balance easily and are at risk of falling regularly. Multi-tasking is often difficult and pain is common. There are a range of medicines prescribed to ease symptoms, but there is no cure. After a while, some medicines cause dyskinesia, where the body moves involuntarily.

Danielle Jones led the project with Joanne Duff and Anna Gillespie, who played improvised structures on piano and flute for the sessions. The sessions always began seated, and progressed to either standing in a circle, or at the barre. This was followed by travelling across the floor and short simple improvisation tasks. The sessions always ended in a circle and were followed by tea and biscuits.

Past research in the area of dance for people with Parkinson's has concentrated on measuring balance, gait and quality of life. The studies have been conducted by scientists and have involved tests or questionnaires before and after the project to produce statistics and analysis. My way of researching is different. I am a qualitative scholar who seeks to understand how and why people make dance meaningful by examining dancing in specific contexts. I have to embed myself within the actual project dealing with words and people, rather than numbers and bodies. In this instance though, because of the evidence that dancing to music actually makes visible changes to how people with Parkinson's move, I decided to join forces with my colleague and dance scientist, Ashley McGill, to measure, as well as interpret, data.

We filmed each session with two film cameras, conducted interviews, asked participants to keep diaries, measured balance and stability with a special balance test, and carried out a postural analysis.

Because we had so many ways of collecting data, we were able to see how dance affected participants in different ways. We summarised that dance, as seen within the English National Ballet project:
  • Aids people with Parkinson's physically, mentally and socially
  • Does not help with physical development in a uniform or linear fashion, but can help with mobility in the short-term, particularly when there is musical accompaniment
  • Gives participants the tools to increase body awareness and to increase confidence in order to use the mobility they have, but may not have had the courage to use
  • Provides tools to help with activities in everyday life
  • Gives participants the opportunity to experience different qualities and ways of moving
  • Can loosen up the spinal area and help with stability and posture
  • Can encourage a greater reach, focus and projection
  • Provides a vehicle for social interaction
  • Precipitates feelings of wellbeing, determination and achievement
  • Provides opportunities to create movement and stimulate the imagination
  • Provides an event for people with Parkinson's that is about art, rather than about disease
  • Provides opportunities to learn about ballet
  • Provides an enjoyable way for participants to exercise as a group in a structured environment
  • Allows participants to enjoy the excitement of being a part of the goings-on of a professional ballet company.
We would like to tell you a little bit about some of the results, notably the ones that are important to values-driven community dance artists.

The dance sessions gave participants the opportunity to move in ways in which they did not normally move. Parkinson's often forces people to move with a particular quality of movement. For example, moving with a light-weight quality, with feet looking as if they are skating the surface of the floor, rather than digging their heel into the ground. Some people entered the project very stiff, with bound and sustained qualities of movement; others, particularly those with dyskinesia or a hesitant way of moving, came with a light, sustained, indirect qualities of movement. Exercises emphasising particular qualities of movement, such as strong, sudden and direct, or light and indirect, or exercises that asked participants to embody the anguish of Juliet, the anger of Tybalt, or the calm of Friar Laurence, enabled participants to experience new ways of moving that freed them up from their habitual qualities.

In interviews and diaries, participants noted the wellbeing they experienced directly from the dance project. Words such as 'elated, happy, feeling good about myself, relieving stress, joyous, uplifting' were used. Smiles and laughter were observed throughout the project. We think that individual and collective achievement and determination to achieve commented upon by participants added to the feeling of wellbeing.

Freedom was also a word that was a common description of participant experience. Firstly, freedom of expression, of creativity, which was mainly given through improvisation exercises and interpretation of movement. Communication is very important for people with Parkinson's, who often find communication with others a challenge due to facial muscles stiffening and voices fading.

Secondly, freedom to fail: The class was a secure place where inclusion was valued through the way the class was facilitated, despite any disability people were feeling at the time. People felt encouraged to take a risk, to give themselves whole heartedly to the movement. It was a positive rather than critical atmosphere.

Lastly, freedom from being identified by their disease: Despite the project being for people with Parkinson's, it was a dance class that was about art and artistic expression, not about disease. This was particularly important for people who did not want to be defined by their neurological condition and who did not frequent the Parkinson's support groups.

A defining aspect of this research was the sociability factor. Several commented on the fact that the dance class was a better place to get to know people than the Parkinson's support groups and certainly there was lots of talking, chatter, and laughter seen throughout the project between the participants. Conversations included swapping and discussing information about how they were dealing with their Parkinson's. The discussions also included things that had nothing to do with Parkinson's, such as families, weekend activities, and dance shows on TV.

This sociability was not only seen in conversations, but also participants got to know each other through dancing. The classes involved partnering, holding hands, mirroring and copying each other's movements, working in a circular formation and touch. It was here that participants were also able to learn more about each other and enjoy the warmth and acknowledgement of others.

An increase in confidence was one of the defining aspects of the project. Building confidence is important when people face many daily challenges, from drying one's hair to carrying a cup of tea, from getting on public transport to eating, from being heard to coping with falling. It was clear in interviews and diaries that participants were gaining in confidence during the dance class and sometimes outside of the class, physically and socially. The greater increase in larger movement and a more outward projection, extending the arms and activating the eye focus seen in the film analysis suggests a lift in confidence by the end of the project. In the balance test at the end of the project, we saw a definite increase in carrying out challenging movement tasks with more daring.

The project did not take place in isolation. It is part of a network of dance groups across the country and abroad for people with Parkinson's. I see the research as being a part of this, as looking at the wider context is important. In visiting the groups in England and Scotland, as well as paying a visit to the Brooklyn Parkinson Group classes run by the Mark Morris Dance Group in New York, I was aware of similar characteristics despite different emphases on style, facilitation and creative input. Firstly, all these classes emphasised inclusion, encouraging people to dance with the ability they have, rather than to struggle with any disability they may feel. Secondly, I saw people move to music with fluency and articulation not necessarily seen as they walked into the studios initially.

In all groups, the sense of social support and enjoyment was palpable. The Brooklyn Parkinson Group was a good illustration of this. Formed around arts and exercise projects, members phone when someone doesn't turn up, send flowers when someone is in hospital, meet for lunch and attend the theatre and art galleries together. This group has been going for 10 years, but even in the English National Ballet project, I saw evidence of a community starting to be built around the dance. In the words of Michael Bennett, English National Ballet participant: "Dancing like this is helping me to get Mr Parkinson out of the driving seat of my life." When faced with an unpredictable disease, dance that encourages confidence, greater awareness of one's own movement potential, social interaction, and communal bonding is vitally important for those who live with Parkinson's.

contact sara.houston@roehampton.ac.uk or 020 8392 3243

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Animated: Autumn 2011