Tango as therapy?

Area scientist studies dance therapy in Parkinsons’ patients, believes it can benefit all.
“Repeated studies have shown that adapted tango improves balance, mobility, endurance … spatial cognition and quality of life,” says Madeleine Hackney. Here, Larry Bullard twirls Ariel Hart during a dance therapy group session. (Photo by Phil Skinner)

“Repeated studies have shown that adapted tango improves balance, mobility, endurance … spatial cognition and quality of life,” says Madeleine Hackney. Here, Larry Bullard twirls Ariel Hart during a dance therapy group session. (Photo by Phil Skinner)

Famed American dancer and choreographer, Agnes DeMille once said, “To dance is to be out of yourself. Larger, more beautiful, more powerful. This is power, it is glory on earth and it is yours for the taking.”

Indeed there is power and beauty in dance; there is also therapeutic benefit. Dance is a great cardiovascular workout, it enhances flexibility and is particularly effective at releasing those pain-relieving, feel-good hormones, endorphins.

Currently, there is a dance therapy program at Emory that has proven to be very effective for patients with movement disorders like Parkinson’s Disease.

In studying the effects of dance on patients, it has also become apparent that dance is an effective tool for helping caregivers as well.

In order to better understand the program and its benefits, we reached out to Madeleine E. Hackney, Ph.D., Research Health Scientist, at the Rehabilitation R&D Center for Visual and Neurocognitive Rehabilitation at the Atlanta VA Medical Center

Dr. Hackney is also an Assistant Professor in the Department of Medicine, Division of General Medicine and Geriatrics at the Emory University School of Medicine

Pulse:

Please tell us about your background and what lead you to start this program at Emory?

Dr. Hackney:

After getting my bachelor’s in fine arts from the New York University Tisch School of the arts in Dance Performance, I performed professionally for many years. I performed in musicals, at theme parks, and did company work. My degree focused mainly on modern dance, but I had jobs that required a range of styles including jazz, theater, ballet and many ethnic dances, like flamenco and Hawaiian. After touring nationally and internationally for seven years I returned to New York City to stay put for a while.

I started teaching yoga, Pilates and dance and also successfully auditioned for a teacher training program with Stepping Out Studios in NYC. There I trained in a variety of partner dance styles, including ballroom dances, country dances, salsa, swing and of course, Argentine tango.

I learned to teach all these dances to at least an intermediate level and competed while in NYC. At the same time of all this teaching, I was also taking undergraduate courses again in the sciences. I had decided I wanted to study how thinking about or focusing on your movement can improve aspects of moving around. My dance experience and my own experiences with injuries had led me to think that the therapeutic approaches that dancers take to healing could help other people.

These approaches include the mindful observation of movement patterns as you try to do complex movement sequences in a dance, Pilates, Alexander technique and related techniques that helped me to overcome injury and just dance better. I had some ideas about how I could help others move better, and knew that I wanted to study movement in a more focused way. Graduate school was on my horizon, so with the premedical curriculum in sciences completed at Hunter College in New York, I applied for graduate school in Movement Science at the Washington University in St. Louis and was accepted in 2005.

I studied with Dr. Gammon Earhart while at Washington University. Their movement science program is top notch and I felt uniquely suited to the study of movement science in a way that I had never felt before. The decision to study movement (kinesiology) was one of the best decisions I have ever made.

Anyway, while there, for my first project, Dr. Earhart and I did a little research and noted an abstract that said tango had benefited frail older adults and another that said tango movements lit up parts of the brain related to movement. Because of this, and because of my background dancing and teaching partnered dances, Dr. Earhart suggested I teach tango to people with Parkinson’s disease (PD).

Naively, I said “Sure!” but I did know that I would have to work on tailoring or adapting traditional methods and steps of Argentine tango for people with PD because of their multiple movement impairments, not the least of which is the tendency of many of them to fall.

I worked on this for 6 months, and then we ran our first pilot study of 9 people with PD in tango versus 10 in an exercise group. Our findings showed that the tango program was better at improving balance. This study was exciting to publish and was even featured in the New York Times. It got things going and I have followed up this work (and so has Dr. Earhart) with several other studies.

In fact, most of the classes have been taught in study scenarios. It would be great to get the program funded with regular support because the evidence is pretty strong that adapted tango is effective.

Pulse:

How is this program is beneficial to your patients?

Dr. Hackney:

Our repeated studies have shown that adapted tango improves balance, mobility, endurance, preferred and quick gait, spatial cognition and quality of life. Programs have been offered twice per week for 12 weeks, so we have examined programs of 20 hours over 12 weeks and 30 hours over 12 weeks.

We have also looked at programs that were more of the boot camp variety — examining a program of 5 classes per week for 2 weeks and a program of 5 classes per week for 3 weeks. Classes were 1.5 hours long.

We are not sure exactly why the programs have benefited these outcomes. We hypothesize that the combination of music with rhythm and having a partner could contribute to positive effects. Lots of studies are showing that music can benefit people with PD and people with movement disorders in general.

Another theory is that external cues might help people with PD because the cues access areas of the brain that are less compromised by the condition. Yet another idea is that focused engagement on movement details can facilitate movement in PD, which makes sense to me, given that my original idea about dance helping people move in their regular lives stems from how they think about their movement.

It should be noted that I have translated my program for older adults in the general community, some with cognitive impairment and some with pretty severe visual impairment. I have also introduced a dance program for people with severe and persistent mental illness. I think there is no question that dance heals.

Pulse:

How dance might benefit anyone reading this? I’m aware there are physical benefits, but I suspect that there are emotional benefits as well. Can you discuss these and perhaps give some specific examples of the benefit?

Dr. Hackney:

Dance can definitely benefit anyone willing to give it a try. First of all it is fun and can distract you from troubles you may have. It demands concentration and can give you a sense of achievement, when you get that difficult combination right. More free form dance is beneficial too because you can expand your motor repertoire and do things you just don’t do in your every day life. By working on something new, and even better — something you’re not that good at — it might tap into the theories of brain plasticity which suggests that the brain changes with experience. The more positive challenges that you set up, the brain can change in positive ways.

Dance is an art form that often requires creativity and that is a perfect set-up for brain plasticity. That is all theoretical and needs to be tested but that’s the general idea.

Dance can be a hopeful therapy. Dance usually involves the full body, and the mind; you can expend around 3 metabolic equivalents just doing 1 hour of ballroom dancing. We know that it can be a reasonable form of aerobic exercise (vigorous for some of the styles like salsa), that it can incorporate flexibility and will increase your skill set and agility.

Dance has been around since the dawn of humankind. It has had multiple purposes — certainly addressing emotional needs has been one of them. Dance/movement therapy is a systematic approach to mental illness and emotional distress, but this is just one formalized example. In Argentina, there is a conference devoted to tango used as therapy. There are so many examples throughout the world of different dances used to make sense of our world.

These days, I take a Zumba class at my gym. I love looking around at all the faces there — different ages, ethnicities, and everyone just ready to have a good time. It’s wonderful to move to fun music. Most of us really need this.

Pulse:

Any final thoughts?

Dr. Hackney:

I want to tell you about my upcoming study, along with collaborators, Drs. Whitney Wharton and Lauren McCullough. It will be for African American female caregivers who are the adult children of a person with Alzheimer’s disease. We want to see if participating in our tango program can relieve some of their stress and improve their health. Based on those who have come before and done great in my classes, I am certain we will all have a good time, including me. I look forward to that!