Taking New Leaps Into Treatment for Parkinson’s Disease
Maia Beaudry, Talia Roman
Illustrations by Mingjia Ni
It’s a Saturday night and you’re sprawled out on the couch, ready to watch your favorite Olympic athletes compete. The first performers that pop up on the screen twirl and leap across the mat, demonstrating an incredible ability to pull off a complex routine. Watching in awe, you start to wonder how they coordinate each movement so effortlessly. The event soon ends and a relay race begins: runners whiz along a track, passing a baton from person to person as they frantically dart to reach the finish line first. Though you may not realize it, there are countless relay races happening this instant in your brain, contributing to the exact coordination you were admiring in the gymnast moments before. The runners in this race are neurons, the fundamental units of our nervous system, while the signaling molecules passed between them act as the baton. One of the main “batons” responsible for your movement is a chemical called dopamine. In a healthy brain, dopaminergic neurons pass the chemical between each other to help coordinate the flow of information between the brain and muscles. If someone suddenly drops the baton, the whole line of communication within the team stops, and it becomes impossible to complete the relay. Without these dopamine handoffs, we would have trouble performing voluntary movements and our bodies could not correctly regulate mood, pleasure, or motivation. If a team of neurons fails to complete a race, it can have drastic consequences in the brain: this lessened communication between neurons can manifest as the symptoms of Parkinson’s disease (PD) [1]. PD is a neurodegenerative disorder — a type of disease that occurs when neurons in the brain stop working or die — which makes it more difficult for people to execute simple movements, let alone perform the complex routines you saw the Olympic athlete perform [1, 2, 3].
Reductions in dopamine and neural communication, which are both associated with Parkinson’s disease, manifest in the body as a lack of control over voluntary movements [1]. This loss of control typically involves shaky movements (tremors), and slowed movement due to muscle rigidity is also common: one’s joints and muscles may begin to feel stiff and tight, the ground less stable, and movements slow and lethargic, almost like walking through water. Most people with Parkinson’s experience physical instability on a daily basis, and it can uproot their normal lives and routines [1]. PD often causes people to develop secondary symptoms in addition to these motor changes [2]. They may become socially isolated — oftentimes leading to depression, anxiety, and other cognitive issues — or develop chronic pain due to the rigidity of their bodies. As neurons and connections deteriorate, cognitive functioning, in addition to motor operation, becomes increasingly impaired [3]. The damage results in symptoms that can often accompany Parkinson’s disease, like dementia [1].
When Treatments Tango: Pharmaceuticals and Combination Therapy
Many common types of drug therapies help preserve and efficiently use the dopamine “batons” that still remain. Combination therapy makes use of two or more treatments working alongside each other to treat PD more effectively than a single drug [4]. The most commonly prescribed drug for PD, called Levodopa, is oftentimes prescribed alongside another class of drugs, called MAO-B inhibitors [5]. Levodopa supplies the brain with synthetic “batons” that can be converted into dopamine so the neurons can still pass them along and eventually finish their “race” [4]. Unfortunately, medications like Levodopa can have negative side effects, particularly increased muscle spasms that occur as the medication wears off. Because Parkinson’s already causes motor difficulties, involuntary muscle contractions compound the issue [1]. MAO-B inhibitors help this issue by prolonging the effectiveness of dopamine already present either naturally or as a result of Levodopa, and are quickly growing in popularity due to their ability to rapidly improve PD symptoms [5]. These inhibitors have fewer detrimental side effects than Levodopa, so when both medications are used in conjunction, a smaller dose of Levodopa is needed, which decreases overall negative side effects [4].
To alleviate the side effects of pharmaceutical treatments, doctors have recently been exploring the use of holistic medicine: a treatment philosophy that collectively focuses on treating the psychological and physical symptoms of a disease [6]. Treatments can include dance, yoga, or other forms of exercise, as well as therapies such as mindfulness meditation, massage, and acupuncture [7]. Because of its success in treating a wide spectrum of health issues including PD, holistic medicine has become more popular in the past few years [6]. Holistic treatments for PD often focus on modes of self-expression, such as dance therapy, because they target and treat physical and mental symptoms in tandem [7].
The Dopamine Jive: Dance Therapy for Parkinson’s Disease
You may have heard someone rave about the rush they felt after an exhausting workout at the gym. Though their muscles are fatigued and their energy is depleted, some irrational part of them wants to keep going. Why is this? The impulse to continue exercising is associated with the release of dopamine, and our brains form a connection between dopamine and pleasure that motivates us to exercise more in the future [8]. Dancing, a widely enjoyed form of exercise, promotes the release of dopamine in the brain [9]. The neurological benefits of dancing have made it a commonly used holistic treatment for a variety of mental illnesses [10].
Dance therapy is gaining popularity as a therapeutic approach to treat Parkinson’s disease because of its ability to improve one’s range of movement and address the secondary symptoms that can accompany a loss of motor control [11]. Motor symptoms are generally shown to improve for a short period of time when undergoing dance therapy, while non-motor symptoms are improved long-term [11]. One organization that promotes the use of dance therapy for this condition, Dance for Parkinson’s Disease, is a world-renowned dance therapy program that has helped to popularize the use of dance therapy in Parkinson’s treatments starting in 2001 [12]. Classes taught by professional dancers in styles ranging from ballet to traditional folk dance are offered for individuals with PD, and are designed to address physical symptoms by promoting balance and coordination [13, 12]. These classes utilize techniques such as imagery, repetition, rhythm, and imitation of movement to help those with PD focus on the connection between their mind and body [13]. The awareness of one’s bodily position and movements is known as kinesthesia. Parkinson’s disease is known to correlate with a weakened sense of kinesthesia, likely due to the lack of dopamine inhibiting communication between the muscles and the brain [14]. Studies performed in conjunction with Dance for PD also consistently show improvements in motor symptoms after dance classes: individuals with PD had fewer tremors and their walking pace became more even [12]. Additionally, dance therapy improved the symmetry of their walking movements and posture more than standard physical therapy exercises [11].
The phenomenon of self-efficacy describes how you are only able to grow when you believe in your potential for success [15]. Take an athlete, for example: if a soccer player does not believe in their own ability to score more goals, they will lose the motivation to improve, and consequently remain stuck at the same skill level. When people with PD have trouble executing basic tasks, they may lose motivation to attempt those tasks, which further decreases their quality of life [15]. Those living with chronic illnesses such as Parkinson’s may begin to question their identity and purpose when faced with major life disruptions [16]. Here is where the expressive nature of dance therapy comes into play: the participants have the opportunity in class to creatively discover their capabilities beyond their physical restrictions [15]. After taking a class, those with PD have expressed feeling “courageous” and “optimistic,” demonstrating how the classes greatly improve both their mood and outlook on life [13]. Through dance, participants are able to form connections with others who struggle with the same limitations, allowing them to overcome the social isolation that can be a byproduct of PD [12, 17]. Volunteers are also present to help assist individuals with PD who may have trouble balancing or standing on their own, further fostering a sense of belonging and community [13]. The various social connections created in a classroom environment encourage participants to seek meaningful interaction beyond the studio [17]. Purely enjoying these classes for the artistic and social opportunities they offer creates a positive feedback loop: the brain is stimulated to produce more dopamine “batons,” pushing participants to come to class more frequently [17].
The confidence gained from social interactions helps individuals to improve their perception of their beauty and identity as well. Changes caused by Parkinson’s disease extend beyond just function, and frequently involve altered appearance of the body [17]. As a result, people with PD may experience a decrease in self-esteem and can struggle to find beauty when looking in the mirror [18]. This altered perception of self is compounded by neurological conditions, such as dementia, that typically accompany PD, furthering the mismatch between one’s sense of self and their actual appearance [1]. The graceful movements of dance that push them to experiment with more fluid textures of movement help people with PD to view themselves in a more positive light [18]. The pathway between motor control and emotional processing is central to expressive movements, allowing dance to help people improve their motor awareness and remain in-touch with their emotions [19]. In order to achieve the full potential of expressive movement, classes help them to work on their kinesthetic awareness. Kinesthesia originates in sensory organs known as proprioceptors that send feedback to the brain about which areas are stretching and relaxing in movement [14]. Having the freedom to move in new ways, the dancers grow to not only believe in their own abilities, but cease to define themselves only by their disease. As they move through space, the dancers have the opportunity to become one with their movements, uniting a sense of beauty with their own identity [17].
Toeing the Line Between Ballet and Medicine
Ballet is a popular type of dance therapy used to treat Parkinson’s [17]. If you were to observe a PD ballet class, you would notice the swift brush of people's feet along the floor and elegant gestures of their arms as they glide and twirl through the studio. Ballet classes specifically designed to treat PD combine simple ballet steps in various sequences with the intention of improving one’s coordination, balance, and stability [13, 20]. Parkinson’s disease is often described as “draw[ing] people inwards” — muscles become tense, the gaze becomes fixed, and movements slow down [18]. These physical changes can deplete feelings of self-worth and potential that become components of a greater negative internalized mindset. In contrast, classical ballet focuses on projecting energy outwards by learning to lead with your chest and extending the limbs to create length in your body [17]. By practicing dynamic ballet movements, people with PD can counteract their negative internalized mindset which increases their confidence [17, 18, 20].
While participating in ballet classes organized and taught by a trained Parkinson’s dance therapist is incredibly beneficial, the high cost and low availability of these resources limits who can access them [21]. An alternative to dance therapy courses are regular dance classes, which can be found in a multitude of styles in nearly every community. Dance sessions have been found to improve mobility and coordination, even when not focused on treating Parkinson’s [21]. The effects of improvements like these extend beyond the classroom: when individuals with PD are able to engage in everyday movements, they gain more independence and are able to participate in daily tasks and activities that bring them joy.
Choreographing a Comprehensive Treatment
Dance is just the tip of the iceberg when it comes to holistic treatments for neurodegenerative disorders such as PD. Holistic medicine can be particularly useful in treating neurodegenerative diseases when used in tandem with pharmaceuticals [6]. While drug therapies seek to mimic the action of dopamine and to mask symptoms, they don’t actually slow the progression of the disease, and instead act as a band-aid solution for secondary symptoms [1]. In contrast, holistic therapy acts just as a training session for an athlete does. A soccer player, for example, must practice shooting drills consistently to keep up their skills. If they were to stop training suddenly, they would find it more difficult to score goals. Like the muscles you continue to build when playing soccer, damaged connections in the nervous system can gradually be rebuilt if they are used on a regular basis because the brain will recognize their importance and divert more energy into strengthening them [22]. Physical therapies that emphasize the mind-body connection, such as dance or yoga, are widely regarded as safe and non-invasive, and therefore supplement drug therapies well [7]. Beyond dance or physical therapy, holistic therapies can take many forms — ranging from acupuncture to music therapy — that have the potential to ease the burden of symptoms affecting people with Parkinson’s [7].
Such holistic therapies can be used to treat more than just PD, creating new treatment options for a wide range of illnesses. Though the effects of holistic medicine are just beginning to be explored, similar therapies rooted in cultural traditions such as massage and herbal medicine have been used systematically for thousands of years [23]. By investigating these options in greater depth, treatments can be designed to address each person’s unique symptomology. Increasing education on the importance of holistic medicines for both health professionals and the general public could inspire more research in this area and further popularize holistic therapies [7]. A Parkinson’s diagnosis can turn one’s world upside down. Holistic medicine treats health beyond just physical wellness, so an upside down world can feel a little more right-side-up. While holistic therapies such as dancing don’t necessarily present a cure for Parkinson’s, they offer promising and effective new dimensions to treatment.
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