Jaques-Dalcroze’s music-based rhythmic training affects gait

parameters and quality of life in Parkinson’s Disease

Promotion de la santé et la prévention face au vieillissement

22. Novembre 2019

Jennifer Masset

Jennifer.masset@hesav.ch

Introduction Parkinson‘s Disease (PD)

GaitIncreased risk of falls

• High impact of multi-task performance in everyday life

MotorCognitiveBradykinesia

Tremor at rest

Rigidity

Dopaminergic medication

?

? - Reduced walking speed

- Increased gait variability(Yogev-Seligmann et al. 2008)

Apathy/ Depression

Attentional Deficits

„Loss of automaticity“

Memory

• Falls major cause of mobidity and mortality in PD

(Jankovic, 2008; Bloem et al. 2006)

Introduction

Neurologic Music Therapy (NMT)

Keus, S. (2014). Poster: Physiotherapy for Parkinson’s disease. A joint Europe Guideline.

• Auditory Stimulation Thaut et al. 1996

• Argentinian Tango Review: Lotzke et al. 2015

• Tai Chi Review: Ni et al. 2014

Exercise paradigm: Jaques Dalcroze

- Emile Jaques Dalcroze (1865 – 1950)

- Children‘s and adolescents‘ music education all over the world

- Music movement therapy

Mind

Body

Space

Time

Bachmann ML. Dalcroze today. An Education Through and into Music. New York: Oxford University Press, 1991

Corporal expression in synchrony with external cues

• Motor-cognitive: balance, coordination, attention, memory

• Multisensory: visual, auditory, tactile

• Emotional: social aspect / group belonging

Exercise paradigm: Jaques Dalcroze

Literature

ConclusionLong-term JD exercise intervention can preventage-related gait impairment under a dual-task

Improved gait under dual-task condition, improved balance, reduced rate of falls and risk of falling

Dalcroze and Geriatrics (Jaques Dalcroze long-term intervention)

Trombetti A et al. Effect of music-based multitask training on gait, balace and fall risk in elderly people: a randomized controlled trial. Arch Intern Med. 2010 Nov 22.Kressig RW et al. Long-term practice of Jaques-Dalcroze Eurhythmics prevents age-related increase of gait variability under dual-task. J Am Geriatr Soc 2005;53:728-9.

Hypotheses

+ temporal processing and internal rhythmic timing

+ gait parameters for single and dual task (motor-cognitive interference)

+ quality of life, course satisfaction

Positive effects after short-term intervention Jaques Dalcroze in Parkinson’s Disease

Dual-Task paradigm:

• Walking while cognitive task:

- Animal naming

Methods

Pilot Study

Participants: n=16

• Parkinson’s Disease: Hoehn &Yahr 2-3

• No regular physical activity / No experience NMT

• Stable medication, Testing « Med On »

Intervention: 1 monthCourse: 2 x 45min / week

Testing Session Testing Session

Gait: - 2 X 10m self-selected speed- 1 X 10m dual- task (animals)- 1 X 10m dual-task (counting)- TUG

Questionnaires: - Quality of Life (PDQ modified)- Satisfaction

Mean Age 67 ± 7 yrs

Gender 12 w / 4 m

Diseaseduration

9.5 ± 6.5

LEDD 712 ± 480 mg

H&Y 2.5

Methods

Pilot Study

Participants: n=16

• Parkinson’s Disease: Hoehn &Yahr 2-3

• No regular physical activity / No experience NMT

• Stable medication, Testing « Med On »

Intervention: 1 monthCourse: 2 x 45min / week

Testing Session Testing Session

Gait: - 2 X 10m self-selected speed- 1 X 10m dual- task (animals)- 1 X 10m dual-task (counting)- TUG

Questionnaires: - Quality of Life (PDQ modified)- Satisfaction

Methods

Parameters

2) Gait Variability (CV%)1.1) Walking Speed (m/s)

1.2) Scores cognitives

Stride Stride

Yogev-Seligmann et al. „The role of executive function and attention in gait. Movement Disorder 2008 Feb 15;23(3):329-42.

Results

Timed Up and Go

Wilcoxon rank-sum test; sum of each domain, pre vs. post intervention for p<0.05

p = 0.001

pre post pre post

20

16

12

8

20

16

12

8

Walking Speed (sec)

ResultsSingle Task 10 m

1.25

1.0

0.75

0.5

Wilcoxon rank-sum test; sum of each domain, pre vs. post intervention for p<0.05

p = 0.011

pre post

Walking Speed (m/s)

p = 0.050

pre post

12

8

4

Gait Variability (CV%) – Stride Length

Results

Dual Task

pre post

p = 0.015

1.25

1.0

0.75

0.5

Walking Speed (m/s) Gait Variability (CV%) – Stride Length

pre post

p = 0.008

12

4

16

Wilcoxon rank-sum test; sum of each domain, pre vs. post intervention for p<0.05

No change for cognitive scores, for p<0.05

Conclusion

Gait parameters

+ significant increase of walking speed for Single-Task, p = 0.01 (gait variability tendency, p = 0.050)

After short-term intervention Jaques Dalcroze in Parkinson’s Disease…

+ highly significant increase in functional capacities (TUG) , p = 0.001

+ significant increase of walking speed for Dual-Task, p = 0.015

+ highly significant improvement of gait variability for dual-task, p=0.008

Methods

Pilot Study

Participants: n=16

• Parkinson’s Disease: Hoehn &Yahr 2-3

• No regular physical activity / No experience NMT

• Stable medication, Testing « Med On »

Intervention: 1 monthCourse: 2 x 45min / week

Testing Session Testing Session

Gait: - 2 X 10m self-selected speed- 1 X 10m dual- task (animals)- 1 X 10m dual-task (counting)- TUG

Questionnaires: - Quality of Life (PDQ modified)- Satisfaction

Quality of life / PDQ

Wilcoxon rank-sum test; sum of each domain, pre vs. post intervention for p<0.05

p = 0.021

p = 0.013

p = 0.041

p = 0.033

p = 0.053

Feedback Participants

Conclusion

- Mobility: Improved gait parameters (walking speed, gait variability)

- Quality of Life: Improved PDQ in domains: mobility, emotional well-being, stigma, cognition)

- Satisfaction: Extremely high global satisfaction (0 drop-out rate)

Perspectives

- JD rhythmic courses as potential complementary therapy

- RCT

- Contact

Thank you for your attention

Dance Class23rd November 1934: Students at the London School of Dalcroze EurythmicsPhoto by Arthur Tanner/Fox Photos/Getty Images