Wednesday, March 3, 2010

Dance Therapy for Alzheimer's Patients

What is dance therapy?
Music therapy was established in 1950. It is designed to improve physical and emotional health through the use of music, through listening, song writing, performing, exploring lyrics or other activities related to music. Music therapy is most often used as part of stress management programs.

NICE guidelines specify that “people with mild to moderate dementia of all types should be given the opportunity to participate in a structured group cognitive stimulation program.” However, because of uncertainty about cost effectiveness, it remains for the voluntary sector to provide these services.

Dance therapy is the use of movement to improve physical and psychological wellbeing. Sessions deliver either structured dancing technique, such as social dancing with a partner, or a more contemporary approach that uses improvisation to link thoughts with movement. Sessions should be tailored to the severity of the dementia. For example, people with more severe dementia benefit from simpler movements and more caregivers to help. Small class sizes with similarly affected participants facilitate participation. Classes should last about an hour to reduce the risk of the symptoms of Alzheimer’s disease hindering further progress.

Social dancing with a partner is a familiar and enjoyable activity for elderly people and provides quality time for the patient and their partner. It develops procedural learning (long term memory initiated by past experience) and concentration because dancing is a dynamic rather than repetitive physical activity and can “link past memories to the present.” A man who attended Scottish country dancing lessons once a month with his wife, who had Alzheimer’s disease, noted that his wife remembered lots of the steps despite her limited cognitive ability. In one project, participants who danced in a circle felt they had been accepted into, and belonged to, a group. So social dancing offers participants an opportunity to succeed and boost their self esteem.

Projects that focused on free and creative expression have had similar benefits. A weekly project in which 8-10 participants used props and various musical genres encouraged people to move however they wanted, rather than follow a routine. Observations included participants engaging and improvement in mood and relationships among participants and between participants and their caregivers. Building relationships led to an increased sense of self and self esteem. One participant in this study remembered things from her childhood and her personal qualities and thought that she had been “got together again.” This type of dance also allowed emotions such as grief, anger, and loss to be tackled and reflected upon, allowing people to celebrate life again.

Dance awakens memories outside the dance session and helps patients “find themselves” again. A multisensory approach with different sounds, colors, and tangible objects further stimulates engagement and stimulation of participants.

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Benefits of dance therapy

Various aspects of a dance session, such as the music, exercise, and social components of dancing, may achieve positive effects. However, vastly varying methods between most studies mean that they fail to agree the most important component. Although a Cochrane review shows that music therapy offers no definite benefits, subsequent research indicates that music can improve autobiographical memory and reduce agitation, anxiety, delusions, and other behavioral symptoms in dementia of any severity.

Exercise slows the progression of cognitive symptoms and is neuro-protective through increasing concentrations of insulin-like growth factor and reducing serum homocysteine. An active mid-life can reduce the risk of Alzheimer’s disease by up to 60% in people with the apolipoprotein E ε4 allele. The positive self esteem and social experience of exercise also improves cognition. However, exercise can be repetitive and there is a degree of “doing it right or wrong,” whereas dance is spontaneous and “always right”; indeed, some propose dance to be the only preventive physical activity. Overall, dance combines all these benefits into an attainable and enjoyable activity for all levels of disability.

According to researchers M. Brotons and S.M. Kroger of the Willamette University Psychology Department in Oregon, in their study on "The Impact of Music Therapy on Language Functioning in Dementia," patients showed statistically significant improvements in speech content and fluency after eight sessions of music therapy combined with conversations.

Other researchers have reported on proven benefits to Alzheimer’s patients derived from music therapy on aspects such as cognitive functions, social skills, and behavior (including reduced agitation and behavioral problems). Music and music therapy are not curative of Alzheimer’s and dementia, but the use of music therapy results in the beneficial effects on dementia and Alzheimer’s symptoms. These benefits lead to an enhanced quality of life for both the patient and his or her caregiver.

Sound of Music

Typically, “stimulating music” activates, while “sedative music” quiets. Stimulating music, with percussive sounds and fairly quick tempos, tends to naturally promote movement, such as toe taps. Look to dance tunes of any era for examples. Slightly stimulating music can assist with activities of daily living: for example, at mealtime to rouse individuals who tend to fall asleep at the table or during bathing to facilitate movement from one room to another.

On the other hand, the characteristics of sedative music—ballads and lullabies—include unaccented beats, no syncopation, slow tempos, and little percussive sound. This is the best choice when preparing for bed or any change in routine that might cause agitation.

Responses that are opposite of those expected can occur and are likely due to a person’s specific associations with the piece or style of music.

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Agitation Management

Non-verbal individuals in late dementia often become agitated out of frustration and sensory overload from the inability to process environmental stimuli. Engaging them in singing, rhythm playing, dancing, physical exercise, and other structured music activities can diffuse this behavior and redirect their attention.
For best outcomes, carefully observe an individual’s patterns in order to use music therapies just prior to the time of day when disruptive behaviors usually occur.

 Emotional Closeness

 As dementia progresses, individuals typically lose the ability to share thoughts and gestures of affection with their loved ones. However, they retain their ability to move with the beat until very late in the disease process.
Ambulatory individuals can be easily directed to couple dance, which may evoke hugs, kisses or caresses; those who are no longer walking can follow cues to rhythmically swing their arms. They often allow gentle rocking or patting in beat to the music and may reciprocate with affection.

An alternative to moving or touching is singing, which is associated with safety and security from early life. Any reciprocal engagement provides an opportunity for caregivers and care receivers to connect with one another, even when the disease has deprived them of traditional forms of closeness.

 How-to of music therapy

 Early stages

  • ·         Go out dancing or dance in the house. 
  • ·         Listen to music that the person liked in the past—whether swing or Sinatra or salsa. Recognize that perceptual changes can alter the way individuals with dementia hear music. If they say it sounds horrible, turn it off; it may to them. 
  • ·         Experiment with various types of concerts and venues, giving consideration to endurance and temperament. 
  • ·         Encourage an individual who played an instrument to try it again. 
  • ·         Compile a musical history of favorite recordings, which can be used to help in reminiscence and memory recall.
Early and middle stages

Use song sheets or a karaoke player so the individual can sing along with old-time favorites.

Middle stages

  • ·         Play music or sing as the individual is walking to improve balance or gait. 
  • ·         Use background music to enhance mood. 
  • ·         Opt for relaxing music—a familiar, non-rhythmic song—to reduce sundowning, or behavior problems at nighttime.
Late stages

  • ·         Utilize the music collection of old favorites that you made earlier. 
  • ·         Do sing-alongs, with “When the Saints Go Marching In” or other tunes sung by rote in that person’s generation. 
  • ·         Play soothing music to provide a sense of comfort. 
  • ·         Exercise to music. 
  • ·         Do drumming or other rhythm-based activities.
  • ·         Use facial expressions to communicate feelings when involved in these activities.
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Negative aspects of dance therapy

Dance therapy may be effective only during a period of regular sessions. Patients and their families awaiting drug treatment or a “wonder cure” may be disappointed when dance therapy is offered. Patients who find dancing and movement difficult might be saddened by this reality. Concerns exist that physical activities in people with dementia in particular may raise the risk of falls and exacerbate various existing health conditions, such as high blood pressure, heart problems, chronic obstructive pulmonary disease, and so on. However, exercise could reduce falls by improving stability and improve the long term progress of other chronic conditions.

Prevention is better than no cure

The main risk factors for dementia include increasing life expectancy, obesity, diabetes, excessive alcohol consumption, and hypertension. Although these are largely vascular dementia risk factors, age is a key cause of Alzheimer’s disease, so prevalence is also set to rise.

Dance therapy could be a preventive measure. Combining physical and mental activities can increase the cognitive reserve, reduce the rate of brain atrophy, stimulate neuroplasticity and neurogenesis, and increase brain perfusion as well as combating many of the risk factors. Early prevention is key, given that clinical presentation of symptoms occurs 10-20 years after the biological changes start.

The resources exist to allow any willing caregivers to run dance therapy classes, regardless of dance experience, and there is a lot of information available. The Expressive Arts with Elders resource also promotes easy, money saving dance techniques, such as using a dustpan as a drum or beans as shakers. Alternatively, professional dance teachers charge about £30 an hour. Additional considerations, such as facilities, facilitators, organizing transport, and coordinating and organizing potential participants and their caregivers require further research, to see whether these factors allow dance therapy to be a cost effective option.

Dance “challenges the stereotypes of ageing and disease.” It also provides a good mix of cognitive and physical stimulation. It is also refreshing for patients and caregivers to experience a treatment that is not a drug regimen.

Sources and Additional Information:
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