The Examination of Dual-Tasking, Dynamic Balance, and Muscle Activity Before and After Adapted Tango in Parkinson’s Disease Open Access
Thodupunoori, Sharanya (Spring 2022)
Published
Abstract
PD postural instability results in lost static and dynamic balance. Dynamic balance involves maintaining/recovering balance in response to perturbation. Dual-tasking (simultaneous performance of two distinct tasks: one cognitive, one motor) is difficult for PD patients given increased cognitive demand. During mobility and balance tasks, abnormal muscle antagonist activity has been observed in PD. Adapted Tango (AT) improves clinical measures of PD symptoms, including static balance. Little is known about effects of dance on dual-tasking and dynamic balance. Further, neurophysiological changes underlying these improvements are yet to be determined. Our study aims to 1) examine how AT impacts dual-tasking and dynamic balance, 2) determine whether completion of AT program is associated with decreased leg muscle antagonist activity, and if this change correlates with clinical measures of balance, and 3) examine case studies for patient improvement, maintenance or regression trajectories. We recruited patients with mild-moderate PD and assigned them to AT or control. Dual-tasking (using the Serial 7 walking test) and Dynamic Gait Index (DGI) were evaluated pre-, post-, and 4 weeks post-intervention. Differences were evaluated using ANOVA and t-tests. Muscle activity modulation (ability to activate and inhibit muscles appropriately according to perturbation direction) was quantified using modulation indices (MI) derived from minimum and maximum EMG activation levels observed across perturbation directions). At baseline, there was a difference between the AT and Control group dual-task cost for correct number of subtractions (p = 0.003), so no between groups comparison was done on this variable at posttest. At posttest, Control had a lower (p = 0.04) dual-task cost for speed. Within group, at posttest, control gave fewer correct subtractions (p < 0.0001), had a lower rate of correct answers/second given while walking (p = 0.0322), and had greater dual-task cost for serial 7s calculations (p=0.0135); AT had a lower percent of correct subtractions (p = 0.0391). DGI performance improved after intervention. MI did not change significantly postintervention. The case series highlights impact of clinical characteristics on participant responses. AT may improve dynamic balance performance, but more research is needed into its effect on dual-tasking and MI.
Table of Contents
1. Introduction..................... 1
1.1. Epidemiology of Parkinson’s disease..................... 1
1.2. Parkinson’s disease affects balance..................... 1
1.3. Dynamic vs. Static balance..................... 2
1.4. Dual-Tasking ..................... 3
1.5. Abnormal antagonist muscle activity..................... 5
1.6. Rehabilitation and Adapted Tango..................... 7
2. Methods..................... 9
2.1. Participants..................... 9
2.2. Adapted tango intervention..................... 10
2.3. Measuring outcomes.....................11
2.4. Dual-tasking assessment and data..................... 11
2.5. Reactive balance assessment.....................12
2.6. EMG collection and processing..................... 13
2.7. Muscle activity modulation index (MI)..................... 14
2.8. Statistical analysis..................... 14
2.9. De Novo Statistical analysis..................... 16
2.10. Case Studies Selection and Analysis..................... 16
3. Results..................... 16
3.1. Participant demographics..................... 16
3.2. Effect of Adapted Tango on dual-tasking measures..................... 17
3.2.1. Between group differences at baseline..................... 18
3.2.2. Between group differences at posttest..................... 19
3.2.3. Within group Pre to Post differences..................... 19
3.3. Effect of Adapted Tango on dynamic balance..................... 22
3.4. Effect of Adapted Tango on Modulation Index..................... 23
3.5. Case Studies..................... 24
3.5.1. Improved in DGI and mobility and cognitive dual-tasking..................... 25
3.5.2. Improved in DGI but not in mobility and cognitive dual-tasking..................... 26
3.5.3. Lack of improvement in both DGI and mobility and cognitive dual-tasking ..................... 26
3.5.4. Improved in DGI and cognitive dual-tasking but not in mobility dual-tasking..................... 27
4. Discussion..................... 28
4.1. The variable impact of AT on dual-tasking..................... 28
4.2. Dynamic balance improved as a result of AT..................... 31
4.3. AT did not affect modulation index..................... 32
4.4. Analysis of individual case studies..................... 33
4.5. Conclusions..................... 35
4.6. Limitations..................... 36
4.6.1. Statistical Analysis..................... 36
4.6.2. Study Sample..................... 37
5. Tables and Figures
Table 1..................... 17
Table 2..................... 20
Table 3..................... 21
Table 4..................... 23
Table 5..................... 23
Table 6..................... 24
Figure 1..................... 10
Figure 2..................... 18
Figure 3..................... 18
Figure 4..................... 23
6. References..................... 38
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