Dramatic Improvement of Parkinsonism While Dancing Tango

Abstract

A 73-year -old woman with a 15-year history of idiopathic Parkinson disease (PD) had severe difficulties in initiating gait and walked only with cane assistance with short shuffling steps. On examination, she had severe bilateral rigidity and bradykinesia. On the pull test, she lost balance spontaneously or with just a gentle pull on the shoulders (UPDRS-III score: 59). She has been an Argentine tango dancer since she was 10 years old, and because she is part of a traditional family of tango dancers, she usually participates in “milongas” (tango parties). When dancing, she could reliably overcome gait disturbance, being able to dance the steps of tango, dramatically improving her motor and gait disturbance, walking backward, making cross-steps, and controlling her balance dynamically. There exists the hypothesis that basal ganglia are involved in providing phasic cues to the supplementary motor area (SMA), which is responsible for activating and deactivating each submovement within the movement sequence, as well as their accurate execution.1 In PD, basal ganglia dysfunction could lead to the loss of internal gait rhythm causing their characteristic gait disorders. Sensory cues appear to be powerful means of improving gait in PD by circumventing dopaminergic, or perhaps nondopaminergic, deficits.1 However, different types of auditory cueing could provide an external rhythm compensating for the defective internal rhythm of the basal ganglia in PD.1 Similarly, certain visual stimuli are also effective in improving gait. Therefore, sensory cues could be employed as a strategy of rehabilitation in PD patients.2 Tango is a particular type of dance that includes external cues, movement strategies, and exercises for balance improvement.3 There is evidence of increased activation of the putamen during the performance of regular, metric-rhythm movements as observed in tango dancing.4 Furthermore, in healthy tango dancers, there was a shift in cortical activation with increased activity in the premotor area and SMAs during imagined series of dancing steps.3 It is believed that auditory cues may bypass the basal ganglia to access the SMA through the thalamus or the premotor cortex through the cerebellum.3 Tango may have a significant contribution in order to supersede involved motor circuits in PD. In PD patients, mobility impairments are exacerbated when they perform a simultaneous secondary task and it is known that multitasking exercises could improve their deteriorated motor performance. Some dances, such as tango, constitute a valuable multitasking activity. Furthermore, it has been observed that patients greatly enjoy this kind of exercise program with high compliance (>90%) and discover that they are able to perform tasks beyond the restrictions caused by PD.5 We consider that tango dancing, being a multitasking activity using auditory, visual, and sensory cues, offers an enjoyable strategy for rehabilitation in PD patients, allowing them to connect with movement through the melody of music. (1) Research Project: A. Conception, B. Organization, C. Execution; (2) Statistical Analysis: A. Design, B. Execution, C. Review and Critique; (3) Manuscript: A. Writing of the First Draft, B. Review and Critique. S.A.R.-Q.: 3A, 3B R.D.R.: 3B T.A.: 3A, 3B N.S.G.: 3A, 3B The authors acknowledge the tango teacher, Humberto “El Puchu” Pauchulú. Funding Sources and Conflicts of Interest: The authors declare that there are no funding sources or conflicts of interest to report. Financial Disclosures for preceding 12 months: The authors declare that there are no disclosures to report. A video accompanying this article is available in the supporting information here. Video. Segment 1: The patient with severe difficulties in initiating gait, with short shuffling steps and moderate compromise of stability in the pull-test maneuver (UPDRS). Segment 2: The patient improving her gait and mobility through the melody of tango. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.