In 20 – 25. 2 . 2023, Blended Intensive program in Neurological rehabilitation ran. More than 30 physiotherapy students and teachers from three universities (Savonia University of Applied Sciences, Finland, Third Faculty of Medicine, Charles University, Czech Republic and University of Thessaly, Greece) actively participated. Students worked together and wrote articles devoted to on the following themes: stroke and rehabilitation, multiple sclerosis and rehabilitation, Parkinson’s disease and rehabilitation, children with neurological disorders and rehabilitation, spinal cord injury and rehabilitation and virtual reality and exergames in rehabilitation of neurological patients. We are going to present their great work here. (Äijö et al 2022.)

Parkinson’s disease (PD) is a brain disease that occurs usually at the age of 50 to 70, and in some rare cases even earlier (Atula 2023). The main symptoms of PD are unintended or uncontrollable movements such as tremors. Also, stiffness, hypokinesia and balance and coordination problems are typical symptoms. Parkinson’s disease develops usually slowly during the years. First the symptoms can be one-sided, but later will affect both sides. Tremor can occur especially on upper limbs during the active movements as well as in rest.

The slowness of motion can be seen as walking velocity, freezing of gait, shorter stride length and rigidity. Rigidity means increased muscle tension and for example slowness of flexion or extension. (Atula 2023; Kaakkola 2013.) PD is caused by death of dopaminergic neurons, and it has been reported, that a pleasurable feeling found from music or exercise can activate the limbic system and increase dopamine release. (Zhou etal. 2021.) The rehabilitating effect of music and dance therapy bases on this rehabilitating effect. In this article we are concentrating on the rehabilitation of PD patients in Finland, Greece and Czech Republic as well as effects of music-based physical therapy on motor function, balance, and gait and on mental health for patients with PD.

In Finland, physiotherapy is a very important part of Parkinson’s disease treatment. The aim of physiotherapy is to increase mobility and, for example, reduce the risk of falling. The goal is to help the patient cope with daily chores. The physiotherapist also assesses the need for mobility aids. Physiotherapy methods used in the treatment of Parkinson’s include balance training, walking training with different equipment in different environments, guidance and counseling that promotes functional ability, alleviating muscle stiffness with manual and physical means, pool therapy and practicing skills related to functional ability. Music and rhythmicity can also be used in physiotherapy.

The treatment of Parkinson’s disease is multidisciplinary in Czech Republic. Treatment includes neurologist, psychiatric, speech therapist, ergotherapist and physiotherapist. Individual and group therapy and spa (for example Karlovy Vary) are used in the treatment.

Movement therapy is focused on motor skills, hypokinesia, posture disorders, rigidity, and gait. Group therapy is very good for the emotional health of our patients. In Czech the use of Bobath concept, Vojtas principle, sensorimotor stimulation and balneotherapy with hydrotherapy, physical therapy and canistherapy is common.

In Greece a lot of methods are used to manage Parkinson’s disease. Stretching is used to manage rigidity and stiffness of the muscles. Functional training places an important role in rehabilitation because the main goal is to make people integrate into society and to be able to function well and feel safe in the environment. Another method that is used is auditory cueing, to enhance gait performance (It has been shown to increase stride length and gait velocity). Rhythmic auditory cueing is the most widely used technique. Visual cueing can be helpful as well. By placing colored taped lines on the floor, a patient with PD can decrease the amount of minutes that freezing of gait appears. The balance is also an important aspect that physiotherapist in Greece is trying to improve one-leg stand or a bosu-ball can be used to enhance balanced and prevent falls. Physiological and mental factors should be taken in account as well.

In Kuopio, Savonia physiotherapy students attended a neurophysiological course in their fifth semester. In this course they worked with real patients who have some neurological disease. These include patients with Parkinson’s disease. In Finland the students also practice various rehabilitation methods that can be used in the treatment of neurological patients. They are taught about the symptoms in Parkinson’s disease, and they are given some ideas on what kind of practices physiotherapists can do with Parkinson patients. In Greece and Czechia, the studies of Parkinson’s disease concentrate on rehabilitation methods as well as neurological basis of the disease. In comparison to Finland, they are taught about Bobath concept and Vojtas principle.

Dance therapy is a useful way to help eliminate motor and nonmotor symptoms of people suffering from PD. As it has been shown to be successful and enjoyable way to treat patients, more clinical therapists have started to incorporate this type of therapy in their physio program. Dancing is a creative activity that a physiotherapist can tailor to fit to each patient’s needs. Nowadays even more research has made it clear that the use of dance, as an alternative treatment, can have good and beneficial effects on motor symptoms such as specific types of walks and poor gain of balance. In a recent S.R and M.A of RCTS, Anna M. Carapellotti (2020) and her team found that dance can improve dynamic balance and the most beneficial form of dance to include was tango and ballroom dancing. Studies have shown changes in gait as well.

They found that the use of dance can increase walking speed, stride length, straight walking time, and decrease gait fatigue as measured by the gait fatigue index (GFI). Another motor impairment that can be improved by dancing is the freezing of gait which can decrease. Coordination while turning can also be enhanced. Specifically, the participation in a 10-week ballroom – Latin dance program shown improvement in coordination in axial and perpendicular body segment (Hulbert et al, 2017). Apart from motor symptoms, studies have shown that mental health can also change. It is found that dance can deplete feelings of depression and apathy after a 12-week program. Another aspect that can be improved by dancing is the quality of life (QoL). In a study made by Lee H. (2018) and his team, they found that QoL was improved by assessing the results with P. D. Questionnaire (PDQ 39).

Apart from dance, another method that can be used with PD patients is music-based movement therapy. Music can be enjoyable and pleasant and that is the reason why many therapists have started to use it as a method in rehabilitation. Music therapy has shown to have beneficial effects on motor function, balance, gait, mental health as well as quality of life (Zhou et al, 2015).

There has been seen a better efficacy on stability improvement when patients keep their eyes closed, during music therapy. These findings may be because of improved proprioception under eyes-closed condition, which enables patients’ control their postural balance better. Additionally, music can increase walking velocity and decrease freezing of gait. (Zhou et al, 2021.) Studies show that the use of familiar songs results in faster gait velocity and less stride length compared to unfamiliar one (Leow et al, 2015). Musical experience can be pleasurable, and it is associated with reducing stress and improving well-being (Rios Romenets et al, 2015). Concerning the quality of life there were not statistically significance findings.

Dance and music can have a drastic difference on PD patients’ rehabilitation. Benefitting these factors, physiotherapist can improve e.g. patients’ walking velocity and ability to function on daily basis. Also, the impact on mental health and quality of life should be considered.

Authors:

Sonja Haukka, Physiotherapy students, Savonia University of Applied Sciences, Kuopio, Finland
Pavlína Beranová, Physiotherapy students, Third Faculty of Medicine, Charles University, Czech Republic
Markéta Mentzlová, Physiotherapy students, Third Faculty of Medicine, Charles University, Czech Republic
Sanni Viitanen, Physiotherapy students, Savonia University of Applied Sciences, Kuopio, Finland
Thalia Zogka, Physiotherapy students, Department School of Health Sciences, University of Thessaly, Greece
Dr. Marja Äijö, PhD, Principal lecturer of gerontology and rehabilitation, Savonia University of Applied Sciences, Kuopio, Finland
Dr. Kamila Řasová, Ph.D., Associative professor of Physiotherapy, Third Faculty of Medicine, Charles University, Czech Republic
Dr. Thomas Besios, Assistant Professor, Department School of Health Sciences, University of Thessaly, Greece,

References:

Atula S. 2023. Parkinsonin tauti. Lääkärikirja Duodecim. Online Publication. https://www.terveyskirjasto.fi/dlk00055. Read 22.2.2023.

Carapellotti A, Stevenson R & Doumas M. 2020. The efficacy of dance for improving motor impairments, non-motor symptoms, and quality of life in Parkinson’s disease: A systematic review and meta-analysis. PLoS ONE 15(8): e0236820. https://pubmed.ncbi.nlm.nih.gov/32756578/. Referred 23.02.2023.

Hulbert S, Ashburn A, Roberts L & Verheyden G. 2017. Dance for Parkinson’s-The effects on whole body co-ordination during turning around. Complement Ther Med. 32:91-97. doi: 10.1016/j.ctim.2017.03.012.

Kaakkola S. 2013. Parkinsonin tauti. Lääketieteellinen aikakauskirja Duodecim. 129 (15): 1605–8. https://www.duodecimlehti.fi/duo11140. Read 22.2.2023.

Lee HJ, Kim SY, Chae Y, Kim MY, Yin C, Jung WS, Cho KH, Kim SN, Park HJ & Lee H. 2018. Turo (Qi Dance) Program for Parkinson’s Disease Patients: Randomized, Assessor Blind, Waiting-List Control, Partial Crossover Study. Explore (NY).14(3):216-223. doi: 10.1016/j.explore.2017.11.002.

Leow LA, Rinchon C & Grahn J. 2015. Familiarity with music increases walking speed in rhythmic auditory cuing. Ann N Y Acad Sci. 1337: 53–61.

Ressner, Pavel a Dana ŠIGUTOVÁ. 2001. LÉČEBNÁ REHABILITACE U PARKINSONOVY NEMOCI. Neurologie pro praxi. 12(1), 31-35 [cit. 2023-02-23]. Dostupné z: www.prakticka-medicina.cz

Rios Romenets S, Anang J, Fereshtehnejad SM, et al. 2015. Tango for treatment of motor and non-motor manifestations in Parkinson’s disease: a randomized control study. Complement Ther Med. 23: 175–184.

Zhou K, Li X, Li J, Liu M, Dang S, Wang D & Xin X. 2015. A clinical randomized controlled trial of music therapy and progressive muscle relaxation training in female breast cancer patients after radical mastectomy: results on depression, anxiety and length of hospital stay. Eur J Oncol Nurs. 19(1):54-9. doi: 10.1016/j.ejon.2014.07.010.

Zhou Z, Zhou R, Wei W, Luan R & Li K. 2021. Effects of music-based movement therapy on motor function, balance, gait, mental health, and quality of life for patients with Parkinson’s disease: A systematic review and meta-analysis. Clin Rehabil. 35(7):937-951. doi: 10.1177/0269215521990526.

Äijö M, Řasová K & Besios T. 2022. Neurological rehabilitation, Blended Intensive program has started. Savonia Article, Savonia-ammattikorkeakoulu. In available: https://www.savonia.fi/en/articles/savonia-article-neurological-rehabilitation-blended-intensive-program-has-started/