Rehabilitative Movement Approaches and Dance Interventions in Parkinson’s Disease

The scope of this work is to address the functional deficits and symptoms experienced by those living with Parkinson’s Disease through movement interventions. Chapter 1 offers a brief overview of current pharmacotherapy and rehabilitation approaches in Parkinson’s, focusing on dance in particular as a movement intervention that may be particularly suited to this population. Chapter 2 focuses on brain plasticity and motor learning in PD, reporting the effects of rTMS applied after the acquisition of a motor skill. In this study, adaptation tested in patients with PD was comparable in the sham and TMS sessions, while retention indices tested on the following day were significantly lower in the sham compared to the TMS session in which retention indices were restored to the level of the controls. Chapter 3 explores biological markers that can be measured as proxies of brain plasticity, which may be affected by an intensive rehabilitation treatment including aerobic exercise, physical and occupational therapies. We tested whether exercise could improve motor function while also enhancing BDNF-TrkB signaling in lymphocytes. After MIRT, all patients showed improvement in motor function, TrkB interaction with NMDAR and BDNF-TrkB signaling. Chapter 4 explores mechanisms that may explain the efficacy of dance interventions on Parkinson’s symptoms. Internal and external cueing strategies, as well as affective and cognitive changes influence the manifestation of motor symptoms. Importantly, plasticity-enhancement though dance may be involved in the improvements of PD symptoms following dance practice. Chapter 5 presents a novel study in which the effects of dance in PD are compared to those of an exercise intervention of matched intensity, but lacking dance elements such as music, metaphorical language, and social reality of grace and beauty. This study shows changes in physiology, affect, self-efficacy and motor performance. Chapter 6 summarizes all these findings while tracing a link between studies on neuroplasticity, exercise-based rehabilitation in PD, and the role of dance in affecting motor performance through mechanism of motivation and modulation of attention