The Effects of Modified Jazz Dance on Balance, Cognition,

1
The Effects of Modified Jazz Dance on Balance,
Cognition, Mood

• Patricia T. Alpert, DrPH, APN, FAANP
• Sally K. Miller, PhD, APN, FAANP
• Harvey W. Wallmann, DPTSc, SCS, LAT, ATC
• Richard Havey, MA

Funded by a grant from the Center for Excellence
in Womens Health
2
Introduction

• Physical activity aerobic exercise in balance
  preservation fall reduction well documented
  (Jessup et al, 2004 Carter et al, 2001, Campbell
  et al, 1997 Chien et al, 2000 Wolf et al, 2003)
• Can jazz dance achieve the same results?
• potential for sustained interest adherence

3
Background

• Falling among elderly is often attributed to a
  decline in balance (Ballard, McFarland, Wallace,
  Holiday Roberson, 2004)
• Changes in cognition mood may also ? the risk
  of falling (Palleschi et al, 1996 Bassuk, Glass,
  Berkman, 1999)
• Important to identify strategies that can improve
  balance, cognition mood to reduce the risk of
  falling

4
Literature Review

• Dance successfully motivated health promotion in
  older Koreans (Jean Choi, 2001 Song et al,
  2004)
• Exercise has positive impact on cognition
  (Paleschi et al, 1996)
• Dance improves mental status of those with
  dementia (Dvarak Poehlman, 1998 Hagen et al,
  2003 Teri et al, 1998 Van de Winckel et al,
  2004)
• Social isolation contributes to depression
  (Anderson, 2002 Dugan Kivett, 1994 Prince et
  al, 1998)

5
Literature Review

• Postural sway (sway) ?s in older people
• frequency of falls ?s as sway increases (Baloh
  et al., 1995 Horak, 1987 Monsell et al., 1997
  Nashner, 1990 Woollacott Shumway-Cook, 1990)
• Mechanisms for postural control begin to
  deteriorate with age
• also resulting in a decline in postural stability
  and an ?d susceptibility to falls (Choy et al.,
  2003 Fernie et al., 1982 Gill et al., 2001
  Lord et al., 1999 Shumway-Cook Woollacott,
  2000 Simoneau et al., 1999)

6
Literature Review

• Balance has been defined as
• the process of maintaining the center of gravity
  (COG) within the bodys base of support (BOS)
  (Nashner, 1990)
• Balance can be described as being either
• static
• maintaining postural stability while standing
  quiet or
• dynamic
• maintaining postural control during voluntary
  movement (Woollacott, 2000 Woollacott Tang,
  1997)

7
Literature Review

• Static balance is often measured using
  computerized dynamic posturography (CDP)
• using a computerized forceplate, CDP is used to
  quantitatively assess sway by measuring shifts in
  the COG
• this requires that the COG remain within the BOS
  (Judge et al., 1995)
• An inability to correctly maintain this COG over
  the BOS results in impaired balance
• Balance utilizes the following sensory systems
• Visual
• Somatosensory
• Vestibular

8
Literature Review

• Exercise can improve or maintain dynamic balance
  as well as ? risk of falling in the elderly
• facilitates independence in mobility and function
  (Barnett et al., 2003 Nordt et al., 1999 Perrin
  et al., 1999 Shumway-Cook et al., 1997)
• Dance-based training has been shown to be
  beneficial in improving static balance and ?ing
  fall risk (Federici et al., 2005 Shigematsu et
  al., 2002)

9
Literature Review

• To date, the authors are not aware of studies
  involving jazz dance training to improve static
  or functional balance

10
Aims of Study

• Aim 1 To determine the effect of modified jazz
  dance on balance
• Aim 2 To determine the effect of modified jazz
  dance on cognition
• Aim 3 To determine the effect of modified jazz
  dance on mood

11
Design Instrumentation

• Prospective descriptive study (pilot study)
• Used the following measures
• NeuroCom Smart Balance Master
• Sensory Organization Test (SOT) measurements
• Folstein Mini Mental Status Examination (MMSE)
  (Folstein et al, 1975)
• Geriatric Depression Scale (GDS) (Kieffer
  Reese, 2002)
• Demographic data age, education, marital status,
  ethnicity, employment status

12
The NeuroCom Smart Balance Master System
13
Instrumentation The SOT

• During testing, the platform or surround booth is
  either fixed or moving (sway-referencing)
• while subjects keep their eyes either open or
  closed (Whipple et al., 1993)
• Subjects are exposed to three 20-second trials
  for each of 6 different conditions (18 trials
  total)
• each trial results in an equilibrium score
• score is expressed as a percentage between 0 and
  100
• 0 indicates sway that is large, resulting in a
  loss of balance, and 100 indicating perfect
  stability (sway is small)
• average score of 3 trials for each condition

14
Instrumentation The SOT

• Composite equilibrium score
• the weighted average of all 6 conditions
• reflects the overall performance on the SOT and
  is conventionally used as a measure of sway
  (NeuroCom International Inc., 1994)

15
The Six SOT Testing Conditions
16
Description of the Six SOT Testing Conditions

• Eyes open, fixed support surface and surround
• visual, vestibular, and somatosensory modalities
  available
• Eyes closed, fixed support surface and surround
• absent visual input
• Eyes open, sway-referenced surround and fixed
  support surface
• visual input inaccurate
• Eyes open, sway-referenced support surface and
  fixed surround
• somatosensory inputs inaccurate
• Eyes closed, sway-referenced support surface and
  fixed surround
• absent visual input and somatosensory input
  inaccurate
• Eyes open, sway-referenced surround and support
  surface
• inaccurate visual and somatosensory inputs

17
Inclusion/Exclusion Criteria

• Inclusion
• Healthy community-dwelling women
• gt 50 years of age
• Willing to participate
• Able to speak English

• Exclusion
• Diagnosed with a condition associated with
  neurological and/or musculoskeletal systems
• Diagnosed with overt psychiatric illness
• Taking medications that interfere with balance,
  mood, cognition and/or coordination

18
Sample

• Single group of healthy community-dwelling women
  (N15)
• Two dropped out of study due to illness
• Enrolled in senior dance class during Fall 2005
  semester
• Ranged in age from 52-88 years old (mean68
  years, sd8.6 years)
• 92 Caucasian
• 8 African American

19
Methodology

• Treatment modified jazz dance class (15 weeks)
• Data were collected at
• Time 1 (pre-treatment-between weeks 1 and week 2
  of jazz class)
• Time 2 (mid-treatment-between weeks 7 and 8 of
  jazz dance class
• Time 3 (post-treatment-after week 15 of jazz
  dance class)

20
Data Analysis

• Data analyses were completed using SPSS (v. 13.0)
  and SAS (v. 9.1)
• Both descriptive inferential statistics were
  used to provide outcome results (were tested for
  normality)
• Repeated-measures ANOVA for jazz dance for within
  group changes over time on predictor variables
  (balance, cognition, mood)
• correlations analyses used to relate intervention
  to each outcome

21
Results

• Differences in mean MMSE GDS scores over time
  were not significant

22
(No Transcript)
23
(No Transcript)
24
Results---cont

• Repeated measures ANOVA showed that balance
  measures (composite equilibrium scores) improved
  throughout the study
• F(2,22) 23.185, (plt .0005)
• Post-hoc analyses (pairwise comparisons)
  indicated ?s in balance as follows
• pre (67.33 10.43) to mid (75.25 6.97),
  (p0.008)
• mid (75.25 6.97) to post (79.00 4.97),
  (p0.033)
• pre (67.33 10.43) to post (79.00 4.97),
  (plt0.0005)

25
ResultsComposite Equilibrium Scores
26
ResultsCondition 3 Equilibrium Scores
27
ResultsCondition 4 Equilibrium Scores
28
ResultsCondition 5 Equilibrium Scores
29
ResultsCondition 6 Equilibrium Scores
30
Discussion

• Healthy women attending jazz class one time per
  week improved balance
• Findings are consistent with studies showing
  balance improvement secondary to dance exercise
  (Federici et al., 2005 Shigematsu et al., 2002
  Verghese, 2006)
• In test conditions SOT 3 through SOT 6,
  sway-referencing occurs
• stresses the individuals balance system by
  introducing perturbations in either the support
  platform or the surround booth
• in response to the individuals inability to
  balance in place

31
Discussion

• SOT 3 (inaccurate visual surround booth)
• somatosensory input becomes dominant
• SOT 4 (inaccurate somatosensory - platform)
• vision becomes the dominant input
• SOT 5 (inaccurate platform vision is absent)
• vestibular and somatosensory inputs become
  dominant (eyes closed)
• SOT 6 (inaccurate visual and somatosensory)
• all inputs used

32
Discussion

• Improved balance with jazz dance requires use of
• Visual
• Somatosensory
• Vestibular
• Jazz dance may tax these systems resulting in
  improved motor sensory orientation
• improves ability to appropriately organize
  sensory information
• helps to negotiate when conflicting stimuli are
  present
• darkness, unstable surfaces, moving objects, etc.

33
Discussion

• No improvement in cognition
• observed small changes but still within normal
  range
• No improvement in depression
• observed small changes but still within normal
  range
• May be due to
• lack of sensitivity of tools used
• length of study not long enough

34
Strengths Limitations

• Strengths
• Prospective design with repeated measures
• Data collection occurred shortly after treatment
  (changes less likely due to daily activity)
• Utilized standardized measurement tools

• Limitations
• Convenience sample which was also small
• More likely to already have healthy behaviors
• More likely to already have strong support system
• No control group

35
Future Direction

• Further research needs to be conducted with the
  following
• Larger sample size
• Including males
• Control group
• Longer duration
• Collect data on functional balance

36
Implications

• Findings suggest jazz dance improves balance
• may have implications to decrease the risk for
  falls in postmenopausal women
• may have sustainability due to being fun
• Does not improve cognition or mood