Exercise as it relates to Disease/Gait and balance for Parkinsons through dance

Parkinson's Disease is the second most common neurological degenerative disease,  following Alzheimer's.  It is a progressive disease caused by neurons in the substantia nigra, being unable to produce dopamine. As a whole, Parkinson's impedes on an individuals activities of daily living. At first, the most obvious signs are gross movement problems such as tremors or shaking, rigidity, slowness of movements and postural instability. In worse cases of Parkinson's, it may affect the patient not only physically but mentally as well. Parkinson's Disease is more prevalent in those over 60 years of age, with 4% of people with PD being over 50. and 1 in 7 patients under the age of 50. There is no cure to Parkinson's disease so there is a large focus on slowing down the degeneration. Exercise, and in particular Dance, has had substantial evidence that it is effective in slowing down the degeneration and provides greater balance, gait, confidence and enjoyment to the patients.

Prevalance & Cost
In 2011, approximately 64,000 Australians had Parkinson's Disease with estimations that one in every 350 people were living with it. Worldwide, an estimated 10 million people are living with Parkinson's disease every day. On average in Australia, the cost of Parkinson's per year is around $7,599. Overall costs of Parkinson's disease in 2011 was approximately $775.4 million in Australia with a direct cost to the health system of $478.5 million per year.

Signs & Symptoms
There are four cardinal signs associated with Parkinson's Disease that can help with identification - TRAP.

Other symptoms may include:
 * Hypomimia - reduced facial expression
 * Dysarthria - unclear articulation in speech
 * Dysphagia - difficulty or discomfort when swallowing
 * Sialorrhoea - hypersalivation
 * Micrographia - decreased size of handwriting
 * Shuffling Gait - more steps taken, but the length of the steps or shortened
 * Festination - all joints (knees, hips, ankles) are flexed when walking, limited full extension occurs
 * Freezing - temporarily unable to move without choice
 * Glabellar reflexes - reptitive tapping on the forehead
 * Anosmia - loss of smell
 * Autonomic system dysfunction
 * Cognitive/neurobehavioral abnormalities
 * Sleep disorders
 * Pain

Cause
Parkinson's Disease is a degeneration of the dopamine producing nuerons within the substantia nigra (in the midbrain). Approximately 50-80% of these neurons will die in Parkinson's patients. As the neurons die, less dopamine is produced and taken to the striatum, the area of the brain that co-ordinates movement. Although a lot of research has been undertaken in the past, the exact cause of the degeneration of the dopamine neurons is still unclear. What is now clear is that there are many triggers for the neural degeneration causing Parkinson's.

Treatment
With no cure, there are few pharmaceutical products that can alleviate symptoms such as levodopa (L-DOPA). L-DOPA is the natural precursor to Dopamine, so it helps to provide a greater amount of dopamine to the necessary pathways. L-DOPA is only effective during the early stages of Parkinson's disease though. If there are not enough neurons in the substantia nigra to be able to produce the dopamine with assistance from L-DOPA, it becomes ineffective. There are also some surgical treatments available but these are for the most sever cases of Parkinson's

Exercise has been evident in slowing down the degeneration. Gait and balance are of a large concern for Parkinson's patients. Their gait cycle tends to consist of more steps of a shorter length and a wider stance in order to maintain balance during the transition of each step. In the most severe of cases, patients will have a shuffling action more so than a typical walking pattern. So exercise and movement in any form is a good measure to take in terms of preventative measures.

Dance for Parkinson's
Dance has many beneficial elements towards Parkinson's disease in assisting the slowing of degeneration. In many cases it has been shown that it can even improve the balance, gait, coordination, enjoyment and activities of daily living. Partnered and non-partnered dancing has been observed and although both have seen improvements, the partnered dancing has seen the more significant trends. Waltz, Foxtrot, Tango & Argentine are common styles which have been proven time again to show improvements. It has also been looked at in both mild cases of Parkinson's and in severe cases showing positive improvements for both.

Those with Parkinson's use external cues to focus their attention to be able to move with normality. With partnered dancing such as Tango/Waltz/Foxtrot, the individual has cues such as the music and their partner that they can focus their attention to. Using specific movement patterns, they can focus on moving towards or with their partner to maximize movement and the choreography provided can be very specific to improving movement and so in such fine intrinsic movement, like used in the Tango, it can improve the coordination and balance of the patient.

Common results show that the most improvement in balance, gait, motor control and activities of daily living, will come from 1 hour classes 2-4 times per week with a focus on short amounts of high activity.