Why partnered dance might optimize motor and cognitive rehabilitation in Parkinson’s[2019 World Parkinson Congress: Madeleine E .Hackney,PhD]

Madeleine E. Hackney, PhD
Associate Professor, Emory University School of Medicine, Department of Medicine
Research Scientist, Atlanta VA Center for Visual and Neurocognitive Re

Partnered dance is cognitively demanding, mentally stimulating movement conversation
•PD epidemic impacts cognition
•Therapy? Simultaneous combination of physical and cognitive training to improve cognition.
•Animal literature shows rehabilitation combining physical and cognitive challenges may be most effective in inducing beneficial, lasting effects on brain structure and function through neural plasticity

Movement and thought are intertwined in everything we do
•Motor-cognitive integration:
•cognition is embodied in action, and the motor system actively engages in mental processing

Neural plasticity
•Brain’s ability to modulate connections between brain cells, based on experiences
•Anatomical, molecular, genetic, structural, functional levels
•Increased synthesis, release of neurotrophins and neurotransmitters
•Reorganization of cortical representations, synaptogenesis, and synaptic potentiation
•Challenge brain with new activities & experiences
•New synaptic connections form between neurons
•Better communication between neurons
•Benefits increase when challenges are “on-going”, ie. Regular motor-cognitive movement therapy!

Dance therapy: Adapted tango
•Partner dancing: sophisticated, yet accessible system of tactile communication that conveys motor intentions and goals between a “leader” (planner of movement: IG) and “follower” (externally cued mover: EG).
•Dance and other communicative training likely provide a synergistic multisensory adjuvant to motor skills training in both aging and disease models
 

Dance relationship to mental stimulation and Cognition Demand

Dance: cogent vehicle for delivering cognitive rehabilitation
•Dance engages cognitive processes through imagery and creative movement
•Dance may improve spatial function and other aspects of cognition
•Increased cardiovascular fitness modulates brain activations associated with spatial learning

Dance components may contribute to cognitive benefit

•HHI stimulates the tactile sensory system via non-verbal communication
•Interactions forces from hands, torso or arm form a sensory/tactile communication channel about movement goals between partners during cooperative physical interactions.
•HHI requires leader to convey explicit motor goals to a follower through pressure and contact at arms or torso.
•Follower infers and enacts motor intentions of the leader
•However, followers can “backlead,”-momentarily acts as leader
•follower can produce a refined version of the movement structure initiated by the leader –SEEN IN THERAPEUTIC SITUATIONS
 

In Partnered

Experimental setup, CODY and the model of the damper system
•Blindfolded expert dancers (N=10) performed a forward/ backward walking step to drum beat while holding Cody’s end effectors
•HIGH and LOW admittance gain of the robot's mobile base controller
•HIGH and LOW stiffness of Cody’s ARMS
•Measured biomechanics of interaction

RESULTS
•Cody, a robot, could be programmed to respond to (i.e., follow) touch cues given by a blinded, expert human-leader that indicated timing, amplitude and direction of steps
•Admittance controller nonspecific to dance enabled cooperative motion during partner dance using only haptic interaction
•Touch information alone was sufficient to perform partnered dance with complex movements, similar to what social dance teaches
•Human leaders reported dancing with robot more or less similar to dancing with a human.
•Biomechanical measures indicated motion synchrony between the partners.
•Expert dancers rated their physical interaction with the robot favorably when human-robot biomechanical metrics of synchrony were greatest and when interaction forces were lowest

Future Studies
•Physical and cognitive elements are integrated in dance. Dance, even with a robot, may be more engaging and enjoyable than computerized cognitive training during or serially after exercise.  
•Future research should investigate mentally stimulating, cognitively engaging, and potentially neuroprotective properties of HHI intrinsic to dance and leverage these “conversations” as an engaging form of rehabilitation