350 likes | 616 Vues
Introduction. Physical activity
E N D
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
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 Falls according to 2000 census: 360,000 480,000 fall-related fractures each year
Fall related fractures account for $20 billion of annual expenditure, projected to be $32 billion by 2020Falls according to 2000 census: 360,000 480,000 fall-related fractures each year
Fall related fractures account for $20 billion of annual expenditure, projected to be $32 billion by 2020
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
> 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 (N=15)
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 (mean=68 years, sd=8.6 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
24. Results---cont Repeated measures ANOVA showed that balance measures (composite equilibrium scores) improved throughout the study
F(2,22) = 23.185, (p< .0005)
Post-hoc analyses (pairwise comparisons) indicated ?s in balance as follows:
pre (67.33 10.43) to mid (75.25 6.97), (p=0.008)
mid (75.25 6.97) to post (79.00 4.97), (p=0.033)
pre (67.33 10.43) to post (79.00 4.97), (p<0.0005)
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