PREMIER SYMPOSIUM INTERNATIONAL SUR LA DANSE ET LE MIEUX-ÊTRE
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Actes de conférence Conference Proceedings PREMIER SYMPOSIUM INTERNATIONAL SUR LA DANSE ET LE MIEUX-ÊTRE Collaborer pour faire progresser la recherche, les politiques et la pratique Collaboratively Advancing Research, Practice and Policy Du 24 au 26 mai 2018 Les Grands Ballets, Édifice Wilder: Espace danse, Montréal
© 2019 Les Grands Ballets Canadiens de Montréal Tous droits réservés / All Rights Reserved Imprimé à / Printed in Montréal, Québec, Canada Première impression / First Printing, 2019 ISBN : 978-1-9995690-1-3 Les Grands Ballets Canadiens de Montréal 1435, rue de Bleury, suite 500 Montréal, QC, Canada H3A 2H7 514.849.0269 CentreDanseTherapie.com
REM E RC I E M E N T S
AC KNO WLE DG E ME NTS
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Ce projet a été financé par le Conseil de recherches This project was supported by the Social Sciences
en sciences humaines du Canada and Humanities Research Council of Canada
Ce projet a été rendu possible en partie grâce au This project has been made possible [in part] by the
gouvernement du Canada Government of Canada (Canadian Heritage)
Consulat général des États-Unis, Montréal, Canada The U.S. Department of State
Fonds de Recherche du Québec-Société et Culture Fonds de Recherche du Québec-Société et Culture
Le Centre national de danse-thérapie tient à The National Centre for Dance Therapy wishes
remercier chaleureusement les partenaires qui ont to thank the sponsors who have made this first
rendu le premier Symposium possible : Symposium possible:
Ces actes de conférences ont été rendus possibles These conference proceedings were made possible
grâce au soutien de Joseph X. DeSouza, du Centre thanks to the support of Joseph X. DeSouza, from
for Vision Research de l’Université York et Rebecca the Centre for Vision Research at York University, as
Barnstaple, du département des études en danse de well as Rebecca Barnstaple, from the Department of
l’Université York. Dance Studies.
Les photos incluses dans ce document ont été prises, Pictures included in this document have been taken
à moins d’indication contraire, par Antoine Saito. by Antoine Saito, unless indicated otherwise.
Ces actes de conférence ont été financé (en partie) These conference proceedings were funded [in part]
par le Consulat général des États-Unis. Les opinions, by a grant from the United States Department of
résultats et conclusions mentionnées dans ce docu- State. The opinions, findings and conclusions stated
ment sont ceux des auteurs et ne reflètent pas néces- herein are those of the authors and do not necessarily
sairement celles du Consulat général des États-Unis. reflect those of the United States Department of State.
TABLE DE S M ATI È RE S
TAB LE O F CO NTE NTS
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06 Un mot du directeur du
Centre national de danse-thérapie
A Word from the Director of the
National Centre for Dance Therapy
09 À propos
About
Les Grands Ballets canadiens de Montréal 09
Le Centre national de danse-thérapie 10
Le Premier symposium international sur la 10
danse et le mieux-être
13 Comité de sélection
Selection Committee
17 Articles inédits
Preprint Papers
Mapping the Strata of Human Movement 18
through Laban Movement Analysis: Analysis,
Synthesis, and Interpretation
Why Partnered Dance Can Optimize Motor 20
Rehabilitation for People with Parkinson's
Disease: a Neuroscientific Perspective
Looking in the Mirror: Limits of Mirror 28
Neuron Theory (MNT) and Applications
for Dance/Movement Therapy (DMT)
39 Conférencières invitées
Keynote Addresses
45 Conférences
Conferences
55 Ateliers expérientiels
Experiential Workshops
87 Groupes de discussion
Discussion GroupsU N MOT D U D I RE C TE U R
WOR D FRO M THE DI RE C TO R
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Ce premier Symposium international s’inscrit This first international Symposium is a reflection
dans la génèse et les valeurs du Centre national of the National Centre for Dance Therapy’s genesis
de danse-thérapie, soit d'unifier les expertises, les and values, its goal being to unify the expertise,
forces et les ambitions de chercheurs, cliniciens, strengths and ambitions of researchers, clinicians,
intervenants, artistes et représentants d'organisa- caregivers, artists and representatives of organiza-
tions qui souhaitent faire de la danse un outil de tions who wish to make dance a tool of well-being
mieux-être pour notre société. for our society.
Cet événement représente pour nous l’aboutisse- To us, this event represents the culmunation of five
ment de cinq années de travail multidisciplinaire years of multidisciplinary and intersectorial work
et intersectoriel avec des gens passionnés et with passionate, convinced people. These confer-
conv aincus. Ces actes de conférence, en consi ence proceedings, in recording their considerable
gnant leurs savoirs multiples, le démontrent bien and varied knowledge, are a good demonstration
et permettront, je l'espère, de faire vivre la passion, of that, and my hope is that they will effectively
la conviction et l'audace de tous les conférenciers, bring to life the passion, the conviction and the
présentateurs et participants du Symposium. boldness of all the Symposium’s lecturers, present-
ers and participants.
Ce que vous retrouverez dans ce document est
un aperçu du contenu des conférences, ateliers What you will find in this document is an overview
expérientiels et groupes de discussion ayant été of the content of the lectures, experiential work-
présentés du 24 au 26 mai 2018. En supplément, shops and discussion groups that were presented
certains présentateurs ont généreusement rédigé on May 24 to 26, 2018. In addition, certain
et partagé avec nous des articles encore inédits à presenters generously wrote and shared with us
ce jour, soit Karen K. Bradley et Cecilia Fontanesi, articles not yet published, specifically Madeleine
Madeleine E. Hackney et le trio Barnstaple, Fonta- E. Hackney and the Barnstaple, Fontanesi and
nesi et DeSouza. DeSouza trio.
Si vous désirez entrer en contact avec les présenta- Should you wish to contact the presenters and
teurs et auteurs, contactez le Centre national de authors, kindly get in touch with the National
danse-thérapie. Centre.
En espérant que ce document soit le premier d'une Hoping that this document will be the first in a
série, je vous invite à participer à notre prochain series, I invite you to take part in our next inter-
symposium international, afin de poursuivre et national symposium in order to continue and
faire évoluer la discussion sur la danse pour le advance the discussion on dance for well-being.
mieux-être.
Christian Sénéchal
Directeur, Centre national de danse-thérapie
Director, National Centre for Dance Therapy
67
Christian Sénéchal
Photo : Sasha Onyshchenko8 8
LES GR AN D S BALLE T S
CANA D IEN S D E M O N TRÉ AL
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Faire bouger le monde. Autrement. Moving the world. Differently.
Depuis plus de 60 ans, Les Grands Ballets Canadiens For over 60 years, Les Grands Ballets Canadiens de
de Montréal sont une compagnie de création, de Montréal has been a creation, production and interna-
production et de diffusion internationale qui se tional performance company devoted to the develop
consacre au développement de la danse sous toutes ses ment of dance in all its forms, while always staying
formes, en s’appuyant sur la discipline du ballet clas- faithful to the spirit of classical ballet. The dancers
sique. Les danseuses et danseurs des Grands Ballets, of Les Grands Ballets, under the artistic direction
sous la direction artistique d’Ivan Cavallari, inter- of Ivan Cavallari, perform choreographies by both
prètent des chorégraphies de créateurs de référence long-established and trendsetting creators. Situated
et d’avant-garde. Établis au cœur du Quartier des at the heart of Montreal’s Quartier des spectacles,
spectacles à Montréal, les Grands Ballets proposent Les Grands Ballets embodies an innovative holistic
une approche holistique innovante unique au monde approach, unique in the world. This approach has
de laquelle sont nés Les STUDIOS, ainsi que le Centre resulted in Les STUDIOS and the National Centre
national de danse-thérapie qui font la promotion de for Dance Therapy, which together promote all the
tous les bienfaits que procure la danse. La mission de benefits that dance can bring. The company’s mission
la compagnie est également d’assurer une ouverture is also to ensure accessibility to art for everyone; in
à l’art pour tous et c’est en ce sens qu’elle a fondé, that spirit its achievements include the founding
entre autres, le Fonds Casse-Noisette qui permet à of The Nutcracker Fund, which every year enables
des milliers d’enfants chaque année d’être initiés au thousands of children to enjoy a first ballet experi-
ballet. Les Grands Ballets, reconnus pour leur excel- ence. Les Grands Ballets, recognized for its excel-
lence, leur créativité et leur audace, sont pleinement lence, c reativity and daring, is fully committed to the
engagés au sein de la collectivité et rayonnent sur local community, and is acclaimed on stages around
toutes les scènes du monde. the world.
www.grandsballets.com www.grandsballets.com
9/ ÀA BO
P RO P OS
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Centre national de danse-thérapie The National Centre for Dance Therapy
Fondé en 2013, le Centre national de danse-théra- Founded in 2013, the National Centre for Dance
pie est une division des Grands Ballets Canadiens T herapy is a division of Les Grands Ballets Canadiens
de Montréal. Sa mission est de promouvoir la danse de Montréal with the mission to promote dance and
et le mouvement comme tremplin à la thérapie et au movement as a springboard to therapy and w ell-being.
mieux-être. Son approche interdisciplinaire permet The Centre’s interdisciplinary approach enables indi-
aux individus et aux communautés de bénéficier de viduals and communities to benefit from clinical
recherches cliniques, de formations ainsi que de research and training, as well as from the provision
prestations de services thérapeutiques et adaptés par of therapeutic and adapted services, through dance
la danse et le mouvement. and movement.
Le Centre propose également des formations inten- The Centre also offers intensive training intended
sives à l’intention des futurs intervenants, en plus for future care providers in addition to conduct-
de mener plusieurs projets de recherche en collab- ing several research projects in collaboration with
oration avec des institutions universitaires. « La academic institutions. As explained by Centre direc-
thérapie par la danse et le mouvement amène souvent tor Christian Sénéchal, “Dance and movement often
les personnes isolées par leurs conditions sociales ou help people who are isolated by their social condition
leur santé à s’exprimer et à socialiser davantage que or by the state of their health to better express them-
dans les formes traditionnelles d’activité physique », selves and to socialize more than they would through
explique Christian Sénéchal, directeur du Centre. traditional forms of physical activity.”
La thérapie par la danse et le mouvement est née aux Dance/movement therapy first emerged in the United
États-Unis dans les années quarante. Elle est depuis States in the 1940s. It has since been used as a stan-
utilisée comme traitement principal, en complément dalone therapy or in complement to certain medical
de certains soins médicaux ou psychothérapeutiques, or psychotherapeutic treatments, and as a means to
ou encore s’inscrit dans une démarche de croissance, foster growth, well-being and creativity.
de mieux-être et de développement de la créativité.
Premier symposium international The First International Symposium
sur la danse et le mieux-être for Dance and Well-Being
Le Centre national de danse-thérapie (CNDT) des Following the success of the First National Sympo-
Grands Ballets Canadiens de Montréal, avec le sout- sium on Dance and Well-Being, Les Grands Ballets
ien et la participation de la Fondation de la famille Canadiens de Montréal’s National Centre for Dance
J.W. McConnell, est heureux d'avoir tenu cet événe- Therapy, with the support and participation of the J.
ment d’envergure internationale axé sur la danse et W. McConnell Foundation, is happy to have hosted a
le mieux-être visant à faire connaître les dernières 3-day event featuring new research and methods in
avancées en matière de recherche et de pratique. dance and well-being, with embodied learning oppor-
Pendant trois jours, les participants ont été invités tunities as participants exchanged expertise related
à partager et à enrichir leur expertise en échangeant to the development of this field. This event was held
avec d’autres professionnels issus de disciplines May 24 to May 26, 2018, at the Édifice Wilder : Espace
connexes. Cet événement a eu lieu du 24 au 26 Danse, in Montreal, Canada.
mai 2018 à l’Édifice Wilder : Espace danse, situé à
Montréal (Canada).
dancetherapycentre.com
Centredansetherapie.com
1011
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COMITÉ D E S É L E C T I O N
S E L E C TI O N CO MMI T TE E
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Sylvie Fortin,
Ph. D., département de danse, UQAM (Montréal, QC)
PhD, Dance Department, UQAM (Montreal, QC)
Sylvie Fortin, Ph. D., est professeure au départe- Sylvie Fortin, PhD, is a professor at the Department
ment de danse de l’Université du Québec à Montréal of Dance of the Université du Québec (UQAM) à
(UQAM) et membre du comité exécutif de la chaire Montréal and a member of the executive committee
UQAM pour le développement de pratiques inno- of the UQAM Research Chair for the Development
vantes en art, culture et mieux-être. Elle a accom- of Innovative Practices in Art, Culture and Well-Be-
pagné par la danse et l’éducation somatique des ing. Through dance and somatic education, she has
danseurs en formation professionnelle, mais aussi supported dancers in their professional training,
des enfants et des adultes en situation de vulnérabil- but also children and adults in vulnerable situations
ité (fibromyalgie, dépression, troubles du compor- (fibromyalgia, depression, eating disorders, drug-ad-
tement alimentaire, maladies neuromusculaires, diction and stroke patients). Having been awarded
accident vasculaire cérébral, toxicomanie). Titulaire with various scholarships, she is part of many research
de nombreuses bourses d’organismes subvention- teams, including at the Marie Enfant Rehabilitation
naires, elle fait partie d’équipes de recherche, notam- Centre and CHU Sainte-Justine. She has authored
ment au Centre de réadaptation Marie Enfant et à and coauthored over a hundred scientific papers and
l’hôpital Sainte-Justine. Elle est auteure ou coauteure book chapters. In 2008, she led the writing team of
d’une centaine d’articles scientifiques et chapitres de Danse et Santé: du corps intime au corps social. In
livres. En 2008, elle a dirigé la rédaction de Danse 2011, she co-directed an issue of Recherches Fémin-
et Santé : du corps intime au corps social . En 2011, istes on social inequalities in the health field and, in
elle a codirigé un numéro de Recherches Féministes 2014, an issue of the Journal of Dance and Somatic
sur les inégalités sociales en santé et, en 2014, un Practices on corporal approaches and intercultural-
numéro du Journal of Dance and Somatic Practices ism. International recognition of her work has led
sur les approches corporelles et l’interculturalité. La Sylvie to present conferences and lead practical work-
reconnaissance internationale envers son travail l’a shops in major training organizations in Europe, Asia,
amenée à prononcer des conférences et à dispenser Africa and the Americas. In 2009, she received the
des ateliers pratiques à travers des lieux majeurs de Distinguished Visiting Scholar Award from Auckland
formation en Europe, Asie, Afrique et Amérique. En University.
2009, elle a reçu le Distinguished Visiting Scholar
Award de l’Université d’Auckland.
13/ CS EOLE
M I TÉ D E SÉ L E C T ION
C T ION COMMIT T E E
Robyn Flaum Cruz,
Ph. D., BC-DMT, LPC, Lesley University Expressive Therapies
PhD Program (Cambridge, MA, États-Unis)
PhD, BC-DMT, LPC, Lesley University Expressive Therapies
PhD Program (Cambridge, MA, USA)
Ancienne présidente de l’American Dance Therapy Previously President of the American Dance Ther-
Association, Robyn Flaum Cruz, PhD, BC-DMT, LPC apy Association, Robyn Flaum Cruz, PhD, BC-DMT,
est une thérapeute certifiée en danse et en mouvement LPC is a Board Certified Dance/Movement Therapist
qui possède 37 ans d'expérience dans sa discipline. with 37 years of experience. She is Editor-in-Chief
Rédactrice en chef émérite de la revue Arts in Psycho- Emerita of The Arts in Psychotherapy and of Amer-
therapy et de l’American Journal of Dance Therapy, ican Journal of Dance Therapy, co-editor of Dance/
elle est également coauteure de Dance/Movement Movement Therapists in Action (2012) - a book on
Therapists in Action (2012), un livre sur les méthodes research methods for dance therapy - and Feders’
de recherche en danse-thérapie, et de The Art and The Art and Science of Evaluation in the Arts Thera-
Science of Evaluation in the Arts Therapies (2013) pies (2013) - on evaluation across the arts therapies.
de Feders, qui traite de l’évaluation dans les thérapies She has published over 50 scholarly articles across
par les arts. Elle a publié plus de 50 articles dans les the disciplines of dance/movement therapy, psychol-
domaines de la thérapie par la danse et le mouvement, ogy and neurology, communication disorders, and
de la psychologie et de la neurologie ainsi que des psychology.
troubles de communication et de la psychologie.
14/ CS EOLE
M I TÉ D E SÉ L E C T ION
C T ION COMMIT T E E
Sarah Berry,
Ph. D., ABD, faculté de médecine, Université McGill (Montréal, QC)
PhD, ABD, Faculty of Medicine, McGill University (Montreal, QC)
Sarah Berry est chercheure en bioéthique à la faculté Sarah Berry is a research fellow in Bioethics (Faculty
de médecine et chargée de cours en sociologie à l’Uni- of Medicine, McGill University), course lecturer
versité McGill, ainsi que consultante en recherche in Sociology (McGill University), and research
pour l’institut de recherche du Centre universi- consultant with the Research Institute of the McGill
taire de santé McGill. Ses intérêts de recherche et University Health Centre. Her research interests
projets en cours se penchent sur le développement and current projects are focused on the development
de méthodologies de recherche mixtes pour l’évalu- of mixed-methods research methodologies for the
ation d’interventions innovantes en santé. Récem- evaluation of novel mental health interventions. Her
ment, elle a été impliquée dans des travaux sur la recent work involves the correlation of neuroscientific
corrélation de données neuroscientifiques et sociales, and social scientific research data, with the aim of
visant à s’impliquer dans une recherche translation- engaging in translational mental health research that
nelle en santé mentale et reflétant diverses théories reflects diverse epistemological and etiological theo-
épistémologiques et étiologiques de la santé mentale. ries of mental health. She is currently coordinating
Elle coordonne actuellement une étude combinant des a study combining neuroscientific methods (rsEEG)
méthodologies neuroscientifiques (rsEEG) et scien- and social scientific methods ( journaling and self-re-
tifiques sociales ( journaux de bord et auto-rapports) port) to assess changes in mental health status follow-
pour examiner les changements dans les statuts de ing a dance intervention. Sarah is Chair of the Board
santé mentale suivant une intervention en danse. of Directors at Centre de jour St-James, a Montreal
Sarah est également présidente du Conseil d’admin- nonprofit organization that provides services and
istration du Centre de jour St-James, un organisme support for people struggling with homelessness,
sans but lucratif offrant des services de soutien aux mental health concerns and substance dependence.
personnes vivant avec des troubles de santé mentale,
des dépendances ou en situation d'itinérance.
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ARTIC L E S I N É D I T S
P RE P RI NT PA P E RS
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Au moment de faire un retour sur le contenu When the time came to look back at the content
partagé au Symposium, nous avons fait appel shared at the Symposium, we approached its
à ses présentateurs pour obtenir des complé- presenters for further information. Some
ments d’information. Quelques auteurs authors forwarded unpublished texts or arti-
nous ont fait part de textes et articles inédits cles on topics they had dealt with in their
sur les sujets qu’ils ont abordés dans leurs presentations and discussion groups. The
présentations et groupes de discussion. Les following three texts, highly substantial, have
trois textes suivants, très étoffés, nous ont été been generously shared with us by presenters
généreusement partagés par des présentateurs and authors. To maintain the integrity of the
et auteurs. Afin de conserver l’intégrité des remarks, we decided to present them in their
propos, nous avons décidé de les présenter original language, that being English.
dans leur langue d’origine, soit l’anglais.
17ARTIC L E S I N É D I T S
P RE P RI NT PA P E RS
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Mapping the Strata of Human Movement
through Laban Movement Analysis: Analysis,
Synthesis, and Interpretation
Karen K. Bradley, MA, CMA (Maryland, MA, USA) and Cecilia Fontanesi, CMA, MPhil, PhD
candidate (New York, NY, USA)
An overview of the system of analysis requires an and other manifestations of both human and non-hu-
understanding that the categories of Laban Move- man movement, together with reflection, contextual-
ment Analysis (LMA)—Body, Effort, Shape, and ization and cultural awareness, is a critical part of the
Space—are not segregated but overlap in complex education of a movement analyst.
ways. A movement moment may be “about” the mover As an example of how those who use movement anal-
addressing a single category (i.e. body actions) or ysis tend to select for features, we note how anima-
multiple categories (i.e. a body action that is also tors make choices depending upon use. We ask the
expressive, or spatial, or expressing a mode of rela- questions: What is emphasized? What is missing or
tionship). The question of whether the observer is lessened in each example?
using the perspective of a net or a spotlight is impor-
tant. Movement analysts are taught to begin with a In the Laban Theory Animation video (Sze, 2015),
soft focus (the net) and then to address the context, the body actions are front and center, but there are
followed by the details (the data) of Body, Effort, aspects of Space and even some Effort qualities. In
Space, and/or Shape. The spotlight approach tends another Laban Animation video (Lin, 2013), the body
to reveal bias, and although bias is always present, the part/body action of walking is emphasized, and the
spotlight approach can blind us to our stance. “Effort” qualities are primarily time-based. In the
Moving Space video (Centermoves, 2010), nobody is
As observers take on perspectives, they investigate present, and the animation is simply demonstrating
with curiosity the patterns of behavior being observed. spatial pathways and constructs.
But several cautionary understandings inform any
evaluation or diagnoses: LMA itself privileges the movement features of an
individual mover, whether that mover is presenting
“Real objectivity is not impersonality, but wholeness; as a single observed entity or is in interaction with
the filling out of personality to more nearly match another, is part of a group, or is presenting cultural
the width of the world.” James Moffat implies that patterns that are shared within an established
detachment from the observed experience is prob- community. The authors suggest that using language
lematic; that we need to process what is seen through that identifies non-verbal features of interactions,
the widest lenses possible, rather than believing that small group behavior, or cultural manifestations may
any “objective” measure gives us the full picture. LMA be necessary to define meaning within a context and
is taught from this understanding: that the fullest of provide a broader opportunity for synthesis of such
perspectives gives the most accurate picture. features into a coherent whole.
Along with the notion of objectivity as wholeness, For interaction analysis, in addition to the LMA
Brandon Shaw (2012) wrote: “In particular, whether concepts of Modes of Shape Change (Shape-Flow,
we have experience performing the kind of move- Directional Shape, Shaping) and Phrasing (shared or
ment enacted by the dancers can greatly alter how we competitive), observing for any or all of the following
perceive the movement. Kinesthetic empathy, or the provides an additional layer of information about
ability to intuit what others are experiencing based the style of a mover in interactions: Turn-taking,
upon their bodily behavior, is particularly shaped by Chronemics (timing style), Proxemics (Space use/
our movement histories.” The direct experience of a shared space), Haptics (Touch behavior), Vocalics
wide selection of movement practices, dance forms,
18/ ARTIC LE S INÉ D IT S
P RE P RI N T PA PE R S
(voice qualities), Gaze, and Co-regulation. The infor- “When submitted to several kinds of statistical anal-
mation gathered from observing interaction behaviors yses the Choreometrics variables grouped themselves
can be extremely useful to the artist, audience, thera- into factors of dimensionality, limbs, rhythm, linking/
pist and client to understand some of the social cues leader, intimacy, regimentation, spacing, integration,
and adaptations necessary for intelligibility. group layout, tactics, stance, torso, self-presentation,
Through the use of behavioral observation coding dynamics, size, refinement, and gender. These, in
software (e.g. Mangold Interact, Noldus Observer, turn, formed clusters associated with some of the
ANVIL, BORIS, ELAN, ChronoViz), it is now possible underlying motive forces of social life and communi-
to code interactions among individuals by record- cation — integration, differentiation, energy, rhythm,
ing and analyzing multiple subjects from videos. gender participation, and control of sexuality.”
Such software allows the coder to focus on gaze and This inquiry offers visibility and equal representa-
facial expressions, as well as gestures, movement tion to all cultural traditions as the result of complex
synchronicity, and behaviors between two or more histories of social and expressive behaviors. In parallel
subjects as determined by the coders. The observation to the Choreometrics project, thousands of sound
still focuses on the individuals, but the data reveals recordings have been collected between the late 1940s
points of match and mismatch between subjects. and the 1990s, then later digitized and shared through
However, when observing small group behaviors, it an online platform called The Global Jukebox. This
is important to define social interactions and their project offers a worldwide accessible digital window
function within groups. Unlike individual behav- into our human heritage through the arts of singing,
iors, social interactions cannot be divided down or dancing, and conversing from around the world.
isolated to one individual's behavior, as they are a Through the lenses of individual, interactive, small
combination of acts and postures that influence each group and cultural patterns and behaviours, a type
group member's behavioral sequence. These interac- of intersectionality is possible: movers can be seen as
tions include but are not limited to attuning, adapt- their unique selves, with a cultural and behavioural
ing, arguing, amending, adjusting, synchronizing history that is shared with others, and as adaptable
(temporal, spatial, expressive), calling-responding, members of a dyad or group.
and bypassing. The small group develops an evolved
set of behaviours that allow for inclusion or exclusion,
References
and the individual adapts, or not, or adapts at times.
Centermoves (2010, Oct. 10). Moving Space: The Laban Scale (Demo).
The meaning and purpose of social interactions, Retrieved from: www.youtube.com/watch?v=D00kel96O-o
including dance performances and folk dances, Lin, Chyicheng (2013, Dec. 8). Laban Animation. Retrieved from:
greatly varies within different cultures across the https://www.youtube.com/watch?v=6mI54rLTCMA
world. The Choreometrics project includes a collec- Shaw, Brandon W. (2012). Sitting-there: Embodied perception, kines-
thetic empathy, and reading pain in dance spectatorship. Doctoral
tion of over 3,000 film clips of dances worldwide, Dissertations Available from Proquest. AAI3546050.
which have been recorded by Alan Lomax and
Sze, Steph (2015, Nov. 3). Rudolph Laban Movement Theory Animation.
analyzed in several hundred coding sheets by Irmgard Retrieved from https://www.youtube.com/watch?v=Bu0W8U7OGTo.
Bartenieff and Forrestine Paulay, among others. By
studying different dance traditions and styles, Chor-
eometrics aims toward offering a cross-cultural view
of human movement, investigating how these dances
emerged in response to social needs and to functions
they served, and in relation with the physical, as well
as cultural, environment.
When cultural patterns emerge, the underlying inten-
tions may be hypothesized by the viewer, who may
recognize aggregates of meaningful instances, still
influenced by her/his own experience, background,
and heritage.
19/ ARTIC LE S IN É D IT S
P RE P RI NT PA PE R S
Why Partnered Dance Can Optimize Motor
Rehabilitation for People With Parinson's
Disease: a Neuroscientific Perspective
Dr. Madeleine E. Hackney, PhD, BFA (Atlanta, GA, USA)
In recent years, repeatedly, the benefits of diverse Hackney & Earhart, 2009). Shorter stride length,
forms of exercise and dance to social, physical and and slower gait speed while performing a cognitive
emotional aspects of well-being for people with dual task may result from an underlying cognitive
Parkinson’s Disease (PD) and older adults have been impairment, which is common in PD (Leroi et al.,
demonstrated. Among these, an adapted form of 2006). A co-morbidity of mild cognitive impairment
Argentine tango dance has emerged as a promising is associated with greater falls risk in older people
therapy to address motor, cognitive and psychoso- with PD (Camicioli & Majumdar, 2010).
cial challenges of individuals with PD. This thesis Spatial cognition (Possin et al., 2008), set-switching
demonstrates why partnering in adapted tango may (the ability to switch between mental tasks) (Cools
be responsible for the beneficial effects of this therapy et al., 2001, and Werheid et al., 2007), executive
because of the neural circuitry underlying the distinct function and attention (Hausdorff et al., 2006) are
roles of leader and follower. impaired and impact mobility adversely in individuals
PD is a neurodegenerative disease primarily affecting with PD. However, exercise programs may improve
the substantia nigra in the basal ganglia of the subcor- cognition (Cruise et al., 2011), reduce rates of “near
tical area of the brain. PD leads to greatly reduced falling” (Ashburn et al., 2007), and fall incidence
production of the neurotransmitter dopamine and (Protas et al., 2005) in people with PD. As pharma-
affects the motor system most noticeably but also cological and surgical methods remain only partially
affects cognitive, autonomic, mental and psychosocial effective in treating symptoms of those with PD, addi-
health of the individual; therefore, adversely impact- tional, non-pharmacological approaches that address
ing quality of life. Individuals with PD experience balance and gait difficulties are necessary (Gage et
reduced mobility from postural instability, bradyki- al., 2004). These therapies should be safe, partic-
nesia (extreme slowness of moving), rigidity, tremor ipant-friendly, promote high adherence and have
and turning difficulty. PD affects 1 million Ameri- demonstrated efficacy in improving disease severity,
cans and has formidable personal and socioeconomic mobility and QOL. Several mobility programs are
costs (>$34 billion/year) that are increasing (Noyes effective (e.g. movement strategies, dance, tandem
et al., 2006). Currently, the estimated prevalence of biking, tai chi) for people with PD (Morris et al.,
PD is 7-10 million individuals worldwide, and PD 2009, Earhart, 2009, Ridgel et al., 2009, Hackney
cases are expected to double by 2030 (Dorsey et al., et al., 2008, Kadivar et al., 2011). Traditional exer-
2007). Multiple motor symptoms, including postural cise programs often suffer from high attrition rates
instability, gait impairment, turning difficulty and because of high patient task demand and lack of social
dual-tasking problems rob patients of QOL (Musli- interaction (Qutubuddin et al. 2007). Ideally, exercise
movic et al., 2008). Turning, gait initiation, and activities should engage and sustain interest, because
walking through doorways or other tight spaces can 60% of all Americans older than 65 do not achieve
trigger freezing, i.e., a stoppage during gait (Morris recommended daily amounts of physical activity
et al., 2001), which affects 53% of patients who have (Macera et al., 2001). Activity levels in individuals
had PD 5 years and more (Nieuwboer et al., 2001). with PD are even further reduced (Toth et al. 1997).
Adverse changes to gait while performing a motor Fortunately, dance is often appropriate and pleasura-
and cognitive task simultaneously are greater in those ble as a therapeutic activity, because of its benefits to
with PD than those without (O’Shea et al., 2002, and
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physical, mental and emotional states. Group social continuing. The tango program may create a social
dance can enhance motivation in older individuals supportive environment and a sense of community
to be active and to pursue healthy, exercise-related involvement, which may enhance motivation to exer-
behaviors. Habitual participation in social dancing cise. Even a high dosage, intensive tango program was
over several years is associated with superior balance, feasible and had low attrition for individuals with
postural stability, gait function and leg reaction times mild-moderate PD (Hackney & Earhart, 2009). This
in older dancers compared to age-matched non-danc- research has received media coverage in the New York
ers (Eyigor et al., 2009, and Verghese, 2006). Jacob- Times, Scientific American, National Public Radio
son et al. (2005) report greater improvements in and in the world-renowned neurologist Oliver Sach’s
balance and complex gait tasks in frail older adults book, Musicophilia . Tango classes for people with PD
that participated in an Argentine tango group than in are now offered in several states, the United Kingdom
a walking group (McKinley et al., 2008). Practicing and Australia.
balance while dancing could be just as effective as, While the mechanisms by which tango conveys bene-
and more enjoyable than, traditional physical thera- fit are not yet understood, Argentine tango has intri-
py-led balance training and possibly lead to greater cate and distinctive steps, sequences and patterns,
adherence. Another important advantage of dance and strongly rhythmic music (with European, Carib-
could be the possibilities arising with neural plasticity, bean and African influences). Along with these
the brain’s ability to modulate connections between qualities, partnering in adapted tango may address
brain cells based upon experience. Because of neural specific impairments associated with PD. Partner
plasticity mechanisms, an individual may experience dancing is a sophisticated, yet accessible system of
therapeutic changes that capitalize on exposure to the tactile communication that conveys motor intentions
new movement concepts and approaches garnered and goals between a ‘leader’ (the planner of move-
through dance. These neural adaptations might ment) and ‘follower’ (the externally cued mover). An
promote enhanced motor and cognitive function. ‘embrace’ or ‘frame’ between the leader and follower is
Since 2006, a series of studies of 20 hours of adapted the primary point of contact through which the leader
Argentine-tango dance (adapted tango) have shown indicates movement qualities and goals to which the
gains in mobility and balance, maintained one month follower responds. Partners maintain contact by hold-
later in individuals with mild-moderate PD (Hack- ing elbows facing one another, maintaining forearms
ney & Earhart, 2009, Hackney et al., 2007, Hackney parallel to the floor. To keep the ‘connection’ clear
& Earhart, 2009, Hackney, 2010, and Hackney & between the partners, tone of the arms should remain
Earhart, 2010). Continued studies of this program in constant throughout the dance. Body weight of part-
a 30-hour format have shown similar mobility gains ners should be lightly directed toward one another,
along with improved spatial cognition and disease so both individuals receive tactile information about
severity (McKee & Hackney, 2013). Importantly, their partner’s axial placement, which is especially
participant-friendly, adapted tango has had low important for communicating motor intentions. In
attrition (15%), demonstrating patient acceptance the adapted tango classes that served as the reha-
and feasibility within a diverse patient population. bilitative therapy in these studies, participants both
More than 150 persons with PD have been recruited to led and followed all dance steps with healthy part-
participate in several interventions of several months’ ners. Therefore, the studies’ participants alternated
duration, using adapted tango to address PD-specific between two motor training approaches: a) leading,
motor difficulties. Adherence is critical to any exercise i.e. internally guiding movement plans, and b) follow-
program, but 60-85% adherence to physical activity ing, i.e., responding to external guidance. Qualities of
in impaired older adults is considered high. With an effective rehabilitative programs are found in both
85% compliance rate, partnered dance’s feasibility leading and following within the context of adapted
and benefits on functional mobility and quality of tango. For example, training for postural instabil-
life for persons with PD were demonstrated for the ity is most effective if dynamic balance practice and
first time. Maintenance of these gains has also been continual adjustment to environmental demands are
demonstrated (McKee & Hackney, 2013), and partic- incorporated (Hirsch et al., 2003).
ipants reported favorable impressions and interest in
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During therapeutic dance, a goal for individuals with factors, both internal and external, and the interplay
PD and older adults is to move with dynamic balance, of multiple body systems. To maintain balance, adults
i.e. the process of moving the center of mass beyond use a combination of information from the soma-
the range of the base of support and re-achieving tosensory (which encompasses touch, proprioception
balance with the next step. Steps that accentuate and and vibration), vestibular and visual systems. As one
challenge dynamic balance are necessary. However, ages, or if one has a progressive neurodegenerative
for those with PD, traditional steps, e.g. the molinete disease like PD, the integrity of this information and
(“windmill, wheel”: grapevine pattern of the feet, the ability to use accurately the information from
performed in a rotating circle around the leader, each of these systems decreases. Therefore, progres-
which involves extensive and continuous contrabody sive movement retraining should involve activities
movement), ochos (figure eight patterns involving that increase awareness and utilization of the three
pivoting with the feet) and the cruzada (“crossed”: systems. Dance almost always uses all three systems.
stepping backward, then crossing one foot over the For example, when standing, one can place attention
other tightly with the succeeding backward step), on the pressure of feet on the ground while keeping
are modified because traditional foot placement for chin and shoulders level (somatosensory), and one
these steps may over-challenge the stability limits of can focus on a vertical target (visual). If one closes
those with PD. Specifically for individuals with PD, one’s eyes while standing on an uneven surface like
having complex movements broken down into simpler soft sand, or a foam cushion, one will likely make use
elements by the teacher, done frequently when follow- of one’s vestibular sense. One also uses one’s vestibular
ing any dance pedagogy, may facilitate motor perfor- system to keep balance while turning. Adapted tango
mance (Morris et al., 2009). Synchronizing movement can target the somatosensory, vestibular and visual
to rhythm, inherent to dance, may enhance movement systems because of the enhanced focus on tactile and
speed in those with PD (Howe et al., 2003). A part- kinesthetic (one’s own “map” of one’s body parts in
ner may enhance balance as even very light touch space) awareness. Further, while dancing, balance will
contact can augment postural control (Jeka, 1997). be challenged through moves that demand balance
It has been demonstrated that the partner does not on single leg support, or complex double leg support
serve as a crutch, given that balance and mobility (cruzada or long strides), or while turning (molinete),
gains were similar between a group that danced with a to name just a few examples.
partner compared to a group without partners (Hack- Regardless of gender, participants learn both leading
ney & Earhart, 2010). The assistive partner for the and following roles to ensure that all participants
patient is ubiquitously a skilled individual without with PD fully explore their motor repertoire. By danc-
functional impairments, trained to guide the indi- ing both roles, each participant practices frequently
vidual with impairment safely through rehabilitative moving both forward and backward, which is impor-
motor patterns conducted within an adapted tango tant from a motor rehabilitative perspective. Yet, in
class (Hackney & Earhart, 2010). This individual can addition, dancing both roles allows a dancer to expe-
serve as both leader and follower, fulfilling several rience two distinct motor-cognitive reference frames
responsibilities within these roles. This individual can that could impact movement ability in different but
a) detect the level of postural/motor disability within equally important ways: while leading, participants
the individual, b) plan an optimal motor rehabilitative practice self-directed, internally generated move-
program (based on the principles of partnered, impro- ments, whilst followers practice responding to exter-
vised dance) for these disabilities and c) monitor the nal cues. Furthermore, changing roles continually
patient continually for the loss of balance and as such, challenges those with PD to attend to their move-
prevent falls. ment, which may be crucial to the motor rehabilita-
Monitoring for instability is crucial because people tion of those with PD. These differences in cognitive
with PD often experience falls, which leads to with- reference frame between leading and following may
drawal, low self-esteem and poor mood (Bloem et al., address particular deficits of motor function, result-
2001). In one study, 70% of PD patients fell within one ing in distinct training gains in mobility because the
year and 50% had a repeat fall the next year (Bloem neural circuitry that drives leading and following
et al., 2004). Falls occur as a result of multiple risk movement likely differs.
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Leaders must have a world-centric reference frame crucial attentional resources to planning movement,
and to dance successfully— multitasking by focusing potentially they can attend more to postural control,
on environment, follower, music, and both current which becomes increasingly necessary as a person
and future motor plans. Leading, which uses inter- ages or contends with a neurodegenerative move-
nally guided cognitive and motor skill, is thought ment disorder. Therefore, both leading and following
to involve employing a “movement strategy” that movement in rehabilitative dance have advantages.
demands increased focus on movement plans and Whether one role is superior to another for rehabilita-
mentally rehearsing and/or preparing for move- tive purposes is unclear, but likely the practice of lead-
ment. Leaders in partnered dances must determine ing and following roles impacts the neural circuitry
precise spatiotemporal movement parameters of a underlying such movement constructs. However, little
dance sequence, e.g., amplitude, direction, timing, is known about the neural mechanisms underlying
and rotation. As such, leading may pose a challenge motor and cognitive improvements as a result of reha-
for individuals with PD, given that they have deficient bilitative training in individuals with PD.
executive control, specifically in cognitive processes A study utilizing positron emission tomography (PET)
involved in planning and executing complex, goal-di- showed improved vocal intensity after training in
rected behavior (Kliegel et al., 2005). However, the Lee Silverman Voice Training (LSVT®) LOUD
movement strategies involving strong cognitive program for speech improvement. These motor
involvement and planning are also associated with improvements were correlated with modification
mobility improvements (Morris et al., 2009). Focus- in motor, auditory, and prefrontal areas but with no
ing on critical movement aspects (e.g. quicker move- associated effect on the basal ganglia (Narayana et al.,
ments, longer steps) helps individuals with PD to 2010). However, in healthy participants, increased
achieve nearly normal speed and amplitude (Morris activity in the putamen, a region of the basal ganglia
et al., 2001). Thus, although people with PD might responsible for controlling movement, was noted
find leading a partner to be highly revealing of their using PET when tango movements were performed
deficits, practicing the leading role could be critical to a metered beat (Brown et al., 2006). In a related
for their motor progress. finding, after a week of tango, healthy individuals
The observed improved function gained via adapted exhibited increased activity of areas involved with the
tango in individuals with PD may be due to benefit control of movement (i.e., the supplementary motor
from multiple external cues present when following (SMA) and premotor cortices) during imagined walk-
movement. If dancing the role of the follower, partic- ing (Sacco et al., 2006).
ipants strongly focus on external cues, which may Underlying mechanistic commonalities may exist
access circuitry involving the cerebellum, thalamus amongst a variety of therapies that effectively target PD
and the cortex, and therefore bypass the basal ganglia symptoms (Asanuma et al., 2006). In the case of deep
(Freedland et al., 2002). Abundant evidence demon- brain stimulation, stimulating the subthalamic nucleus
strates benefits of rehabilitative exercise that exploits is thought to suppress abnormal downstream network
external cueing and specifically targets neural systems activity produced by the malfunctioning basal ganglia
that support balance (Kadivar et al., 2011, and Nieux- (Trost et al., 2006). If the mechanism of improvement
boer et al., 2009). External cueing has improved resulting from dance training is similar, abnormal
movement initiation (Dibble et al., 2004, and Jiang neural activity in the basal ganglia, thalamus and corti-
& Norman, 2006). Other research showed that people cal motor structures may be reduced. Alternatively, with
with PD have faster reaction times when externally effective treatment, there may be enhanced compensa-
cued compared to self-initiated movement (Ballanger tory capabilities within areas involving the cerebellum,
et al., 2006). Importantly, while following in adapted the thalamus and cortical sensory and motor areas (Yu
tango, (in contrast to leading) the participant is not et al., 2007). Another possibility could be a restorative
required to plan precise spatiotemporal parameters of mechanism, i.e. increased activity in the basal ganglia,
movement (e.g. direction, length of step, timing, and demonstrated to be hypoactive in drug-naïve individuals
amount of rotation). From moment to moment the in early stages of PD (Spraker et al., 2010).
follower receives movement guidance from the leader
via tactile cues. Because followers are not devoting
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In healthy individuals performing tasks in which older adults with PD may be better prepared to shift
they follow or respond to a cue, cerebellar circuitry quickly into an appropriate motor skill to adapt to
is primarily recruited, while striatal (basal ganglia) sudden changes in their environment. In adapted
circuitry is primarily recruited in leading tasks tango classes, instructors have encouraged the honing
(Taniwaki et al., 2006, Lewis et al., 2007, and Sen of partnership skills by maintaining connection
et al., 2010). Because there is dysfunction of the through the embrace while changing weight fully,
basal ganglia, people with PD have difficulty inter- walking backward, maintaining posture, and align-
nally generating movement (Low et al., 2002, and ment. Participants are encouraged to practice steps
Wu et al., 2011). PD may influence neural circuitry and develop confidence in their ability to perform
governing leading and following movements on a these steps; however, some individuals with PD have
task-specific basis. For example, during following expressed preference for learning fewer steps but
movements, people with PD activate cerebellar, repeatedly practicing them. And switching the lead-
thalamic and cortical areas similarly to individuals ing and following roles is also viewed as challenging.
who do not have PD; however, during leading tasks Learning new movement can be difficult and frus-
in individuals with PD, both cerebellar and striatal trating for many people. Aging and disease probably
areas are activated (Lewis et al., 2007). In keep- increase the challenge. However, the act of learning,
ing with the idea of increased compensatory activ- practicing and exploring new movement in a part-
ity and/or connectivity of cerebellar circuits during nership should be emphasized over the perfection
leading tasks, striato-cortical and striatocerebellar of any one step. Simply being exposed to new move-
connections are weaker in individuals with PD than ment, attempting to perform it, and then seeing the
in individuals without PD, while cortico-cerebellar flip version of the movement by switching from the
connections are strengthened (Wu et al., 2011). As a leading to following role (and vice versa) may in fact
compensatory response, those with PD tend to recruit have had great impact on the findings of mobility
cerebellar and thalamic circuitry to perform tasks improvements in those with PD.
involving internally generated movement increas- Balance and mobility disorders resulting in falls
ingly with time (Sen et al., 2010). Whether leading among older adults with and without PD pose a seri-
or following is better for improving movement capa- ous public health problem in the United States. Costs
bilities in those with PD remains equivocal. Possibly associated with falls among older adults are estimated
practicing the leading role could lead to enhanced to be as much as $100 billion. Further, adults over
activity in the striatal-cortical areas, if the mecha- the age of 65 represent the fastest-growing popu-
nism of improvement is restorative. However, if the lation in the United States. Today, unprecedented
mechanism of improvement via adapted tango is numbers of people age 85 and older in the US desire
largely compensatory, following dance might prove to maintain independence throughout their lifetime.
most beneficial, given that compensatory pathways Therefore, an immediate and pressing need exists
involving the cerebellum are likely upregulated with for activity programs specifically designed to reduce
such practice. More research is necessary to deter- physical frailty and the rising incidence of falls among
mine the answers to these questions. the older adult population, as well as those with PD.
Possibly, learning both roles and switching roles For these programs to be most targeted in their effi-
several times during a dance session is a key to cacy, focused research to determine mechanisms of
enhanced mobility and the ability to accomplish improvement and to optimize training programs
daily activities. Motor skills required to complete must be conducted. Currently, there is insufficient
activities of daily living often require adaptability to information about human-human full-contact inter-
ever-changing and unpredictable environments in actions and how humans communicate the complex,
which we all find ourselves. While the practice and sophisticated motor intentions of partnered dance
rehearsal of comfortable steps may reinforce “healthy” by tactile means. How do partnered dancers inter-
movement patterns, it may not encourage adaptabil- pret subtle changes in pressure at points of contact
ity. By continually exercising mental and motor capac- in order to determine (or direct) direction, magni-
ities through the study of an ever-expanding motor tude and timing? The means by which the leader
repertoire and through switching roles repeatedly, communicates the tactile message to the follower and
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how the follower receives the message have not been Language differences do not pose a problem in tango
quantified by reliable measures. We currently have because partnered dance is a language itself, formed
insufficient information about neural mechanisms by a human-human tactile connection and non-verbal
by which a skilled assistive partner determines the communication.
level of postural/motor disability within the individ- This advantage of non-verbal communication
ual (e.g. via vision, pressure points of contact)—the between partners has no doubt contributed to the fact
criteria for planning an optimal motor rehabilita- that research into adapted tango has also appealed
tive program for these particular disabilities—and to individuals the world over. Studies about its effec-
monitors the patient for perturbations and balance tiveness are taking place in diverse locations, includ-
instability. Knowledge about neural changes that may ing Australia, the United Kingdom, Argentina, the
occur after repeated and targeted training with lead- United States, and Canada among others. My work
ing and following tasks will allow the development has been presented at the Welcome Center in London
of better rehabilitation training strategies for those and at an annual Tango Terapia conference in Argen-
with PD. tina; and I was invited to speak in Sweden twice,
once in the Nobel Forum, upon this subject. Given
Adapted Argentine Tango Impact Worldwide,
the involvement of international researchers in the
International Influences upon the Work and debilitating illness of PD, the melding of neurologi-
the Participant cal rehabilitation with further study of dance and its
Today, Argentine tango is a partnered dance with an powerful mechanisms will lead to the development of
incredible worldwide presence. People dance tango all cross-cutting, novel ideas that broach international
over the world and many have become fanatical about boundaries. This body of work has brought up ques-
the art form, a passion to which I also succumbed tions about dance for its powers to heal, its powers
when I first began learning the dance in the year to form connections between individuals of diverse
2000. At this time, I had only recently returned from backgrounds and needs. Dance has always had multi-
a year’s stint as a professional dancer in Japan at an faceted roles in society, which figures such as Selma
amusement park with the largest wave pool in the Jeanne Cohen certainly recognized. My work has been
world, preceded by two years touring Europe with a calling to demonstrate dance’s ability to penetrate
musicals, including . Little did I know then how the one of the most challenging of human conditions -
tango I began to learn while touring would impact degeneration of the ability to move. Through dance,
my future career choices and research plans. My own we may all, even those who are most adversely chal-
international experiences as a professional dancer, lenged, be able to learn to move again.
dealing with multiple injuries and constantly striv-
ing to improve my technical abilities, undoubtedly
laid the foundation for my inquiry into the study
of dance for therapeutic purposes. My early career
focused on theatrical dance forms (i.e. ballet, theater
and contemporary forms) but after returning to New
York, NY, I was fortunate enough to be able to explore
an interest in partnered dances by being trained
at Stepping Out dance studios to be a ballroom
and social dance instructor. I learned to teach and
perform American ballroom, International ballroom
and social dances, including hustle, salsa, country
western, swing, and naturally Argentine tango. For
two intense years, I went every night to a different
milonga (a social Argentine tango dance) in NYC, a
perfect locale for me to continue to find international
influences, because this dance perhaps like no other,
draws individuals from all over the world together.
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