ARTICLE Effects of Tango on Functional Mobility in Parkinson’s Disease: A Preliminary Study Madeleine E. Hackney, Svetlana Kantorovich, Rebecca Levin, and Gammon M. Earhart Abstract: Recent research has shown that dance, specifically tango, may be an appropriate and effective strategy for ameliorating functional mobility deficits in people who are frail and elderly. Individuals with Parkinson’s disease (PD) experience declines in functional mobility that may be even more pronounced than those experienced by frail elderly individuals without PD. The purpose of this study was to compare the effects of two movement programs: tango classes or exercise classes. Nineteen subjects with PD were randomly assigned to a tango group or a group exercise class representative of the current classes offered in our geographical area for individuals with PD. Subjects completed a total of 20 tango or exercise classes and were evaluated the week before and the week following the intervention. Both groups showed significant im- provements in overall Unified Parkinson’s Disease Rating Scale (UP- DRS) score and nonsignificant improvements in self-reported Freezing of Gait. In addition, the tango group showed significant improvements on the Berg Balance Scale. The exercise group did not improve on this measure. Finally, the tango group showed a trend toward improvement on the Timed Up and Go test that was not observed in the exercise group. Future studies with a larger sample are needed to confirm and extend our observation that tango may be an effective intervention to target functional mobility deficits in individuals with PD. (JNPT 2007;31: 000–000) INTRODUCTION G ait changes commonly noted in Parkinson’s disease (PD) include a flexed posture, shuffling steps, difficulty with stride length regulation, reduced foot clearance during swing phase, and increased cadence, leading to the potential for falls and the associated sequelae. 1–6 A prospective study found that roughly 60% of people with PD experienced at least one fall in a six-month period. 7 People with PD often have more difficulty turning while walking than they do when walking in a straight line, which may place individuals at greater risk for falls while turning. These falls are eight times more likely to result in hip fracture than are falls during straight walking. 8 Turning can also trigger freezing (ie, a slowing or stoppage of movement) during gait. Freezing, a common problem affect- ing 53% of patients who have had PD for over five years, 9 also occurs with gait initiation and when walking through doorways or other tight spaces. 10 People with PD often have difficulty walking in dual-task conditions. 11–14 Gait speed, stride length, and gait stability all decrease when individuals with PD are placed in dual-task conditions where they have to walk while they concurrently do another task such as mental arithmetic. Loss of functional mobility can lead to low self esteem, poor mood, withdrawing from activities, and de- creased quality of life. 15 A number of different exercise programs have been suggested to address movement difficulties in an attempt to improve mobility and reduce risk of injury. 16 –18 Several exercise programs tailored specifically for individuals with PD (eg, Fit ‘N Fun, 16 Motivating Moves, 17 Parkinson’s Dis- ease & the Art of Moving 18 ) are commercially available, but none have been rigorously investigated to evaluate their effects. Despite this lack of evidence, the only currently offered group exercise programs for people with PD in our area are of this type. As such, one goal of our study was to provide evidence regarding the effects of this type of exercise on functional mobility in people with PD. Recent evidence suggests that dance can also be used as a therapeutic intervention to effectively target balance and complex gait tasks in healthy elderly individuals. 19 Dance/ movement therapy has been recommended for elderly people to increase or maintain their range of motion. 20 Dance/ movement therapy has also been used as a successful thera- peutic intervention for people with PD. A group of subjects with PD who participated in free-form movement demon- strated improvements in movement initiation. 21 Jacobson et al 19 reported preliminary results of Argen- tine tango lessons compared to walking on clinical measures of balance and gait in the frail elderly individual. They reported greater improvements in balance and complex gait tasks in the tango group as compared to the walking group. This suggests that the movements and patterns of tango may be as effective as strength/fitness exercise approaches for addressing balance and gait deficits. In addition to the specific movements, tango may also be beneficial because, like most dance, it involves coordination of movement to music. The music may serve as an external auditory cue. Use of such cues to facilitate movement is known to be beneficial for individuals with PD. 22–24 Auditory cues can improve gait initiation, walking speed, and cadence in laboratory set- tings 22,23 and while performing a functional task within the Program in Physical Therapy (M.E.H., R.L., G.M.E.), Department of Biol- ogy (S.K.), Department of Anatomy and Neurobiology (G.M.E.), and Department of Neurology (G.M.E.), Washington University School of Medicine, St. Louis, Missouri Address correspondence to: Gammon M. Earhart, E-mail: earhartg@wustl. edu Copyright © 2007 Neurology Section, APTA ISSN: 1557-0576/07/3104-0001 DOI: 10.1097/NPT.0b013e31815ce78b JNPT • Volume 31, December 2007 1