Dance-Rhythm-Therapy for Patients with Parkinson’s Disease

Emilie Jauffret-Hanifi, Svetlana Panova, France Schott-Billmann

INTRODUCTION

Dance has always been part of the rituals of healing and celebration in traditional cultures. Over time, it has maintained an important role in various civilizations and can serve various functions. It is an art that allows the articulation of movement through rhythm and the added possibility of sculpting time and space through movement.

Rhythm is everywhere and around us all the time. Our first rhythmic experience is that of the heartbeat and breathing. Thus, rhythm is an activity both perceived by a human being and produced by them: the external rhythm is related to our own inner rhythmic experience.

It is this relationship that we have been exploring for six years in our Dance-Rhythm-Therapy workshops with people with Parkinson’s disease (PD).¹ The Primitive Expression method that we use in our work in DRT² (Dance-Rhythm-Therapy) is based on the use of rhythm, especially “primitive” rhythms: beating and swaying (Schott-Billmann, 2015a). People with PD have significant physiological arrhythmias, resulting in psychological and emotional disorders and withdrawal into themselves.

Many studies on the use of rhythm (McIntosh, Brown, Rice, & Thaut, 1997; Pacchetti et al., 2000; Sacks, 2007; Nombela, Hughes, Owen, & Grahn, 2013) and on dance practice in PD (Hackney, Kantorovitch, Levin, & Earhart, 2007, 2009; Marchant, Sylvester, & Earhart, 2010; Heiberger et al., 2011) have legitimized these mediations³ as a method of supportive care in the management of PD which is, after Alzheimer’s disease, the most common neurodegenerative disease in France (Moisan et al., 2018).

After a presentation of the Primitive Expression method and PD, we will describe the methodology which allowed us to establish a protocol of practice and experimentation in DRT with the patients. By correlating the symptoms, the tools used, and the benefits obtained, we are then better able to identify the medical and psychological benefits of the Primitive Expression as a supportive care for PD.

A DANCE-RHYTHM-THERAPY METHOD: PRIMITIVE EXPRESSION

Today, there are different approaches in dance-therapy; DRT is one of them. It gives a central place to the rhythm as well as to the social and therapeutic function of folk dances, which for centuries were performed in town squares (Schott-Billmann, 2015a). Among all these dances, one of them held our attention: Primitive Expression.

Herns Duplan, a Haitian dancer and disciple of the African-American choreographer Katherine Dunham, created Primitive Expression in the 1970s. It is a simple and powerful Metis dance, rhythmed by the drum with structured, codified, symbolic, and repetitivegestures and vocalized by asemantic phonemes. He valued the word “Primitive”, which should be understood as “primordial.” Not meant to be a hypothetical primitive society but the first gesture performed with the first rhythms: the heartbeat and breath. The heartbeat converted in the drumbeat that accompanies dance; the breath converted in the rhythm and balanced movements.

African and Afro-American dances present characteristics close to the dances of therapeutic rituals: energetic and strongly rhythmed by a drum beat. Moreover, the gestures are accessible, repetitive, and liberating. Thus, this type of dance seemed to us adaptable to a dance-therapy method.

The Primitive Expression method, developed by France Schott-Billmann, preserves the ritual elements, the tribal climate and the evocation of a “primitive” imaginary world. But it engages in a different type of relationship with the participants. In this case, Primitive Expression is proposed as a third-party mediating dance. It allows a therapeutic process based on symbolization¹ to discover the right distance between the other and oneself, the imagination and reality, desire and the Law (Schott-Billmann, 2018).

For therapeutic use, we use several tools.

The Ritual

The ritual calls for repetition and rhythm. The latter is given by' the drum, struck by a percussionist. His cadence connects to the vital rhythm; beat and cadence imitate the heart and the breath, the first rhythmic and musical experience perceived by the fetus in the womb. To this is added the use of the voice without words that refers to preverbal language. The repetition of sound patterns and gestures recalls the repetitive nature of a baby’s play.

The group becomes a sort of autonomous entity' in which the dancers wrap themselves and merge, finding solid support and heady resonance. In fact, this method is “choral”: in the unison of gestures and the chanted or melodic voice, each dancer becomes in relation to the group that swings in cadence, like the child in the arms of the mother who rocks them (Schott-Billmann, 2018).

Rhythmic Games

Primitive Expression reactivates the transitional space through rhythmic games inspired by' those shared by mother and child, from lullabies to exchanges of gestures and facial expressions. We can compare the humanizing, socializing, structuring, and empowering work of the mother to her child and that of the therapist to his or her patient (Winnicott, 2002; Dolto, 2013). Anthropology shows us that the activities of traditional societies which are necessary for social and individual balance make use of the structures of children’s games with mothers or peers (e.g., repetition games with words) (Schott-Billmann, 2011, 2013, 2015b).

Creation Times

These are choreographic and rhythmic, gestural and verbal times’ in the sessions. These creation times are always done in small groups for the dynamics of relationship and communication between its members while respecting the rhythmic framework. These creations are based on themes with strong therapeutic potential (e.g., the ugly duckling that becomes a swan), which then solicit the patients’ imaginations.

The Therapist’s Function

The therapist is the guarantor of the framework. They give injunctions to the dancers who relive with them an archaic and hypnotic parental relationship. Their injunctions are meant to have intrinsic value and effectiveness. They are gestural and verbal; the gestures are accessible, powerful, and figurative, and the words they pronounce are related to their symbolism. Thus, everyone can extract a particular memory, can appropriate archetypal images from the collective unconscious, can give meaning to the emotional experiences they trigger and can build social bonds (Schott-Billmann, 2018).

The Symbolization of Impulses

The injunctions given to the dancers are therefore symbols that appeal to the imagination. Through these symbolic gestures, the dancers play primary emotions, primary actions (e.g., take/give, attract/repel), first gestures coupled in opposites (e.g., appear/disappear) which are at the source of the symbolization mechanism. For Winnicott (2002), therapy is playing. In Primitive Expression, the dancers play and joy reigns. Since the therapist also plays, it is felt not real, so there is no guilt, we pretend—that is, we say without saying— while saying!

The Self-Awareness Process

Primitive Expression enables us to be more aware of ourselves, of our body. But it is in the unconscious that the true transformation takes place. The gestures emitted by the dance-rhythm-therapist are a symbolic statement; the participants capture them; the gestures are repeated, they insist on being heard, read. The gesture that is seen, enacted, and felt arouses analogies, associations, emotions. It makes sense. The meaning is what the dancer feels when he receives the symbolic gesture and then begins to incorporate it, to appropriate it, to embody it. The process leads to the gesture speaking to him; the dancer expresses corporeally and freely the emotion that the gesture has aroused in them, which will be different from the one in the neighboring dancer (Schott-Billmann, 2018).

PARKINSON’S DISEASE (PD)

PD is manifested by impressive and key motor disorders mainly in adults age 60, but younger subjects can also be affected. It is due to the disappearance, unexplained until today, of neurons in a brain area called the black substance. The function of these neurons is to make and release dopamine, a neurotransmitter essential to the control of the body’s movements. Their necrosis show motors symptoms of the disease, which are called “Parkinson’s triad.” These are:

• Slowness (Bradykinesia) related to the difficulty initiating and coordinating movements. Patients feel fatigued, numbness or the feeling of being blocked. Blocking (akinesia) is when key motor skills, such as writing, which are semi-automatic actions are affected. In the case of walking, the blocking can manifest as dragging, fast and small steps (called festination) in front of an obstacle or even a stopping of the movement (called freezing).

• • Hypertonia, muscular rigidity, muscular or tendinous pain, and a feeling of stiffness. This can be observed at rest with a posture that is clenched, arched forward, and the head bowed.
• • Tremor: it is an involuntary tremor at rest; if the person initiates a movement it stops. As well as akinesia, Parkinson shaking is closely correlated to the emotional state of mind. A stressful situation or a strong emotion can make shaking considerably worse. Conversely, in comforting and safe situations, the shaking can be significantly reduced.

The degeneration of dopamine also causes non-motor symptoms, such as depression and fatigue, because it plays a role in the regulation of mood, psychic tone, and pleasure.

Dance, Rhythm, and PD

The treatment of PD is complex. It combines medication (L-Dopa Therapy) and supporting drug-free treatments: motor rehabilitation and physical activity. As PD is reflected mainly through motor disorders, the regular practice of physical activity is one of the pillars of its management (Rafferty et al., 2017).

Many studies (Hackney et al., 2007; Westheimer, 2007; Hackney & Earhart, 2009; Marchant et al., 2010; Heiberger et al., 2011), based on small groups, have shown the usefulness and benefits that the practice of dance could bring to patients at the motor, psychological, or relational levels. These observations were confirmed at the Congress of Neurology in Shanghai, where the positive effects of movement based on music, walking, and balance related to the symptoms associated with PD were shown (De Dreu, Van der Wilk, Poppe, Kwakkel, & Van Wegen, 2012).

Regarding dance-therapy, there are very few studies on the use of it for PD (Westbrook & McKibben, 1989). This study highlights the fact that dance-therapy improves the initiation of movement in people with PD as well as walking speed.

Much research has also been done on the use of rhythm in PD (McIntosh et al., 1997; Nombela et al., 2013; Pacchetti et al., 2000; Sacks, 2007). The research shows that the use of rhythm facilitates walking and helps patients overcome slow movements, freezing, imbalance, and lack of muscle control.

All of this research show us that Primitive Expression is an interesting dance-therapy method in the accompaniment of treating Parkinson’s patients because it uses both danced movement and rhythm as specific tools to meet the needs and problems of participants.

That’s why Doctor Fève, a Parkinson’s expert at Bellan Hospital in Paris who knew the work of France Schott-Billmann, proposed to her in 2010 that she pilot a DRT workshop for a group of 12 Parkinson’s patients.

Meeting the Patients

It is quite different to read descriptions of the disease and to be confronted with its manifestations in patients. When we met the 12 patients (five men, seven women, aged 28 to 72), their physical suffering struck us, especially that of the young Parkinson’s patients.

As dancers, for whom the automatisms of the body are self-evident, this triggered in us a deep empathy, and we fully understood the complaint of patients about the psychological consequences of their motor disabilities. They talked about the difficulty of concentration and attention, loss of initiative, apathy, anxiety, memory loss, loss of self-esteem and in the majority, sadness, depression, or even despair due to the loss of quality of life.

At one of the first sessions, we proposed to the patients that they walk around while listening to the drum by moving their body freely (if we can say that, because we were struck by the stiffness of their movements) and singing all together. Despite reduction of the kine-sphere,¹’ the powerful effect of rhythm and song emerged: the disappearance of tremors and blockages, but more importantly, the group members’ smiles, manifestations of joy and the desire to begin the process.