Interpersonal, Intrapersonal, and Organizational Intersections: A Socio-Ecological Discussion of Adapted Tango Dance for People with Parkinson’s Disease
Introduction:
Adapted Argentine tango (adapted tango) has been shown to be effective at improving motor, cognitive and psychosocial function in individuals with mild-moderate Parkinson’s disease in several studies over the last decade.
Adapted tango is a powerful form of therapy because it integrates traditional exercise content with social dance. Engaging and fun, social dance is acceptable across cultures and may address intrapersonal, interpersonal and organizational spheres. Historically, health interventions have had single-level targets focused on intrapersonal factors and largely resulted in improvements for only short durations. As societal norms and environmental contexts influence behavior, leveraging interpersonal, intrapersonal, and organizational levels of participants’ socio-ecological realms can increase an intervention’s impact.
The Interpersonal Level:
Relationship-related goals are important to older adults. The World Health Organization’s International Classification of Functioning, Disability and Health emphasizes social participation among individuals with mobility and other challenges. An individual’s functioning and participation in activities is an interplay between health condition, environment, and personal contextual factors. The caregiver/care recipient dynamic influences the person with PD, and the physical and psychological health of the caregiver.
Adapted tango may help people with PD re-attain and retain healthy relationships with family. Social dance benefits may extend to caregivers of people with PD by reducing stress and its downstream physiologic correlates, and re-establishing connections with loved ones. Dance-based therapy minimizes stress, promotes exercise, and preserves cognitive function. Adapted tango involves teamwork, communication and problem solving, which can foster relationships outside of adapted tango. Improved health and function in participants may alleviate some disease burden for family members. Our data show caregivers find adapted tango an acceptable activity that provides some benefit to stress, which may promote positive interactions between the caregiver and loved ones.
The adapted tango intervention addresses interpersonal relationships not only because of care partner involvement, but also because of relationships that are developed or fostered with other family members, friends, and new acquaintances as a result of the intervention. The intervention is partnered, and participants dance with multiple individuals in addition to their care partners. This promotes meaningful interactions that would not occur otherwise.
The Organizational Level:
The success of adapted tango programs is influenced by the organizational level. Places with large open spaces appropriate for dancing are places where people gather to learn, to explore their movement repertoire, to make friends and have fun. Often people form vibrant communities in places to dance, which can enrich social networks. By creating a space where everyone is needed and wanted, participants can develop a sense of “felt membership.” By encouraging social, positive touch experiences and providing the opportunity for positive interactions with diverse community members, adapted tango may improve motor, cognitive and psychosocial function among people with PD.
The Intrapersonal Level:
Despite the many benefits of adapted tango, many people with PD find it difficult to sustain an exercise program. Common intrapersonal issues underlying these difficulties include physical limitations, fear of falling, lack of motivation, scheduling conflicts, not knowing how to exercise, poor neighborhood conditions, risk of “overdoing it” and a perception of being “too old.”
Synthesizing the three-level socio-ecological model and adapted tango:
Using a health-literate approach, adapted tango may remove the above barriers to participating in traditional partnered dance and is highly accessible because of 1) adapted movements (intrapersonal), 2) teacher/student relationships, and involvement of family, caregivers and volunteers (interpersonal), and 3) support and facilitation of classes from organizations that typically promote health behaviors in younger and neurotypical populations integrating with Parkinson populations (organizational). When an intervention affects all three of these levels, it can spur new interactions and cause positive behavioral change.
Given partnered dance’s popularity, adapted tango is scalable and sustainable for broad use across the nation, and should be considered as a cogent vehicle for delivering therapy that will address motor, cognitive and psychosocial function.
Madeleine E. Hackney presented at the 5th World Parkinson Congress in Kyoto, Japan. She is currently a Research Scientist with the Center for Visual and Neurocognitive Rehabilitation at the Atlanta VA Health Care System, and she is an Associate Professor of Medicine in the Department of Medicine, Division of General Medicine and Geriatrics at Emory University School of Medicine.
Allison Bay is a Clinical Research Coordinator at Emory University School of Medicine.
Ideas and opinions expressed in this post reflect that of the author(s) solely. They do not necessarily reflect the opinions of the World Parkinson Coalition®