http://www.mdpi.com/1660-4601/12/3/3120/htm
Marika Demers 1,2,†,* and Patricia McKinley 1,2,† 1 School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, QC H3G 1Y5, Canada; E-Mail: patricia.mckinley@mcgill.ca 2 Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, 3205 Place Alton-Goldbloom, Laval, QC H7V 1R2, Canada †
These authors contributed equally to this work. * Author to whom correspondence should be addressed; E-Mail: marika.demers@mail.mcgill.ca; Tel.: +1-450-688-9550; Fax: +1-514-398-6360. Academic Editor: Paul B. Tchounwou Received: 10 December 2014 / Accepted: 9 March 2015 / Published: 16 March 2015
Abstract
Dance can be a promising treatment intervention used in rehabilitation for individuals with disabilities to address physical, cognitive and psychological impairments. The aim of this pilot study was to determine the feasibility of a modified dance intervention as an adjunct therapy designed for people with subacute stroke, in a rehabilitation setting. Using a descriptive qualitative study design, a biweekly 45-min dance intervention was offered to individuals with a subacute stroke followed in a rehabilitation hospital, over 4 weeks. The dance intervention followed the structure of an usual dance class, but the exercises were modified and progressed to meet each individual’s needs. The dance intervention, delivered in a group format, was feasible in a rehabilitation setting. A 45-min dance class of moderate intensity was of appropriate duration and intensity for individuals with subacute stroke to avoid excessive fatigue and to deliver the appropriate level of challenge. The overall satisfaction of the participants towards the dance class, the availability of space and equipment, and the low level of risks contributed to the feasibility of a dance intervention designed for individuals in the subacute stage of post-stroke recovery. More between these sections at the link.3. Results 3.1. Participation All healthcare professionals working in the Stroke program expressed openness to suggest this research project to the clients who met the inclusion criteria. However, clinicians needed frequent reminders to suggest participating in this research project. Of the 41 rehabilitation beds designated to the neurological clientele, approximately 10 clients were eligible to participate in this study at any given time. Over a period of 20 weeks, 16 participants were recruited for the class and nine participants completed eight dance sessions. None of the participants had any formal training in dance prior to their stroke, defined as having taken more than one year of dance lessons in adulthood. Of the participants who dropped out from the dance classes, four participants were discharged from rehabilitation before the completion of eight dance sessions. Three other participants dropped out of the dance class after trying one or two sessions, because they did not like this intervention and were not engaged in the dance classes. The individual characteristics of the participants who completed the program are presented in Table 2. The mean age of those participants was 63.7 ± 11.7 years (range 47–78) and the majority of the participants were female. Participants were taking 5.9 ± 1.5 medications daily, excluding medication taken when required. The number of individuals who participated in the dance intervention varied from three to eight at one time. This number included the study participants, individuals with other medical conditions and former participants (n = 5) who continued to participate in the dance intervention after the completion of the program, as out-patients. For all participants with low BBS initial score (<40/56), the BBS improved over time, as they continued to receive their usual care in addition to receiving the dance intervention. 3.2. Frequency, Duration and Intensity For this study, nine participants were able to complete a 45-min dance class in addition to their usual care. A 45-min session was long enough to respect the structure of a usual dance class and allowed participants to learn a short routine with a few dance steps. Participants often experienced mild to moderate fatigue after 45 min of moderate intensity dance exercises. However, beyond this time, a significant increase in fatigue was reported, even if the exercises were modified to allow more resting time. In the context of functional intensive rehabilitation, the frequency of two sessions per week in addition to the usual treatment was feasible and realistic in terms of the availability of therapists and turnout to the dance class. The intensity of the treatment was not standardized but graded for each participant according to endurance levels to provide moderate treatment intensity. 3.3. Space The dance class can be performed in an open or closed room. For this study, the selection of an open room rather than a separate private area had advantages for the dance program, but also some inconvenience or the other OTs. One of the advantages for the participants was that they enjoyed performing the learned choreography for an audience composed of therapists, family members or other clients in the treatment room. Another advantage was the ability to stimulate the interest of other clients and possibly recruit new participants. Because of the proximity of the class to the other therapists, additional assistance was available if required. The inconvenience for the other therapists using the room included a temporary loss of space in the treatment room and the possible disturbance to their clients due to the music. Since the dance class was performed in a corner of the therapy department, this prevented from having anyone walk through the dance class while it was taking place and minimized disruption. No formal complaints were received from either the therapists or the patients for losing space or being disturbed by the music.
3.4. Music Selection The songs that solicited the most participation were the popular hits of the 50s’ to 80s’. Participants reported that they preferred songs with a fast pace and a strong beat, whatever the music style. Most of the time, the music was selected based on the participant’s preference in a predetermined playlist.
3.5. Occurrence of Adverse Events The main risks for participating were the risk of fall and an increase in fatigue. No negative consequences to participation were experienced during or after the dance classes, except increased fatigue: “I worked hard, I’m tired”. However, when surveyed, the participants did not feel more tired than after their usual therapies: “I feel as tired as after a good session of physio”. During the dance class, the participants did not want to stop even if they were becoming fatigued.
3.6. Participants’ Perception Participants reported that dance was a challenging, but enjoyable activity, and it was a great complement to their usual therapies. They also mentioned that they enjoyed interacting with the other participants. Two participants expressed that the dance intervention gave them confidence to move in their own body and dance in an informal social context. One participant said “(The dance intervention) allowed me to meet other people with the same kind of problems as me”. Another one expressed that “The exercises are not easy, but I have a lot of fun to attend those classes”. Participants also spontaneously reported an improvement in their standing balance and a decreased fear of falling: “I feel safer to move when I'm standing”, “I can see that my balance is better, because of the dance group”. All participants reported that they liked to perform in front of a small audience because they feel “proud of their accomplishment”. They stated that it was their favourite part of the dance class. Eight participants mentioned being satisfied with the dance intervention and one expressed being “neutral”. Of the seven participants who dropped from the study, three did not enjoy the intervention and consequently dropped the classes. The remaining four participants expressed being satisfied with the intervention, but received their discharge before the completion of eight dance classes.
3.7. Support from Staff and the Organization The stroke team and the program coordinators were open to this new intervention, because it was perceived as a fun and innovative approach to increase treatment intensity, and the classes did not interfere with the usual care. When the intervention was implemented, the program coordinators and the research team worked closely to select an appropriate space for the dance classes. When the dance classes were implemented, the OT aid provided her support by helping the transportation of participants and the preparation of the room. The OTs were open to the dance classes, even if a portion of the occupational therapy treatment room was not available during the dance classes. The treating physical and occupational therapists collaborated with the dance instructor to progress the level of difficulty based on each client’s improvements and to target the individualized treatment objectives. Overall, positive feedback and encouragements were received from the staff.A final discussion session at the link.
1
School of Physical and Occupational
Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal,
QC H3G 1Y5, Canada; E-Mail: patricia.mckinley@mcgill.ca
2
Feil and Oberfeld Research Center,
Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in
Rehabilitation of Greater Montreal, 3205 Place Alton-Goldbloom, Laval,
QC H7V 1R2, Canada
†
These authors contributed equally to this work.
*
Author to whom correspondence should be addressed; E-Mail: marika.demers@mail.mcgill.ca; Tel.: +1-450-688-9550; Fax: +1-514-398-6360.
Academic Editor:
Paul B. Tchounwou
Received: 10 December 2014 / Accepted: 9 March 2015 / Published: 16 March 2015
No comments:
Post a Comment