Alzheimer's is a chronic neurodegenerative condition that destroys brain cells, which over time causes memory and thinking skills to deteriorate. It is the most common form of neurocognitive disorder, accounting for over 60% of cases. In Quebec today, 1.79% of the population suffers from Alzheimer or a neurocognitive disorder.
Carol Jones is an artist, choreographer, dance teacher and dance therapy intern, who has been using dance, rhythm and dance therapy to support people with Alzheimer's disease. We asked her to tell us about her experience with this population.
In 2014, I started my studies in dance therapy and in 2015, my mom was diagnosed with Alzheimer's. At that time, I wanted to quit the program to devote myself to my mom, but the director of the program at the National Centre for Dance therapy convinced me to continue. I would have regretted that decision. When I was younger, I wanted to become a doctor, but having obtained a scholarship from the Ballets Jazz de Montréal, I chose dance! Today, dance therapy brings together all my passions. My mother loved to dance, she followed me throughout my career, she used to drive me to all my dance lessons when I was young. Unaware of my journey in dance therapy, but remembering that I dance, my mother, who has been a nurse and loved sports and was then at the early stages of the disease, had the initiative to create a group of elderly people to dance with me. From the first class, I realized the importance of my training in dance therapy. Very quickly, I noticed moments of spectacular lucidity following the dance sessions!
By moving, by doing what we love, we have an impact on our everyday life. By dancing, we create a structure, thus reducing anxiety and bringing joy! My mom knew it! Until stage 5, we can experience joyful moments: people living with Alzheimer's don’t lose their mind, they lose part of their memory, but long-term memory can remain intact for a long time. From stage 6, Alzheimer's affects all brain functions, including long-term memory... For me, that was hard! And then, the pandemic plunged my mother into stage 7. With the confinement, her deterioration accelerated.
Today my mom has passed away. As I searched through her papers, I realized that she had known for a long time that she suffered from Alzheimer’s, long before it was even noticeable. I had to place her in the care of people I trusted in a senior's residence so that together we could better cope with this incurable disease.
Aging in general is accompanied by some fatigue. We don't have the energy we once had, but by respecting our new rhythms, we live the best we can! However, a person with Alzheimer’s can have severe depressive and lethargic moments. In the presence of music, their body vibrates, and when they dance their body wakes up, they breathe more easily, the blood circulates, the small aches disappear momentarily, they find energy, the joy of life, they create connections.
Physical deconditioning leads to harmful effects, from mild to more severe. It can cause issues with balance and walking, leading to a risk of recurrent falls and fractures, or a decline in cognitive performance with a risk of confusion, or even a reduction in cardiorespiratory capacities with a risk of heart failure and infection. It is essential to put in place intervention plans to prevent the deconditioning of our elderly and people living with Alzheimer's. Dancing becomes a preventive act!
As we have said, the positive results are numerous and quantifiable: stimulation and maintenance of cognitive gains, self-confidence, invigorated reflexes, well-being, mobility, endurance, improved cardiovascular functions, maintenance of healthy bones, minimizing the risks fall, positive effect on the immune system and more... Dancing stimulates the secretion of hormones such as endorphins and dopamine, commonly known as "the happy hormones" and dancing generates smiles!
Dancing is mostly practised in pairs or in groups. This helps maintain social bonds and interactions can help slow the degenerative process. In addition, I often have my participants sing, engaging them in significant vocal and respiratory work. In fact, I use different forms of dance and movement since I have a passion for rhythm. As the daughter of a jazzman (drum player), nourished by African rhythms, I often use percussive dance in my workshops and my interventions. Building rhythms from the beat of our heart, our breathing and walking, bodily percussions, motor activity, become playful and organic while promoting the maintenance of the nervous system.
In short, through its social (dance in small and large groups), cognitive (problem solving and limprovised explorations) and sensory (reminiscence, expression of feelings) components, dance stimulates brain activity holistically. In the presence of a song, a distant known tune, a significant rhythm, a peculiar smell, the body remembers and acts. As an artist and dance therapist, I can count on this memory to have access to the personal artistic signature - choreographic and poetic - of every person living with Alzheimer's that I have met.
The impact of dance on people with Alzheimer's has become, in recent years, a research focus. Personally, I follow the work of Dr. De Souza and Dr. Barnstaple (brain, dance, and movement), Dr. Bherer (Laboratory for the Study of Cognitive Health in Seniors) and Dr. Dalla Bella (BRAMS). My work is thus not only based on intuition, but also on science.
The person living with Alzheimer's is living in the present. When stimulated, she comes alive and sometimes experiences impressive moments of lucidity. These moments of lucidity become doors that open onto their past and their future. In return, these bursts of light especially brighten up the present: a time that becomes imprinted with joy, confidence, pride and belonging.
In my dance workshops, I ask questions, we dare answers. Through dance, we highlight and dance their testimonies. The exchanges offer avenues for various solutions. Also, I build my workshops by believing in the neuroplasticity of the brain, a notion that is becoming, it seems, the common point between all the disciplines revolving around Alzheimer's.
When the person with Alzheimer's dances, they strengthen their skills (walking, general mobility, speaking, a certain aspect of logic, etc.). The recourse to a greater freedom of movement, as well as to known images and shapes, to important dates, to places they have visited, helps to consolidate the crumbling personality. The bonds of empathy that are forged between the dance therapist and the participant answers a basic need which lasts beyond the dance experience.
Beyond ensuring a safe environment that promotes ease of movement, the dance therapist wishes to establish meaningful human contact. To achieve this, details can become important: from the temperature of the room to the surrounding noises, to the lighting to, of course, musical choices.
People living with Alzheimer's gradually lose their peripheral vision, so it is important to make clear eye contact with them and, with their permission, to hold their hands. Virtual sessions can sometimes be an interesting challenge in this regard and it’s then that the caregiver becomes a great ally.
Also, a person living with Alzheimer's can easily become anxious about sudden noises. In a group, we will use accessories (octoband, wool ball, etc.) to solidify and stabilize the contact.
In a near future, it would be interesting to adopt a widely used tool called "All About Me", developed by the Alzheimer Society, to access the habits and preferences of the person more quickly.
Rhythm is fundamental, it is the basis of the fundamental systems of human life. It manifests itself in breathing (3 beats: inspiration, suspension, expiration), in the heart (2 beats: systole, diastole), in walking (2 beats: left, right). It also imposes itself in the neurological structure (brain and spinal cord). Rhythm is a driving force, which is why percussive dancing is so instinctive with humans. Rhythm, a motor function, manifests itself in children throughout their growth and becomes important in the development of their coordination, their awareness, and in the control of their emotions. Rhythm and movement would therefore be the basis of intelligence.
What about the person living with Alzheimer's? I would be tempted to conclude that they, while losing control of their rhythm, use it to maintain their coordination, their conscience and to act on the control of their emotions.
For me, the use of rhythm is intuitive since I grew up in it! I discovered African polyrhythms with Dr. Dauphin, among others. Ethnomusicology has generously described the organic role of music in African life. In fact, just before the pandemic, I was planning a second trip to the University of Ghana where I was invited as an artist and dance therapist. For people with Alzheimer’s, this approach of using rhythm can be interesting to work with. Barely audible, their body music (heart, breathing, brain, walking, etc.) must be captured, heard then recreated, evoked, by the therapist, who can seize the natural movement and the needs of their client to awaken body and mind.
Yes. Not at first, but eventually, yes.
The depressive and lethargic states, as well as the violent and aggressive moments, that the disease can cause, as well as dysphasia (language) and aphasia (communication), can have an impact on the movement. Aging as such also plays a role.
We adapt our intervention according to the degree of the disease. We also make sure to choose the right music to support our intervention.
Melodies where the rhythm is really put forward can have an almost magical effect!
I have seen people confined to their wheelchairs start to tap the beat with their feet, then trying to stand up, or actually succeeding in standing up to walk and to dance! Once a man, an ex-musician, with whom I did some more complex hand games, pretended to be a drummer and sang "The piano man" to the beat!
On March 19, 2020, I was forced to leave my mother's residence and was not allowed to return until May 21. At the senior’s residence, I had gotten into the habit of coming by in the evenings and guiding residents to dance and sing on a volunteer basis. When I returned in May, a man living with Alzheimer's immediately recognized me by identifying me as the person we sing and dance with! Unfortunately, due to the pandemic, I was no longer allowed to dance with him or the others, only with my mother. And we took advantage of it until the end. The last music she heard was "In the garden" by Max Richter ...
I had so many wonderful moments with her ...
"As long as the heart beats, there is dance. I thank my mom and all those people living with Alzheimer's. Thanks to our dances they helped me, artistically and humanely."Carol Jones