University of Montana ScholarWorks at University of Montana Graduate Student eses, Dissertations, & Professional Papers Graduate School 2019 e Effects of Argentine Tango on Balance and Quality of Life in Subjects With Traumatic Brain Injury Pamela Marie Peterson Let us know how access to this document benefits you. Follow this and additional works at: hps://scholarworks.umt.edu/etd Part of the Movement and Mind-Body erapies Commons is esis is brought to you for free and open access by the Graduate School at ScholarWorks at University of Montana. It has been accepted for inclusion in Graduate Student eses, Dissertations, & Professional Papers by an authorized administrator of ScholarWorks at University of Montana. For more information, please contact [email protected]. Recommended Citation Peterson, Pamela Marie, "e Effects of Argentine Tango on Balance and Quality of Life in Subjects With Traumatic Brain Injury" (2019). Graduate Student eses, Dissertations, & Professional Papers. 11420. hps://scholarworks.umt.edu/etd/11420
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University of MontanaScholarWorks at University of MontanaGraduate Student Theses, Dissertations, &Professional Papers Graduate School
2019
The Effects of Argentine Tango on Balance andQuality of Life in Subjects With Traumatic BrainInjuryPamela Marie Peterson
Let us know how access to this document benefits you.Follow this and additional works at: https://scholarworks.umt.edu/etd
Part of the Movement and Mind-Body Therapies Commons
This Thesis is brought to you for free and open access by the Graduate School at ScholarWorks at University of Montana. It has been accepted forinclusion in Graduate Student Theses, Dissertations, & Professional Papers by an authorized administrator of ScholarWorks at University of Montana.For more information, please contact [email protected].
Recommended CitationPeterson, Pamela Marie, "The Effects of Argentine Tango on Balance and Quality of Life in Subjects With Traumatic Brain Injury"(2019). Graduate Student Theses, Dissertations, & Professional Papers. 11420.https://scholarworks.umt.edu/etd/11420
The Effects of Argentine Tango on Balance and Quality of Life in Subjects With Traumatic Brain Injury
By
PAMELA MARIE PETERSON
Bachelors of Science Degree, University of Montana, Missoula, Montana, 2014 Associate of Science, Solano Community College, Fairfield, California, 2011
Thesis
presented in partial fulfillment of the requirements for the degree of
Master of Science
In Health and Human Performance
The University of Montana Missoula, MT
Official Graduation Date May 2019
Approved by:
Scott Whittenburg, Dean of The Graduate School
Graduate School
Dr. Charles Dumke, Chair Health and Human Performance
Dr. Matthew Bundle
Health and Human Performance
Ann Stevenson, LCPC
Peterson 2019
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ABSTRACT
This study investigated the effect of a six-week tango-based intervention on the balance
and quality of life on subjects with traumatic brain injury (TBI). Twenty-two men and women
were assigned into three groups TBI group (TBI: n=2; 44.5±2.1 years), Treatment control (TC:
n=8; 30.9±12.3 years), Control (CG: n=12; 32.8±9.6 years). The TC group showed an
improvement in stress levels compared to the CG p<0.05. While all groups improved in most of
the feet on foam with eyes closed condition over time, those that participated in tango
improved more (time p<0.05). Findings demonstrate that tango improves stress in subjects
with TBI, and may improve balance regardless of TBI.
ACKNOWLEDGEMENTS
I would like to thank both of my professors who helped me more than I can say with this
project: Dr. Dumke and Dr. Bundle. Thank you to Ann Stevenson as well for her unfailing
Quality of life scores were separated into their respective categories and then summed
to get each subject’s score before and after the intervention.
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Considerations:
Subjects gave their written informed consent to engage in all measures and activities
associated with this study.
Statistical Procedures:
Statistical analysis using 3x2, 2x2 ANOVA and a two-tailed independent t-test for
balance measures as well as 3x2 and 2X2 ANOVA for quality of life measures in SPSS.
Significance was set at p<0.05.
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Chapter 4 Results:
Twenty-six subjects participated in pre assessment of quality of life and balance testing
consisting of surveys and analysis of balance in six conditions each with twenty- three
completing the study for a total of 49 quality of life surveys and 294 balance scores assessed.
Further analysis of these scores broke each of these conditions into ten categories that were
evaluated: Center of Pressure Area, Displacement, Anterior-Posterior Displacement, Medial-
lateral Displacement, Average Velocity, Peak Velocity, AP Average Velocity, ML Average
Velocity, AP Peak Velocity and ML Peak Velocity.
Each of the subjects participated in weekly practice sessions and dance classes with the
duration of each being 1.5 hours. Both TBI participants missed one class and they attended all
practice sessions. Of the treatment group four had perfect attendance, two missed a practice
session, and three missed both a class and a practice session which was the maximum to miss
without being removed from the study.
In the treatment groups there were n=2 with TBI and n=12 without TBI three of which
were removed due to non-compliance with attendance protocols. The control group had n=12
subjects. The TBI group had one female aged 43 and one male aged 48. In the treatment
control group, there were six females aged 34±12 years and four males aged 27±13years. The
control group included six females aged 29±9 years and six males aged 33±8 years.
Quality of Life:
Using the DASS-21, the scale of the data are 0-21 in all categories and the data are
without units.
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Quality of Life:
Quality of Life:
Depression:
There was not a main effect of time, nor a significant time*group interaction for
depression (Figure 2A).
Anxiety:
There was not a main effect of time, nor a significant time*group interaction for anxiety
(Figure 2B).
Stress:
There was a p=0.029 time*group significant interaction in the treatment control group
(Figure 2C). Post hoc analysis demonstrated that the treatment control group was different
from both the TBI and control group post intervention.
Figure 2: The TBI Group (n=2), Treatment control (n=8), and Control (n=12). There was a p=0.029 time*group interaction in the stress category for the treatment control group.
*
A B C
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Balance:
There were six conditions for each of the ten categories: feet together with eyes open
(FTEO), feet together with eyes closed (FTEC), feet apart with eyes open (FAEO), feet together
on foam with eyes open (FFTEO), feet together on foam with eyes closed (FFTEC), and feet
apart on foam with eyes open (FFAEO). The level of difficulty for the subjects from least to
most difficult is as follows: FAEO, FTEO, FFAEO, FTEC, FFTEO, and FFTEC as demonstrated in
Figure 3.
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Figure 3: This Figure represents the control group and is mean ± SD during the pre-assessment phase of the trial and shows the progressive difficulty of the conditions.
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Center of Pressure Area (cm2):
Figure 5:The TBI Group (n=2), Treatment control (n=8), and Control (n=12). There was a p=0.002 time in the FFTEC category for the TBI group.
Figure 4: The TBI Group (n=2), Treatment control (n=8), and Control (n=12).
*
A B C
D E F
A B C
Peterson 2019
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Center of Pressure Area (cm2):
Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for center
of pressure area (Figure 4A).
Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for center
of pressure area (Figure 4B).
Feet Together Eyes Closed
There was not a main effect of time, nor a significant time*group interaction for center
of pressure area (Figure 4C).
Foam Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for center
of pressure area (Figure 4D).
Foam Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for center
of pressure area (Figure 4E).
Foam Feet Together Eyes Closed
There was a p=0.002 significant main effect of time in the TBI Group (Figure 4F). Post
hoc analysis demonstrated that the TBI group was different from both the treatment control
and control group post intervention.
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Percent Change scores:
There was no significant percent change across the groups (Figure 5) for center of
pressure area.
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Displacement (cm):
Figure 7:The TBI Group (n=2), Treatment control (n=8), and Control (n=12). There was a p=0.001 time interaction in the FFTEC category for all groups.
*
*
*
Figure 6: The TBI Group (n=2), Treatment control (n=8), and Control (n=12).
A B C
D E F
A B C
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Displacement (cm):
Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for
displacement (Figure 6A).
Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for
displacement (Figure 6B).
Feet Together Eyes Closed
There was not a main effect of time, nor a significant time*group interaction for
displacement (Figure 6C).
Foam Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for
displacement (Figure 6D).
Foam Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for
displacement (Figure 6E).
Foam Feet Together Eyes Closed
There was a There was a p=0.001 significant main effect of time for all groups (Figure
6F).
Percent change scores:
There was no significant percent change across the groups (Figure 7) for displacement.
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AP Displacement (cm):
Figure 9: The TBI Group (n=2), Treatment control (n=8), and Control (n=12). There was a p=0.029 time interaction in the FFTEC category for the treatment control group.
*
Figure 8: The TBI Group (n=2), Treatment control (n=8), and Control (n=12).
A B C
D E F
A B C
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AP Displacement (cm):
Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for AP
displacement (Figure 8A).
Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for AP
displacement (Figure 8B).
Feet Together Eyes Closed
There was not a main effect of time, nor a significant time*group interaction for AP
displacement (Figure 8C).
Foam Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for AP
displacement (Figure 8D).
Foam Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for AP
displacement (Figure 8E).
Foam Feet Together Eyes Closed
There was a p=0.029 significant main effect of time for the treatment control group
(Figure 8F). Post hoc analysis demonstrated that the effect of time was different for the
treatment control group than the TBI and control groups.
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Percent change scores:
There was no significant percent change across the groups (Figure 9) for AP
displacement.
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ML Displacement (cm):
Figure 10: The TBI Group (n=2), Treatment control (n=8), and Control (n=12).
Figure 11: The TBI Group (n=2), Treatment control (n=8), and Control (n=12).
A B C
D E F
A B C
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ML Displacement (cm):
Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for ML
displacement (Figure 10A).
Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for ML
displacement (Figure 10B).
Feet Together Eyes Closed
There was not a main effect of time, nor a significant time*group interaction for ML
displacement (Figure 10C).
Foam Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for ML
displacement (Figure 10D).
Foam Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for ML
displacement (Figure 810E).
Foam Feet Together Eyes Closed
There was not a main effect of time, nor a significant time*group interaction for ML
displacement (Figure 10F).
Percent change scores:
There was no significant percent change across the groups (Figure 11) for ML
displacement.
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Average Velocity (cm/s):
Figure 13: The TBI Group (n=2), Treatment control (n=8), and Control (n=12). There was a p=0.001 time interaction in the FFTEC category for all groups.
*
*
*
Figure 12: The TBI Group (n=2), Treatment control (n=8), and Control (n=12).
A B C
D E F
A B C
Peterson 2019
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Average Velocity (cm/s):
Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for average
velocity (Figure 12A).
Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for average
velocity (Figure 12B).
Feet Together Eyes Closed
There was not a main effect of time, nor a significant time*group interaction for average
velocity (Figure 12C).
Foam Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for average
velocity (Figure 12D).
Foam Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for average
velocity (Figure 12E).
Foam Feet Together Eyes Closed
There was a p=0.001 significant main effect of time for all groups (Figure 12F).
Percent change scores:
There was no significant percent change across the groups (Figure 13) for average
velocity.
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Peak Velocity (cm/s):
Figure 15: The TBI Group (n=2), Treatment control (n=8), and Control (n=12). There was a p=0.000 time interaction in the FFTEC category for all groups.
*
* *
Figure 14: The TBI Group (n=2), Treatment control (n=8), and Control (n=12).
A B C
D E F
A B C
Peterson 2019
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Peak Velocity (cm/s): Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for peak
velocity (Figure 14A).
Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for peak
velocity (Figure 14B).
Feet Together Eyes Closed
There was not a main effect of time, nor a significant time*group interaction for peak
velocity (Figure 14C).
Foam Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for peak
velocity (Figure 14D).
Foam Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for peak
velocity (Figure 14E).
Foam Feet Together Eyes Closed
There was a p<0.001 significant main effect of time for all groups (Figure 14E).
Percent change scores:
There was no significant percent change across the groups (Figure 15) for peak velocity.
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AP Average Velocity (cm/s):
Figure 16:The TBI Group (n=2), Treatment control (n=8), and Control (n=12). There was a p=0.008 time interaction in the FFTEC category for the TBI group.
*
Figure 17: The TBI Group (n=2), Treatment control (n=8), and Control (n=12).
A B C
D E F
A B C
Peterson 2019
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AP Average Velocity (cm/s):
Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for AP
average velocity (Figure 16A).
Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for AP
average velocity (Figure 16B).
Feet Together Eyes Closed
There was not a main effect of time, nor a significant time*group interaction for AP
average velocity (Figure 16C).
Foam Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for AP
average velocity (Figure 16D).
Foam Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for AP
average velocity (Figure 16E).
Foam Feet Together Eyes Closed
There was a p=0.008 significant main effect of time for the TBI group (Figure 16E). Post
hoc analysis demonstrated that the effect of time was different for the TBI group than the
treatment control and control groups.
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Percent change scores:
There was no significant percent change across the groups (Figure 17) for AP average
velocity.
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AP Peak Velocity (cm/s):
Figure 19:The TBI Group (n=2), Treatment control (n=8), and Control (n=12). There was a p=0.014 time interaction in the FFTEC category for the treatment control group.
*
Figure 18: The TBI Group (n=2), Treatment control (n=8), and Control (n=12).
A B C
D E F
A B C
Peterson 2019
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AP Peak Velocity (cm/s):
Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for AP
peak velocity (Figure 18A).
Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for AP
peak velocity (Figure 18B).
Feet Together Eyes Closed
There was not a main effect of time, nor a significant time*group interaction for AP
peak velocity (Figure 18C).
Foam Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for AP
peak velocity (Figure 18D).
Foam Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for AP
peak velocity (Figure 18E).
Foam Feet Together Eyes Closed
There was a p=0.014 significant main effect of time for the treatment control group
(Figure 18E). Post hoc analysis demonstrated that the effect of time was different for the
treatment control group than the TBI and control groups.
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Percent change scores:
There was no significant percent change across the groups (Figure 19) for AP peak
velocity.
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ML Average Velocity (cm/s):
Figure 21: The TBI Group (n=2), Treatment control (n=8), and Control (n=12). There was a p=0.000 time interaction in the FFTEC category for all groups.
*
* *
Figure 20: The TBI Group (n=2), Treatment control (n=8), and Control (n=12).
A B C
D E F
A B C
Peterson 2019
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ML Average Velocity (cm/s):
Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for ML
average velocity (Figure 20A).
Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for ML
average velocity (Figure 20B).
Feet Together Eyes Closed
There was not a main effect of time, nor a significant time*group interaction for ML
average velocity (Figure 20C).
Foam Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for ML
average velocity (Figure 20D).
Foam Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for ML
average velocity (Figure 20E).
Foam Feet Together Eyes Closed
There was a p<0.001 significant main effect of time for all groups (Figure 20E).
Percent change scores:
There was no significant percent change across the groups (Figure 21) for ML average
velocity.
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ML Peak Velocity (cm/s):
Figure 23: The TBI Group (n=2), Treatment control (n=8), and Control (n=12). There was a p=0.000 time interaction in the FFTEC category for all groups.
*
* *
Figure 22: The TBI Group (n=2), Treatment control (n=8), and Control (n=12).
A B C
D E F
A B C
Peterson 2019
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ML Peak Velocity (cm/s):
Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for ML
peak velocity (Figure 22A).
Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for ML
peak velocity (Figure 22B).
Feet Together Eyes Closed
There was not a main effect of time, nor a significant time*group interaction for ML
peak velocity (Figure 22C).
Foam Feet Apart Eyes Open
There was not a main effect of time, nor a significant time*group interaction for ML
peak velocity (Figure 22D).
Foam Feet Together Eyes Open
There was not a main effect of time, nor a significant time*group interaction for ML
peak velocity (Figure 22E).
Foam Feet Together Eyes Closed
There was a p<0.001 significant main effect of time for all groups (Figure 22E).
Percent change scores:
There was no significant percent change across the groups (Figure 23) for ML peak
velocity.
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Effect of tango independent of TBI:
Because of the low numbers of TBI patients in this study, data was also analyzed by a 2x2
ANOVA on the TC and CG. This resulted in a significant main effect of time in the areas of
center of pressure area (FFAEO) in the treatment control group p=0.025, displacement for the
treatment control group (FFTEC) p=0.006 and both groups (FFAEO) p=0.016. The velocity
changes were also significantly altered in the areas of: average velocity for both groups (FFAEO)
p=0.017, Peak velocity for the treatment control group (FFTEC) p=0.001 and for both groups
(FFAEO) p=0.040, AP average velocity for the treatment control group (FFTEC) p=0.032, AP peak
velocity for the treatment control group (FFTEC) p= 0.013, ML average velocity for both groups
(FFTEC) p=0.002, and for the treatment control group (FAEO) p=0.045. There were also several
trends for time*group interactions, including COP area (FFTEO) p=0.089 and AP displacement
(FAEO) p=0.070.
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Chapter 5 Discussion:
This is the first study to explore tango as an intervention for traumatic brain injury. The
tango groups showed the most improvement in the most areas. The non-intervention control
group did show improvements, though those may be explained by the learning effect of testing.
The TBI group improved in seven of the thirteen areas tested and significantly more than the
other groups in two of the seven. The treatment control group showed improvement in seven
of thirteen areas with significant improvement in three of the seven while the control group
only showed improvement in six of thirteen areas with no significance on their own.
Quality of Life:
While there was no significance shown in the reduction of depression or anxiety, the
treatment control group who participated in the tango intervention showed significant
improvement in stress. These stress findings are consistent with those of Pinniger et al. 2012
whose healthy subjects danced tango and were compared to controls37. Furthermore,
anecdotally, several subjects reported they felt better after the tango. One noticed an
improvement in online quizzes when taken after tango classes compared to before starting the
classes, which is corroborated by studies which examine exercise and learning80–82.
Balance:
In this study, the primary change of interest was how the tango intervention
changed subject’s balance measures over time. There were trends of changes with time. While
not statistically significant, whether from the variability between the subjects and/or the small
sample size, it is apparent from the data that while the control group remains relatively steady,
there are consistent improvements in the tango treatment groups. These improvements are
Peterson 2019
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consistent with other research on tango compared with other types of movement therapy. In
2011, Ricotti et al. studied 9 year old soccer players and found that break dancing improved
their objective balance measures over 6 months of training83. Additionally, Bavli et al. 2016
tested basketball players with an aerobic dance class to ascertain if it would influence their
balance and according to their static flamingo test, dance was an effective way to improve
these healthy athlete’s balance84.
Figures 7 and 13 and show trends in changes of displacement and average velocity
respectively. The percent change of the control group remains relatively consistent, where the
percent change of the intervention groups show more improvement especially in the area
FFTEC which is the most difficult of the challenges presented to the subjects. These types of
improvements following tango interventions were noted in the studies by Hackney et al. 2007
and 2009 using Berg Balance testing on Parkinson’s patients10,26. While the Berg balance test,
in conjunction with the other tests used in their study, is an effective means of establishing a
subject’s balance, it is still a subjective measure. Our study was unique in that our measure of
balance eliminated the subjectivity of these measures and relied on the objectivity of the force
plates. Rodacki et al. (2017) studied ballroom dancing and used both the subjective measures
of the timed up and go and six minute walking test as well as the objectivity of force plate
analysis. They found that there was a significant change over time and between groups after
the dancing intervention in CoP area and displacement. Unlike our study, however, they had
very little variability in subjects as they used only older women as their subjects. They also had
a longer time interval eight weeks vs six and their subjects met three times per week instead of
two.
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TBI
Our small population of subjects with traumatic brain injury showed a significant
decrease (54%) in the center of pressure area measure with feet together on foam with eyes
closed the treatment control improved only 13% and the control group got worse by 43%. The
anterior-posterior velocity was decreased by 27% compared to a decrease of 17% in the
treatment control and 4% in the control groups with feet together on foam with eyes closed.
These changes did not reach a significant time*group interaction, however this could be due to
the low power by having only an n=2 in our TBI group, or the large variance in our outcomes.
Yet, this remains to our knowledge the first study to evaluate tango as a treatment intervention
in TBI sufferers.
Treatment Control:
The treatment control groups improved in anterior-posterior displacement by 21% while
the other groups appeared to worsen (TBI, 47%; and CG, 15%) with feet apart eyes open. Peak
anterior-posterior velocity was decreased by 21% compared to TBI’s 23% and CG’s 3%
decreases with feet together on foam with eyes closed. These changes did not reach a
significant time*group interaction, however this could be due to low power, or the large
variance in our outcomes. Together, however, despite our more robust measurements of
balance this work supports previous investigations utilizing tango as an intervention on the
improvement of balance10,16,17,20,21,26,.
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Limitations:
There may have been several reasons why we did not find statistical significance of the
tango intervention. The first is the variance in the subjects. Previous studies had a narrow
range of ages of their subject pool—usually within seven years while I had a SD of twelve years
in the treatment control group. The aging effect on balance85 itself is enough to exacerbate the
variability to skew the data. Secondly, the number of subjects was lacking. We did not have
enough individuals to have statistical power for the TBI group to show effect. Additionally, the
time frame of the treatment was too short. Most studies that evaluated balance were two to
four weeks longer than our study10,16,17,23,26.
Chapter 6 Conclusion:
This study shows that tango may have an effect on both individuals with and without
traumatic brain injury on balance. Furthermore, tango demonstrated reductions in stress in all
the subjects that participated in the intervention.
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References:
1. Report to Congress on Traumatic Brain Injury Epidemiology and Rehabilitation | Concussion