Dr. A. Arieli (Israel)
All those at the final party of the Parkinson’s Association experienced an amazing, emotional event not soon to be forgotten. The climactic moment came when a number of participants, who up until then had been slumped immobile and rigid in their wheelchairs, rose up suddenly and joined in the circle of dancing. Their hands trembling like leaves, they straightened themselves hesitantly, at first with the help of a partner, gradually stretching their backs and necks, their expressionless “masks” vanished, and a row of determined, intent faces appeared instead. They stood next to their wheelchairs, hanging onto their partners hips as they struggled to stand tall. One person who was bent over at a ninety-degree angle, grabbed onto his wife as he tried to sway his body back and forth along with the tune. The crowd surrounded the dancers in a circle as they clapped their hands to the rhythm of the music; their applause giving the dancers even greater momentum, as they held their heads high and unaccustomed smiles shone on their faces. Their proud looks seemed to say:”Just wait and see what I can do.” As their grasp on their partners grew stronger, they led them around the floor to the music’s beat. My eyes welled up with emotion and I wasn’t the only one in the room in tears. Since that day, I can’t stop pondering how to explain what happened, a phenomenon which, had I not been there myself, I never would have believed it. As a physician, I naturally turned to the professional literature to search for a logical answer.
The importance of rhythm
Recent neurophysiological studies reveal that rhythm can play a major role in the management of Parkinson’s symptoms. A person who does not have Parkinson’s is aided by internal cues which are relayed to him through his senses, especially his hearing, sight, and the internal sense of motor control, such as a rhythmic gait (and, of course, dancing). This is not so for a person with Parkinson’s, whose damaged basal ganglia causes a great reduction in the amount of dopamine made available to his nervous system; the ability to rely on internal automatic signals related to movement is impaired. They are dependent on external cues, such as the rhythm of music or a metronome which are able to bypass the damaged regions of the brain and to directly reach the cerebral cortex, also called the "supplementary motor area" or SMA, the region of the brain which is responsible for mental concentration among other functions. In this way, the person with Parkinson's can consciously pay attention to steps and gain some control over movements. Assuming that this theory is correct, this only partially explains the amazing scene we observed, the ability of people who have already got out of their wheelchairs to keep on dancing. But what was it that initially motivated them to stand up in the first place?
"The placebo effect"
One explanation was recently given by Dr Sharon Hassin-Baer, which is apparently connected to the so-called "placebo effect", in her article "Clinical Trials in Parkinson's Patients," published in Amitim, the Israeli Parkinson's Association journal. She describes an "exciting phenomenon known as paradoxical movement, or kinesia paradoxica." In special circumstances "this enables people to do the seemingly impossible for a short period of time, such as when a severely ill patient who is practically unable to walk, suddenly starts to run when he/she senses danger" she emphasises.
Is it therefore also possible that being swept up in a contagious happy mood, such as the people with Parkinson's felt at the final party, can also contribute to such phenomena? Can intense enthusiasm also produce inexplicable results under certain circumstances? Dr. Raul de la Fuente-Fernandez and his colleagues at the University of British Columbia in Vancouver, B.C., published a series of articles dealing with this subject. They found a marked improvement in symptoms in people with Parkinson’s and they claimed that only the anticipation of receiving a new drug was enough to produce a significant boost in dopamine levels due to the "placebo effect." Like many other neurological researchers, they emphasised the importance of the reward circuit system, also in the same area of the basal ganglia. This region is connected to many other different pathways in the brain through neurotransmitters, which are also activated by the secretion of dopamine!
When I described this emotional event to my friends, I was told that the people with Parkinson's stand up from their wheelchairs at every final party. Could it be that the anticipation of happiness and applause is what causes the "placebo effect?" Yet, I have one small confession to make…
I am not satisfied with the hypotheses of the neuroscientists, even if they are correct. I think that reduction is only a partial explanation for what I witnessed. It seems that it has more to do with mind over matter…How is it that they found the strength to get out of their wheelchairs? Is it possible that they had a sudden rush of dopamine?
To me, the only logical explanation is the power of collective joy. When the Parkinson's group was charged with positive energy, a feeling of elation buoyed their spirits, and together they felt invincible. They were swept up in the emotion of their last joyful reunion, and their feelings of success and camaraderie gave them the ability to dance for a long time. Even I found the strength to dance for three hours without stopping despite my advanced age. Perhaps it was the sense of contagious happiness that kindled the last possible spark of dopamine from their nervous systems, and gave them the ability to stand up and get out of their wheelchairs. I know that this is not very scientific, but I have no other alternative explanation…
Dr. A. Arieli
10 November 2009
