Original article| Volume 44, 102256, September 2020

Effects of a 10-week multimodal dance and art intervention program leading to a public performance in persons with multiple sclerosis - A controlled pilot-trial


      • A 10 week individual choreo-based dance and art program was performed in pwMS.
      • Dance showed positive effects on fatigue, cognitive performance during a task and motor functions.
      • The art group also showed improvement in fatigue, cognition and cognitive performance during a dual task.
      • Both groups performed live on stage, sharing there MS perspective through art and dance.
      • Larger sample sizes, and research of dance in different disability groups are recommended.



      : Dance therapy is increasingly reported in neurological diseases for improving several motor and cognitive functions, but was mostly studied in partner dance. No individual choreo-based dance program has ever been reported in MS.


      : The aim of this pilot study is to investigate effects of a ten-week choreo-based dance intervention on different impairments in MS.


      : Seventeen participants with MS were allocated to a dance group (DG) or an art group (AG) for a ten-week intervention program, with a public live performance at the end of the intervention.


      : The DG received choreo-based dance courses twice a week for 90 min, while the active control AG weekly contributed to the production by painting, music, spoken word and photo- or videography. Measurements for fatigue and fatigability, physical capacity and coordination, sensory function, cognitive capacity, quality of life and dual task performance took place before and after the intervention. Differences were analysed with Wilcoxon Signed Rank test.


      : Both groups improved significantly on executive cognitive performance during dual task and fatigue. Only the DG improved significantly on functional lower limb strength, hand function, coordination, self-reported balance and walking, and showed a trend towards improving on cognition (PASAT). The AG showed significant improvements in on cognitive function (SDMT).


      : A ten-week multimodal dance intervention has positive effects on impact of fatigue, physical capacity and coordination, and cognitive performance during a dual task. Larger samples, follow-up measurements and research in different disability groups is recommended.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Multiple Sclerosis and Related Disorders
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Van Geel F.
        • Moumdjian L.
        • Lamers I.
        • Bielen H.
        • Feys P
        Measuring walking-related performance fatigability in clinical practice: a systematic review.
        Eur. J. Phys. Rehabil. Med. 2019; 56: 88-103
        • Kluger B.M.
        • Krupp L.B.
        • Enoka R.M
        Fatigue and fatigability in neurologic illnesses: proposal for a unified taxonomy.
        Neurology. 2013; 80: 409-416
        • Seamon B.A.
        • Harris-Love M.O.
        Clinical assessment of fatigability in multiple sclerosis: a shift from perception to performance.
        Front. Neurol. 2016; 7: 194
        • Thickbroom G.W.
        • Sacco P.
        • Faulkner D.L.
        • Kermode A.G.
        • Mastaglia F.L
        Enhanced corticomotor excitability with dynamic fatiguing exercise of the lower limb in multiple sclerosis.
        J. Neurol. 2008; 255: 1001-1005
        • Cameron M.H
        Balance, gait, and falls in multiple sclerosis.
        Handb. Clin. Neurol. 2018; 159: 237-250
        • Broekmans T.
        • Gijbels D.
        • Eijnde B.O.
        • Alders G.
        • Lamers I.
        • Roelants M.
        • et al.
        The relationship between upper leg muscle strength and walking capacity in persons with multiple sclerosis.
        Multiple Sclerosis. 19. Houndmills, Basingstoke, England2013: 112-119
        • Kalron A.
        • Achiron A.
        • Dvir Z
        Muscular and gait abnormalities in persons with early onset multiple sclerosis.
        J. Neurol. Phys. Ther.: JNPT. 2011; 35: 164-169
        • Brincks J.
        • Andersen E.D.
        • Sorensen H.
        • Dalgas U
        Impaired postural balance correlates with complex walking performance in mildly disabled persons with multiple sclerosis.
        Neurorehabil. 2017; 41: 227-235
        • Leone C.
        • Severijns D.
        • Dolezalova V.
        • Baert I.
        • Dalgas U.
        • Romberg A.
        • et al.
        Prevalence of walking-related motor fatigue in persons with multiple sclerosis: decline in walking distance induced by the 6-minute walk test.
        Neurorehabil. Neural Repair. 2016; 30: 373-383
        • Kister I.
        • Bacon T.E.
        • Chamot E.
        • Salter A.R.
        • Cutter G.R.
        • Kalina J.T.
        • et al.
        Natural history of multiple sclerosis symptoms.
        Int. J. MS Care. 2013; 15: 146-158
        • Bertoni R.
        • Lamers I.
        • Chen C.C.
        • Feys P.
        • Cattaneo D
        Unilateral and bilateral upper limb dysfunction at body functions, activity and participation levels in people with multiple sclerosis.
        Mult. Scler. 2015; 21: 1566-1574
        • Trenova A.G.
        • Slavov G.S.
        • Manova M.G.
        • Aksentieva J.B.
        • Miteva L.D.
        • Stanilova S.A
        Cognitive impairment in multiple sclerosis.
        Folia Med. (Plovdiv). 2016; 58: 157-163
        • Langdon D.W.
        Cognition in multiple sclerosis.
        Curr. Opin. Neurol. 2011; 24: 244-249
        • Veldkamp R.
        • Baert I.
        • Kalron A.
        • Tacchino A.
        • D'Hooge M.
        • Vanzeir E.
        • et al.
        Structured cognitive-motor dual task training compared to single mobility training in persons with multiple sclerosis, a multicenter RCT.
        J. Clin. Med. 2019; 8
        • Motl R.W.
        • Sandroff B.M.
        • Kwakkel G.
        • Dalgas U.
        • Feinstein A.
        • Heesen C.
        • et al.
        Exercise in patients with multiple sclerosis.
        Lancet Neurol. 2017; 16: 848-856
        • Broadbent F.J.SJM.
        I can do more than I thought I could”: exploring the online blogs from the sailing sclerosis oceans of hope journey.
        J. Disabil. Rehabil. 2020; 42: 880-886
        • Steimer J.
        • Weissert R.
        Effects of sport climbing on multiple sclerosis.
        Front. Physiol. 2017; 8: 1021
        • Van Asch P.T.K
        • de groote L.
        • Eijnde B.O.
        • Feys P
        "Move to sport" in Belgium: an organisational model to facilitate skilled guidance of persons with MS during exercise and sport in the community.
        Neurol. Rehabil. 2013; 19: 56-60
        • Keytsman C.
        • Van Noten P.
        • Spaas J.
        • Nieste I.
        • Van Asch P.
        • Eijnde B.O
        Periodized home-based training: a new strategy to improve high intensity exercise therapy adherence in mildly affected patients with multiple sclerosis.
        Mult. Scler. Relat. Disord. 2019; 28: 91-97
        • Feys P.
        • Moumdjian L.
        • Van Halewyck F.
        • Wens I.
        • Eijnde B.O.
        • Van Wijmeersch B.
        • et al.
        Effects of an individual 12-week community-located "start-to-run" program on physical capacity, walking, fatigue, cognitive function, brain volumes, and structures in persons with multiple sclerosis.
        Multiple Sclerosis. 25. Houndmills, Basingstoke, England2019: 92-103
        • D'Hooghe M.B.
        • Feys P.
        • Deltour S.
        • Van de Putte I.
        • De Meue J.
        • Kos D.
        • et al.
        Impact of a 5-day expedition to machu picchu on persons with multiple sclerosis.
        Mult. Scler. Int. 2014; 2014761210
        • Hamacher D.
        • Hamacher D.
        • Rehfeld K.
        • Hokelmann A.
        • Schega L
        The effect of a six-month dancing program on motor-cognitive dual-task performance in older adults.
        J. Aging Phys. Act. 2015; 23: 647-652
        • Hamacher D.
        • Hamacher D.
        • Rehfeld K.
        • Schega L
        Motor-cognitive dual-task training improves local dynamic stability of normal walking in older individuals.
        Clin. Biomech. (Bristol, Avon). 2016; 32: 138-141
        • Kattenstroth J.C.
        • Kalisch T.
        • Holt S.
        • Tegenthoff M.
        • Dinse H.R
        Six months of dance intervention enhances postural, sensorimotor, and cognitive performance in elderly without affecting cardio-respiratory functions.
        Front. Aging Neurosci. 2013; 5: 5
        • Zhang Q H.J.
        • Wei L.
        • Jia Y.
        • Jin Y
        Effects of dance therapy on cognitive and mood symptoms in people with Parkinson's disease: a systematic review and meta-analysis.
        Complement Ther. Clin. Pract. 2019; 36: 12-17
        • Patterson K.K.
        • Wong J.S.
        • Prout E.C.
        • Brooks D
        Dance for the rehabilitation of balance and gait in adults with neurological conditions other than Parkinson's disease: a systematic review.
        Heliyon. 2018; 4: e00584
        • Scheidler A.M.
        • Kinnett-Hopkins D.
        • Learmonth Y.C.
        • Motl R.
        • Lopez-Ortiz C
        Targeted ballet program mitigates ataxia and improves balance in females with mild-to-moderate multiple sclerosis.
        PLoS ONE. 2018; 13e0205382
        • Ng A B.S.
        • Suh J.
        • Huenink P.
        • Gregory T.
        • Gambon S.
        • Miller D
        Ballroom dance for persons with multiple sclerosis: a pilot feasibility study.
        Disabil. Rehabil. 2019; 13: 1-7
        • Mandelbaum R.
        • Triche E.W.
        • Fasoli S.E.
        • Lo A.C
        A Pilot Study: examining the effects and tolerability of structured dance intervention for individuals with multiple sclerosis.
        Disabil. Rehabil. 2016; 38: 218-222
        • Rietberg M.B.
        • Van Wegen E.E.
        • Kwakkel G
        Measuring fatigue in patients with multiple sclerosis: reproducibility, responsiveness and concurrent validity of three Dutch self-report questionnaires.
        Disabil. Rehabil. 2010; 32: 1870-1876
        • Van Geel F.
        • Veldkamp R.
        • Severijns D.
        • Dalgas U.
        • Feys P
        Day-to-day reliability, agreement and discriminative validity of measuring walking-related performance fatigability in persons with multiple sclerosis.
        Multiple Sclerosis. Houndmills, Basingstoke, England20191352458519872465
        • Goldman M.D.
        • Marrie R.A.
        • Cohen J.A
        Evaluation of the six-minute walk in multiple sclerosis subjects and healthy controls.
        Multiple Sclerosis. 14. Houndmills, Basingstoke, England2008: 383-390
        • Baert I.
        • Freeman J.
        • Smedal T.
        • Dalgas U.
        • Romberg A.
        • Kalron A.
        • et al.
        Responsiveness and clinically meaningful improvement, according to disability level, of five walking measures after rehabilitation in multiple sclerosis: a European multicenter study.
        Neurorehabil. Neural Repair. 2014; 28: 621-631
        • Cattaneo D.
        • Regola A.
        • Meotti M
        Validity of six balance disorders scales in persons with multiple sclerosis.
        Disabil. Rehabil. 2006; 28: 789-795
        • Meretta B.M.
        • Whitney S.L.
        • Marchetti G.F.
        • Sparto P.J.
        • Muirhead R.J
        The five times sit to stand test: responsiveness to change and concurrent validity in adults undergoing vestibular rehabilitation.
        J. Vestib. Res. 2006; 16: 233-243
        • Baert I.
        • Smedal T.
        • Kalron A.
        • Rasova K.
        • Heric-Mansrud A.
        • Ehling R.
        • et al.
        Responsiveness and meaningful improvement of mobility measures following MS rehabilitation.
        Neurology. 2018; 91: e1880-e1e92
        • Feys P.
        • Lamers I.
        • Francis G.
        • Benedict R.
        • Phillips G.
        • LaRocca N.
        • et al.
        The Nine-Hole Peg Test as a manual dexterity performance measure for multiple sclerosis.
        Multiple Sclerosis. 23. Houndmills, Basingstoke, England2017: 711-720
        • Stolk-Hornsveld F.C.J
        • Hendriks E.P.
        • van der Baan R.
        • Harmeling-van der Wel B.C
        The Erasmus MC modifications to the (revised) Nottingham sensory assessment: a reliable somatosensory assessment measure for patients with intracranial disorders.
        Clin. Rehabil. 2006; 20: 160-172
        • Sonder J.M.
        • Burggraaff J.
        • Knol D.L.
        • Polman C.H.
        • Uitdehaag B.M
        Comparing long-term results of PASAT and SDMT scores in relation to neuropsychological testing in multiple sclerosis.
        Multiple Sclerosis. 20. Houndmills, Basingstoke, England2014: 481-488
        • Hobart J.
        • F J.
        • Lamping D.
        • Fitzpatrick R.
        • Thompson A.
        The SF-36 in multiple sclerosis: why basic assumptions must be tested.
        J. Neurol. Neurosurg. Psychiatr. 2001; 71: 363-370
        • Harrison A.M.
        • Das Nair R.
        • Moss-Morris R.
        Operationalising cognitive fatigability in multiple sclerosis: a Gordian knot that can be cut?.
        Mult. Scler. 2017; 23 (1682-96)
        • Hobart J.
        • D L.
        • Fitzpatrick R.
        • Riazi A.
        • Thompson A
        The Multiple Sclerosis Impact Scale (MSIS29)—A new patient-based outcome measure.
        Brain: J. Neurol. 2001; : 962-973
        • Debaere F.
        • Van Assche D.
        • Kiekens C.
        • Verschueren S.M.
        • Swinnen S.P
        Coordination of upper and lower limb segments: deficits on the ipsilesional side after unilateral stroke.
        Exp. Brain Res. 2001; 141: 519-529
        • Moore J.L.
        • Potter K.
        • Blankshain K.
        • Kaplan S.L.
        • OʼDwyer L.C.
        • Sullivan J.E
        A core set of outcome measures for adults with neurologic conditions undergoing rehabilitation.
        J. Neurol. Phys. Ther. 2018; 42: 174-220
        • Benedict R.H.
        • DeLuca J.
        • Phillips G.
        • LaRocca N.
        • Hudson L.D.
        • Rudick R.
        • et al.
        Validity of the Symbol Digit Modalities Test as a cognition performance outcome measure for multiple sclerosis.
        Multiple Sclerosis. 23. Houndmills, Basingstoke, England2017: 721-733
        • Roar M.
        • Illes Z.
        • Sejbaek T
        Practice effect in symbol digit modalities test in multiple sclerosis patients treated with natalizumab.
        Mult. Scler. Relat. Disord. 2016; 10: 116-122
        • Fraser C.
        • Keating M.
        The effect of a creative art program on self-esteem, hope, perceived social support, and self-efficacy in individuals with multiple sclerosis: a pilot study.
        J. Neurosci. Nurs. 2014; 46: 330-336
        • Young H.J.
        • Mehta T.S.
        • Herman C.
        • Wang F.
        • Rimmer J.H
        The effects of M2M and adapted yoga on physical and psychosocial outcomes in people with multiple sclerosis.
        Arch. Phys. Med. Rehabil. 2019; 100: 391-400
        • Bosma L.V.
        • Kragt J.J.
        • Brieva L.
        • Khaleeli Z.
        • Montalban X.
        • Polman C.H.
        • et al.
        Progression on the multiple sclerosis functional composite in multiple sclerosis: what is the optimal cut-off for the three components?.
        Multiple Sclerosis. 16. Houndmills, Basingstoke, England2010: 862-867