Chapters Transcript Video Arts and Health: Translating Research to Practice via Community Engagement Jatin Ambegaonkar, Ph.D., A.T.C., O.T., C.S.C.S., presents at the Johns Hopkins Department of PM&R’s Grand Rounds on July 20, 2021. So I know I have a presentation that I will make about talking about the work that I have done regarding arts and health and hopefully uh we will have some time to have a Q. And a later on to discuss how we can potentially work together if need be. I do see Andrea and a couple of other people I have spoken to say, hey good to see you and thank you Jack for coordinating the schedule for the emails and so on and so forth. So with that no financial disclosures and I'll talk about the big picture objectives of the conversation today. So I will talk about a little bit about me and the arts and the health research which in that I have work done over the last 15 to 20 years at George Mason and the University of north Carolina at Greensboro. I'll discuss how we've tried at the university at George Mason University to translate some of this research trying to work from the lab and to the field studio and in this case and and the community big picture uh and across the lifespan how we've so I've picked some examples of how that has worked across the lifespan with a general idea of promoting overall health and well being of the community and hopefully that will round out the conversation and give us something that's okay. Uh So a little bit about me as Dr. Freelander started with I got my bachelor's degree in occupational therapy at the University of Mumbai nine medical school in India. I worked after that for a year or so at the Paraplegic Foundation as an occupational therapist. I really enjoyed working with sports and athletics and recognized that I had to come to the United States from India to get some advanced knowledge about that. So I got my masters up at Springfield College in massachusetts, where I did my work on sports injury prevention and management, athletic training And then moved down to the University of North Carolina in Greensboro, where I did my doctoral work and exercise science and sports studies. And I have been at George Mason University for the last 16 years. We had the privilege there to start the performing arts medicine program there, start the PhD program and lead that in in kinesiology and co found the sports medicine, assessment research and testing laboratory and again only the arts and the health part is what I am presenting today, but we have a broader profile that includes post traumatic osteoarthritis, concussion research and other related work. But we'll try to talk about accent health work today. So when we talk about this work, I the overarching vision is really looking at health for arts and artists and athletes and using physical activity that is arts related to improve the health outcomes of the large picture community. Because I think when I started working with the population of performing artists, my job was to open up and start first Performing arts medicine clinic at the university there in north Carolina and had work with multidisciplinary team and leave that group and recognized that this was a population that really needed help. Uh and then recognizing that the value and the rigor that performing art is put in their craft can be used to engender health for other communities which might not have thought about the arts except for listening to music and watching performances and moving in wedding parties and so on and so forth. But recognizing the value of actually moving consistently. And I think all of us in B. M. And I recognize the network. So when we talk about the approach that we take in the laboratory, we really try to have a combination of a participant with the practitioner kind of approach and we use the trip model which some of you may have heard of the translating research, injury prevention and practice where you measure the problem, identify the cause of the problem. What is the gap in the literature, developed a plan to kind of assess and examine and treat the problem, examine the location specific the genre, specific the space specific population specific context and implement plan the plan and re circle and recycle this plan over and over in a closed loop system to allow for improved health. Um, and so we will talk a little bit, I will share a little bit about how we have tried to do that at the university and in the laboratory across the lifespan with Children with adults and with older adults and I'll get to these details in the next next few minutes. So with Children, this was one of the first projects that we started in looking at physical activity and enjoyment. So the physical part and the site part looking at dance exercises, dance focused physical education in middle school girls. Because the research clearly talks about and none of us need to you have this again and again. But this is what what our population and in fact the world, global population looks like over a third of the population regarding Children and overweight and obese. Uh 75% of them really don't meet the CDC recommended guidelines of 60 minutes of physical activity a day uh with the 30 minutes part of that being in school. And so we recognized that this was an opportunity in an underserved low SCS area where physical education is the time where students really have no choice but to hopefully be active because their parents might not be able to afford extracurricular physical activity after school. And the research also suggests that dance is a fun favorite activity, physical activity in girls. So we combine those two and we used a combination of culturally appropriate ballroom dance forums. It was a lower SCS, primarily Latinos as hispanic population school system. And we used the P. E. Class to instruct these clacks is walls, the rumba and the cha cha to a lot of students as far as we're excited to start for them because they were getting close to them. You can see in eras which is a big part in the culture and so this was something that they could train for they could work with and really enjoy starting to become physically active and learn how to do that. We then used biosensors. And the biosensor that we did use for this project was called by Zephyr biosensor and it's a chest mounted similar to a polar heart rate monitor. But on the bottom right you can see there are a lot of other profiles that you can pick up from this. The heart rate and posture and respiratory rate and so on and so forth. So we use that. And then after each session we also used a patient reported participate in this case survey called the pieces questionnaires which stands for the physical activity enjoyment scales. Where participants were able to rate how much they enjoy the activity. And some other questions are on the right hand side. So what did we really find from this work? We found that it was good to see first off that participants were able to maintain what we like to call them moderate to vigorous physical activity. Which is where the good physical activity sets as far as the heart rate is concerned. About 30 36% of the time. So about 30 minutes or 30 odd minutes. That that they were in class they were using their bodies and getting physically vigorously active during this 90 minute class. And the bases survey did suggest that this was an enjoyable activity for them. Then they were really having a good time, most of them at least. There were some who didn't voluntary project. And so they we did find evidence that this was a physically good activity that was enjoyable. And so then we expanded this work. We asked for some funding from the number one health foundation which is in Prince William County, the big hospital system there and we were able to get some funding and what we used in this project, we expanded the scope of this project. We use another sensor called the active graph which is a research created some of us have heard of it. Research gate Fitbit for lack of better word, which also records physical activity. And so for this project we expanded the grouping. We did well physical activity that were performed when we categorized that into either a group sport activity, for example, soccer. When they were learning again in the E class is um some individual activity that included sports, like tennis, some fitness, some basic fitness activities that the students were required to do as part of the physical education classes and our dance class roots of the social or the arts based physical activity class. And so what we really found here was that across the four different activities, the group activity was the activity resulted in the highest amount of yeah, that was, sorry, the highest amount of moderate to vigorous physical activity because this was the only activity which had a competition associated with it as it was a team sport. And the other three activities, the social, the individual and the physical activity that was fitness related were relatively similar in terms of amount of work that was done by the participants. So, again, what does that mean? What is next? We really found that dance as a form of physical activity in middle school Children seems to be a good way for them to keep and stay active. It really did not require a whole lot of equipment. There is not some music uh, and appropriate and oftentimes this was we linked and sync it with the community benefit that they could use this in their own social lives after. And we really believed that this was a good way for us to enter the community. Especially a community which did not, or does not have a resource for physical activity outside of school. That the parents we found did not have the money to, to send their kids to after school clubs and programs that this was a great way to enter the community. And so we are expanding this project now across the county. Hopefully we'll have more good information to report in the future. Ah, coming back coming up to the adult population. Uh, this uh, this is what we're talking about the about 18, 18 year old. And plus so at George Mason University, we've been having our physical activity performance arts medicine clinic since 2000 and eight and in 2015 that recognized that there were other colleagues across the nation who were doing kind of similar things. And so we started a consortium which we call the share consortium that stands for supporting healthy arts research. And you can see some of the colleagues uh and the logos on there. We have uh multiple teams across the country and they are a combination of physicians, athletic trainers, physiotherapists, physical therapists, nurses who work with these populations of performing artists and their individual schools and the individual institutions. And at George mason, we defeat the data into us and we are collecting a lot of exposure data. So looking at where, how big this population is really. I mean we've all know The popularity of shows including so you think you can dance and the celebrity dance shows. There are 10 million students who are engaged in in Dance as a form of physical activity of the performing arts. There are half a million teachers, 400 higher education institutions colleges and universities which offer this and about 75,000 professionals full time professionals who use this form of activity as a form of livelihood. We also know That dancing is demanding, 80% of all dancers get injured across the season. A 3rd of them are acute injuries, but Over 65% of them a chronic injuries and most of these injuries are to the lower body. So dance is a demanding activity. A lot of injuries that occur in this board. And when we talk about what it means to make a healthy artist, we are looking at this combination of physical, mental, emotional and spiritual and so we've tried to concentrate on the physical, mental and emotional within our laboratory and I will not go through all of them. But generally we are we are trying to look at all of these areas, the physical mental nutrition, sleep, education, and literacy for the population, the training volumes, all of them. And how do they combine and collectively feed off of each other to create what we call the healthy artist and healthy performer. So what we've done is we, our plan is to and we are doing this. The nation reported measures. We collect physical fitness measures, screening measures at the start of the year and they are a combination of power, strength, agility, speed, and so on, so called, very standard, nothing, nothing very high technical in terms of demands because we recognize that a lot of dancers and and educators may not have access to a lot of high tech laboratory equipment. So it's been a conscious choice to make it low tech and easy to do this and also translate herbal that translate to the dancers. Um and so we are looking at exposure, how much will work lower is that they are going through across the season in the year. And then some participant reporter, we are looking at sleep, self reported sleep measures and the health related quality of life measures. And with the general idea being that we are trying to see what the linkages of these are across to work towards the two overarching goals that we want to reduce risk for injury and optimize our enhanced performance. And so we've done a pretty, pretty uh pretty big profile and some of this is going to go into all of it. But we looked at fitness and how baseline witness associates with injury, supplemental or strength and conditioning training, nutrition period. Izing nutrition, how does balance relate to performance or the quality of life work literacy. How do you, how does literature that you educate the participants about staying healthy hard? Is that help or doesn't their injury risk? The biomechanical work using three biomechanics and DMG my electron biography. And they've looked at footwear and how the effect of footwear is on changing the biomechanics during motion. So we've done some of this work but I'll talk about a couple of take away points with regards to injury risk. Um what we found is a test called the star excursion balance test, which is the picture on the right, you see where the dancer is standing or the participants standing on the central point and reaching across predetermined line. Ah And they're asked to do that on both sides. And what we found is if there is a symmetry E four centimeters greater difference greater than four centimeters from the left to the right side. The injury risk is 2 to 3 times more. And then this is norm the same measures than normal to the participants lower legs length which is defined as from the oasis to the medial Malia list. And What they should be reaching is about 94% of their leg length and the reach distances and anything less than that. Um Less than 89% or so. Uh we found that there is an increased risk for injury based on how how low it goes similarly, we use a test called the single leg hop. And there are two versions of the heart test, but some of you may be using or have used. Um But the single leg hop test is single leg. They're happening from by leg position to a single leg and they have to balance on that other leg. And what we found out is from our work is that if the participants are not able to land at least 70% of their body height for each unit percent. Change thereof, There is a 15-20% higher probability every every percent that goes down from that 78%. So those are a couple of things that we are finding. Again, these are relatively in our dataset which is about About 7-8 years old. But we are collecting more data and hopefully we're gonna as a more robust modeling to that work. So what is next? We are looking at the nutrition some sleep measures and really trying to see using using multiple variables how this can really tell us anything that we can inform them the dance teachers about how they can use this to improve the health of their participants. Ah moving over now to the older adult population and how we try to use this in the older adult population in the community. Uh We do know we've had a couple of projects. One is called the Boys Project which stands for precision outreach intervention surveillance and exercise. And this collaboration across all Dominion. And a couple of local partners on the Atomic Health Foundation which is down near good grades. They provided funding for this project. And here what the problem was we entered the problem was really looking at falls and Falls risk and the Associated cause that are direct and indirect and I don't need to tell you as a group what that what that looks like for population. So what we did is we designed ah randomized controlled trial where we looked at group fitness programs for 10 weeks and we used two different types of programs. Dance based program called the Lebed Method and the the sale program which comes out of Washington which is a self safe and active independent living program. And we compared those and examined how they were able to improve and both of them were able to improve strength, coordination and balance and decrease false risk on the physical performance scale. We then expanded this work to look at community engagement and we were funded by the national government for the arts research can projects where we used community engagement in older adults. And we added in here, we also added music as a health modality. Looking at the arts again, collaboration with the filter performing arts center and a couple of colleges within our university. And here what we're looking at is not just falls risk for the broader picture of the physical, the mental with an alzheimer's is a big, big issue in the old riddle population and if Covid has taught us anything it's the value of social connections and so the psychosocial part recognizing that as adults age, they lose their cohorts and their friends and family and that can and and wittingly decrease their social connections and can be then as practitioners use arts and help to foster and engender positive relationship and continued social connections with people. Ah And so here what we did is we designed a randomized controlled trial Again with three groups, dance based group, a music brace group which did Ukulele and control again twice a week for 10 weeks. We looked at some physical, some cognition, some qualitative work and we tested them before after and retention month after. Ah And so what we had was this was free for the participant twice a week that they were able to dance and learn and just connect you. And the control group really was an active control where they had conversations about how to become healthy. And so for the physical performance we used a scale that is validated called the short physical performance battery which combines some of the common tests that are often times done in clinical settings balance single leg, tandem, a short walking and the chair standing task. And what we saw here you can see 33 to post to post and one and across the three group that there was a slight overall perceptible difference across the tree times where scores did improve to examine cognition, we use the Montreal cognitive assessment scale which is a combination of different things including memory, executive function, attention abstraction, orientation, ah And likewise we saw over time there was an improvement, not a whole lot of improvement because our population was a community developed population but there was improvement from the pre to the post from the focus interviews on the qualitative work and the surveys we found that participants suggested that they really made connections, They learned new skills, improved their perception of self and felt personal growth often times this was the only time that the participants were able to get out and meet people, connect with people and they were able to form new friendships that they hadn't in. Sometimes that was really one of the most gratifying parts of the conversation. And at the end of the day we end of the project, we had open social where the participants skin really they were able to perform. They did a little performance for the overall audience and it was open, community based setting that we did this and it was really fun experience for all of all of the participants and as as the researcher groups. So what's next with Covid? We have now started virtual training sessions using the arts and health. We have to be appropriate to the culture and age of the population. But generally we are looking at this as an overall holistic way to kind of improve well being. And we are working with some colleagues of colleagues at walter reed now to science, see how we can use this in service members at the Active duty Medical Homes there. So, overall, really this this conversation is really talking about when we look at our profile, we look at community as being the center and the grants allowed for funding which allows for some training for the students and practitioners who in training which provides service to the community and then the research is the end product or the latent part that comes out and that's hopefully that provides information for the next round of funding and that creates a continuous loop for us. Um overall, what does it mean, collaborate, communicate, think of the big picture labs, not better than the field feels not better than the lab. There is some work we do inside the lab, there is some work we do in the field, there is some work we do in the studios, all of it really works towards a healthy community because that's what we all end up eventually, hopefully wanting to do to improve the health and well being of the community. Um, I was thankful to be invited, I looked at uh and uh, I'm thankful for ken Andrea was here, Amanda have known for some years who are in the rehabilitation sciences program there at johns Hopkins, had a great conversation with Dr Raghavan earlier this spring about potential work that we could do together with the Peabody Institute with Dr huer and Dr Sarah Batiste Gray and I looked at Dr imams and again, this, this is not an exclusive and inclusive list. There are probably other connections that I would love to see if we can have some conversations and work uh and see what we can do together to again improve the health of the community. None of this works really works without a team and I'm thankful and grateful to have a great team of students and practitioners work with me and us to do what we do. Hopefully we can continue to do this and that brings me to the end of my formal conversation and I'm glad to take questions if there are any at this point, did anyone have any questions? Hi jaden. It's Andrea thank you for your presentation and updating us with everything that you have done um just in terms of dance screens and you know, going into coming back to in person. Um I guess last year did you guys still screen? Like how did covid affect the screening process? What were some, what were some things that you saw during that time from the collegiate level of dance? Yeah, so I think so. We were we didn't, we did not have physical screens last year because of Covid, everything was clearly the whole the whole world literally shut down. We did do some online health quality of life work that continued and uh we have a couple of projects that are in review right now where we did find that there was a lot of mental anxiety, again, mirroring what the global population did, that people are concerned about what they were doing. The quality of life fell down. Hopefully it's on a stick back. But what we did with our dance kinesiology class was our athletic trainers, had our dancers shoot videos that we gave instructions to them to shoot 32nd videos of themselves doing some other task. And there was a video that she made um to show what the tests would be. And we started it only with the freshman students at this point because just the volume was not feasible from a logistics sense. And so we tried to maintain just relative neutral. Didn't try to do a whole lot. We did some participant related conversations, even our performances which were the galas and the other conversations that were all virtual. So really this year was a washout. Hopefully when we come back in the fall we will have a chance to again reengage with some of this. And now we're really trying to again see how low tech in terms of expertise can we go without losing the research fidelity of the measures that we do so that they can be done remotely and or with somebody away not being in front of the practitioner who can then correct and so on and so forth. But again, no, not, not really, not really know what that would look like. So we'll see. We'll see. Hopefully we'll keep them active, keep them going. Great. Thank you. Yes. I have a question about working with people with Parkinson's. Yes, absolutely. Uh, so we are in conversation, uh, we are in conversation with a couple of colleagues and Andrea and myself. We are part of an organization called the International Association for Dance Medicine and Science. I Adams. I also, um, President, chief of the Journal for the organization, the Journal of Dance Medicine Science and for the journal actually we just opened up another avenue called Dance for Health. And we have a couple of editors who joined the group and they are looking at Dance for health and looking at Parkinson's is ah and other potential movement disorder is something we are looking at. There's a whole another line of practitioners that do what is called dance therapy, which is a little bit different from what we are calling Dance for help. Um and so the the organization is trying to figure out what that means, but for our purposes. Absolutely, thank you. That is something that we are looking at. We are conversing with David Levinthal up in new york and some of the work he has done with the Mark, the Mark Morris and Alvin Ailey dance group that that they've done some great work and hopefully we are going to work, hopefully we're going to be able to work with them in the near future. But thanks for asking and reminding me of that work. Any final questions, anyone? All right, well Justin thank you so much for your presentation uh and for sharing your work with us. Um it seems really wonderful to be able to engage with the community and I know that all of us are looking forward to a world where we don't have to be so afraid to do so, so thank you for that. And I'm sure we will be in touch again with future projects. Um, everybody enjoy your day. Thank you. Thank you. And thank you, folks, yep. Thanks steven. Thank you. Thank you so much. Created by
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