The Effects of Argentine Tango on Balance and Quality of ...

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The Effects of Argentine Tango on Balance andQuality of Life in Subjects With Traumatic BrainInjuryPamela Marie Peterson

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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

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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

support for the nature of this endeavor.

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TABLE OF CONTENTS

CHAPTER 1 INTRODUCTION ........................................................................................ 1

INTRODUCTION ..................................................................................................................... 1

STATEMENT OF PROBLEM ....................................................................................................... 2

STATEMENT OF PURPOSE........................................................................................................ 3

RESEARCH HYPOTHESIS .......................................................................................................... 3

SIGNIFICANCE OF THE STUDY ................................................................................................... 4

RATIONALE OF THE STUDY ...................................................................................................... 4

LIMITATIONS ........................................................................................................................ 4

DELIMITATIONS .................................................................................................................... 5

DEFINITION OF TERMS ......................................................................................................... 96

CHAPTER 2: REVIEW OF RELATED LITERATURE .......................................................... 10

EXERCISE ........................................................................................................................... 10

MUSIC .............................................................................................................................. 10

DANCE .............................................................................................................................. 11

SOCIAL INTERACTIONS .......................................................................................................... 13

TANGO ............................................................................................................................. 13

SUMMARY ......................................................................................................................... 14

CHAPTER 3: METHODOLOGY ..................................................................................... 15

SUBJECTS .......................................................................................................................... 15

RESEARCH DESIGN .............................................................................................................. 15

OUTCOMES ....................................................................................................................... 16

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CONSIDERATIONS ................................................................................................................ 19

CHAPTER 4: RESULTS ................................................................................................ 20

QUALITY OF LIFE ................................................................................................................. 20

BALANCE ........................................................................................................................... 22

CHAPTER 5: DISCUSSION ........................................................................................... 49

QUALITY OF LIFE ................................................................................................................. 49

BALANCE ........................................................................................................................... 49

CHAPTER 6: CONCLUSION ......................................................................................... 52

REFERENCES ............................................................................................................. 53

APPENDICES ............................................................................................................. 63

APPENDIX 1: DASS 21 QUESTIONNAIRE .................................................................................. 63

APPENDIX 2: COURSE DESIGN ................................................................................................ 64

APPENDIX 3: ATTENDANCE SPREADSHEET ................................................................................ 68

APPENDIX 4: STATISTICAL ANALYSIS TABLE ............................................................................... 69

APPENDIX 5: GRAPHS OF INDIVIDUAL SUBJECT DATA .................................................................. 70

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Introduction: Traumatic brain injury (TBI) is a disruption in the normal function of the brain caused by

a blow to the head, violent shaking, or penetration of the brain tissue with varying degrees of

severity1,2. Effects of TBI can be long or short term and symptoms can include physical,

cognitive, behavioral, and emotional impairments2. Many studies have evaluated different

treatment techniques post TBI3. According to the American Academy of Neuroscience review in

2018, people with severe brain injury had lower mortality 3 years post discharge if they had a

multidisciplinary approach to their treatment4. A multidisciplinary approach is best to address

the complexity of symptoms that vary depending on the severity of injury2,4.

Studies suggest that participating in an exercise regimen after a TBI aids in patient

recovery5. Several exercise modalities have been explored for TBI recovery including various

aerobic activities6 and progressive strength training techniques7 that showed improvement in

motor functions. It has also been suggested that individual choice in the type and intensity of

exercise may be more logistically sustainable than regimented exercise protocols for recovery8,9

due to the motivation of the individual to complete the tasks on their own10.

In addition to physical movement, several studies provide evidence that musical

interventions have been successful in the treatment and recovery of patients with TBI11,12.

Music therapy is the planned and intentional use of music to address physical, cognitive, social,

psychological, and other needs of the individual11,12. It has been shown to reduce circulating

stress hormones which improves the efficacy of other therapies done at the same time1,13,14.

Combining the modalities of music and exercise could have an additive effect on gait and

balance control in those suffering from TBI. A study by Thornberg et al. used a controlled

rhythmic exercise with music and visual inputs such as colors and words to produce movement

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and verbal recognition in patients after stroke15. In her study, she concluded that activities

promoting connection to the body provides a sense of wholeness and allows subjects to add

meaning to their lives through social interaction and engagement with the environment and

themselves15.

Dance is a modality that combines exercise with music. Tango is a partner dance

developed in Argentina in the mid-19th century involving long steps and complex patterns of

movement14. One of the few times tango has been examined as an intervention was in a case

study by Hackney et al. as a treatment for a patient with chronic stroke16. She found

measurable improvements on gait, mobility and balance as well as cognitive factors16.

Recently, there have been studies examining the benefits of dance interventions in people with

Parkinson’s disease3,17,18. In another, larger, study by Madeleine Hackney, it was concluded

that tango had more benefit than the Fit ‘n Fun exercise protocols for Parkinson’s disease in a

subject’s functional mobility10. This could be the result of the complexity of movement

patterns required for tango such as turning, varying speed, and varied direction of movement

stimulating areas of the brain controlling balance centers19.

Statement of Problem:

Traumatic brain injuries are common and complex. Because not everyone has

behavioral issue or severe impairments as a result of TBI the need for outpatient treatment is

generally not warranted1. Though medical intervention is not always prescribed, or the patient

has recovered to a point where they no longer need the clinical intervention, patients often

have symptoms of disorganized movements and postural problems that persist and cause a loss

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of quality of life1. Research has been done using interventions such as rhythmic exercise and

dance to increase the quality of life for other brain disorders including degenerative balance

disorders associated with age13,20–23, Alzheimer’s disease24, stroke16,25 and Parkinson’s

disease3,10,17,18,26–28, while one study looked at aerobic dance and TBI29, none have looked at

how tango can benefit individuals with TBI.

Statement of Purpose:

The purpose of the study is to investigate the effects of Argentine tango on balance

control and quality of life in subjects with traumatic brain injury compared to both a non-

traumatic brain injury tango intervention and non-intervention control group.

Research Hypothesis:

There will be no difference between the control group and the Tango groups in Quality

of life scores pertaining to Stress as reflected in the Pre and Post DASS-21 Questionnaire.


of life scores pertaining to Anxiety as reflected in the Pre and Post DASS-21 Questionnaire.


of life scores pertaining to Depression as reflected in the Pre and Post DASS-21 Questionnaire.

There will be no difference between the control group and the Tango groups in center

of pressure anterior to posterior displacement as reflected in the Pre and Post force platform

assessments.

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of pressure medial to lateral displacement as reflected in the Pre and Post force platform

assessments.


of pressure area as reflected in the Pre and Post force platform assessments.


of pressure path length as reflected in the Pre and Post force platform assessments.

Significance of the Study:

This is the only study exploring the effects of Argentine tango on balance and quality of

life on persons with traumatic brain injury.

Rationale of the Study:

Because Argentine tango is dynamic and improvisational, continuous corrections need

to be made without the benefit of anticipated patterns which will, in theory, enhance the

balance required for the activities of daily life.

Limitations:

Argentine tango combines the musicality11,12,30,31 and mindfulness32–37 components with

the physical to enhance effectiveness. It also has higher adherence rates3,20 which makes it a

candidate for a long term intervention for improving physical and mental qualities of life in

persons with traumatic brain injury.

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Delimitations:

Studies have already explored various physical therapy modalities for balance or music

interventions individually or in conjunction with other mindfulness therapies for traumatic

brain injury to great effect. However, unless stipulated by the individual participating in the

intervention, they do not combine mindfulness techniques, interpersonal touch, social

interactions, physical movements, and rhythmic/ musical stimulation and reflex simultaneously.

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Definition of Terms:

• Traumatic Brain Injury (TBI): “A disruption in the normal function of the brain that can be

caused by a bump, blow, or jolt to the head or a penetrating head injury1.” This definition

has been expanded to include explosive blasts as a cause1.

• Postural Control: complex motor skill involving sensory and motor systems working

together to prevent falls38,39

o Center of Pressure: the location of vertical ground reaction vector on the force

platform40.

o Postural Sway: horizontal movement around the center of gravity41

• Balance: the condition of someone or something in which its weight is equally divided so

that it can stay in one position or be under control while moving42.

• Quality of life: how people see their lives compared to their ideal lives based on societal

norms43–45

o Stress: uncomfortable emotional experience accompanied by predictable

biochemical, physiological and behavioral changes46,47.

o Anxiety: an emotion characterized by feelings of tension, worried thoughts and

physical changes like increased blood pressure48.

o Depression: a common mental disorder with symptoms including: a lack of interest

and pleasure in daily activities, significant weight loss or gain, insomnia or excessive

sleeping, lack of energy, inability to concentrate, feelings of worthlessness or

excessive guilt and recurrent thoughts of death or suicide49.

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o DASS 21: is a 21-item self-report instrument designed to measure the three related

negative emotional states of depression, anxiety and tension/stress50.

• Argentine Tango

o Walking: The lead moves forwards or backwards and the follower moves backwards

or forwards in parallel or crossed system

o Cross system: Occurs whenever the couple are stepping together on his and her

right feet and then on his and her left feet, regardless of direction. The opposite

of parallel system51.

o Parallel system: The natural condition when a couple dance in an embrace facing

each other, the lead stepping on his left, the follower on her right foot, and then the

lead stepping on his right, the follower on her left foot, regardless of direction51.

o Sidesteps: Moving as a unit to the side

o Ochos: (eights) Pivoting on one foot forward or backward with the feet together

during the pivot and extended during the step as in figure eights. Typically executed

with feet together (ankles touching) instead of one foot extended51,52.

o Giros (turn): While follower does molinete, leader turns on one foot placing the toe

of the foot in front and executing a sharp turn52.

o Molinete: Windmill; wheel: A figure in which the follower dances a grapevine

pattern around the leader, stepping in a side-back crossing step-side-forward

crossing pattern as the leader pivots at the center of the figure. This is a very

common figure in tango which challenges both roles to maintain good posture,

balance, and technique51.

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o Rock step: A split weight check and replace, usually led as the leader steps forward

with the left foot interrupting his or her forward step. May also refer to a subtle

shifting of weight from foot to foot in place and in time with the music done by the

lead before beginning a dance to give the follow the rhythm intended to ensure that

the follow will begin on the correct foot51.

▪ Rock step turn: using the rock step to change direction by pivoting on the

forward foot

o Cruzada: Cross; occurs anytime a foot is crossed in front or in back of the other52.

o Calisita: “merry-go-round”53; occurs when the lead circles around a stationary

(pivioting) follow.

o Parada pasada:

▪ Parada (stop) happens when the leader places a foot against a follower's foot

and leads them to stop54.

▪ Pasada (stepover) often follows a parade. It occurs when the follower steps

over the leader's foot often to return to the center herself in front of the

leader54.

o Adorno: ornament, decoration55; a movement in tango that is not led

• Body:

o Axis: The center vertical line around which one's balance is maintained52

o Line of Dance: Moving in a counter clockwise circle with the group of dancers at a

social dance

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• Lead: Traditionally a male role, a lead invites the follow to perform steps and step

sequences

• Follower: Traditionally a female role, a follower “follows” the lead but the role is not

passive. The follow can set the timing and the emotion of the dance based on how they

follow the leader’s invitations.

• Practica: Informal Tango dance practice

• Milonga: Formal Argentine tango dance party

Figure 1: Schematic of the complex interaction of tango

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Chapter 2: Review of Related Literature:

Exercise:

Following the initial physical therapy to return to normal function after traumatic

incident, depending on the extent of the injury, can be months to years of additional intensive

physical therapies1. Some of the greatest gains during this time can be made in the

psychological effects of chronic illness—depression and resultant decrease in cognitive

function1. Exercise has been found to be as effective as medications at soothing the

dysregulated sympathetic nervous system post TBI6,15,56–60. In addition to being dysregulated,

the treatment of depression and anxiety after traumatic brain injury is challenged by increased

sensitivity to medications and vulnerability to side effects61.

Exercise mitigates persistent problems with balance and stability. Progress was made

toward normalcy and safety for people who live with traumatic injury or other balance

disorders using yoga58, monitored circuit training7,9,62,63 and other highly individualized

interventions57,64.

Music:

Music is a multi-dimensional tool newly introduced to the world of psychotherapy. It

has the power to enhance and destroy motivation and bridge the gaps between brain cells65. In

2009, Altenmüller et al. observed after 15 sessions of music therapy there were not only

improvements in motor control and precision of movements over controls, but there was

better cortical connectivity in the EEG in the damaged parts of the brain than in the control

groups. Neurologic music therapy has huge implications for people with traumatic brain injury

for depression and for motor control66–68.

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Emotional regulation is difficult for those with traumatic brain injury. Music therapy can

help modulate the peaks and valleys of nervous system dysregulation by stimulating the para-

limbic system causing feelings of happiness or satiety69–71. Thaut et al. looked at executive

function and emotional adjustment in persons with traumatic brain injury. They found that the

treatment group who used percussion instruments to follow patterns led by a therapist were

significantly improved in anxiety, depression and sensation seeking and more mentally

flexible70.

Adding music to movement therapies that are not dance has shown to have significant

improvements to patients’ quality of life and mobility due to a sense of being connected to the

whole body15. Two weeks after stroke, adding music to wheelchair-seated arm activities

showed greater satisfaction and greater range of motion in the shoulder and elbow in the

affected arm compared to the control group72. Pacchetti et al. found a similar phenomenon

when adding music to weekly physical therapy in Parkinson’s patients73. His patients saw a

decrease in bradykinesia, improvements in activities of daily living and overall happiness

factors73. In subjects who completed Dance For Parkinson’s (DFP) protocols, there were no

improvements to balance due to the seated nature of the exercise but showed positive

improvement in social application and quality of life scores3.

Dance:

In 2002, Dault et al. performed a study involving aerobic dancing compared to muscular

training on subjects with traumatic brain injury29. The dancing was individualized slide and step

dancing with gradual addition of arms while the muscular training was traditionally prescribed

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musculoskeletal training using Nautilus equipment. The study concluded, based on force plate

analysis, that the dance group benefited more in balance and coordination than the weight

training (control) group29.

The older adults also show improvements in postural control with dance-based

programs. An eight-week ballroom dance study showed improvement in balance and

functional performance using subjective tests such as the Timed up and go, Tinetti test, etc.

and objective measures such as force plate data compared to controls23. Kattenstroth et al.

found after six months of a weekly dance class, there were significant changes to posture and

balance that were tested with both subjective tests and with force plates as well as cognition

and quality of life changes that were tested with the everyday competence questionnaire22.

Parkinson’s disease has some of the same hallmarks of instability and resulting deficits

in quality of life as persons with traumatic brain injury due to lack of mobility including postural

instability, gait difficulties, impaired functional mobility3,10,17,18,26–28, and depression17,18. Several

studies have explored dance and how it impacts motor function in people with Parkinson’s

disease with mixed results based on modality. Ballet did not show significant balance

improvement based on the measurements taken with the explanation being fatigue during the

measurements since they were taken directly after the class, but it did show a significant

improvement to motor control scores as well as those to quality of life18. Subjects who

participated in improvisational28 and modern dance27 showed improvement in balance scores

using the Fullerton scale. The case study showing improvement with improvisational dancing

was substantiated with changes in fMRI imaging showing the possibility the basal ganglia can

reroute to reestablish connections to improve movement patterns28. This finding is also being

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explored by Hafting et al. in the older adult population as it pertains to dance with the

explanation neurons are part of a grid system and even if they are atrophied or missing, they

still hold the space—the location they connected to can be reached74 and dancing can help

reconnect these pathways13.

Social interactions:

The social interaction of activities is well known to help with depression and anxiety.

Tango goes a step further by combining music and partner using interpersonal touch to

alleviate the feelings of isolation and loneliness32,33,35. In a study by Quiroga Murcia et al., the

role of hormone was evaluated as were the roles of partner and music33. They found that

regular tango decreased cortisol levels which were additive with partner and with music and

testosterone fluctuations were mitigated after the second introduction which substantiated

previous, self-reported research on the subject of well-being33. It is important to note that this

decrease in cortisol is unique to Argentine tango perhaps due to its more casual

atmosphere75,76.

Tango:

Hackney et al. in several studies spanning 2007-2010 looked at how tango used as an

intervention could improve quality of life in subjects compared to other interventions such as

American Ballroom tango26, and group exercise classes10; as well as a longer term study

following a single individual for a duration of 20 weeks17. Overall, she and her colleagues found

that when compared to exercise only tango improved on the balance measures, and compared

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to the other dance modalities the groups participating in tango showed the same if not more

improvement in balance according to the Berg Balance scale.

Used as treatment for chronic stroke, there were similar effects. In 2012, Hackney again

tested tango as an intervention in a case study showing marked improvement after 20 hours of

tango classes in balance and coordination as well as a commitment to continuing the course of

treatment16.

Tango has also been used in non-pathological older adults with balance and confidence

problems. Patricia McKinley and colleagues in 2005 did a feasibility study that found tango

targeted balance and complex task execution better than other modalities specifically

compared to a walking program21. She repeated the study in 2008. After the follow-up it was

determined both groups were significantly improved, but the attrition rate for the tango group

was much less than for the walking group there was only 1 compared to 4 in the walking group

which might have more significant ramifications for long-term treatment choices20.

Summary:

The literature shows there is strong evidence Argentine tango can be an effective

intervention for generalized traumatic brain injury because it is the integration of movement,

music, social interaction and mindfulness practice.

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Chapter 3 Methodology:

Subjects:

Subjects were selected from volunteers in the Missoula, MT and surrounding communities

with an interest in learning to dance Argentine Tango. All subjects had no previous dance

experience or did not dance regularly within the last year and were between 18 and 50 years of

age with the average age of 32 years. Because Argentine Tango is a partner dance, we wanted

each group to have 5 males and 5 females to conform to traditional leader and follower roles,

we had 6 females and 5 males with the instructors substituting for the absent partner. There

were three groups: Tango with TBI, Tango without TBI, and the Control Group.

The TBI group were individuals who have an history of TBI with recovery lasting greater than

1 year and have ambulatory ability (n=2). The severity of TBI in the participants were

determined by self-reported acknowledgement of Glasgow Coma Scale scores between 9-12

which are considered moderate77.

The Non-TBI group were individuals with no known TBI (n=12). They participated in the

same tango intervention and measurements as the TBI group. Three of the participants elected

to remove themselves from the study leaving n=9.

The Control group were individuals without a known TBI who did not participate in the

tango intervention (n=12).

Research Design:

All participants from each group participated in pre and post testing of balance and

quality of life scores.

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TBI and Treatment Control groups participated in a six-week introductory Argentine

tango class once per week provided by Tango Connections, of Missoula, MT. The instructors for

the course were Lori Mitchell and Michaela Stockhouse. The class covered basic movements

such as walking with a partner in parallel and cross systems and progressed to more complex

movements throughout the course. A detailed description of the classes is available in

Appendix 3. Subjects were discouraged to participate in non-tango dancing during the

experiment and were required to practice tango one time per week outside of class during

organized practicas supervised by members of the tango community and instructors3,18,19,22–

24,27–29,34,35. These were held for one and one-half hours per week on Monday, Thursday and

Friday evenings in various venues in Missoula and the Bitterroot Valley. These were monitored

by rollcall by the PI who attended all functions. Subjects were removed from the study if they

missed more than one class and one practica. Subject number one was removed from analysis

after completing the protocol due to a syncopal episode during the treatment period.

Outcomes:

Postural control evaluation:

Subjects reported to Ed 010 by appointment. Subjects were responsible for ensuring

they did not arrive to the laboratory inebriated or otherwise incapacitated. The laboratory

portion of the assessment took approximately 15-20 minutes per subject. During data

collection subjects performed a cognitive challenge (serial sevens). Data was collected on all

subjects within two days of completion of intervention to ensure effect is measured. The entire

assessment took about one hour per individual including the survey.

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The assessments included pre and post intervention time points in a modified sensory

orientation test in 6 different conditions. Subjects were asked to stand on the force plate for 45

seconds with their:

(1) Feet together and eyes open,

(2) Feet together and eyes closed,

(3) Feet apart and eyes open, and

(4) Standing on foam with feet together and eyes open

(5) Standing on foam with feet together and eyes closed

(6) Standing on foam with feet apart and eyes open

Quality of Life evaluation:

Subjects filled out a survey (DASS-21) to evaluate their mental state of depression,

anxiety and stress78 to determine the quality of life impact of the intervention. The surveys

were manually scored and the deidentified data were entered into excel for analysis.

Analysis:

Balance evaluation:

In this study we used a BerTec 6040 force platform with a dual pass of a 6-pole, low

pass, Butterworth filter producing a zero-lag filter with an effective cutoff frequency of 40 Hz,79

along with the Axoscope 10.2 to analyze postural sway similar to those used in the Dault

study29. Each of these conditions was assessed at 1000 Hz for the middle 30 seconds

eliminating the step on and off period to ensure steady state. The foam measured 12.7 cm in

depth. Readings of Anterior/Posterior and Medial/Lateral Center of Pressure (COP)

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displacement, COP area, and COP path length were taken from this assessment using

WaveMetrics Inc., Igor Pro 6.34A; OR, USA program. Center of pressure was assessed from the

ground reaction force record in accordance with Newton’s first law:

𝐶𝑜𝑃𝑋 = −𝑀𝑦

𝐹𝑧

𝐶𝑜𝑃𝑌 =𝑀𝑥

𝐹𝑧

We calculated the center of pressure area by writing a code in Igor to convert the non-

simple figure generated by the raw data using the maximum and minimum values to find the

perimeter of the figures. We then calculated the area using a modification of Green’s Theorem

for a simple closed figure. Where c is the clockwise oriented simple closed curve.

𝑎𝑟𝑒𝑎 𝑜𝑓 𝐷 = ∬ 𝑑𝐴

=1

2∫𝑥𝑑𝑦 − 𝑦𝑑𝑥

𝐶

We calculated percent change in the pre to post intervention measurements to remove

the variability between subjects. This was calculated by using the formula:

𝑃𝑒𝑟𝑐𝑒𝑛𝑡 𝑐ℎ𝑎𝑛𝑔𝑒 =(𝑝𝑜𝑠𝑡 𝑖𝑛𝑡𝑒𝑟𝑣𝑒𝑛𝑡𝑖𝑜𝑛 𝑑𝑎𝑡𝑎 − 𝑝𝑟𝑒 𝑖𝑛𝑡𝑒𝑟𝑣𝑒𝑛𝑡𝑖𝑜𝑛 𝑑𝑎𝑡𝑎)

𝑝𝑟𝑒 𝑖𝑛𝑡𝑒𝑟𝑣𝑒𝑛𝑡𝑖𝑜𝑛 𝑑𝑎𝑡𝑎× 100

Quality of Life evaluation:

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

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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


of pressure area (Figure 4B).

Feet Together Eyes Closed


of pressure area (Figure 4C).

Foam Feet Apart Eyes Open


of pressure area (Figure 4D).

Foam Feet Together Eyes Open


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.

*

*

*


A B C

D E F

A B C

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Displacement (cm):



displacement (Figure 6A).



displacement (Figure 6B).



displacement (Figure 6C).



displacement (Figure 6D).



displacement (Figure 6E).


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.

*


A B C

D E F

A B C

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AP Displacement (cm):


There was not a main effect of time, nor a significant time*group interaction for AP















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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There was no significant percent change across the groups (Figure 9) for AP

displacement.

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ML Displacement (cm):



A B C

D E F

A B C

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ML Displacement (cm):


There was not a main effect of time, nor a significant time*group interaction for ML
















displacement (Figure 10F).


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.

*

*

*


A B C

D E F

A B C

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Average Velocity (cm/s):


There was not a main effect of time, nor a significant time*group interaction for average

velocity (Figure 12A).



velocity (Figure 12B).



velocity (Figure 12C).



velocity (Figure 12D).



velocity (Figure 12E).


There was a p=0.001 significant main effect of time for all groups (Figure 12F).


There was no significant percent change across the groups (Figure 13) for average

velocity.

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Peak Velocity (cm/s):


*

* *


A B C

D E F

A B C

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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).



velocity (Figure 14B).



velocity (Figure 14C).



velocity (Figure 14D).



velocity (Figure 14E).


There was a p<0.001 significant main effect of time for all groups (Figure 14E).


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.

*


A B C

D E F

A B C

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AP Average Velocity (cm/s):



average velocity (Figure 16A).



average velocity (Figure 16B).



average velocity (Figure 16C).



average velocity (Figure 16D).



average velocity (Figure 16E).


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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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.

*


A B C

D E F

A B C

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AP Peak Velocity (cm/s):



peak velocity (Figure 18A).



peak velocity (Figure 18B).



peak velocity (Figure 18C).



peak velocity (Figure 18D).



peak velocity (Figure 18E).


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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There was no significant percent change across the groups (Figure 19) for AP peak

velocity.

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ML Average Velocity (cm/s):


*

* *


A B C

D E F

A B C

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ML Average Velocity (cm/s):



average velocity (Figure 20A).



average velocity (Figure 20B).



average velocity (Figure 20C).



average velocity (Figure 20D).



average velocity (Figure 20E).




There was no significant percent change across the groups (Figure 21) for ML average

velocity.

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ML Peak Velocity (cm/s):


*

* *


A B C

D E F

A B C

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ML Peak Velocity (cm/s):



peak velocity (Figure 22A).



peak velocity (Figure 22B).



peak velocity (Figure 22C).



peak velocity (Figure 22D).



peak velocity (Figure 22E).




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

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50

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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53

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Appendix 1:

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Appendix 2:

Day 1

- Entrance, solo walking to music while everyone arrives

- Warm up with where are you standing on your foot and grounding to push off to step

- Tango play

- Practice embrace (arms on chest), slots, simple straight walking

- Slots, walking, pause

- Slots, walking/pause/ sidestep

- Slots, walking with big step vs small step, fast step vs slow step

- Introduction to rock step solo

- Practice embrace (arms on chest), Rock step with partner (forward, side, with rotation)

- Sugar bowl similar Practice embrace (leads hands on follower arms)

- Introduction to line of dance

Forward walking around corner, if working try tight circle

Twisting to Cross walking in parallel (lead steps to outside of followers trailing leg)

Big side step with ankle attitude

Day 2

-Warm up

-Just Walking - halfway thorough song switch who is walking backwards

-Finding your axis

-Calicita drill to feel pivot (shoulders connected to feet)

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-Solo pivot practice with group

-Any steps dance - big steps, super slow

-Little guns

-big guns

-Any steps dance - small steps

-Followers initiate ochos, lead is there for moral support

-Leads lead the ochos

-Any steps dance - Poema

-Cross walking if there’s time

Day 3

-Review of walking, pause, side step, self pivot. Demonstrated rock step.

-Gave them chances for free dance.

-Review and practice of back ocho

-Introduce front ocho

-Lots of drilling and in place practice.

-Introduce walking ochos

-Introduce basic left hand turn

-Ended with general musicality/ movement attitude

A turn -> probably review ochos, introduce front ochos, have a turn occur out of front ochos

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How to keep them engaged (introduce more musicality?), how to help those who are

frustrated/struggling from feeling left out.

Day 4

Suggested: Review connection, even compression, and delayed compression (go back to slots

and practice embrace again temporarily?) /control while spiraling pivoting/ and being

responsible to move oneself (dance with no hands, maybe do this one twice? First and last?),

Introduce molinete, practice what we’ve learned

Day 5

Suggested: Brief review of previous steps and introduce the Quality&Type game (teacher prep:

find classical songs that go well with the different qualities and ones that can be interpreted in

more than one way), no new “steps” introduced in this class, emphasis on musicality

(specifically classical) MAKE SURE THERE IS A DRY ERASE MARKER WE CAN USE if we can

borrow the whiteboard?

Day 6

Suggested: Review as needed, Introduce Parada pasada with sandwich and follower options,

practice what we’ve learned and encourage fun

-Review ochos

-give dance

-Review molinete

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-give dance

-Back to ochos, practice

-give dance

-Ochos, slowing down the follower, pausing the follower in the middle of the step, follower is

focused on technique while listening to the lead

-give dance

-Ochos, can lead balance mostly on one foot while slowing to pause the follower before

collection and then slide their opposite foot to meet the follower trailing foot, sandwich, then

invite follower to collect on forward foot. [Teacher Stop there and let them practice for a short

moment] Continuing step by follower stepping over and resolving pivot to face lead. Lead has

shifted weight to step onto outstretched foot.

-give dance

-Some follower adorno ideas

-Some lead adorno ideas

-Rotate each dance to practice with new people until end of class.

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Appendix 3:

#####

ID

Num

ber

C/I

Co

nf.

Par Q

Co

nsen

t

Pre

DA

S

S

Pre

bala

n

ce

Cla

ss

Week 1

Pra

ctic

e

week 1

Cla

ss

Week 2

Pra

ctic

e

week 2

Cla

ss

Week 3

Pra

ctic

e

week 3

Cla

ss

Week 4

Pra

ctic

e

week 4

Cla

ss

Week 5

Pra

ctic

e

week 5

Cla

ss

Week 6

Pra

ctic

e

week 6

Po

st

DA

SS

Po

st

Bala

nce

Heig

ht

3C

ontro

lY

es

XX

XX

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

XX

182.2

5

8C

ontro

lY

es

XX

XX

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

XX

175.2

6

10

Co

ntro

lY

es

XX

XX

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

XX

167.6

4

14

Co

ntro

lY

es

XX

XX

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

XX

182.8

8

15

Co

ntro

lY

es

XX

XX

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

XX

165.1

16

Co

ntro

lY

es

XX

XX

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

XX

180.3

4

17

Co

ntro

lY

es

XX

XX

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

XX

163.8

3

18

Co

ntro

lY

es

XX

XX

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

XX

185.4

2

20

Co

ntro

lY

es

XX

XX

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

XX

170.1

8

21

Co

ntro

lY

es

XX

XX

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

XX

188

22

Co

ntro

lY

es

XX

XX

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

XX

157.4

8

23

Co

ntro

lY

es

XX

XX

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

XX

188

2T

BI

Yes

XX

XX

Thurs

XT

hurs

XM

onday

XM

onday

XT

hurs

day

XM

onday

XX

173

11

TB

IY

es

XX

XX

XF

riday

XF

riday

XF

riday

XF

riday

XF

riday

Frid

ay

XX

170

1T

CY

es

XX

XX

XT

hurs

XT

hurs

XM

onday

XM

onday

XT

hurs

day

XM

onday

XX

164

4T

CY

es

XX

XX

XF

riday

XM

onday

XT

hurs

day

XT

hurs

day

XM

onday

XM

onday

XX

165

5T

CY

es

XX

XX

XT

hurs

XF

riday

XT

hurs

day

XT

hurs

day

Thurs

day

XM

onday

XX

174.5

6T

CY

es

XX

XX

XT

hurs

XF

riday

XT

hurs

day

XT

hurs

day

XT

hurs

day

XM

onday

XX

165.5

7T

CY

es

XX

XX

XX

Mo

nday

XM

onday

XM

onday?

XF

riday

XM

onday

XX

179.7

5

9T

CY

es

XX

XX

XT

hurs

XM

onday

XM

onday

XM

onday

XM

onday

XX

166.5

19

TC

Yes

XX

XX

XT

hurs

XM

onday

XM

onday

XT

hurs

day

XM

onday

XM

onday

XX

168

24

TC

Yes

XX

XX

Frid

ay

Thurs

XM

onday

XM

onday

XM

onday

XM

onday

XX

157.5

25

TC

Yes

XX

XX

Frid

ay

Thurs

XT

hurs

day

26

TC

Yes

XX

XX

Frid

ay

XM

onday

XX

Thurs

day

XM

onday

XM

onday

XX

191.5

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Appendix 4:

OUTCOMES TIME TIME*GROUP TIME TIME*GROUP TIME TIME*GROUP TIME TIME*GROUP Assumed unassumed

DEPRESSION 0.183 0.264 0.173 0.238 0.023 0.15 0.018 0.035

ANXIETY 0.45 0.917 0.409 0.939 0.381 0.688 0.312 0.733

STRESS 0.675 0.029 0.694 0.023 0.059 0.019 0.053 0.016

COP AREA 1 1 1 0.991 1 0.977 0.987 1 0.991 0.137 0.239 1=FTEO

COP AREA 2 0.784 0.652 0.805 0.612 0.522 0.826 0.465 0.762 0.714 0.731 2=FTEC

COP AREA 3 0.273 0.434 0.35 0.602 0.077 0.235 0.125 0.359 0.083 0.059 3=FAEO

COP AREA 4 0.896 0.198 0.765 0.767 0.506 0.089 0.843 0.489 0.233 0.221 4=FFTEO

COP AREA 5 0.002 0.094 0.431 0.489 0.061 0.881 0.223 0.256 0.456 0.371 5=FFTEC

COP AREA 6 0.752 0.108 0.658 0.121 0.025 0.525 0.037 0.716 0.75 0.791 6=FFTAEO

DISPLACEMENT 1 0.556 0.475 0.573 0.483 0.668 0.259 0.711 0.265 0.379 0.384

DISPLACEMENT 2 0.737 0.239 0.674 0.161 0.299 0.123 0.192 0.08 0.09 0.069

DISPLACEMENT 3 0.202 0.668 0.224 0.747 0.124 0.385 0.148 0.461 0.256 0.179

DISPLACEMENT 4 0.142 0.837 0.121 0.546 0.176 0.689 0.073 0.293 0.359 0.299

DISPLACEMENT 5 0.001 0.395 0.165 0.482 0.006 0.791 0.082 0.245 0.259 0.203

DISPLACEMENT 6 0.128 0.823 0.183 0.853 0.016 0.906 0.031 0.81 0.655 0.617

AP DISPLACEMENT 1 0.887 0.742 0.903 0.695 0.634 0.283 0.676 0.437 0.956 0.957

AP DISPLACEMENT 2 0.761 0.709 0.66 0.829 0.095 0.485 0.845 0.606 0.313 0.365

AP DISPLACEMENT 3 0.499 0.166 0.617 0.264 0.093 0.07 0.139 0.119 0.119 0.135

AP DISPLACEMENT 4 0.524 0.566 0.691 0.778 0.991 0.742 0.902 0.551 0.307 0.28

AP DISPLACEMENT 5 0.029 0.297 0.289 0.383 0.143 0.145 0.15 0.183 0.151 0.116

AP DISPLACEMENT 6 0.687 0.566 0.573 0.673 0.861 0.275 0.785 0.798 0.705 0.698

ML DISPLACEMENT 1 0.446 0.156 0.409 0.107 0.118 0.114 0.11 0.037 0.023 0.064

ML DISPLACEMENT 2 0.557 0.277 0.58 0.259 0.291 0.906 0.238 0.778 0.529 0.561

ML DISPLACEMENT 3 0.602 0.913 0.669 0.969 0.621 0.553 0.474 0.859 0.487 0.487

ML DISPLACEMENT 4 0.431 0.313 0.312 0.628 0.764 0.946 0.763 0.669 0.399 0.407

ML DISPLACEMENT 5 0.069 0.314 0.242 0.614 0.161 0.205 0.198 0.349 0.802 0.775

ML DISPLACEMENT 6 0.56 0.42 0.677 0.504 0.064 0.237 0.075 0.883 0.985 0.987

AVERAGE VELOCITY 1 0.556 0.475 0.573 0.483 0.518 0.104 0.711 0.265 0.379 0.384






PEAK VELOCITY 1 0.4 0.428 0.433 0.474 0.166 0.223 0.187 0.254 0.303 0.351

PEAK VELOCITY 2 0.493 0.06 0.505 0.044 0.091 0.344 0.063 0.279 0.718 0.762

PEAK VELOCITY 3 0.171 0.463 0.259 0.71 0.051 0.245 0.11 0.438 0.173 0.182

PEAK VELOCITY 4 0.72 0.845 0.544 0.941 0.52 0.611 0.268 0.982 0.866 0.853

PEAK VELOCITY 5 0 0.271 0.05 0.364 0.001 0.37 0.024 0.174 0.186 0.139

PEAK VELOCITY 6 0.258 0.753 0.33 0.769 0.04 0.976 0.065 0.784 0.891 0.898

AP AVERAGE VELOCITY 1 0.747 0.542 0.783 0.567 0.785 0.292 0.855 0.311 0.438 0.4






AP PEAK VELOCITY 1 0.411 0.486 0.442 0.534 0.18 0.263 0.2 0.296 0.816 0.84

AP PEAK VELOCITY 2 0.409 0.033 0.435 0.022 0.06 0.275 0.035 0.198 0.284 0.321

AP PEAK VELOCITY 3 0.255 0.455 0.346 0.661 0.086 0.242 0.155 0.396 0.308 0.332

AP PEAK VELOCITY 4 0.84 0.915 0.674 0.763 0.499 0.912 0.281 0.598 0.484 0.444

AP PEAK VELOCITY 5 0.014 0.563 0.245 0.399 0.013 0.37 0.098 0.196 0.151 0.109

AP PEAK VELOCITY 6 0.289 0.991 0.391 0.928 0.165 0.99 0.287 0.709 0.82 0.817

ML AVERAGE VELOCITY 1 0.28 0.5 0.271 0.485 0.517 0.353 0.513 0.341 0.524 0.593




ML AVERAGE VELOCITY 5 0 0.373 0.174 0.499 0.002 0.912 0.082 0.257 0.422 0.38


ML PEAK VELOCITY 1 0.332 0.438 0.34 0.448 0.308 0.222 0.322 0.228 0.185 0.227

ML PEAK VELOCITY 2 0.43 0.486 0.44 0.493 0.195 0.262 0.195 0.266 0.538 0.591

ML PEAK VELOCITY 3 0.049 0.926 0.079 0.873 0.045 0.894 0.092 0.806 0.339 0.279

ML PEAK VELOCITY 4 0.504 0.647 0.356 0.833 0.203 0.455 0.084 0.952 0.993 0.992

ML PEAK VELOCITY 5 0 0.116 0.026 0.336 0.001 0.406 0.021 0.174 0.192 0.145

ML PEAK VELOCITY 6 0.404 0.574 0.418 0.56 0.047 0.852 0.044 0.768 0.692 0.714

3X2 WITHOUT SUBJECT 1 3X2 WITH SUBJECT 1 2X2 WITHOUT SUBJECT 1 2X2 WITH SUBJECT 1

2 tailed non paired t

tests

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Appendix 5:

Figures include Subject 1 and show outlier status.

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