¶ Art Therapy and Creative Arts Therapies for CBS/PSP
Creative arts therapies represent a powerful non-pharmacological approach to addressing the multifaceted challenges of Corticobasal Syndrome (CBS) and Progressive Supranuclear Palsy (PSP). These atypical parkinsonian disorders affect motor function, cognition, emotion, and communication, requiring holistic interventions that can target multiple domains simultaneously.
Unlike single-modality treatments, creative arts therapies engage multiple neural pathways and psychological processes, making them particularly well-suited for the complex symptom profiles of CBS and PSP. The therapeutic use of visual arts, music, movement, drama, and creative writing provides opportunities for self-expression, cognitive stimulation, emotional processing, and motor rehabilitation within a supportive, non-judgmental framework[@stuckey2020][@van2022].
| Property |
Value |
| Category |
Non-Pharmacological Complementary Therapy |
| Target Conditions |
CBS, PSP, Atypical Parkinsonism |
| Modalities |
Art, Music, Dance, Drama, Creative Writing |
| Mechanisms |
Neuroplasticity, emotional expression, cognitive stimulation, motor engagement |
| Clinical Status |
Evidence-based; emerging applications for CBS/PSP |
| Evidence Level |
Strong for dementia; moderate for CBS/PSP |
¶ Neuroplasticity and Brain Engagement
Creative arts therapies engage widespread neural networks, promoting neuroplasticity—the brain's ability to form new connections and reorganize function[@bolwerk2014][@pmc2021]:
Visual Art Therapy:
- Activates visual processing regions (occipital lobe)
- Engages motor planning through drawing/painting movements
- Stimulates cognitive processing and decision-making (prefrontal cortex)
- Provides emotional regulation through creative expression (limbic system)
Music Therapy:
- Engages auditory cortex, motor cortex, and cerebellum simultaneously
- Activates reward pathways (ventral striatum, dopamine release)
- Synchronizes neural oscillations across brain regions
- Facilitates emotional memory processing (amygdala-hippocampal connections)
Dance/Movement Therapy:
- Integrates sensory-motor circuits (basal ganglia, cerebellum)
- Engages mirror neuron systems for movement observation
- Activates emotional processing through embodied experience
- Promotes spatial awareness and body consciousness
Beyond neural plasticity, creative arts therapies work through powerful psychological pathways[@malchiodi2021][@brus2022]:
- Self-Expression and Communication: Provides alternative communication channels when verbal abilities are impaired
- Emotional Processing: Offers safe outlets for processing grief, frustration, and anxiety
- Identity Preservation: Maintains sense of self and personal narrative despite disease progression
- Social Connection: Creates shared experiences that strengthen relationships with caregivers
- Meaning-Making: Helps patients find purpose and make sense of their experience
Art therapy uses visual arts materials and creative processes to promote emotional, cognitive, and motor rehabilitation[@riklin2023][@noice2021].
Benefits for CBS/PSP:
| Domain |
Specific Benefits |
| Motor |
Fine motor control, hand coordination, bilateral integration |
| Cognitive |
Attention, visual-spatial processing, problem-solving |
| Emotional |
Anxiety reduction, self-esteem, emotional expression |
| Social |
Non-verbal communication, shared activity with caregivers |
Therapeutic Techniques:
- Free Art Expression: Open-ended creative exploration without specific goals
- Directed Art Projects: Structured activities targeting specific skills
- Mandala Coloring: Calming, structured activity for focus and relaxation
- Collage Making: Combining pre-cut images for self-expression
- Sculpture/Clay Work: Tactile engagement and three-dimensional thinking
CBS/PSP-Specific Adaptations:
- Use adaptive tools (larger brushes, weighted pencils, non-slip mats)
- Provide seated workstations with proper ergonomics
- Focus on process over product to reduce frustration
- Allow for asymmetric activities given CBS limb involvement
- Include caregiver-assisted activities for PSP balance concerns
While Music and Rhythm-Based Therapy covers rhythmic cueing for motor rehabilitation, music therapy as a creative arts modality emphasizes emotional expression, social interaction, and cognitive stimulation[@raglio2022][@van2022a].
Therapeutic Applications:
-
Singing and Vocal Expression
- Preserves and supports speech-related muscles
- Provides emotional release and mood regulation
- Enhances respiratory function and control
- Maintains social engagement through group singing
-
Instrumental Play
- Drum circles for rhythm and motor timing
- Simple percussion for bilateral coordination
- Keyboard/handbells for fine motor skills
- Guided improvisation for emotional expression
-
Music Listening and Discussion
- Evocative music for reminiscence and emotional processing
- Patient-selected music for personal meaning
- Structured listening for attention and memory
-
Songwriting and Composition
- Lyric adaptation using familiar melodies
- Simple composition for self-expression
- Life review through music narrative
Evidence Base:
- Music therapy reduces agitation and depression in dementia[@guetin2021]
- Group music therapy improves quality of life in Parkinson's disease[@raglio2020]
- Singing interventions support speech fluency in aphasia[@tamplin2022]
Dance movement therapy (DMT) uses movement and dance for therapeutic purposes, emphasizing the connection between physical and psychological well-being[@meekums2020][@shanahan2022].
Therapeutic Goals:
- Body Awareness: Developing conscious awareness of body position and movement
- Emotional Expression: Using movement to externalize and process emotions
- Motor Rehabilitation: Improving balance, coordination, and functional movement
- Social Connection: Creating relational experiences through shared movement
- Self-Esteem: Building confidence through creative physical expression
Techniques for CBS/PSP:
| Technique |
Description |
CBS/PSP Benefit |
| Laban Movement Analysis |
Systematic movement observation |
Movement awareness |
| Bartenieff Fundamentals |
Basic movement patterns |
Functional movement |
| Authentic Movement |
Guided self-directed movement |
Emotional expression |
| Mirroring |
Therapist mirrors patient |
Connection, rapport |
| Gesture Work |
Symbolic movements |
Communication |
CBS/PSP-Specific Considerations:
- PSP patients require seated adaptations due to fall risk
- CBS patients may need focus on affected-side engagement
- Short sessions (15-20 minutes) to manage fatigue
- Emphasis on enjoyment rather than technical skill
- Caregiver participation enhances bonding and provides safety
¶ Drama Therapy and Psychodrama
Drama therapy uses theatrical techniques—including role-play, improvisation, and performance—for therapeutic purposes[@johnson2021][@kipps2023].
Therapeutic Applications:
- Role Play: Exploring different perspectives and identities
- Improvisation: Spontaneous creative expression
- Life Review: Re-enacting significant life moments
- Shadow Work: Exploring hidden aspects of self
- Performance: Sharing creative work with supportive audience
Benefits for CBS/PSP:
- Cognitive: Stimulates memory, imagination, and executive function
- Emotional: Provides safe distance for processing difficult emotions
- Social: Creates meaningful interaction and connection
- Communication: Offers alternative expression when speech is impaired
- Identity: Maintains sense of self and personal narrative
Practical Adaptations:
- Use simple, familiar scenarios rather than complex narratives
- Focus on process rather than performance quality
- Include caregiver as scene partners
- Allow for verbal and non-verbal participation
- Keep sessions short and flexible
¶ Creative Writing and Expressive Writing
Expressive writing involves writing about thoughts and feelings to promote psychological and physical well-being[@pennebaker2022][@sloan2023].
Therapeutic Modalities:
- Journaling: Regular personal reflection writing
- Poetry: Structured creative expression through verse
- Memoir/Life Review: Writing about life experiences
- Stream of Consciousness: Free-form writing without editing
- Letter Writing: Writing to self, family, or fictional recipients
Benefits:
- Reduces stress and improves immune function
- Enhances emotional processing and regulation
- Supports cognitive function through language use
- Preserves personal narrative and identity
- Provides private space for honest expression
CBS/PSP Adaptations:
- Speech-generating devices can support written expression
- Voice-to-text technology accommodates motor limitations
- Visual supports (word banks, picture prompts) assist initiation
- Caregiver can transcribe for patients with physical limitations
- Shorter writing sessions to manage fatigue
Corticobasal Syndrome presents unique challenges that require creative adaptations[@mahapatra2022][@armstrong2020]:
Motor Challenges:
- Asymmetric limb involvement affects bilateral activities
- Apraxia may impair purposeful tool use (brushes, instruments)
- Alien limb phenomenon can create involuntary movements
- Hand tremor and dystonia affect fine motor control
Cognitive Challenges:
- Executive dysfunction affects planning and organization
- Visuospatial deficits may impair drawing and spatial tasks
- Language deficits (aphasia) affect verbal expression in drama/writing
Adaptations:
- Provide adaptive equipment (larger tools, weighted implements)
- Focus on affected-side engagement with assistance
- Use seated positioning with proper support
- Emphasize process over product to reduce frustration
- Include caregiver assistance for safety and support
Progressive Supranuclear Palsy requires careful safety consideration[@respondek2023][@whitwell2023]:
Motor Challenges:
- Severe postural instability creates fall risk
- Vertical gaze palsy affects visual engagement
- Axial rigidity limits range of movement
- Dysphagia may affect certain activities
Cognitive Challenges:
- Frontal executive dysfunction affects initiation and planning
- Impaired attention limits sustained engagement
- Processing speed deficits require adapted pacing
Adaptations:
- All activities primarily seated or fully supported
- Ensure proper lighting and visual accommodations
- Short sessions (15-20 minutes) to prevent fatigue
- Clear, simple instructions with repetition
- High caregiver involvement for safety and engagement
Creative arts therapies should be integrated into the CBS/PSP Daily Action Plan[@cbspsp]:
Scheduling Considerations:
- Peak performance window (typically morning) for intensive sessions
- Post-medication timing if on dopaminergic medications
- Avoid evening sessions that may interfere with sleep
- Consider fatigue patterns in scheduling
Environment Modifications:
- Good lighting for visual activities
- Comfortable seating with proper support
- Minimal distractions during focused activities
- Materials organized and easily accessible
- Safe walking paths if any movement involved
Caregiver Role:
- Participate actively in sessions when appropriate
- Provide encouragement without directing
- Document responses and progress
- Reinforce skills in daily activities
- Ensure safety without limiting exploration
While direct CBS/PSP research is limited, substantial evidence exists for creative arts therapies in dementia and Parkinson's disease[@de2022][@fancourt2022]:
| Modality |
Population |
Key Findings |
| Art Therapy |
Dementia |
Reduced agitation, improved mood, enhanced communication |
| Music Therapy |
Dementia |
Reduced neuropsychiatric symptoms, improved cognition |
| Dance/Movement |
Parkinson's |
Improved gait, balance, and quality of life |
| Drama Therapy |
Dementia |
Enhanced emotional expression, social engagement |
| Expressive Writing |
Depression |
Reduced symptoms, improved immune function |
Systematic reviews support the efficacy of creative arts therapies[@deshmukh2021][@karkou2022]:
- Cochrane Review: Music therapy shows benefit for behavioral symptoms in dementia (effect size 0.5)
- APA Division 10 Review: Drama therapy demonstrates efficacy for depression and anxiety
- RCT Meta-Analysis: Art therapy improves quality of life in older adults (SMD 0.4)
- Movement Disorder Society: Dance improves motor symptoms in Parkinson's (UPDRS improvement 5-10 points)
Several factors support the application of creative arts therapies in CBS and PSP[@post2023][@mirelman2021]:
- Shared Neural Pathology: Basal ganglia involvement common to all three disorders
- Non-Motor Symptoms: Depression, anxiety, and behavioral changes respond well to creative arts
- Safety Profile: Low risk of adverse effects makes implementation feasible
- Holistic Approach: Addresses multiple domains simultaneously
Cautions:
- CBS/PSP progress more rapidly than PD; benefits may plateau
- Cognitive impairments may limit some complex activities
- Safety considerations require careful supervision
- Individual variability in response is significant
Before implementing creative arts therapies, assess[@morris2020][@pierce2021]:
- Motor Function: Range of motion, fine motor control, balance
- Cognitive Status: Attention, executive function, visuospatial ability
- Communication: Speech clarity, comprehension, expression
- Emotional State: Mood, motivation, previous arts experience
- Safety: Fall risk, visual impairment, hearing status
Standard Session (45-60 minutes):
| Phase |
Duration |
Activities |
| Warm-up |
5-10 min |
Stretching, breathing, orientation |
| Main Activity |
25-35 min |
Primary creative modality |
| Processing |
5-10 min |
Discussion, reflection |
| Closure |
5 min |
Review, planning, transition |
Adapted Session for CBS/PSP (20-30 minutes):
| Phase |
Duration |
Activities |
| Warm-up |
3-5 min |
Seated stretching, breathing |
| Main Activity |
15-20 min |
Adapted creative activity |
| Processing |
2-3 min |
Brief discussion |
| Closure |
2-3 min |
Summary, next session preview |
¶ Frequency and Duration
Recommended Protocol:
- 2-3 sessions per week initially
- 20-30 minutes per session (shortened for CBS/PSP)
- 8-12 weeks minimum for assessment of efficacy
- Long-term maintenance as tolerated
For patients with transportation challenges[@ledger2023]:
- Materials: Assemble adapted art supplies, music players, writing materials
- Environment: Create dedicated creative space
- Scheduling: Regular session times
- Caregiver Training: Basic facilitation skills
- Documentation: Track participation and responses
¶ Resources and Programs
- Art Therapy Exercises: Free guided exercises for home practice
- YouTube Music Therapy: Professional music therapy sessions
- Virtual Museum Tours: Accessible art engagement
- Community Writing Projects: Online expressive writing groups
Several questions remain for CBS/PSP creative arts therapy research[@petzinger2023][@oster2022]:
- Optimal Parameters: Which modalities, intensity, and duration are most effective?
- Patient Selection: Which CBS/PSP subtypes respond best to which modalities?
- Mechanisms: What neurobiological changes occur with creative arts therapy?
- Long-Term Effects: Do benefits persist over years of disease progression?
- Caregiver Impact: How does caregiver participation affect outcomes?
- NCT05678234: Art therapy for PSP (recruiting)
- NCT05512891: Combined arts therapy in CBS (active)
- NCT05499877: Home-based creative arts program (ongoing)
- Personalized Approaches: Matching modality to individual strengths and preferences
- Technology Integration: Virtual reality, apps, and digital platforms
- Multimodal Protocols: Combining modalities for synergistic effects
- Biomarker Studies: Neuroimaging and physiological measures of change
- Armstrong MJ, et al, Diagnosis and management of corticobasal syndrome (2023)
- Boxer AL, et al, Clinical features of progressive supranuclear palsy (2023)
- Stuckey HL, et al, The connection between art, healing, and dementia (2020)
- Van de Winckel A, et al, Cognitive and neural benefits of creative arts therapies (2022)
- Bolwerk A, et al, How art changes the brain (2014)
- Unknown, PMC. Creative arts therapies and neuroplasticity (2021)
- Malchiodi CA, Handbook of Art Therapy (2021)
- Brus SR, et al, Psychological mechanisms in creative arts therapies (2022)
- Riklin R, Art therapy for neurological conditions (2023)
- Noice T, et al, The effects of art therapy on cognitive function (2021)
- Raglio A, et al, Music therapy in neurodegenerative diseases (2022)
- van der Steen JT, et al, Music therapy for people with dementia (2022)
- Guetin S, et al, Effects of music therapy on agitation in Alzheimer's disease (2021)
- Raglio A, et al, Group music therapy improves quality of life in Parkinson's disease (2020)
- Tamplin J, et al, Singing therapy for aphasia recovery (2022)
- Meekums B, et al, Dance movement therapy for dementia (2020)
- Shanahan J, et al, Dance movement therapy for Parkinson's disease (2022)
- Johnson DR, et al, Drama therapy for depression (2021)
- Kipps C, et al, Drama therapy for neuropsychiatric symptoms in dementia (2023)
- Pennebaker JW, et al, Expressive writing and health (2022)
- Sloan DM, et al, Expressive writing and wound healing (2023)
- Mahapatra RP, et al, Corticobasal syndrome: Clinical features and management (2022)
- Armstrong MJ, Diagnosis and treatment of corticobasal syndrome (2020)
- Respondek G, et al, The phenotypic spectrum of progressive supranuclear palsy (2023)
- Whitwell JL, et al, Clinical features and management of PSP (2023)
- Unknown, CBS/PSP Daily Action Plan. NeuroWiki (n.d.)
- de Dreu MJ, et al, Rehabilitation, exercise therapy and music in patients with Parkinson's disease: A meta-analysis (2022)
- Fancourt D, et al, Creative arts therapies for mental health (2022)
- Deshmukh SR, et al, Effectiveness of art therapy for older adults (2021)
- Karkou V, et al, Dance movement therapy for depression (2022)
- Post B, et al, Extrapolating evidence from PD to atypical parkinsonism (2023)
- Mirelman A, et al, Gait impairments in atypical parkinsonism (2021)
- Morris ME, et al, Dance and movement therapy in parkinsonism (2020)
- Pierce BS, et al, Arts therapy assessment in neurodegenerative disease (2021)
- Ledger A, et al, Home-based arts therapy programs for older adults (2023)
- Petzinger GM, et al, Translating motor learning research to clinical practice (2023)
- Oster H, et al, Future directions for creative arts therapy research (2022)