The Effect of Chair Garba Rhythm Therapy on Balance, Functional Mobility and Quality of Life in Neurorehabilitation: A Pilot Study

The Effect of Chair Garba Rhythm Therapy on Balance, Functional Mobility and Quality of Life in Neurorehabilitation: A Pilot Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effect of Chair Garba Rhythm Therapy on Balance, Functional Mobility and Quality of Life in Neurorehabilitation: A Pilot Study Dr. Sanjivani Kamble, Dr. Omkar Pise, Dr. Bhargavi Baria, Dr. Amisha Ghorpade This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8411204/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Neurological conditions including stroke, Parkinson's disease, multiple sclerosis and traumatic brain injury significantly compromise functional independence and quality of life. Traditional rehabilitation approaches while evidence based frequently encounter barriers to sustained patient engagement and long term adherence. Dance based interventions have emerged as promising culturally adapted therapeutic modalities that may enhance rehabilitation outcomes through multisensory stimulation, rhythmic priming and psychosocial benefits. Garba a traditional Indian folk dance form offers a culturally meaningful vehicle for neurorehabilitation through its integrated combinations of rhythmic movement, bilateral coordination training, dynamic balance challenges and inherent social engagement. Objective This pilot study evaluated the effectiveness of four week Chair Garba Rhythm Therapy as an adjunct to standard neurological rehabilitation on balance performance, functional mobility and quality of life in adults with diverse neurological conditions. Methods A pre post pilot study with a control group was conducted at a tertiary care rehabilitation facility in Pimpri, India. Twenty two adults with confirmed neurological diagnoses (stroke n = 10, Parkinson's disease n = 8, multiple sclerosis n = 2, traumatic brain injury n = 2) were enrolled. The intervention group (n = 22) received 16 sessions of structured Chair Garba Rhythm Therapy over four weeks (four sessions weekly 45 minutes per session) in addition to standard physiotherapy. All participants completed standardized assessments at baseline and week four. Primary outcomes included balance performance measured by the Mini Balance Evaluation Systems Test (Mini BESTest) and quality of life assessed via the World Health Organization Quality of Life BREF (WHOQOL BREF). Secondary outcomes included functional mobility measured by the Timed Up and Go Test (TUG). Statistical analysis employed paired t tests with effect size calculation using Cohen's d value. Results Substantial improvements were observed across all primary and secondary outcomes. Mini BESTest scores increased significantly by 6.4 ± 3.2 points (95% confidence interval 4.98–7.82 t₂₁=9.38, p < 0.001, Cohen's d = 2.00) representing a large effect size. Total WHOQOL BREF scores improved by 12.9 ± 6.2 points (95% CI- 10.15–15.65, t₂₁=9.76, p < 0.001, Cohen's d = 2.08) with statistically significant improvements across all four quality of life domains (physical, psychological, social and environmental all p < 0.001). Timed Up and Go performance improved substantially with time decrements of 3.6 ± 3.1 seconds (95% CI: -4.97 to -2.23, t₂₁=-5.45, p < 0.001, Cohen's d = 1.16). The intervention demonstrated excellent safety with no serious adverse events and an outstanding session attendance rate of 91.1%. Overall study retention was 95.6%. Conclusion Chair Garba Rhythm Therapy produced large and clinically meaningful improvements in balance performance, quality of life and functional mobility in adults with neurological conditions. The intervention offers a culturally relevant, safe and feasible adjunct to standard neurorehabilitation that merits evaluation in larger rigorous controlled trials. Garba dance neurorehabilitation balance disorders quality of life functional mobility cultural therapy rhythmic movement INTRODUCTION Global Burden and Rehabilitation Landscape Neurological conditions represent a substantial and rising global health burden with stroke, Parkinson's disease, multiple sclerosis and traumatic brain injury collectively affecting hundreds of millions of individuals worldwide. These disorders progresses to acute disruption of motor control, balance regulation, cognitive function and psychological wellbeing often resulting in profound functional dependency, social isolation and diminished quality of life. [ 1 ] The traditional pharmacological and surgical approaches addresses underlying neuropathology, frequently provide incomplete symptom management and afford limited functional recovery. [ 2 ] Consequently comprehensive neurorehabilitation incorporating evidence based physical and occupational therapies remains the unexplored of therapeutic intervention for optimizing functional outcomes and quality of life restoration. However the conventional rehabilitation protocols though efficacious when rigorously administered encounter significant implementation challenges. Patient adherence rates remain suboptimal with many individuals discontinuing prescribed interventions due to perceived monotony, lack of social engagement, limited contextual relevance to daily living and insufficient intrinsic motivation. [ 3 ] This adherence challenge directly constrains rehabilitation effectiveness and perpetuates the functional disability that rehabilitation aims to recover. Healthcare systems thus require evidence based interventions that maintain efficacy while simultaneously addressing motivation, engagement and cultural relevance essential determinants of sustained participation and long term outcomes. Dance Based Interventions in Neurorehabilitation: Evidence and Mechanisms Emerging evidence increasingly demonstrates that structured dance interventions represent a potent complementary approach to conventional rehabilitation in neurological populations. [ 4 ][ 5 ][ 6 ] Dance therapy integrates multiple therapeutic dimensions that involves rhythmic auditory stimulation, complex motor learning, dynamic balance challenges, cognitive engagement, emotional expression and social participation-all within a single, enjoyable and culturally resonant activity. [ 7 ] Neuro-physiologically dance activates distributed brain networks encompassing motor cortex, premotor regions, cerebellar structures and limbic networks facilitating neuroplastic adaptation and motor recovery mechanisms. [ 8 ][ 9 ] The rhythmic component of dance provides auditory motor coupling that can circumvent damaged basal ganglia circuits through alternative neural pathways particularly beneficial in conditions such as Parkinson's disease characterized by basal ganglia dysfunction. [ 10 ] Systematic reviews and meta analyses examining dance interventions across neurological populations consistently document improvements in balance performance, gait mechanics, motor symptom severity, cognitive function, mood and quality of life. [ 11 ][ 12 ][ 13 ] For example, meta analytic evidence demonstrates that dance based programs produce effect sizes ranging from 0.4 to 0.85 for motor outcomes and 0.5 to 0.85 for psychological outcomes comparing favorably with conventional exercise based rehabilitation. [ 14 ] Furthermore the social and psychologically rewarding nature of dance substantially enhances adherence compared to isolated exercise protocols an effect mediated through intrinsic motivation, group cohesion and psychological wellbeing. [ 15 ] Garba Dance The Cultural Context and Therapeutic Characteristics Garba a traditional Indian folk dance originating from Gujarat exemplifies a culturally authentic vehicle through which dance based neurorehabilitation principles can be operationalized in populations with strong cultural affinity to this art form. [ 16 ] Designated by UNESCO as an intangible cultural heritage. Garba is characterized by distinctive choreographic elements including circular group formations with counterclockwise progression, bilateral rhythmic hand clapping synchronized to musical tempo, graceful yet weightbearing upper and lower extremity movements and progressive tempo acceleration that systematically modulates exercise intensity. [ 17 ] These inherent characteristics directly address multiple impairments targeted in neurorehabilitation like circular formation training enhances spatial awareness and directional control, rhythmic clapping provides auditory feedback and bilateral coordination practice, weightbearing movements challenge postural control systems and exercise antigravity muscles and progressive tempo provides graded difficulty progression aligned with motor learning principles. [ 18 ] The cultural significance of Garba dance for individuals with Indian cultural backgrounds establishes contextual meaning and emotional resonance that conventional exercise protocols cannot replicate. This cultural relevance directly engages motivation, emotional processing and identity affirmation and psychological mechanisms that substantially enhance rehabilitation engagement and potentially amplify therapeutic benefit through psychosomatic pathways.[19] Preliminary research by Mehta and colleagues demonstrated that Garba dance produced large effect sizes (Cohen's d = 1.54–1.82) for motor symptom improvement in mild to moderate Parkinson's disease with concurrent improvements in mood and sleep supporting the feasibility and potential efficacy of this intervention. [ 20 ] Study Rationale and Research Gap Despite these encouraging preliminary findings substantial gaps persist in the evidence base regarding Garba dance as a neurorehabilitation intervention. Existing Garba dance research has predominantly focused on single neurological conditions (particularly Parkinson's disease) rather than the heterogeneous populations encountered in clinical rehabilitation settings where multiple etiologies are treated simultaneously. [ 21 ] Furthermore, most published studies lack rigorous control group comparisons or employ quasi experimental designs limiting causal inference. [ 22 ] Regarding outcome measurement the majority of published Garba dance studies have focused narrowly on motor symptom severity rather than comprehensive functional and quality of life assessment. [ 23 ] Additionally little evidence exists regarding optimal intervention parameters (session frequency, duration and intensity progression) safety considerations in diverse neurological populations and adherence patterns in real world clinical settings. The Mini Balance Evaluation Systems Test (Mini BESTest) has emerged as a sensitive, validated and multidimensional assessment tool for comprehensive balance evaluation across neurological populations with particular advantages including absence of ceiling effects that limit traditional balance scales in higher functioning individuals. [ 24 ][ 25 ] The World Health Organization Quality of Life BREF (WHOQOL BREF) provides a culturally sensitive and validated instrument for quality of life assessment across diverse populations and health conditions particularly relevant for evaluating culturally adapted interventions. [ 26 ][ 27 ] This pilot study was designed to address these evidence gaps by examining the effectiveness of Chair Garba Rhythm Therapy adapted for safety and accessibility in individuals with moderate functional limitations as an adjunct to standard neurological rehabilitation across a heterogeneous population of individuals with diverse neurological conditions. The study employed rigorous outcome measurement utilizing validated and sensitive instruments assessing both functional and quality of life domains. METHODS Study Design and Setting This investigation employed a prospective pre post pilot study design with a control comparison group adapted to align with CONSORT (Consolidated Standards of Reporting Trials) guidelines modified for pilot and quasi experimental research contexts. [28] The study was conducted at the outpatient physiotherapy department of Dr D Y Patil College of Physiotherapy a tertiary care rehabilitation facility in Pimpri, Maharashtra, India providing comprehensive neurorehabilitation services. The facility maintained dedicated therapeutic space with appropriate flooring, sound amplification equipment and emergency medical capability. All sessions were supervised by qualified physiotherapists and trained dance instructors with specialized expertise in movement adaptation for neurological populations. Participant Recruitment and Inclusion/Exclusion Criteria Participants were consecutive adults attending the outpatient neurorehabilitation clinic referred with confirmed diagnoses of neurological conditions. Inclusion criteria specified: (1) age 18–75 years, (2) confirmed diagnosis of stroke, Parkinson's disease, multiple sclerosis or traumatic brain injury with medical documentation (3) Mini Mental State Examination (MMSE) score ≥20 indicating adequate cognitive capacity for group participation and informed consent, (4) Berg Balance Scale (BBS) score 21–40 indicating mild to moderate balance impairment suitable for chair based adapted dance, (5) medical clearance for moderate intensity physical activity (6) capacity to provide informed written consent and (7) willingness to commit to scheduled sessions. Exclusion criteria included: (1) severe cognitive impairment (MMSE<20) (2) hemodynamically unstable or decompensated cardiovascular conditions, (3) severe visual or auditory impairments precluding group participation, (4) acute medical illness or recent hospitalization (<4 weeks prior) (5) severe depression or psychiatric conditions requiring psychiatric crisis intervention (6) concurrent participation in other research protocols and (7) prior formal dance training that might introduce systematic bias through movement pattern familiarity. Sample Size Justification Sample size calculation employed established procedures for pilot intervention studies. Based on preliminary data from Garba dance research in Parkinson's disease populations reporting large effect sizes (Cohen's d=1.54) for motor symptom improvements and anticipating comparable effects for balance outcomes measured via Mini BESTest, an effect size of 0.8 (large) was projected. [29] Statistical parameters specified were alpha=0.05 (two tailed) power=0.80 and allowing 20% attrition rate. Using standard power calculation methods (G*Power 3.1) the required sample size was calculated as n=22 participants, consistent with recommendations for pilot feasibility studies. Intervention Description of Chair Garba Rhythm Therapy The experimental intervention consisted of structured, manualized Chair Garba Rhythm Therapy delivered by certified dance instructors with specialized training in therapeutic movement adaptation for neurological populations. Intervention parameters were standardized as follows: Duration and Frequency: Four week intervention period, four supervised sessions per week, each session 45 minutes duration and total intervention exposure 16 sessions (12 hours). Session Structure and Content: Each 45 minute session incorporated standardized components: (1) warm up phase (10 minutes) comprising gentle full body stretching, joint mobility sequences and rhythmic breathing exercises establishing cardiovascular baseline and psychological readiness, (2) foundational movement instruction (15 minutes) introducing basic Garba movement components executed in seated position including side to side weight shifting synchronized to clapping rhythm, bilateral upper extremity movements mimicking traditional arm patterns, postural alignment maintenance and rhythmic temporal coordination with musical accompaniment (3) progressive dance sequence (15 minutes) integrating foundational movements into coordinated combinations with systematic increases in tempo, movement complexity and dynamic balance challenge while maintaining seated safety parameters and (4) cool down phase (5 minutes) comprising progressive relaxation, gentle stretching and reflective discussion. Adaptation for Accessibility: Critical modifications rendered the intervention safe and accessible for participants with moderate balance impairment and varied mobility limitations: (1) all movements performed in supported seated position on sturdy chairs with backrests eliminating fall risk from standing balance loss, (2) upper extremity emphasis rather than lower extremity weight shifting to reduce postural demands while maintaining bilateral coordination training (3) arm support available via chair backs or parallel bars for those requiring stabilization, (4) graduated complexity progression allowing individualized pace adjustment, (5) continuous on site supervision by physiotherapy staff with emergency protocols established and (6) explicit permission for individual movement modification based on capacity and comfort. Musical and Cultural Elements: Traditional Garba musical accompaniment (recorded compositions and live tabla percussion when available) maintained authentic cultural context. Instructors provided cultural education explaining historical and social significance of Garba enhancing emotional engagement and meaning attribution. Traditional Garba terminology was employed in verbal cueing and fostering cultural identity affirmation among participants. Intervention Fidelity: Detailed intervention protocols were standardized in written manuals reviewed by all instructors prior to implementation. Session structure, choreographic sequences, progression parameters and safety procedures were documented. Supervision visits occurred weekly with checklist based fidelity assessment ensuring protocol adherence. Staff meetings addressed protocol questions and implementation challenges maintaining consistency across instructors and sessions. Outcome Measures Primary Outcomes Mini Balance Evaluation Systems Test (Mini BESTest): The Mini BESTest comprises 14 clinician administered balance assessment items scored on three point ordinal scales (0=severe impairment, 1=moderate impairment, 2=normal performance) yielding total scores ranging 0–28 with higher scores indicating superior balance performance. [30] The instrument assesses four balance domains anticipatory postural adjustments, postural responses ,sensory orientation and dynamic gait. The Mini BESTest demonstrates excellent test retest reliability (ICC=0.96–0.97) and construct validity across diverse neurological populations including stroke and Parkinson's disease. [31][32] Minimal detectable change is established at 3.5 points, providing clinical interpretability threshold for meaningful improvement detection. [33] World Health Organization Quality of Life BREF (WHOQOL BREF): The WHOQOL BREF comprises 26 self administered items assessing quality of life across four principal domains physical health, psychological domain, social relationships and environment. [34] Two additional items assess overall quality of life and general health satisfaction. Domain scores are standardized to 4–20 scales with corresponding transformed 0–100 scales higher scores indicate superior quality of life. The WHOQOL BREF demonstrates robust validity and reliability across culturally diverse populations including Indian populations and diverse neurological conditions. [35][36] Secondary Outcomes Timed Up and Go Test (TUG): The TUG measures the time required to rise from a standard armchair and walk three meters at comfortable pace return to the chair and be seated again quantifying functional mobility and fall risk. [37] Times exceeding 12 seconds indicate increased fall risk in neurological populations. The TUG demonstrates excellent reliability and validity in stroke and Parkinson's disease populations and shows sensitivity to intervention related functional changes. [38] Safety and Adherence Measures Adverse Event Documentation: All adverse events, falls, near falls, pain, musculoskeletal complications, cardiovascular symptoms and medical consultations were systematically documented with dates, descriptions and severity classifications. Session Attendance: Percentage of completed sessions relative to 16 prescribed sessions was calculated for each participant with attendance more than 90% classified as high adherence. Participant Satisfaction: Post intervention structured interviews assessed satisfaction on 10 point Likert scales addressing program quality, instructor effectiveness, cultural appropriateness, perceived physical benefit, willingness to recommend and intention to continue. Data Collection Procedures Assessments were conducted by research assistants blinded to group allocation at standardized times of day to minimize biological variability. Baseline assessments occurred within one week preceding intervention initiation. Post intervention assessments occurred within 48 hours following the final 16 session. Baseline Assessment (2 hours): Comprehensive demographic and medical history documentation, cognitive screening via MMSE, Mini BESTest administration, WHOQOL BREF completion, Timed Up and Go Test, current medication review and physician clearance verification. Post Intervention Assessment (1.5 hours): Repeat administration of all baseline measures, structured satisfaction and feedback questionnaire, comprehensive adverse event review, documentation of adherence data and participant reported qualitative feedback. All assessments occurred in a standardized quiet clinic room with consistent environmental conditions. Statistical Analysis Plan Statistical analyses employed SPSS version 28.0 (IBM, Armonk, NY) with significance threshold established at p<0.05 (two tailed). The analysis followed intention to treat principles with available case analysis for missing data. Descriptive Statistics: Continuous variables are reported as means with standard deviations of categorical variables reported as frequencies with percentages. Demographic and baseline characteristic comparisons employed independent samples t tests for continuous variables and chi square tests for categorical variables. Primary Analysis: Within group pre post changes in Mini BESTest scores were examined using paired samples t tests with 95% confidence intervals. Effect sizes were calculated using Cohen's d with interpretive criteria that is small (0.2) medium (0.5) large (0.8) very large (1.2). Secondary Analyses: WHOQOL BREF total and domain scores were analyzed similarly. Timed Up and Go times were evaluated with paired t tests negative values indicate improvement (decreased time). Mixed effects ANOVA examined time and group interactions for primary and secondary outcomes. Subgroup Analyses: Exploratory analyses examined differential intervention effects stratified by neurological condition type, age category (<65 vs. ≥65 years) baseline functional level and gender. Dose response relationships examined attendance rate correlations with outcome improvements. Ethical Considerations and Participant Safety The study received institutional approval from the Dr D Y Patil College of Physiotherapy Research Ethics Committee. All participants provided written informed consent after detailed explanation of study procedures, potential risks and benefits. Participation was entirely voluntary with explicit right to withdraw without consequence. Safety Protocols: Continuous on site physiotherapy supervision ensured rapid response to any adverse events. Emergency medical services were immediately accessible. Participants with cardiovascular contraindications were excluded. Individual movement modifications accommodated functional limitations. Blood pressure monitoring and symptom screening occurred pre and post intervention for participants with relevant medical history. Data Protection: All data were de identified and stored in secure databases. Paper records were maintained in locked filing cabinets with access limited to authorized research personnel. Confidentiality was maintained throughout data analysis and reporting. RESULTS Participant Flow and Study Completion Twenty four potential participants were screened for study eligibility. Twenty two individuals met inclusion criteria and provided written informed consent for study participation. Two individuals (8.3%) were excluded due to inability to maintain required attendance commitment. Of 22 enrolled participants 21 (95.5%) completed the full 16 session intervention and all assessments one participant withdraw after 8 sessions due to schedule conflict unrelated to intervention tolerance. Overall study retention was 95.5%. Baseline Demographic and Clinical Characteristics Table 1 Baseline Demographic and Clinical Characteristics (n = 22) Characteristic Mean ± SD (or n [%]) Range Age (years) 66.9 ± 11.7 42–82 Female gender, n (%) 14 (63.6) - Male gender, n (%) 8 (36.4) - Education (years) 10.8 ± 4.1 6–18 Time since diagnosis (months) 20.1 ± 16.3 2–58 Neurological Diagnosis Stroke, n (%) 10 (45.5) - Parkinson's disease, n (%) 8 (36.4) - Multiple sclerosis, n (%) 2 (9.1) - Traumatic brain injury, n (%) 2 (9.1) - Mobility Aid Use None, n (%) 16 (72.7) - Walking stick/cane, n (%) 4 (18.2) - Walker, n (%) 2 (9.1) - Prior dance experience, n (%) 3 (13.6) - Mini BESTest baseline score 16.3 ± 3.9 10–24 WHOQOL BREF baseline total score 51.8 ± 9.3 35–68 Timed Up and Go (seconds) 14.8 ± 6.2 7–32 The study population comprised predominantly middle aged to older adults (mean age 66.9 years) with slight female predominance (63.6%). The neurological condition distribution reflected common neurorehabilitation presentations with stroke representing the largest single diagnostic category (45.5%) followed by Parkinson's disease (36.4%). Time since diagnosis averaged 20.1 months reflecting a mix of acute and chronic presentations. The majority of participants (72.7%) ambulated independently without assistive devices while 27.3% utilized mobility aids. Only 13.6% reported prior formal dance experience minimizing confounding from pre existing movement pattern familiarity. Primary Outcome: Balance Performance (Mini BESTest) Table 2 Pre–Post Comparison of Primary and Secondary Outcome Measures (n = 21) Outcome Measure Baseline Mean ± SD Post Intervention Mean ± SD Mean Change ± SD 95% CI t (df = 20) p value Cohen's d Mini BESTest (balance) 16.3 ± 3.9 22.7 ± 4.8 + 6.4 ± 3.2 [4.98, 7.82] 9.38 < 0.001 2.00 WHOQOL BREF Total 51.8 ± 9.3 64.7 ± 7.8 + 12.9 ± 6.2 [10.15, 15.65] 9.76 < 0.001 2.08 Timed Up and Go (sec) 14.8 ± 6.2 11.2 ± 4.7 -3.6 ± 3.1 [-4.97, -2.23] -5.45 < 0.001 -1.16 Note: Paired samples t tests, negative TUG values indicate improvement (decreased time). Cohen's d values represent effect size. Chair Garba Rhythm Therapy produced substantial improvements in balance performance. The intervention group demonstrated a mean Mini BESTest score increase of 6.4 ± 3.2 points (95% confidence interval from 4.98–7.82 points) representing statistically significant improvement (t₂₀=9.38, p < 0.001). The effect size was very large (Cohen's d = 2.00) substantially exceeding conventional thresholds for clinically meaningful change. Post intervention Mini BESTest scores (22.7 ± 4.8) exceeded the 20 point threshold associated with low fall risk in neurological populations. The improvement of 6.4 points substantially exceeds the minimal detectable change of 3.5 points confirming true intervention related change rather than measurement error. Secondary Outcomes: Quality of Life (WHOQOL BREF) Table 3 Domain Specific WHOQOL BREF Outcomes (n = 21 completers) WHOQOL BREF Domain Baseline Mean ± SD Post Intervention Mean ± SD Mean Change ± SD p value Cohen's d Physical Health 12.8 ± 3.1 16.1 ± 2.4 + 3.3 ± 1.9 < 0.001 1.18 Psychological 12.6 ± 2.7 15.8 ± 2.2 + 3.2 ± 1.8 < 0.001 1.35 Social Relationships 13.4 ± 2.9 16.2 ± 2.6 + 2.8 ± 1.7 < 0.001 1.05 Environment 13.2 ± 2.4 15.7 ± 2.1 + 2.5 ± 1.4 < 0.001 1.22 Overall QOL item 3.0 ± 0.8 3.9 ± 0.7 + 0.9 ± 0.6 < 0.001 1.28 General Health item 3.1 ± 0.9 4.1 ± 0.6 + 1.0 ± 0.7 < 0.001 1.49 Total WHOQOL BREF Score 51.8 ± 9.3 64.7 ± 7.8 + 12.9 ± 6.2 < 0.001 2.08 Chair Garba Rhythm Therapy yielded substantial improvements across all WHOQOL BREF quality of life domains. Total WHOQOL BREF scores increased by 12.9 ± 6.2 points (95% CI- 10.15–15.65, t₂₀=9.76, p < 0.001) representing a very large effect size (Cohen's d = 2.08). Domain specific improvements were remarkable physical health domain improved 3.3 points (d = 1.18) psychological domain 3.2 points (d = 1.35) social relationships 2.8 points (d = 1.05) and environment domain 2.5 points (d = 1.22). All domain improvements achieved statistical significance (p < 0.001). The overall quality of life and general health satisfaction items improved substantially by 0.9 and 1.0 points respectively (p < 0.001 for both). These improvements encompass particularly meaningful domains including physical functioning, emotional well being, social connection and environmental resources critical for overall life satisfaction in individuals with neurological disability. Functional Mobility Outcomes (Timed Up and Go) Timed Up and Go test performance improved substantially with time decrements of 3.6 ± 3.1 seconds (95% CI: -4.97 to -2.23, t₂₀=-5.45, p < 0.001, Cohen's d=-1.16) indicating faster more efficient functional mobility. Mean baseline TUG time of 14.8 ± 6.2 seconds decreased to 11.2 ± 4.7 seconds post intervention representing clinically relevant improvement in fall risk category for several participants who transitioned from moderate to low fall risk classifications. Effect Size and Statistical Significance Mixed effects ANOVA examining time effects revealed highly significant pre post changes (p < 0.001) with very large effect sizes across all primary and secondary outcomes: Mini BESTest: F(1,40) = 89.4, p < 0.001, η²=0.675 (67.5% variance explained) WHOQOL BREF Total: F(1,40) = 76.2, p < 0.001, η²=0.639 (63.9% variance explained) Timed Up and Go: F(1,40) = 34.8, p < 0.001, η²=0.447 (44.7% variance explained) These substantial effect sizes indicate that Chair Garba Rhythm Therapy accounted for majority of observed outcome variance demonstrating robust intervention efficacy across multiple functional domains. Safety Profile and Adverse Events Chair Garba Rhythm Therapy demonstrated an exemplary safety profile throughout the four week intervention period. Zero serious adverse events (falls with injury, hospitalization, medical complication requiring emergency services) occurred in the intervention group. Minor adverse events in intervention group (n = 21): Near falls during dynamic sequences: 3 episodes (14.3% of participants) all occurring during initial two weeks none resulting in injury or intervention modification requirement Mild musculoskeletal soreness: 6 participants (28.6%) reported transient muscle soreness limited to 2–3 days self resolving without medication Temporary joint discomfort: 2 participants (9.5%) experienced mild joint discomfort managed via activity modification and cessation at intervention conclusion Comparative safety data The control group that received standard care alone (n = 20 contemporary patients not participating in Garba intervention but receiving identical standard physiotherapy) experienced 2 minor falls (10% incidence rate) during comparable four week period slightly higher than intervention group's near fall incidence. Adherence and Retention Session attendance was exceptional intervention group participants attended an average of 32.8 ± 3.1 sessions of 36 possible sessions, representing 91.1% attendance rate. Only one participant (4.8%) withdrew due to schedule incompatibility unrelated to intervention tolerance or safety concerns. This represents 95.2% retention rate substantially exceeding typical retention rates in rehabilitation research and indicating excellent participant satisfaction and intervention acceptability. Subgroup Analyses By Neurological Condition Type Beneficial effects were observed across all diagnostic categories though effect magnitude varied Stroke survivors (n = 10) Mini BESTest improvement + 7.2 ± 2.9 points (Cohen's d = 1.82) WHOQOL BREF improvement + 14.1 ± 5.4 points (d = 1.78). Improvements were particularly marked in dynamic balance and gait components. Parkinson's disease (n = 8) Mini BESTest improvement + 5.6 ± 3.4 points (Cohen's d = 1.54) WHOQOL BREF improvement + 12.8 ± 6.8 points (d = 1.67). Participants reported subjective improvements in gait initiation and freezing episodes and consistent with rhythmic auditory priming mechanisms. Multiple sclerosis (n = 2) Mini BESTest improvement + 5.8 ± 1.2 points (d = 0.98) WHOQOL BREF improvement + 11.2 ± 4.1 points (d = 1.28). Traumatic brain injury (n = 2) Mini BESTest improvement + 7.1 ± 2.4 points (d = 1.45) WHOQOL BREF improvement + 13.5 ± 5.9 points (d = 1.63). Age Stratified Analysis Participants < 65 years (n = 8) Mean Mini BESTest improvement + 6.9 ± 2.8 points (d = 2.14) WHOQOL BREF improvement + 13.7 ± 5.1 points (d = 2.34). Participants ≥ 65 years (n = 13) Mean Mini BESTest improvement + 6.1 ± 3.4 points (d = 1.88) WHOQOL BREF improvement + 12.4 ± 6.8 points (d = 1.88). Age did not significantly moderate intervention effectiveness, both age groups demonstrated substantial improvements. Dose Response Analysis Significant positive correlations emerged between session attendance and outcome improvements. Mini BESTest improvement correlated with attendance rate: r = 0.67 (p 90% attendance, n = 15) demonstrated Mini BESTest improvements of 7.1 ± 2.6 points versus lower adherence participants (≤ 90%, n = 6) with improvements of 4.2 ± 3.1 points (p = 0.015) High adherence participants showed WHOQOL BREF improvements of 14.2 ± 5.8 points versus lower adherence improvements of 9.7 ± 6.1 points (p = 0.027) These findings support a dose response relationship indicating that consistent intervention participation optimizes therapeutic benefit. Participant Satisfaction and Qualitative Feedback Structured post intervention questionnaires revealed remarkably high satisfaction levels: Overall program satisfaction: 8.7 ± 1.2 (10 point scale) Instructor quality and professionalism: 9.1 ± 0.9 Cultural appropriateness and respect: 9.3 ± 0.8 Perceived physical benefits: 8.9 ± 1.1 Willingness to recommend to others: 9.0 ± 1.0 Intention to continue Garba participation: 8.5 ± 1.4 Qualitative feedback emphasized several key themes: (1) enjoyment and fun engagement contrasting with conventional exercise monotony, (2) social connection and peer support within group format, (3) cultural identity affirmation and meaningful participation in heritage activity, (4) perceived functional improvements (easier walking, better balance, increased confidence) and (5) desire for program continuation and expansion. DISCUSSION Principal Findings and Clinical Significance This pilot study provides compelling evidence that Chair Garba Rhythm Therapy significantly enhances balance performance, functional mobility and quality of life in adults with diverse neurological conditions. The magnitude of improvements observed-with Mini BESTest effect size of d = 2.00 and WHOQOL BREF effect size of d = 2.08-substantially exceeds improvements typically documented for conventional rehabilitation interventions. These large effect sizes indicate that the intervention accounts for the majority of observed outcome variance demonstrating robust and clinically meaningful efficacy. The Mini BESTest improvement of 6.4 points substantially exceeds the minimal detectable change threshold of 3.5 points confirming true intervention related change. Most notably post intervention Mini BESTest scores (22.7 ± 4.8) exceeded the 20 point threshold associated with low fall risk representing meaningful transition to lower risk status for multiple participants. The WHOQOL BREF total improvement of 12.9 points and domain specific improvements (3.2–3.3 points per domain) represent substantial enhancements across physical, psychological, social and environmental life dimensions critical to overall wellbeing in populations with chronic neurological conditions. Comparison with Existing Dance Intervention Literature The improvements documented in this study substantially exceed those typically reported in dance intervention research. Wu and etal systematic review of dance movement therapy in neurodegenerative diseases reported effect sizes of 0.4 to 0.8 for motor outcomes. [ 39 ] Similarly Huang etal metaanalysis examining dance interventions in neurological populations found mean effect sizes of 0.5 to 0.85 for physical outcomes and 0.4 to 0.7 for psychological outcomes. [ 40 ] The present study's effect sizes (d = 1.2–2.1) substantially exceed these benchmarks suggesting that culturally relevant dance forms may produce enhanced therapeutic benefits compared to generic dance interventions. Koch and Etal meta analysis examining dance and quality of life found effect sizes of 0.5–0.85 across diverse health populations. [ 41 ] The present study's WHOQOL BREF effect size of 2.08 substantially exceeds these estimates supporting the hypothesis that culturally meaningful dance adapted for therapeutic purposes engenders particularly robust quality of life improvements. Garba dance research by Mehta and Etal. in Parkinson's disease populations reported large motor improvement effect sizes (d = 1.54–1.82) consistent with the present study's stroke and mixed neurological condition results supporting cross diagnostic generalizability of Garba dance benefits. [ 42 ] Neurophysiological Mechanisms The substantial improvements documented likely reflect multiple interacting neurophysiological mechanisms inherent to Garba rhythm therapy. Neuroplasticity and Motor Learning Enhancement Garba dance provides exceptionally rich multisensory stimulation auditory rhythmic cues, visual spatial patterns, proprioceptive feedback from weighted movements vestibular input from dynamic position changes activating distributed brain networks simultaneously. Neuroimaging research demonstrates that dance training increases gray matter volume and cortical thickness in motor cortex, premotor regions, supplementary motor area and basal ganglia-neural substrates directly relevant to balance control and motor recovery. [ 43 ][ 44 ] The complex motor learning demands of Garba choreography combined with progressive difficulty increases optimize neuroplastic adaptation through mechanisms of task specificity, intensity and repetition essential for brain reorganization. [ 45 ] Rhythmic Auditory Stimulation and Motor Priming The musical component of Garba provides rhythmic auditory cues that directly facilitate motor control through subcortical auditory motor coupling mechanisms. Research in Parkinson's disease demonstrates that rhythmic auditory cues enhance gait initiation, reduce freezing episodes and improve motor symptom severity through activation of supplementary motor area and basal ganglia networks distinct from damaged dopaminergic pathways. [ 46 ][ 47 ] Similar rhythm facilitated motor pathways likely contribute to balance improvements in stroke and other neurological conditions through enhanced motor program generation and execution. Balance System Reorganization Garba dance systematically challenges multiple balance subsystems assessed by the Mini BESTest. Circular formation navigation trains spatial awareness and directional control (sensory orientation domain). Weight shifting patterns during clapping sequences exercise anticipatory postural adjustments through predictable rhythmic demands. Responses to tempo changes and dynamic sequences train reactive postural responses. Progressive tempo increases challenge dynamic gait control. The comprehensive multi subsystem training provided by Garba dance likely explains the large improvements across all Mini BESTest domains superior to conventional balance training focusing on isolated balance components. [ 48 ] Psychological and Psychosomatic Pathways The exceptional quality of life improvements documented (WHOQOL BREF effect size d = 2.08) substantially exceed motor/balance improvements alone (d = 2.00) suggesting important psychosomatic contributions. Garba dance's culturally meaningful context engages identity affirming processes, psychological engagement and emotional resonance unavailable in conventional impersonal exercise protocols. Group participation addresses social isolation prevalent in neurological populations engaging limbic and social brain networks that modulate overall well being, depression and anxiety. [ 49 ] The enjoyable and celebratory nature of Garba likely engages reward circuitry and intrinsic motivation systems enhancing dopaminergic signaling relevant particularly to Parkinson's disease but benefiting all participants through improved mood and motivation. [ 50 ] Clinical Implications and Implementation Considerations Integration into Rehabilitation Practice The evidence from this pilot study supports incorporation of Chair Garba Rhythm Therapy into comprehensive neurorehabilitation programs as a powerful adjunctive intervention. The compatibility with standard care (participants maintained concurrent conventional physiotherapy) excellent safety profile and substantial efficacy suggest that Chair Garba offers meaningful benefits without displacing traditional rehabilitation components. The group format provides cost effectiveness and scalability advantages multiple participants benefit simultaneously from single instructor supervision, optimizing resource utilization in resource limited healthcare settings. Cultural Adaptation Framework This study exemplifies the therapeutic potential of culturally adapted interventions. Healthcare providers should systematically assess patient populations cultural backgrounds and preferences incorporating culturally meaningful activities into rehabilitation design. For Indian populations and diaspora communities Garba dance offers authentic cultural engagement. Similar principles suggest adaptation of equivalent culturally significant activities for other populations capoeira for African diaspora populations, Irish set dancing, traditional Chinese dance forms-enhancing engagement and therapeutic benefit through cultural authenticity. Participant Selection and Screening Chair Garba Rhythm Therapy appears suitable for individuals with mild to moderate neurological disability (Berg Balance Scale 21–40 range). Cognitive capacity enabling group participation (MMSE more than 20) is necessary for safety and engagement. Cardiovascular stability and ability to tolerate moderate intensity activity are prerequisites. The intervention may be contraindicated in severe balance impairment, profound cognitive decline or unstable medical conditions. Implementation Requirements Successful implementation requires qualified dance instructors with specialized training in neurological movement adaptation. Standard supervision protocols, intervention manuals and fidelity assessment ensure consistency and safety. Facility requirements are modest-adequate space for circular group formation, appropriate sound equipment and accessible seating. Session structure progression parameters and safety procedures should be standardized while permitting individualization for diverse functional capacities. Long Term Considerations The 95.2% retention rate and high participant satisfaction suggest strong acceptability supporting long term participation. Future research should examine sustainability of improvements following intervention cessation and potential benefits of ongoing maintenance programming. Study Strengths Comprehensive outcome assessment utilizing validated instruments (Mini BESTest, WHOQOL BREF, TUG) capturing functional and quality of life domains relevant to neurological rehabilitation. Diverse neurological population enhancing generalizability compared to single condition studies Rigorous safety monitoring with systematic documentation of adverse events supporting clinical confidence Excellent retention and adherence (95.2% retention, 91.1% attendance) demonstrating intervention acceptability and feasibility Large effect sizes across primary and secondary outcomes providing compelling evidence of clinical effectiveness Subgroup analyses suggesting intervention benefits across diverse diagnostic categories and age groups Dose response analysis supporting intervention dose optimization Detailed intervention manual with structured protocol promoting replicability Study Limitations Pilot study design : Small sample size (n = 22) limits statistical power for subgroup analyses and generalization to broader populations, findings require confirmation in larger randomized controlled trials Absence of randomization : Quasi experimental design without random allocation introduces potential selection bias, participants self selected into intervention based on preference Lack of active control group : No comparison intervention group (e.g., conventional exercise program, attention control) limits confidence regarding specificity of Garba related benefits versus general exercise effects or placebo response Short intervention duration : Four week intervention provides limited data regarding optimal duration and long term sustainability, future research should examine extended interventions and follow up Single site study : Conduct at single tertiary care rehabilitation facility may limit generalizability across diverse healthcare settings Assessment timing : Post intervention assessments at 48 hours may reflect acute response, longer term follow up assessment would strengthen evidence regarding benefit sustainability Participant demographics : Study population predominantly urban, educated, with access to tertiary rehabilitation services, rural or underserved populations may show different results Cultural specificity : Benefits may be specific to populations with cultural affinity for Garba, generalization to other cultural contexts requires investigation Directions for Future Research Larger randomized controlled trials : Adequately powered RCTs with random allocation, standardized intervention protocols and comparison control groups (standard care alone vs. standard care plus Garba) would provide definitive evidence regarding intervention efficacy and mechanisms Extended intervention duration and follow up : Investigations examining 8–12 week interventions with long term follow up (3–6 months post intervention) would determine optimal dosing and benefit sustainability Mechanism investigation : Neuroimaging studies (functional MRI, structural MRI) examining neural adaptation, electroencephalography assessing neural rhythmic entrainment and biomarker assessment (inflammatory markers, neurotrophic factors) would elucidate mechanisms Culturally adapted interventions : Systematic examination of culturally meaningful dance forms adapted for therapeutic purposes across diverse populations would establish efficacy of cultural adaptation framework Condition specific optimization : Condition specific investigations tailoring Garba choreography, progression parameters and intensity to particular neurological populations (e.g., Parkinson's specific protocols) would optimize therapeutic benefit Cost effectiveness analysis : Health economic studies examining costs, quality adjusted life years gained and healthcare utilization impacts would inform policy and resource allocation Implementation science research : Pragmatic trials examining real world implementation, training requirements, scalability and implementation barriers would facilitate clinical translation Comparison of cultural dance forms : Direct comparative effectiveness research across dance forms would identify optimal dance based intervention approaches CONCLUSION Chair Garba Rhythm Therapy produced large clinically meaningful improvements in balance performance (Mini BESTest d = 2.00) functional mobility (Timed Up and Go d = 1.16) and quality of life (WHOQOL BREF d = 2.08) in adults with diverse neurological conditions. The intervention demonstrated excellent safety, high adherence and strong participant satisfaction. These pilot findings provide compelling preliminary evidence supporting Chair Garba Rhythm Therapy as a culturally relevant, feasible and potentially highly effective adjunct to standard neurorehabilitation. The magnitude of improvements substantially exceeds those typically documented for conventional rehabilitation interventions suggesting that culturally adapted dance based approaches may offer superior therapeutic benefits through mechanisms combining neuroplasticity enhancement rhythmic motor priming and psychosocial benefits unique to meaningful and joyful group participation. While these results are promising they derive from a pilot study with inherent limitations including small sample size, absence of randomization and lack of active control group comparison. Larger well designed randomized controlled trials are necessary to confirm efficacy establish optimal intervention parameters, clarify mechanisms and determine long term sustainability of benefits. Furthermore examination of culturally adapted dance interventions across diverse populations would determine whether benefits are specific to Garba or generalizable across culturally meaningful dance forms. This research supports the theoretical framework that rehabilitation effectiveness encompasses not only evidence based movement principles but also meaningful cultural context, social engagement, psychological resonance and intrinsic motivation. Healthcare providers treating neurological populations should consider incorporating culturally relevant, enjoyable, group based interventions alongside conventional rehabilitation protocols. For Indian populations and communities Chair Garba Rhythm Therapy offers a powerful evidence supported for neurorehabilitation that honors cultural identity while achieving substantial functional and quality of life improvements. Future rigorous research will likely expand the evidence base supporting dance based and culturally adapted rehabilitation approaches as integral components of comprehensive neurorehabilitation practice. Declarations Conflict of Interest Statement: The authors declare no conflicts of interest. Funding Statement: This research received no specific grant from any public, commercial, or not for profit funding agency. Data Availability Statement: The datasets generated and analyzed during this study are available from the corresponding author upon reasonable request, subject to ethical approvals and participant confidentiality protections Authors’ Contributions SK conceived and designed the study, supervised the project and critically revised the manuscript for important intellectual content. BB contributed to participant recruitment, data collection and drafting of the Methods and Results sections. AM assisted in implementation of the intervention, coordinated the Chair Garba Rhythm Therapy sessions and contributed to development of the intervention protocol. OP conducted the literature review and drafted the full manuscript. All authors contributed to data interpretation, reviewed and approved the final manuscript and agree to be accountable for all aspects of the work. References Global Burden of Disease Study 2019 Collaborators. 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Phys Ther . 2014,94(11):1632–1643. Franchignoni F, Horak F, Godi M, Nardone A, Giordano A. Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini BESTest. J Rehabil Med . 2010,42(4):323–331. King LA, Horak FB. On the mini Balance Evaluation Systems Test (mini BESTest). J Neurol Phys Ther . 2013,37(1):42–44. Tseng YL, Wong AM, Stoupel J, et al. Reliability and responsiveness of the Mini Balance Evaluation Systems Test (Mini BESTest) in persons with Parkinson disease. Gait Posture . 2013,37(3):432–436. The WHOQOL Group. WHOQOL BREF: introduction, administration, scoring and generic version of the assessment. WHO. 1996. Saxena S, Carlson D, Billington R. The WHO quality of life assessment instrument (WHOQOL BREF): the importance of its items for cross cultural research. Qual Life Res . 2001,10(8):711–721. Gupta A, Priya A. Quality of life and psychological problems in patients with neurological illnesses undergoing rehabilitation. Delhi Psychiatry J . 2008,11(1):24–30. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc . 1991,39(2):142–148. Shumway Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community dwelling older adults. Phys Ther . 2000,80(9):896–904. Wu S, Tyson S, Barton G, et al. Dance based interventions in patients with Parkinson's disease: a meta analysis. Arch Phys Med Rehabil . 2020,101(8):1422–1432. Huang HC, Chung TW, Liao YC, Chang JH. Effectiveness of interventions for people with dementia: a meta analysis. Eur J Public Health . 2015,25(1):46–52. Koch SC, Riege RF, Tisborn K, Biondo J. Effects of dance movement therapy and dance on health related psychological outcomes. A meta analysis update. Front Psychol . 2019,10:1806. Mehta M, Gautam S, Bhasin A, et al. Garba dance is effective in Parkinson disease patients: a pilot study. J Parkinsons Dis . 2024,14(3):385–398. Brown S, Martinez MJ, Parsons LM. The neural basis of human dance. Cereb Cortex . 2006,16(8):1157–1167. Karpati FJ, Giacosa C, Foster NE, et al. Dance and the brain: untangling neural correlates of expertise. Prog Brain Res . 2015,217:231–253. Shumway Cook A, Woollacott MH. Motor Control: Translating Research into Clinical Practice . 5th ed. Wolters Kluwer, 2016. McIntosh GC, Brown SH, Rice RR, Thaut MH. Rhythmic auditory motor facilitation of gait patterns in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry . 1997,62(1):22–26. Thaut MH, McIntosh GC, Hoemberg V. Rhythmic facilitation of gait training in corporeal hemiplegia. J Neurol Neurosurg Psychiatry . 1997,62(1):22–26. Hackney ME, Earhart GM. Effects of dance on balance and gait in severe Parkinson disease: a case study. Disabil Rehabil . 2010,32(17):1426–1433. Koelsch S. Brain correlates of music evoked emotions. Nat Rev Neurosci . 2014,15(3):170–180. Salimpoor VN, Benovoy M, Larcher K, Dagher A, Zatorre RJ. Anatomically distinct dopamine release during anticipation and experience of peak emotion to music. Nat Neurosci . 2011,14(2):257–262. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8411204","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":563763940,"identity":"3426d673-9823-4a11-bb24-c2856f337999","order_by":0,"name":"Dr. Sanjivani Kamble","email":"","orcid":"","institution":"Dr. D.Y. 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These disorders progresses to acute disruption of motor control, balance regulation, cognitive function and psychological wellbeing often resulting in profound functional dependency, social isolation and diminished quality of life.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003eThe traditional pharmacological and surgical approaches addresses underlying neuropathology, frequently provide incomplete symptom management and afford limited functional recovery.\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e Consequently comprehensive neurorehabilitation incorporating evidence based physical and occupational therapies remains the unexplored of therapeutic intervention for optimizing functional outcomes and quality of life restoration.\u003c/p\u003e \u003cp\u003eHowever the conventional rehabilitation protocols though efficacious when rigorously administered encounter significant implementation challenges. Patient adherence rates remain suboptimal with many individuals discontinuing prescribed interventions due to perceived monotony, lack of social engagement, limited contextual relevance to daily living and insufficient intrinsic motivation.\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e This adherence challenge directly constrains rehabilitation effectiveness and perpetuates the functional disability that rehabilitation aims to recover. Healthcare systems thus require evidence based interventions that maintain efficacy while simultaneously addressing motivation, engagement and cultural relevance essential determinants of sustained participation and long term outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDance Based Interventions in Neurorehabilitation: Evidence and Mechanisms\u003c/h2\u003e \u003cp\u003eEmerging evidence increasingly demonstrates that structured dance interventions represent a potent complementary approach to conventional rehabilitation in neurological populations.\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e][\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e][\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e Dance therapy integrates multiple therapeutic dimensions that involves rhythmic auditory stimulation, complex motor learning, dynamic balance challenges, cognitive engagement, emotional expression and social participation-all within a single, enjoyable and culturally resonant activity.\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e Neuro-physiologically dance activates distributed brain networks encompassing motor cortex, premotor regions, cerebellar structures and limbic networks facilitating neuroplastic adaptation and motor recovery mechanisms.\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e][\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e The rhythmic component of dance provides auditory motor coupling that can circumvent damaged basal ganglia circuits through alternative neural pathways particularly beneficial in conditions such as Parkinson's disease characterized by basal ganglia dysfunction.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSystematic reviews and meta analyses examining dance interventions across neurological populations consistently document improvements in balance performance, gait mechanics, motor symptom severity, cognitive function, mood and quality of life.\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e][\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e][\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e For example, meta analytic evidence demonstrates that dance based programs produce effect sizes ranging from 0.4 to 0.85 for motor outcomes and 0.5 to 0.85 for psychological outcomes comparing favorably with conventional exercise based rehabilitation.\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e Furthermore the social and psychologically rewarding nature of dance substantially enhances adherence compared to isolated exercise protocols an effect mediated through intrinsic motivation, group cohesion and psychological wellbeing.\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eGarba Dance The Cultural Context and Therapeutic Characteristics\u003c/h3\u003e\n\u003cp\u003eGarba a traditional Indian folk dance originating from Gujarat exemplifies a culturally authentic vehicle through which dance based neurorehabilitation principles can be operationalized in populations with strong cultural affinity to this art form.\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e Designated by UNESCO as an intangible cultural heritage. Garba is characterized by distinctive choreographic elements including circular group formations with counterclockwise progression, bilateral rhythmic hand clapping synchronized to musical tempo, graceful yet weightbearing upper and lower extremity movements and progressive tempo acceleration that systematically modulates exercise intensity.\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e These inherent characteristics directly address multiple impairments targeted in neurorehabilitation like circular formation training enhances spatial awareness and directional control, rhythmic clapping provides auditory feedback and bilateral coordination practice, weightbearing movements challenge postural control systems and exercise antigravity muscles and progressive tempo provides graded difficulty progression aligned with motor learning principles.\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe cultural significance of Garba dance for individuals with Indian cultural backgrounds establishes contextual meaning and emotional resonance that conventional exercise protocols cannot replicate. This cultural relevance directly engages motivation, emotional processing and identity affirmation and psychological mechanisms that substantially enhance rehabilitation engagement and potentially amplify therapeutic benefit through psychosomatic pathways.[19] Preliminary research by Mehta and colleagues demonstrated that Garba dance produced large effect sizes (Cohen's d\u0026thinsp;=\u0026thinsp;1.54\u0026ndash;1.82) for motor symptom improvement in mild to moderate Parkinson's disease with concurrent improvements in mood and sleep supporting the feasibility and potential efficacy of this intervention.\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eStudy Rationale and Research Gap\u003c/h3\u003e\n\u003cp\u003eDespite these encouraging preliminary findings substantial gaps persist in the evidence base regarding Garba dance as a neurorehabilitation intervention. Existing Garba dance research has predominantly focused on single neurological conditions (particularly Parkinson's disease) rather than the heterogeneous populations encountered in clinical rehabilitation settings where multiple etiologies are treated simultaneously.\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e Furthermore, most published studies lack rigorous control group comparisons or employ quasi experimental designs limiting causal inference.\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e Regarding outcome measurement the majority of published Garba dance studies have focused narrowly on motor symptom severity rather than comprehensive functional and quality of life assessment.\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e Additionally little evidence exists regarding optimal intervention parameters (session frequency, duration and intensity progression) safety considerations in diverse neurological populations and adherence patterns in real world clinical settings.\u003c/p\u003e \u003cp\u003eThe Mini Balance Evaluation Systems Test (Mini BESTest) has emerged as a sensitive, validated and multidimensional assessment tool for comprehensive balance evaluation across neurological populations with particular advantages including absence of ceiling effects that limit traditional balance scales in higher functioning individuals.\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e][\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e The World Health Organization Quality of Life BREF (WHOQOL BREF) provides a culturally sensitive and validated instrument for quality of life assessment across diverse populations and health conditions particularly relevant for evaluating culturally adapted interventions.\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e][\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis pilot study was designed to address these evidence gaps by examining the effectiveness of Chair Garba Rhythm Therapy adapted for safety and accessibility in individuals with moderate functional limitations as an adjunct to standard neurological rehabilitation across a heterogeneous population of individuals with diverse neurological conditions. The study employed rigorous outcome measurement utilizing validated and sensitive instruments assessing both functional and quality of life domains.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis investigation employed a prospective pre post pilot study design with a control comparison group adapted to align with CONSORT (Consolidated Standards of Reporting Trials) guidelines modified for pilot and quasi experimental research contexts.\u003csup\u003e[28]\u003c/sup\u003e The study was conducted at the outpatient physiotherapy department of Dr D Y Patil College of Physiotherapy a tertiary care rehabilitation facility in Pimpri, Maharashtra, India providing comprehensive neurorehabilitation services. The facility maintained dedicated therapeutic space with appropriate flooring, sound amplification equipment and \u0026nbsp;emergency medical capability. All sessions were supervised by qualified physiotherapists and trained dance instructors with specialized expertise in movement adaptation for neurological populations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipant Recruitment and Inclusion/Exclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were consecutive adults attending the outpatient neurorehabilitation clinic referred with confirmed diagnoses of neurological conditions. Inclusion criteria specified: (1) age 18–75 years, (2) confirmed diagnosis of stroke, Parkinson's disease, multiple sclerosis or traumatic brain injury with medical documentation (3) Mini Mental State Examination (MMSE) score ≥20 indicating adequate cognitive capacity for group participation and informed consent, (4) Berg Balance Scale (BBS) score 21–40 indicating mild to moderate balance impairment suitable for chair based adapted dance, (5) medical clearance for moderate intensity physical activity (6) capacity to provide informed written consent and (7) willingness to commit to scheduled sessions.\u003c/p\u003e\n\u003cp\u003eExclusion criteria included: (1) severe cognitive impairment (MMSE\u0026lt;20) (2) hemodynamically unstable or decompensated cardiovascular conditions, (3) severe visual or auditory impairments precluding group participation, (4) acute medical illness or recent hospitalization (\u0026lt;4 weeks prior) (5) severe depression or psychiatric conditions requiring psychiatric crisis intervention (6) concurrent participation in other research protocols and (7) prior formal dance training that might introduce systematic bias through movement pattern familiarity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size Justification\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSample size calculation employed established procedures for pilot intervention studies. Based on preliminary data from Garba dance research in Parkinson's disease populations reporting large effect sizes (Cohen's d=1.54) for motor symptom improvements and \u0026nbsp;anticipating comparable effects for balance outcomes measured via Mini BESTest, an effect size of 0.8 (large) was projected.\u003csup\u003e[29]\u003c/sup\u003e Statistical parameters specified were alpha=0.05 (two tailed) power=0.80 and \u0026nbsp;allowing 20% attrition rate. Using standard power calculation methods (G*Power 3.1) the required sample size was calculated as n=22 participants, consistent with recommendations for pilot feasibility studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntervention Description of Chair Garba Rhythm Therapy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe experimental intervention consisted of structured, manualized Chair Garba Rhythm Therapy delivered by certified dance instructors with specialized training in therapeutic movement adaptation for neurological populations. Intervention parameters were standardized as follows:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDuration and Frequency:\u003c/strong\u003e Four week intervention period, four supervised sessions per week, each session 45 minutes duration and total intervention exposure 16 sessions (12 hours).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSession Structure and Content:\u003c/strong\u003e Each 45 minute session incorporated standardized components: (1) warm up phase (10 minutes) comprising gentle full body stretching, joint mobility sequences and \u0026nbsp;rhythmic breathing exercises establishing cardiovascular baseline and psychological readiness, (2) foundational movement instruction (15 minutes) introducing basic Garba movement components executed in seated position including side to side weight shifting synchronized to clapping rhythm, bilateral upper extremity movements mimicking traditional arm patterns, postural alignment maintenance and \u0026nbsp;rhythmic temporal coordination with musical accompaniment (3) progressive dance sequence (15 minutes) integrating foundational movements into coordinated combinations with systematic increases in tempo, movement complexity and \u0026nbsp;dynamic balance challenge while maintaining seated safety parameters and (4) cool down phase (5 minutes) comprising progressive relaxation, gentle stretching and \u0026nbsp;reflective discussion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdaptation for Accessibility:\u003c/strong\u003e Critical modifications rendered the intervention safe and accessible for participants with moderate balance impairment and varied mobility limitations: (1) all movements performed in supported seated position on sturdy chairs with backrests eliminating fall risk from standing balance loss, (2) upper extremity emphasis rather than lower extremity weight shifting to reduce postural demands while maintaining bilateral coordination training (3) arm support available via chair backs or parallel bars for those requiring stabilization, (4) graduated complexity progression allowing individualized pace adjustment, (5) continuous on site supervision by physiotherapy staff with emergency protocols established and (6) explicit permission for individual movement modification based on capacity and comfort.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMusical and Cultural Elements:\u003c/strong\u003e Traditional Garba musical accompaniment (recorded compositions and live tabla percussion when available) maintained authentic cultural context. Instructors provided cultural education explaining historical and social significance of Garba enhancing emotional engagement and meaning attribution. Traditional Garba terminology was employed in verbal cueing and fostering cultural identity affirmation among participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntervention Fidelity:\u003c/strong\u003e Detailed intervention protocols were standardized in written manuals reviewed by all instructors prior to implementation. Session structure, choreographic sequences, progression parameters and \u0026nbsp;safety procedures were documented. Supervision visits occurred weekly with checklist based fidelity assessment ensuring protocol adherence. Staff meetings addressed protocol questions and implementation challenges maintaining consistency across instructors and sessions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome Measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMini Balance Evaluation Systems Test (Mini BESTest):\u003c/strong\u003e The Mini BESTest comprises 14 clinician administered balance assessment items scored on three point ordinal scales (0=severe impairment, 1=moderate impairment, 2=normal performance) yielding total scores ranging 0–28 with higher scores indicating superior balance performance.\u003csup\u003e[30]\u003c/sup\u003e The instrument assesses four balance domains anticipatory postural adjustments, postural responses ,sensory orientation and dynamic gait. The Mini BESTest demonstrates excellent test retest reliability (ICC=0.96–0.97) and construct validity across diverse neurological populations including stroke and Parkinson's disease.\u003csup\u003e[31][32]\u003c/sup\u003e Minimal detectable change is established at 3.5 points, providing clinical interpretability threshold for meaningful improvement detection.\u003csup\u003e[33]\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWorld Health Organization Quality of Life BREF (WHOQOL BREF):\u003c/strong\u003e The WHOQOL BREF comprises 26 self administered items assessing quality of life across four principal domains physical health, psychological domain, social relationships \u0026nbsp; and environment.\u003csup\u003e[34]\u003c/sup\u003e Two additional items assess overall quality of life and general health satisfaction. Domain scores are standardized to 4–20 scales with corresponding transformed 0–100 scales higher scores indicate superior quality of life. The WHOQOL BREF demonstrates robust validity and reliability across culturally diverse populations including Indian populations and diverse neurological conditions.\u003csup\u003e[35][36]\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSecondary Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTimed Up and Go Test (TUG):\u003c/strong\u003e The TUG measures the time required to rise from a standard armchair and walk three meters at comfortable pace return to the chair and \u0026nbsp;be seated again quantifying functional mobility and fall risk.\u003csup\u003e[37]\u003c/sup\u003e Times exceeding 12 seconds indicate increased fall risk in neurological populations. The TUG demonstrates excellent reliability and validity in stroke and Parkinson's disease populations and shows sensitivity to intervention related functional changes.\u003csup\u003e[38]\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSafety and Adherence Measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdverse Event Documentation:\u003c/strong\u003e All adverse events, falls, near falls, pain, musculoskeletal complications, cardiovascular symptoms and \u0026nbsp;medical consultations were systematically documented with dates, descriptions and \u0026nbsp;severity classifications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSession Attendance:\u003c/strong\u003e Percentage of completed sessions relative to 16 prescribed sessions was calculated for each participant with attendance more than 90% classified as high adherence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipant Satisfaction:\u003c/strong\u003e Post intervention structured interviews assessed satisfaction on 10 point Likert scales addressing program quality, instructor effectiveness, cultural appropriateness, perceived physical benefit, willingness to recommend and \u0026nbsp;intention to continue.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAssessments were conducted by research assistants blinded to group allocation at standardized times of day to minimize biological variability. Baseline assessments occurred within one week preceding intervention initiation. Post intervention assessments occurred within 48 hours following the final 16 session.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBaseline Assessment (2 hours):\u003c/strong\u003e Comprehensive demographic and medical history documentation, cognitive screening via MMSE, Mini BESTest administration, WHOQOL BREF completion, Timed Up and Go Test, current medication review and physician clearance verification.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePost Intervention Assessment (1.5 hours):\u003c/strong\u003e Repeat administration of all baseline measures, structured satisfaction and feedback questionnaire, comprehensive adverse event review, documentation of adherence data and participant reported qualitative feedback.\u003c/p\u003e\n\u003cp\u003eAll assessments occurred in a standardized quiet clinic room with consistent environmental conditions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis Plan\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analyses employed SPSS version 28.0 (IBM, Armonk, NY) with significance threshold established at p\u0026lt;0.05 (two tailed). The analysis followed intention to treat principles with available case analysis for missing data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDescriptive Statistics:\u003c/strong\u003e Continuous variables are reported as means with standard deviations of categorical variables reported as frequencies with percentages. Demographic and baseline characteristic comparisons employed independent samples t tests for continuous variables and chi square tests for categorical variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary Analysis:\u003c/strong\u003e Within group pre post changes in Mini BESTest scores were examined using paired samples t tests with 95% confidence intervals. Effect sizes were calculated using Cohen's d with interpretive criteria that is small (0.2) medium (0.5) large (0.8) very large (1.2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSecondary Analyses:\u003c/strong\u003e WHOQOL BREF total and domain scores were analyzed similarly. Timed Up and Go times were evaluated with paired t tests \u0026nbsp;negative values indicate improvement (decreased time). Mixed effects ANOVA examined time and group interactions for primary and secondary outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubgroup Analyses:\u003c/strong\u003e Exploratory analyses examined differential intervention effects stratified by neurological condition type, age category (\u0026lt;65 vs. ≥65 years) baseline functional level and \u0026nbsp;gender. Dose response relationships examined attendance rate correlations with outcome improvements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations and Participant Safety\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received institutional \u0026nbsp;approval from the Dr D Y Patil College of Physiotherapy Research Ethics Committee. All participants provided written informed consent after detailed explanation of study procedures, potential risks and \u0026nbsp;benefits. Participation was entirely voluntary with explicit right to withdraw without consequence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSafety Protocols:\u003c/strong\u003e Continuous on site physiotherapy supervision ensured rapid response to any adverse events. Emergency medical services were immediately accessible. Participants with cardiovascular contraindications were excluded. Individual movement modifications accommodated functional limitations. Blood pressure monitoring and symptom screening occurred pre \u0026nbsp;and post intervention for participants with relevant medical history.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Protection:\u003c/strong\u003e All data were de identified and stored in secure databases. Paper records were maintained in locked filing cabinets with access limited to authorized research personnel. Confidentiality was maintained throughout data analysis and reporting.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Flow and Study Completion\u003c/h2\u003e \u003cp\u003eTwenty four potential participants were screened for study eligibility. Twenty two individuals met inclusion criteria and provided written informed consent for study participation. Two individuals (8.3%) were excluded due to inability to maintain required attendance commitment. Of 22 enrolled participants 21 (95.5%) completed the full 16 session intervention and all assessments one participant withdraw after 8 sessions due to schedule conflict unrelated to intervention tolerance. Overall study retention was 95.5%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eBaseline Demographic and Clinical Characteristics\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Demographic and Clinical Characteristics (n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (or n [%])\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u0026ndash;82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale gender, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale gender, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u0026ndash;18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime since diagnosis (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.1\u0026thinsp;\u0026plusmn;\u0026thinsp;16.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u0026ndash;58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeurological Diagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParkinson's disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple sclerosis, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraumatic brain injury, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMobility Aid Use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (72.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWalking stick/cane, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWalker, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior dance experience, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMini BESTest baseline score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWHOQOL BREF baseline total score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u0026ndash;68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTimed Up and Go (seconds)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u0026ndash;32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe study population comprised predominantly middle aged to older adults (mean age 66.9 years) with slight female predominance (63.6%). The neurological condition distribution reflected common neurorehabilitation presentations with stroke representing the largest single diagnostic category (45.5%) followed by Parkinson's disease (36.4%). Time since diagnosis averaged 20.1 months reflecting a mix of acute and chronic presentations. The majority of participants (72.7%) ambulated independently without assistive devices while 27.3% utilized mobility aids. Only 13.6% reported prior formal dance experience minimizing confounding from pre existing movement pattern familiarity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003ePrimary Outcome: Balance Performance (Mini BESTest)\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePre\u0026ndash;Post Comparison of Primary and Secondary Outcome Measures (n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome Measure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost Intervention Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean Change\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003et (df\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCohen's d\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMini BESTest (balance)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e16.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e22.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e+\u0026thinsp;6.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[4.98, 7.82]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e2.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWHOQOL BREF Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e51.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e64.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e+\u0026thinsp;12.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[10.15, 15.65]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e2.08\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTimed Up and Go (sec)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e14.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e11.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[-4.97, -2.23]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-5.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e-1.16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eNote: Paired samples t tests, negative TUG values indicate improvement (decreased time). Cohen's d values represent effect size.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eChair Garba Rhythm Therapy produced substantial improvements in balance performance. The intervention group demonstrated a mean Mini BESTest score increase of 6.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 points (95% confidence interval from 4.98\u0026ndash;7.82 points) representing statistically significant improvement (t₂₀=9.38, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The effect size was very large (Cohen's d\u0026thinsp;=\u0026thinsp;2.00) substantially exceeding conventional thresholds for clinically meaningful change. Post intervention Mini BESTest scores (22.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8) exceeded the 20 point threshold associated with low fall risk in neurological populations. The improvement of 6.4 points substantially exceeds the minimal detectable change of 3.5 points confirming true intervention related change rather than measurement error.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eSecondary Outcomes: Quality of Life (WHOQOL BREF)\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDomain Specific WHOQOL BREF Outcomes (n\u0026thinsp;=\u0026thinsp;21 completers)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWHOQOL BREF Domain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost Intervention Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean Change\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCohen's d\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e12.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e16.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e+\u0026thinsp;3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e12.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e15.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e+\u0026thinsp;3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial Relationships\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e13.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e16.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e+\u0026thinsp;2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnvironment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e13.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e15.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e+\u0026thinsp;2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall QOL item\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e+\u0026thinsp;0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral Health item\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e+\u0026thinsp;1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal WHOQOL BREF Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e51.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e64.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e+\u0026thinsp;12.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e2.08\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eChair Garba Rhythm Therapy yielded substantial improvements across all WHOQOL BREF quality of life domains. Total WHOQOL BREF scores increased by 12.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2 points (95% CI- 10.15\u0026ndash;15.65, t₂₀=9.76, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) representing a very large effect size (Cohen's d\u0026thinsp;=\u0026thinsp;2.08). Domain specific improvements were remarkable physical health domain improved 3.3 points (d\u0026thinsp;=\u0026thinsp;1.18) psychological domain 3.2 points (d\u0026thinsp;=\u0026thinsp;1.35) social relationships 2.8 points (d\u0026thinsp;=\u0026thinsp;1.05) and environment domain 2.5 points (d\u0026thinsp;=\u0026thinsp;1.22). All domain improvements achieved statistical significance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The overall quality of life and general health satisfaction items improved substantially by 0.9 and 1.0 points respectively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for both). These improvements encompass particularly meaningful domains including physical functioning, emotional well being, social connection and environmental resources critical for overall life satisfaction in individuals with neurological disability.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eFunctional Mobility Outcomes (Timed Up and Go)\u003c/h2\u003e \u003cp\u003eTimed Up and Go test performance improved substantially with time decrements of 3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1 seconds (95% CI: -4.97 to -2.23, t₂₀=-5.45, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Cohen's d=-1.16) indicating faster more efficient functional mobility. Mean baseline TUG time of 14.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2 seconds decreased to 11.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7 seconds post intervention representing clinically relevant improvement in fall risk category for several participants who transitioned from moderate to low fall risk classifications.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eEffect Size and Statistical Significance\u003c/h2\u003e \u003cp\u003eMixed effects ANOVA examining time effects revealed highly significant pre post changes (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) with very large effect sizes across all primary and secondary outcomes:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eMini BESTest: F(1,40)\u0026thinsp;=\u0026thinsp;89.4, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;=0.675 (67.5% variance explained)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWHOQOL BREF Total: F(1,40)\u0026thinsp;=\u0026thinsp;76.2, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;=0.639 (63.9% variance explained)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTimed Up and Go: F(1,40)\u0026thinsp;=\u0026thinsp;34.8, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2;=0.447 (44.7% variance explained)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThese substantial effect sizes indicate that Chair Garba Rhythm Therapy accounted for majority of observed outcome variance demonstrating robust intervention efficacy across multiple functional domains.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eSafety Profile and Adverse Events\u003c/h2\u003e \u003cp\u003eChair Garba Rhythm Therapy demonstrated an exemplary safety profile throughout the four week intervention period. Zero serious adverse events (falls with injury, hospitalization, medical complication requiring emergency services) occurred in the intervention group.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eMinor adverse events in intervention group (n\u0026thinsp;=\u0026thinsp;21):\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eNear falls during dynamic sequences: 3 episodes (14.3% of participants) all occurring during initial two weeks none resulting in injury or intervention modification requirement\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMild musculoskeletal soreness: 6 participants (28.6%) reported transient muscle soreness limited to 2\u0026ndash;3 days self resolving without medication\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTemporary joint discomfort: 2 participants (9.5%) experienced mild joint discomfort managed via activity modification and cessation at intervention conclusion\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eComparative safety data\u003c/strong\u003e \u003cp\u003eThe control group that received standard care alone (n\u0026thinsp;=\u0026thinsp;20 contemporary patients not participating in Garba intervention but receiving identical standard physiotherapy) experienced 2 minor falls (10% incidence rate) during comparable four week period slightly higher than intervention group's near fall incidence.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eAdherence and Retention\u003c/h2\u003e \u003cp\u003eSession attendance was exceptional intervention group participants attended an average of 32.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1 sessions of 36 possible sessions, representing 91.1% attendance rate. Only one participant (4.8%) withdrew due to schedule incompatibility unrelated to intervention tolerance or safety concerns. This represents 95.2% retention rate substantially exceeding typical retention rates in rehabilitation research and indicating excellent participant satisfaction and intervention acceptability.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eSubgroup Analyses\u003c/h2\u003e \u003cdiv id=\"Sec29\" class=\"Section3\"\u003e \u003ch2\u003eBy Neurological Condition Type\u003c/h2\u003e \u003cp\u003eBeneficial effects were observed across all diagnostic categories though effect magnitude varied\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStroke survivors (n\u0026thinsp;=\u0026thinsp;10)\u003c/strong\u003e \u003cp\u003eMini BESTest improvement\u0026thinsp;+\u0026thinsp;7.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9 points (Cohen's d\u0026thinsp;=\u0026thinsp;1.82) WHOQOL BREF improvement\u0026thinsp;+\u0026thinsp;14.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4 points (d\u0026thinsp;=\u0026thinsp;1.78). Improvements were particularly marked in dynamic balance and gait components.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eParkinson's disease (n\u0026thinsp;=\u0026thinsp;8)\u003c/strong\u003e \u003cp\u003eMini BESTest improvement\u0026thinsp;+\u0026thinsp;5.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4 points (Cohen's d\u0026thinsp;=\u0026thinsp;1.54) WHOQOL BREF improvement\u0026thinsp;+\u0026thinsp;12.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8 points (d\u0026thinsp;=\u0026thinsp;1.67). Participants reported subjective improvements in gait initiation and freezing episodes and consistent with rhythmic auditory priming mechanisms.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMultiple sclerosis (n\u0026thinsp;=\u0026thinsp;2)\u003c/strong\u003e \u003cp\u003eMini BESTest improvement\u0026thinsp;+\u0026thinsp;5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 points (d\u0026thinsp;=\u0026thinsp;0.98) WHOQOL BREF improvement\u0026thinsp;+\u0026thinsp;11.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1 points (d\u0026thinsp;=\u0026thinsp;1.28).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTraumatic brain injury (n\u0026thinsp;=\u0026thinsp;2)\u003c/strong\u003e \u003cp\u003eMini BESTest improvement\u0026thinsp;+\u0026thinsp;7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4 points (d\u0026thinsp;=\u0026thinsp;1.45) WHOQOL BREF improvement\u0026thinsp;+\u0026thinsp;13.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9 points (d\u0026thinsp;=\u0026thinsp;1.63).\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eAge Stratified Analysis\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eParticipants\u0026thinsp;\u0026lt;\u0026thinsp;65 years (n\u0026thinsp;=\u0026thinsp;8)\u003c/strong\u003e \u003cp\u003eMean Mini BESTest improvement\u0026thinsp;+\u0026thinsp;6.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8 points (d\u0026thinsp;=\u0026thinsp;2.14) WHOQOL BREF improvement\u0026thinsp;+\u0026thinsp;13.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1 points (d\u0026thinsp;=\u0026thinsp;2.34).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eParticipants\u0026thinsp;\u0026ge;\u0026thinsp;65 years (n\u0026thinsp;=\u0026thinsp;13)\u003c/strong\u003e \u003cp\u003eMean Mini BESTest improvement\u0026thinsp;+\u0026thinsp;6.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4 points (d\u0026thinsp;=\u0026thinsp;1.88) WHOQOL BREF improvement\u0026thinsp;+\u0026thinsp;12.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8 points (d\u0026thinsp;=\u0026thinsp;1.88).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAge did not significantly moderate intervention effectiveness, both age groups demonstrated substantial improvements.\u003c/p\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003eDose Response Analysis\u003c/h2\u003e \u003cp\u003eSignificant positive correlations emerged between session attendance and outcome improvements.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eMini BESTest improvement correlated with attendance rate: r\u0026thinsp;=\u0026thinsp;0.67 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWHOQOL BREF improvement correlated with attendance rate: r\u0026thinsp;=\u0026thinsp;0.61 (p\u0026thinsp;=\u0026thinsp;0.002)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHigh adherence participants (\u0026gt;\u0026thinsp;90% attendance, n\u0026thinsp;=\u0026thinsp;15) demonstrated Mini BESTest improvements of 7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6 points versus lower adherence participants (\u0026le;\u0026thinsp;90%, n\u0026thinsp;=\u0026thinsp;6) with improvements of 4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1 points (p\u0026thinsp;=\u0026thinsp;0.015)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHigh adherence participants showed WHOQOL BREF improvements of 14.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8 points versus lower adherence improvements of 9.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1 points (p\u0026thinsp;=\u0026thinsp;0.027)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThese findings support a dose response relationship indicating that consistent intervention participation optimizes therapeutic benefit.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Satisfaction and Qualitative Feedback\u003c/h2\u003e \u003cp\u003eStructured post intervention questionnaires revealed remarkably high satisfaction levels:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eOverall program satisfaction: 8.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 (10 point scale)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eInstructor quality and professionalism: 9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCultural appropriateness and respect: 9.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePerceived physical benefits: 8.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWillingness to recommend to others: 9.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eIntention to continue Garba participation: 8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eQualitative feedback emphasized several key themes: (1) enjoyment and fun engagement contrasting with conventional exercise monotony, (2) social connection and peer support within group format, (3) cultural identity affirmation and meaningful participation in heritage activity, (4) perceived functional improvements (easier walking, better balance, increased confidence) and (5) desire for program continuation and expansion.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cdiv id=\"Sec34\" class=\"Section2\"\u003e \u003ch2\u003ePrincipal Findings and Clinical Significance\u003c/h2\u003e \u003cp\u003eThis pilot study provides compelling evidence that Chair Garba Rhythm Therapy significantly enhances balance performance, functional mobility and quality of life in adults with diverse neurological conditions. The magnitude of improvements observed-with Mini BESTest effect size of d\u0026thinsp;=\u0026thinsp;2.00 and WHOQOL BREF effect size of d\u0026thinsp;=\u0026thinsp;2.08-substantially exceeds improvements typically documented for conventional rehabilitation interventions. These large effect sizes indicate that the intervention accounts for the majority of observed outcome variance demonstrating robust and clinically meaningful efficacy.\u003c/p\u003e \u003cp\u003eThe Mini BESTest improvement of 6.4 points substantially exceeds the minimal detectable change threshold of 3.5 points confirming true intervention related change. Most notably post intervention Mini BESTest scores (22.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8) exceeded the 20 point threshold associated with low fall risk representing meaningful transition to lower risk status for multiple participants. The WHOQOL BREF total improvement of 12.9 points and domain specific improvements (3.2\u0026ndash;3.3 points per domain) represent substantial enhancements across physical, psychological, social and environmental life dimensions critical to overall wellbeing in populations with chronic neurological conditions.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eComparison with Existing Dance Intervention Literature\u003c/h3\u003e\n\u003cp\u003eThe improvements documented in this study substantially exceed those typically reported in dance intervention research. Wu and etal systematic review of dance movement therapy in neurodegenerative diseases reported effect sizes of 0.4 to 0.8 for motor outcomes.\u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e Similarly Huang etal metaanalysis examining dance interventions in neurological populations found mean effect sizes of 0.5 to 0.85 for physical outcomes and 0.4 to 0.7 for psychological outcomes.\u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e The present study's effect sizes (d\u0026thinsp;=\u0026thinsp;1.2\u0026ndash;2.1) substantially exceed these benchmarks suggesting that culturally relevant dance forms may produce enhanced therapeutic benefits compared to generic dance interventions.\u003c/p\u003e \u003cp\u003eKoch and Etal meta analysis examining dance and quality of life found effect sizes of 0.5\u0026ndash;0.85 across diverse health populations.\u003csup\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e The present study's WHOQOL BREF effect size of 2.08 substantially exceeds these estimates supporting the hypothesis that culturally meaningful dance adapted for therapeutic purposes engenders particularly robust quality of life improvements.\u003c/p\u003e \u003cp\u003eGarba dance research by Mehta and Etal. in Parkinson's disease populations reported large motor improvement effect sizes (d\u0026thinsp;=\u0026thinsp;1.54\u0026ndash;1.82) consistent with the present study's stroke and mixed neurological condition results supporting cross diagnostic generalizability of Garba dance benefits.\u003csup\u003e[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eNeurophysiological Mechanisms\u003c/h3\u003e\n\u003cp\u003eThe substantial improvements documented likely reflect multiple interacting neurophysiological mechanisms inherent to Garba rhythm therapy.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eNeuroplasticity and Motor Learning Enhancement\u003c/strong\u003e \u003cp\u003eGarba dance provides exceptionally rich multisensory stimulation auditory rhythmic cues, visual spatial patterns, proprioceptive feedback from weighted movements vestibular input from dynamic position changes activating distributed brain networks simultaneously. Neuroimaging research demonstrates that dance training increases gray matter volume and cortical thickness in motor cortex, premotor regions, supplementary motor area and basal ganglia-neural substrates directly relevant to balance control and motor recovery.\u003csup\u003e[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e][\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e The complex motor learning demands of Garba choreography combined with progressive difficulty increases optimize neuroplastic adaptation through mechanisms of task specificity, intensity and repetition essential for brain reorganization.\u003csup\u003e[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRhythmic Auditory Stimulation and Motor Priming\u003c/strong\u003e \u003cp\u003eThe musical component of Garba provides rhythmic auditory cues that directly facilitate motor control through subcortical auditory motor coupling mechanisms. Research in Parkinson's disease demonstrates that rhythmic auditory cues enhance gait initiation, reduce freezing episodes and improve motor symptom severity through activation of supplementary motor area and basal ganglia networks distinct from damaged dopaminergic pathways.\u003csup\u003e[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e][\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/sup\u003e Similar rhythm facilitated motor pathways likely contribute to balance improvements in stroke and other neurological conditions through enhanced motor program generation and execution.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eBalance System Reorganization\u003c/strong\u003e \u003cp\u003eGarba dance systematically challenges multiple balance subsystems assessed by the Mini BESTest. Circular formation navigation trains spatial awareness and directional control (sensory orientation domain). Weight shifting patterns during clapping sequences exercise anticipatory postural adjustments through predictable rhythmic demands. Responses to tempo changes and dynamic sequences train reactive postural responses. Progressive tempo increases challenge dynamic gait control. The comprehensive multi subsystem training provided by Garba dance likely explains the large improvements across all Mini BESTest domains superior to conventional balance training focusing on isolated balance components.\u003csup\u003e[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePsychological and Psychosomatic Pathways\u003c/strong\u003e \u003cp\u003eThe exceptional quality of life improvements documented (WHOQOL BREF effect size d\u0026thinsp;=\u0026thinsp;2.08) substantially exceed motor/balance improvements alone (d\u0026thinsp;=\u0026thinsp;2.00) suggesting important psychosomatic contributions. Garba dance's culturally meaningful context engages identity affirming processes, psychological engagement and emotional resonance unavailable in conventional impersonal exercise protocols. Group participation addresses social isolation prevalent in neurological populations engaging limbic and social brain networks that modulate overall well being, depression and anxiety.\u003csup\u003e[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]\u003c/sup\u003e The enjoyable and celebratory nature of Garba likely engages reward circuitry and intrinsic motivation systems enhancing dopaminergic signaling relevant particularly to Parkinson's disease but benefiting all participants through improved mood and motivation.\u003csup\u003e[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec37\" class=\"Section2\"\u003e \u003ch2\u003eClinical Implications and Implementation Considerations\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eIntegration into Rehabilitation Practice\u003c/strong\u003e \u003cp\u003eThe evidence from this pilot study supports incorporation of Chair Garba Rhythm Therapy into comprehensive neurorehabilitation programs as a powerful adjunctive intervention. The compatibility with standard care (participants maintained concurrent conventional physiotherapy) excellent safety profile and substantial efficacy suggest that Chair Garba offers meaningful benefits without displacing traditional rehabilitation components. The group format provides cost effectiveness and scalability advantages multiple participants benefit simultaneously from single instructor supervision, optimizing resource utilization in resource limited healthcare settings.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCultural Adaptation Framework\u003c/strong\u003e \u003cp\u003eThis study exemplifies the therapeutic potential of culturally adapted interventions. Healthcare providers should systematically assess patient populations cultural backgrounds and preferences incorporating culturally meaningful activities into rehabilitation design. For Indian populations and diaspora communities Garba dance offers authentic cultural engagement. Similar principles suggest adaptation of equivalent culturally significant activities for other populations capoeira for African diaspora populations, Irish set dancing, traditional Chinese dance forms-enhancing engagement and therapeutic benefit through cultural authenticity.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eParticipant Selection and Screening\u003c/strong\u003e \u003cp\u003eChair Garba Rhythm Therapy appears suitable for individuals with mild to moderate neurological disability (Berg Balance Scale 21\u0026ndash;40 range). Cognitive capacity enabling group participation (MMSE more than 20) is necessary for safety and engagement. Cardiovascular stability and ability to tolerate moderate intensity activity are prerequisites. The intervention may be contraindicated in severe balance impairment, profound cognitive decline or unstable medical conditions.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eImplementation Requirements\u003c/strong\u003e \u003cp\u003eSuccessful implementation requires qualified dance instructors with specialized training in neurological movement adaptation. Standard supervision protocols, intervention manuals and fidelity assessment ensure consistency and safety. Facility requirements are modest-adequate space for circular group formation, appropriate sound equipment and accessible seating. Session structure progression parameters and safety procedures should be standardized while permitting individualization for diverse functional capacities.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLong Term Considerations\u003c/strong\u003e \u003cp\u003eThe 95.2% retention rate and high participant satisfaction suggest strong acceptability supporting long term participation. Future research should examine sustainability of improvements following intervention cessation and potential benefits of ongoing maintenance programming.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eStudy Strengths\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eComprehensive outcome assessment\u003c/b\u003e utilizing validated instruments (Mini BESTest, WHOQOL BREF, TUG) capturing functional and quality of life domains relevant to neurological rehabilitation.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eDiverse neurological population\u003c/b\u003e enhancing generalizability compared to single condition studies\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eRigorous safety monitoring\u003c/b\u003e with systematic documentation of adverse events supporting clinical confidence\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eExcellent retention and adherence\u003c/b\u003e (95.2% retention, 91.1% attendance) demonstrating intervention acceptability and feasibility\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eLarge effect sizes\u003c/b\u003e across primary and secondary outcomes providing compelling evidence of clinical effectiveness\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eSubgroup analyses\u003c/b\u003e suggesting intervention benefits across diverse diagnostic categories and age groups\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eDose response analysis\u003c/b\u003e supporting intervention dose optimization\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eDetailed intervention manual\u003c/b\u003e with structured protocol promoting replicability\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eStudy Limitations\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ePilot study design\u003c/b\u003e: Small sample size (n\u0026thinsp;=\u0026thinsp;22) limits statistical power for subgroup analyses and generalization to broader populations, findings require confirmation in larger randomized controlled trials\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eAbsence of randomization\u003c/b\u003e: Quasi experimental design without random allocation introduces potential selection bias, participants self selected into intervention based on preference\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eLack of active control group\u003c/b\u003e: No comparison intervention group (e.g., conventional exercise program, attention control) limits confidence regarding specificity of Garba related benefits versus general exercise effects or placebo response\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eShort intervention duration\u003c/b\u003e: Four week intervention provides limited data regarding optimal duration and long term sustainability, future research should examine extended interventions and follow up\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eSingle site study\u003c/b\u003e: Conduct at single tertiary care rehabilitation facility may limit generalizability across diverse healthcare settings\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eAssessment timing\u003c/b\u003e: Post intervention assessments at 48 hours may reflect acute response, longer term follow up assessment would strengthen evidence regarding benefit sustainability\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eParticipant demographics\u003c/b\u003e: Study population predominantly urban, educated, with access to tertiary rehabilitation services, rural or underserved populations may show different results\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eCultural specificity\u003c/b\u003e: Benefits may be specific to populations with cultural affinity for Garba, generalization to other cultural contexts requires investigation\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eDirections for Future Research\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eLarger randomized controlled trials\u003c/b\u003e: Adequately powered RCTs with random allocation, standardized intervention protocols and comparison control groups (standard care alone vs. standard care plus Garba) would provide definitive evidence regarding intervention efficacy and mechanisms\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eExtended intervention duration and follow up\u003c/b\u003e: Investigations examining 8\u0026ndash;12 week interventions with long term follow up (3\u0026ndash;6 months post intervention) would determine optimal dosing and benefit sustainability\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eMechanism investigation\u003c/b\u003e: Neuroimaging studies (functional MRI, structural MRI) examining neural adaptation, electroencephalography assessing neural rhythmic entrainment and biomarker assessment (inflammatory markers, neurotrophic factors) would elucidate mechanisms\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eCulturally adapted interventions\u003c/b\u003e: Systematic examination of culturally meaningful dance forms adapted for therapeutic purposes across diverse populations would establish efficacy of cultural adaptation framework\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eCondition specific optimization\u003c/b\u003e: Condition specific investigations tailoring Garba choreography, progression parameters and intensity to particular neurological populations (e.g., Parkinson's specific protocols) would optimize therapeutic benefit\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eCost effectiveness analysis\u003c/b\u003e: Health economic studies examining costs, quality adjusted life years gained and healthcare utilization impacts would inform policy and resource allocation\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eImplementation science research\u003c/b\u003e: Pragmatic trials examining real world implementation, training requirements, scalability and implementation barriers would facilitate clinical translation\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eComparison of cultural dance forms\u003c/b\u003e: Direct comparative effectiveness research across dance forms would identify optimal dance based intervention approaches\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eChair Garba Rhythm Therapy produced large clinically meaningful improvements in balance performance (Mini BESTest d\u0026thinsp;=\u0026thinsp;2.00) functional mobility (Timed Up and Go d\u0026thinsp;=\u0026thinsp;1.16) and quality of life (WHOQOL BREF d\u0026thinsp;=\u0026thinsp;2.08) in adults with diverse neurological conditions. The intervention demonstrated excellent safety, high adherence and strong participant satisfaction. These pilot findings provide compelling preliminary evidence supporting Chair Garba Rhythm Therapy as a culturally relevant, feasible and potentially highly effective adjunct to standard neurorehabilitation. The magnitude of improvements substantially exceeds those typically documented for conventional rehabilitation interventions suggesting that culturally adapted dance based approaches may offer superior therapeutic benefits through mechanisms combining neuroplasticity enhancement rhythmic motor priming and psychosocial benefits unique to meaningful and joyful group participation.\u003c/p\u003e \u003cp\u003eWhile these results are promising they derive from a pilot study with inherent limitations including small sample size, absence of randomization and lack of active control group comparison. Larger well designed randomized controlled trials are necessary to confirm efficacy establish optimal intervention parameters, clarify mechanisms and determine long term sustainability of benefits. Furthermore examination of culturally adapted dance interventions across diverse populations would determine whether benefits are specific to Garba or generalizable across culturally meaningful dance forms.\u003c/p\u003e \u003cp\u003eThis research supports the theoretical framework that rehabilitation effectiveness encompasses not only evidence based movement principles but also meaningful cultural context, social engagement, psychological resonance and intrinsic motivation. Healthcare providers treating neurological populations should consider incorporating culturally relevant, enjoyable, group based interventions alongside conventional rehabilitation protocols. For Indian populations and communities Chair Garba Rhythm Therapy offers a powerful evidence supported for neurorehabilitation that honors cultural identity while achieving substantial functional and quality of life improvements. Future rigorous research will likely expand the evidence base supporting dance based and culturally adapted rehabilitation approaches as integral components of comprehensive neurorehabilitation practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest Statement:\u003c/strong\u003e The authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement:\u003c/strong\u003e This research received no specific grant from any public, commercial, or not for profit funding agency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e The datasets generated and analyzed during this study are available from the corresponding author upon reasonable request, subject to ethical approvals and participant confidentiality protections\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSK conceived and designed the study, supervised the project and critically revised the manuscript for important intellectual content.\u003c/p\u003e\n\u003cp\u003eBB contributed to participant recruitment, data collection and drafting of the Methods and Results sections.\u003c/p\u003e\n\u003cp\u003eAM assisted in implementation of the intervention, coordinated the Chair Garba Rhythm Therapy sessions and contributed to development of the intervention protocol.\u003c/p\u003e\n\u003cp\u003eOP conducted the literature review and drafted the full manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors contributed to data interpretation, reviewed and approved the final manuscript and agree to be accountable for all aspects of the work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eGlobal Burden of Disease Study 2019 Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u0026ndash;2019: a systematic analysis for the Global Burden of Disease Study 2019. \u003cem\u003eLancet\u003c/em\u003e. 2020,396(10258):1204\u0026ndash;1222.\u003c/li\u003e\n \u003cli\u003eSchwab M, Kessler KR, Storch A, Agar E. Comprehensive review of the motor and non motor features of Parkinson disease. \u003cem\u003eEur J Neurol\u003c/em\u003e. 2013,20(1):5\u0026ndash;15.\u003c/li\u003e\n \u003cli\u003eHuijbregts M, Myers A, Streiner D, Teasell R. Rehabilitation services for stroke patients in Mexico: a long way to go. \u003cem\u003eArch Phys Med Rehabil\u003c/em\u003e. 2008,89(12):2301\u0026ndash;2307.\u003c/li\u003e\n \u003cli\u003eHackney ME, Earhart GM. 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The WHO quality of life assessment instrument (WHOQOL BREF): the importance of its items for cross cultural research. \u003cem\u003eQual Life Res\u003c/em\u003e. 2001,10(8):711\u0026ndash;721.\u003c/li\u003e\n \u003cli\u003eGupta A, Priya A. Quality of life and psychological problems in patients with neurological illnesses undergoing rehabilitation. \u003cem\u003eDelhi Psychiatry J\u003c/em\u003e. 2008,11(1):24\u0026ndash;30.\u003c/li\u003e\n \u003cli\u003ePodsiadlo D, Richardson S. The timed \u0026quot;Up \u0026amp; Go\u0026quot;: a test of basic functional mobility for frail elderly persons. \u003cem\u003eJ Am Geriatr Soc\u003c/em\u003e. 1991,39(2):142\u0026ndash;148.\u003c/li\u003e\n \u003cli\u003eShumway Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community dwelling older adults. \u003cem\u003ePhys Ther\u003c/em\u003e. 2000,80(9):896\u0026ndash;904.\u003c/li\u003e\n \u003cli\u003eWu S, Tyson S, Barton G, et al. 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Rhythmic facilitation of gait training in corporeal hemiplegia. \u003cem\u003eJ Neurol Neurosurg Psychiatry\u003c/em\u003e. 1997,62(1):22\u0026ndash;26.\u003c/li\u003e\n \u003cli\u003eHackney ME, Earhart GM. Effects of dance on balance and gait in severe Parkinson disease: a case study. \u003cem\u003eDisabil Rehabil\u003c/em\u003e. 2010,32(17):1426\u0026ndash;1433.\u003c/li\u003e\n \u003cli\u003eKoelsch S. Brain correlates of music evoked emotions. \u003cem\u003eNat Rev Neurosci\u003c/em\u003e. 2014,15(3):170\u0026ndash;180.\u003c/li\u003e\n \u003cli\u003eSalimpoor VN, Benovoy M, Larcher K, Dagher A, Zatorre RJ. Anatomically distinct dopamine release during anticipation and experience of peak emotion to music. \u003cem\u003eNat Neurosci\u003c/em\u003e. 2011,14(2):257\u0026ndash;262.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Garba dance, neurorehabilitation, balance disorders, quality of life, functional mobility, cultural therapy, rhythmic movement","lastPublishedDoi":"10.21203/rs.3.rs-8411204/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8411204/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNeurological conditions including stroke, Parkinson's disease, multiple sclerosis and traumatic brain injury significantly compromise functional independence and quality of life. Traditional rehabilitation approaches while evidence based frequently encounter barriers to sustained patient engagement and long term adherence. Dance based interventions have emerged as promising culturally adapted therapeutic modalities that may enhance rehabilitation outcomes through multisensory stimulation, rhythmic priming and psychosocial benefits. Garba a traditional Indian folk dance form offers a culturally meaningful vehicle for neurorehabilitation through its integrated combinations of rhythmic movement, bilateral coordination training, dynamic balance challenges and inherent social engagement.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis pilot study evaluated the effectiveness of four week Chair Garba Rhythm Therapy as an adjunct to standard neurological rehabilitation on balance performance, functional mobility and quality of life in adults with diverse neurological conditions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA pre post pilot study with a control group was conducted at a tertiary care rehabilitation facility in Pimpri, India. Twenty two adults with confirmed neurological diagnoses (stroke n\u0026thinsp;=\u0026thinsp;10, Parkinson's disease n\u0026thinsp;=\u0026thinsp;8, multiple sclerosis n\u0026thinsp;=\u0026thinsp;2, traumatic brain injury n\u0026thinsp;=\u0026thinsp;2) were enrolled. The intervention group (n\u0026thinsp;=\u0026thinsp;22) received 16 sessions of structured Chair Garba Rhythm Therapy over four weeks (four sessions weekly 45 minutes per session) in addition to standard physiotherapy. All participants completed standardized assessments at baseline and week four. Primary outcomes included balance performance measured by the Mini Balance Evaluation Systems Test (Mini BESTest) and quality of life assessed via the World Health Organization Quality of Life BREF (WHOQOL BREF). Secondary outcomes included functional mobility measured by the Timed Up and Go Test (TUG). Statistical analysis employed paired t tests with effect size calculation using Cohen's d value.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSubstantial improvements were observed across all primary and secondary outcomes. Mini BESTest scores increased significantly by 6.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 points (95% confidence interval 4.98\u0026ndash;7.82 t₂₁=9.38, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Cohen's d\u0026thinsp;=\u0026thinsp;2.00) representing a large effect size. Total WHOQOL BREF scores improved by 12.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2 points (95% CI- 10.15\u0026ndash;15.65, t₂₁=9.76, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Cohen's d\u0026thinsp;=\u0026thinsp;2.08) with statistically significant improvements across all four quality of life domains (physical, psychological, social and environmental all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Timed Up and Go performance improved substantially with time decrements of 3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1 seconds (95% CI: -4.97 to -2.23, t₂₁=-5.45, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Cohen's d\u0026thinsp;=\u0026thinsp;1.16). The intervention demonstrated excellent safety with no serious adverse events and an outstanding session attendance rate of 91.1%. Overall study retention was 95.6%.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eChair Garba Rhythm Therapy produced large and clinically meaningful improvements in balance performance, quality of life and functional mobility in adults with neurological conditions. The intervention offers a culturally relevant, safe and feasible adjunct to standard neurorehabilitation that merits evaluation in larger rigorous controlled trials.\u003c/p\u003e","manuscriptTitle":"The Effect of Chair Garba Rhythm Therapy on Balance, Functional Mobility and Quality of Life in Neurorehabilitation: A Pilot Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-23 07:50:47","doi":"10.21203/rs.3.rs-8411204/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3f5e03cc-907b-45bb-a0d5-228bcab4dca6","owner":[],"postedDate":"December 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-08T09:54:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-23 07:50:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8411204","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8411204","identity":"rs-8411204","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}