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the tulip story
The Tulip Story
Michael Tan
the tulip story
An Art and Health initiative
by Assistant Professor Michael Tan,
School of Art, Design and Media,
Nanyang Technological University,
in partnership with Parkinson Society Singapore.
Project Team Members:
Cheryl Teo Han Xin (2014 2015),
Kong Chong Yew (2014 2015),
Joanne Lio Shi Qi (2012),
Deborah Chen Jia Hui (2011)
The Tulip Story
Published by:
Michael Tan Koon Boon
School of Art, Design and Media
Nanyang Technological University
Book design by:
Factory 1611
Kong Chong Yew, Call the Shots
Michael Tan Koon Boon
Printed by:
ISBN Number:
© Michael Tan Koon Boon 2015
  
the tulip story
Michael Tan
Ms Julie Lau, President, Parkinson Society Singapore
Michael Tan
Creative Paperclay Workshop 1: 5 May — 9 June 2011
Creative Paperclay Workshop 2: 6 June — 11 July 2012
Creative Paperclay Workshop 3: 23 April — 28 May 2014
Creative Paperclay Workshop 4: 13 August — 27 August 2014
Creative Paperclay Workshop 5: 3 September — 17 September 2014
Sharing by patient and their caregiver
Tan Siok Bee, Advanced Practice Nurse
the tulip story
  Assistant Professor Michael Tan
This project was made possible by the Academic
Research Fund (Tier 1) – RG56/10 from the
Ministry of Education, Singapore. Access to the
grant would not be possible without the support from
the School of Art, Design and Media at Nanyang
Technological University. Thus, I wish to express
my gratitude to the review panel for entrusting me
with this opportunity to explore the potential of
art participation in promoting a sense of wellbeing
among people aected by Parkinson’s Disease.
A special thank you to my project partner,
the Parkinson Society Singapore (PSS), for their
curiosity and willingness to embark on this journey
in art, health and wellbeing. I would like to particularly
thank Dr Louis Tan Chew Seng for connecting me to
PSS. I am also grateful to Ms Julie Lau, President
of PSS, and all board members of PSS, for your
openness and the trust given to my team and me.
The unwavering support from past and present PSS
sta was integral to the success of the project. On
behalf of my team, I wish to convey our appreciation
to Mrs Elise Ho, Ms Chin Ai Lee, Ms Helen Khoo,
Ms Tina Tan and Beng Choo. Thank you for the
patience shown while we were trying to figure out
the schedules for the series of workshops, and for
the undivided attention given ensuring that the
activity space is conducive for the team and
participants during the actual run of the programmes.
The project could not be accomplished without
the commitment given by my team of art assistants.
Heartfelt thank yous to Cheryl Teo Han Xin,
Kong Chong Yew, Joanne Lio Shi Qi and Deborah
Chen Jia Hui. Thank you for your curiosity and
interest to embark on this journey with me.
The level of commitment that all of you brought
to the project has been exceptional! It was
a privilege working with each of you.
Last, but more importantly; the project would not
be realised without the participants. To all the
PD Warriors who have returned to join us week
after week. Thank you for your persistence and
determination. Your resilience is inspirational!
Cheah Sek Tin, Fung Chee Eng, Lee Kim Hong,
Leet Peng Mun, Lilian Lee, Woo Pak Nung,
Allen Fernando,Goh Leng Huat, Han Ting Tang,
Harry Foo Kok Teng, Jenny Lee Yoke Lin,
Lee Kim Hong, Peter Tan, Lim Chor Han,
Regu Doraisamy, Cheow Chew Khoon, Patricia Liu,
Mona Hong, Goh Jew Keng, Oh Keng Seng,
Fong Seow Hua, Tahir Bin Sheikh Mohamad Kassim,
Beatrice Low, Jason Foo, John Lim, Oh Keng Seng,
Leong Piew Seng, John Lim, Leong Piew Seng,
Han Hai Wah. Caretakers: Magdalene Lau,
Saw Bee Leng, Agnes Tan, Cheah Helen, Anne Lee,
Yeo Yan Ngoh, Janie Lee, Sarni, Tante, Kasmi, Yanti.
the tulip story 
the tulip story 
  Ms Julie Lau, President, Parkinson Society Singapore
The Tulip Story showcases a collection of creative
paperclay artworks by people with Parkinson
(PwP) and their caregivers, compiled by Assistant
Professor Michael Tan from the School of Art,
Design and Media at Nanyang Technological
University. It also celebrates the successful art
and health initiative led by Assistant Professor Tan
in partnership with Parkinson Society Singapore
through which have enriched the life of members,
PwP and their caregivers, who had participated
in the series of workshops. Drawing on the
participants' responses, the book offers a glimpse
of the benefits, participating in art activities offered
to enhance the quality of life for PwP and their
caregivers. The book will be of great interest to
all involved in devising care plans for the PwPs
and their caregivers such as healthcare
professionals, social workers, and for creative
practitioners who are interested in exploring
arts and health.
We dedicate the book to all Parkinson Warriors and
their families who have taught us so much about the
arduous Parkinson journey. They constantly remind
us that the battle against Parkinson begins with
the will and courage to rise above the challenges.
We are grateful for their life stories and artworks
that are interspersed throughout the pages of this
book. These serve as encouragement to everyone
traversing along the same route.
Finally, we hope that this book will bring light to
you and hope for the future as you move towards
a brighter tomorrow in your journey with Parkinson.
the tulip story
the tulip story
The impact of Parkinson’s Disease (PD) is extensive.
The disease does not only affect the patients
themselves but also their caregivers. In Singapore,
3 in every 100,000 people are living with PD[1].
With an aging population, the number of PD
cases is expected to increase exponentially[2].
People living with PD do not only experience distress
with their own movement, but the increasing motor
deficit also diminishes their ability to express,
communicate and interact with others[3].
Depression and anxiety[4], cognitive decline[5]
and social phobia[6] are complications commonly
associated with the onset of PD. The occurrence
of these conditions may inevitably affect a patient’s
sense of wellbeing and their quality of life.
Caring for people with PD can be a physically and
emotionally demanding task. Experience of stress
is commonly reported among PD caregivers[7-9].
A recent study on PD caregivers in Singapore
highlighted that physical, psychosocial and social
wellbeing of the caregiver can be compromised
as a result of caregiving[10]. Physical and emotional
fatigue, restriction in lifestyle, sense of guilt,
lacking sense of support, and insufficient coping
skills to help one relax were the various key
concerns reported by caregivers.
Arts and Health: A Brief Introduction
While the arts may not be in a position to provide
physical cure for PD, participating in the arts,
perhaps could be a means for us to attend to some
of the challenges faced by PD patients and their
caregivers resulting from the onset of PD such as
social isolation and constricting lifestyle. A holistic
approach towards care recognizes that health and
wellbeing are continuously shaped and influenced
by the physical, social and emotional dimensions.
The relations among these dimensions are
interconnected. Thus a holistic approach to PD care
and support ought to look beyond caring for physical
health; to include consideration for the social and
emotional needs of people affected by PD.
In the past decade, a constant stream of research
has emerged to highlight that participating in the
arts can have positive impact on the health and
wellbeing of individuals and communities[11-13],
regardless of their health and social status,
across life course[14, 15]. Participating in creative
art activities such as drawing, dance, singing and
drama, were found to promote mental and physical
health of people in late life[16]. In the UK, for example,
under the Arts On Prescription programme,
doctors are prescribing art to the seniors to help
combat mental health problems and social isolation.
A Dose of Wellbeing
Through Creative Paperclay
  Assistant Professor Michael Tan
      
the tulip story
Engaging in arts activities can promote brain plasticity,
self-confidence and esteem, while at the same time,
it offers a sense of connectivity to others[17].
This is probably an appropriate juncture for me to
briefly introduce the field of arts and health, an area
of practice that I have come to know in recent years.
Arts and health is an interdisciplinary field that
interrogates, imagines and mobilises art and design
practices with the intent to augment health and
wellbeing of individuals and communities. It is a
diverse field served by practitioners from the arts,
health, humanities and social sciences. The arts
mentioned here would include, but is not limited to,
music, drama, dance and movement, visual arts,
writing and singing. Therapy – having the intent to
treat or cure might not necessarily be the motivation
behind all arts and health endeavours.
At the moment, arts and health is an area of
practice that is little explored in Singapore.
Given the challenges emerging from the changing
social demographics such as population aging,
arts and health, in my opinion, is an important
area of practice that should not be dismissed.
The arts can play a role in caring for people in
society. Inspired by the contributions that art
participation can potentially offer to promote
health and wellbeing of individuals and communities,
I undertook this pilot project to investigate what
might be the benefits of participating in creative
paperclay workshops and how participation in art
might promote a sense of wellbeing amongst PD
patients and caregiver. In doing so, I hope to make
a case for the contribution, participation in art
makes towards holistic care and support for
people coping with PD.
Creative Paperclay Workshops at
Parkinson Society Singapore
With support from the Academic Research Fund
- Tier 1 (RG56/10) awarded by the Ministry of
Education, a series of creative paperclay workshops
was developed and offered to members of PSS.
The workshops were conceived as self-enrichment
programme and were not concerned with therapy.
The workshops had several aims. Firstly, to provide
an opportunity for participants to explore paperclay
as a material for creative exploration. Secondly,
to impart basic knowledge and techniques to work with
paperclay and acrylic colour, and guide participants
to create original art pieces. Lastly, the workshops
hope to foster interest in creative paperclay.
A total of five workshop series were offered from
2011 to 2014. The workshop series were offered
in two formats. They were either offered as
Six-Week long workshops with longer projects or
as Three-Week long workshops with a shorter project
brief. Regardless of the format, all workshops ran
for approximately 90 minutes. The workshops
were opened to PD patients and their caregivers.
Announcement for each series of the workshops was
advertised on the PSS website and PSS newsletter.
PSS Staff also helped to promote the workshop and
register participants. Participation to the workshop is
completely voluntary. My artist assistants and myself
served as facilitators for all sessions. Various project
themes were used to engage and lead participants to
create their art pieces.
Manipulating modelling clay can be beneficial for
individuals with PD. The choice to explore paperclay
builds on understandings gained from the study
Clay works by workshop participants
      
the tulip story
Clay works by Fung Chee Eng
The following section highlights the various key
themes that have emerged from the participants’
responses of their experience and opinion of
the workshop.
Uplifting Mood Through
Creative Paperclay Workshop
From the responses, we learnt that participating
in activity is deemed as important for people
coping with PD. Idleness were a concern amongst
PD patients and caregivers. Participants expressed
a desire to remain active while coping with PD.
There seems to be a general agreement among
participants that having nothing to do can have
adverse effect on the wellbeing of people coping
with PD. Participants expressed a tendency for
patients to be preoccupied by despairing thoughts
at times when they are left unoccupied. The creative
paperclay workshops were favoured among the
participants as they offered an opportunity to
remain active. The participants enjoyed being
able to immerse themselves in new experiences,
in this instance, learning and creating art.
They were occasions that participants looked
by Elkis-Abuhoff et al[18] and Goldblatt et al.[19].
The former found that manipulating modelling
clay helps decrease rigidity and emotional distress;
while the latter indicated that clay manipulation
can help alleviate depression, obsessive-compulsive
behaviours and phobic anxiety. In the scope of this
project, paperclay was favoured over modelling
clay for various reasons. Firstly, the white and
paintable surface of paperclay is appreciated for
the limitless creative possibility it offers participants.
The material allows a great degree of personalisation
through the use of colour, compared to modelling
clay which is often pre-coloured and has surfaces
that cannot be painted on. Secondly, paperclay is
widely available at local major stationary stores
or art supply shops. Thirdly, paperclay is a
non-toxic material that hardens when exposed
to air. It does not need firing like pottery clay.
Paperclay is excellent to create decorative pieces
such as artwork and pencil holders. However,
it is not a suitable material to create functional
objects such as a plate or a mug as paperclay
is not resistant to water.
To investigate how participating in creative
paperclay workshops may help promote a sense
of wellbeing amongst PD patients and caregiver,
a series of questionnaires and focus group interviews
were conducted with participants at the end of each
workshop series. With an interest to learn about the
lived experience of the participants, the project
undertook a qualitative, phenomenological approach.
      
Engaging in arts activities can promote
brain plasticity, self-condence and
esteem, while at the same time, it offers
a sense of connectivity to others.
the tulip story
forward to. Participating in the workshop was
also seen as an opportunity to engage in physical
and cognitive activity.
Feeling of happiness, pleasure, enjoyment and
fulfilment were commonly reported amongst
participants. Those emotions emerged through
various engagements and processes that participants
were involved in during the workshop sessions.
For most participants, the workshops offered them
a first hand experience to explore paperclay as
an art material. Initial feelings of uncertainty and
having doubt about ones creative capability were
not uncommon amongst the participants. However,
over the course of the workshops, participants gained
confidence as they noticed the improvement in the
quality of their creation. Their ability to overcome
challenges faced in the course of creating a piece
of work, and discovery of their creative capacity
also helped promote their sense of self-esteem.
Participants were intrigued by their ability to
exceed the perception of their own creative ability.
The workshops also open space for reminiscence
as a participant recollected his childhood, ‘I find
that making this art brought me back to my
childhood days of playing in the mud. I have very
pleasant memories of my childhood.’
The workshops were regarded as a good distraction
and a form of time out for both patients and their
caregivers. One PD participant shared, ‘I think we
should stay engaged. By keeping engaged we have
hope and anticipation. When we create there is a
sense of fulfilment we feel better. When you do the
things you feel absorbed. So your mind don’t think
of other things’. Participants often find themselves
absorbed by the art making process, that time
passed by quickly for them.
Good instructional and facilitation skills were
deemed as an integral aspect that contributed
to their positive experience of the workshops.
Participants enjoyed the attentiveness and support
they received from the art facilitators during the
workshops. In addition, they also appreciated the
freedom given to them to explore independently
and the respect for individual expression maintained
by the art facilitators. Participants felt free to
express themselves, and were empowered by
a sense of autonomy the workshops offered.
This acknowledgment helped foster a relaxing,
non-judgmental and nurturing atmosphere that
participants appreciated.
Pleasure was also attained from realising and
appreciating one’s ability to transform their thought
into material form, and from looking at the creations.
As one participant noted: ‘It is wonderful in that you
know, the creativity that you see from everyone else,
the colour that they use and all that is one of the
highlight, like he said a mini exhibition.’
It seems that imaginative engagement from
creative play can be a beneficial form of distraction
      
the tulip story
as it offers one time off from their illness.
One PD patient accounted his experience of
immersing in the creating process, ‘I think
[art making] is useful because it exercise our
imagination to be creative. Then I feel that during
the moment, the process, you become absorbed
then you don’t think of nonsense. Feel absorbed.’
Bonding moments with caregiver
The creative workshop provided a different
context for people with PD and their caregiver to
interact and relate to each other. The change of
environment could be useful to help renew relation.
The collaborative process also offered new avenues
for patients and caregivers to engage each other
and foster relationships. One caregiver commented,
‘I think [the workshop] is a very good bonding
session for caregiver and patient. Like in our case,
it will not be possible if not the both of us working
on it. He could do the background, but the finer
works, I will fashion it.’
Energizing Atmosphere, Combating Isolation
Besides providing an opportunity to participate
in art activity and learning, the workshops also
offered an opportunity to participant to socialise and
connect with others. Participants enjoyed the lively
atmosphere of the workshop. Chattering among the
participants and interaction with the art facilitators
fostered a cordial and unthreatening environment
for participants. This helped create an atmosphere
of togetherness and camaraderie with each other.
A PD participant shared, ‘I feel that the environment
is good. I don't have to be on guard and I am able to
express myself creatively. I feel relaxed being able
to do the things I do.’ Finding motivation to attend
the workshop may be challenging at time, however
the energizing atmosphere can transform ones mood
as one PD participant revealed, ‘I feel lethargic
sometimes, but once I got to the class, the presence
of my classmates made me feel good.’
New Found Aspiration Through Participation in Art
The creative paperclay workshop also opened new
aspiration for participants, giving them a sense of
purpose. They have expressed a desire to improve
the quality of their work and develop their skill
further. In addition to creating their personal art
pieces, participants were also invited to create
‘I think we should stay engaged.
By keeping engaged we have hope
and anticipation. When we create,
there is a sense of fullment and
we feel better.' — PD Patient
art pieces to help raise awareness for Parkinson.
The tulip is synonymous with Parkinson. Since 1980,
the tulip was adopted and used widely around
the world as a symbol for Parkinson. The special
connection between the flower and Parkinson was
formed through a red tulip that Dutch horticulturalist,
J.W.S. Van der Wereld created. As a person living
with Parkinson, Van der Wereld wanted to honour
Dr James Parkinson – the first person who described
Parkinson. To extend the expression of the resilience
and hope for people living with Parkinson, one of
the projects in the workshop engaged participants
to ‘grow’ a field of tulips art for use to promote
awareness for Parkinson. Their artworks were
featured at PSS open house events and more
recently, in December 2014, the tulip art pieces
were displayed at the Singapore Art Museum
during an arts, health and wellbeing roundtable.
Come April 2015, the tulips pieces will also be
showcased at the atrium of Tan Tock Seng Hospital
in conjunction with World Parkinson’s Day 2015.
Coping with PD can be challenging, but having
access to opportunity to remain active can enable
PD patients and caregivers to continue to lead
rich and meaningful lives. Although the arts may
not offer physical cure for PD, preliminary findings
from this pilot programme suggests that participating
in the arts, in this instance, creative paperclay,
can help promote a sense of wellbeing among
people coping with PD.
Participants expressed that the creative paperclay
workshop helped improve their mood, energise
them, and open new aspirations and artistic pursuits.
In addition, participating in the workshop could be
a helpful way to combat isolation as they provide
opportunity to be with others. With promising
potential demonstrated by this pilot project on arts
and wellbeing, there perhaps could be more of such
opportunities to explore possibilities with different
forms of arts and investigate how they might
contribute to holistic care of Parkinson.
      
the tulip story       
the tulip story
the tulip story
The Creative Paperclay Workshops builds on understandings that modeling clay
has benecial quality for individuals with Parkinson’s Disease, decreasing somatic
dysfunction and emotional distress, depression, obsessive-compulsive behaviors
and phobic anxiety.
Taking Moment,
Creating Moments
    
1 5
 ,  
the tulip story
Creative Paperclay
Workshop 1
5 May - 9 June 2011
The first creative paperclay workshop was launched
on 5 May 2011 at 26 Dunearn Road, where the
Parkinson Society Singapore was previously
located. The 6-Week programme introduced
participants to basic knowledge of working with
paperclay. Using their newly acquired knowledge,
participants created original art pieces in respond to
a variety of themes such as clay mobiles and birds.
   1
Programme lead: Michael Tan
Programme Assistant: Deborah Chen Jia Hui
Participants: Cheah Sek Tin, Fung Chee Eng,
Lee Kim Hong, Leet Peng Mun,
Lilian Lee, Woo Pak Nung
the tulip story
Clay works by Cheah Sek Tin
Clay works by Fung Chee Eng
   1
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Clay works by Lee Kim Hong Clay works by Leet Peng Mun
   1
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Clay works by Lilian Lee
Clay works by Woo Pak Nung
   1
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Creative Paperclay
Workshop 2
6 June - 11 July 2012
   
Clay work by Jenny Lee Yoke Lin
In 2012, the workshop began to include participation
from caregivers. Over 6 weeks, patients and their
caregivers came together to co-create a series
of artwork.
Paperclay tulips for PD Awareness. The tulip
is synonymous with Parkinson. To extend the
expression of the resilience and hope for people
living with Parkinson, one of the projects in the
creative clay workshop engages the participants
to create a field of tulips art pieces as a means
to raise awareness for Parkinson.
Clay work by Peter Tan
Programme lead: Michael Tan
Programme Assistant: Joanne Lio Shi Qi
Participants: Allen Fernando & Magdalene Lau*,
Cheah Sek Tin & Cheah Helen*, Fung Chee Eng
& Anne Lee*, Goh Leng Huat & Yeo Yan Ngoh*,
Han Ting Tang & Sarni*, Harry Foo Kok Teng
& Janie Lee*, Jenny Lee Yoke Lin & Tante*,
Lee Kim Hong & Kasmi*, Peter Tan
& Agnes Tan*, Woo Pak Nung & Yanti*.
the tulip story
Clay works by Fung Chee Eng Clay works by Goh Leng Huat
   
the tulip story
Clay works by Allen Fernando Clay work by Cheah Sek Tin
   
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Clay work by Han Tin Tang Clay work by Harry Foo Kok Teng
   
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Clay works by Woo Pok Nung
Clay works by Lim Kim Hong
   
the tulip story
The third creative paperclay workshop was held
at the new Parkinson Society Center at Bishan.
The 6-Week programme introduced participants
to basic knowledge of working with paperclay.
Using their newly acquired knowledge, participants
created original art pieces in response to a variety
of themes such as clay mobiles and birds.
Creative Paperclay
Workshop 3
23 April - 28 May 2014
Clay work by Peter Tan and Agnes Tan
   3
Programme lead: Michael Tan
Programme Assistant: Cheryl Teo Han Xin,
Kong Chong Yew
Participants: Allen Fernando & Magdalene Lau*,
Cheow Chew Khoon & Saw Bee Leng*, Lim Chor Han
& Goh Jew Keng*, Peter Tan & Agnes Tan*,
Patricia Liu, Regu Doraisamy, Mona Hong
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Clay works by Cheow Chew Khoo and Saw Bee Leng Clay works by Lim Chor Han and Goh Je w Keng
   3
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Clay work by Mona Hong Clay work by Patricia Liu
   3
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Clay work by Allen Fernando Clay works by Regu Doraisamy
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Creative Paperclay
Workshop 4
13 August - 27 August 2014
The fourth creative paperclay workshop was
designed to be a collaborative art project where
participants of the workshop were led to create their
individual pieces of tulips before they were pieced
together to form a field of tulips.
   4
Programme lead: Michael Tan
Programme Assistant: Cheryl Teo Han Xin,
Kong Chong Yew
Participants: Peter Tan & Agnes Tan*, John Lim,
Leong Piew Seng, Han Hai Wah, Mona Hong
A eld of tulips – clay works of Peter Tan, John Lim, Leong Piew Seng,
Han Hai Wah, and Mona Hong
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Creative Paperclay
Workshop 5
3 September - 17 Se ptember 2014
   5
Building on the success of creative workshop 4,
the fifth creative paperclay workshop extended
the collaborative tulip art project. Participants were
once again led to create individual pieces of tulips
before they were pieced together to form a new
field of tulips.
Programme lead: Michael Tan
Programme Assistant: Cheryl Teo Han Xin,
Kong Chong Yew
Participants: Patricia Liu, Jason Foo,
Cheow Chew Khoon & Saw Bee Leng*, Beatrice Low,
Rebecca Fong Seow Hua, Richard Oh Keng Seng,
Tahir Bin Sheikh Mohamad Kassim
New eld of tulips – clay works of Patricia Liu, Jasons Foo,
Cheow Chew Khoon, Beatrice L ow, Rebecca Fong , Richard Oh,
and Tahir Bin Sheikh Mohamed K assim
the tulip story    5
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the tulip story       
While the arts may not offer physical cure for PD, participating in the arts,
perhaps could be a means for people coping with PD to attend to some of
the challenges such as social isolation and constricting lifestyle. What good
has art offered participants? The following pages capture some of
the personal accounts of participants and their caregivers.
What Good is
Art for Me
Personal accounts of par ticipants and their caregivers
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‘I think we should stay engaged. By keeping engaged
we have hope, and anticipation. When I create,
there is a sense of fulfilment; I feel better.
When I am creating the paperclay art I feel
absorbed. My mind doesn’t think of other things.’
— PD Patient
‘I think making art is useful because it exercises our
imagination to be creative. Then I feel that during
the moment, the process, I feel absorbed so you
won’t think of nonsense. I think art is useful, it keeps
you engaged. I think art is useful for people with
Parkinson.’ — PD Patient
‘I have no knowledge about these at the beginning,
but I developed an interest after attending the
workshop. Once I started doing, I began to feel
relaxed. Because he is beside me and I don’t have
to look after him or be worried that he might fall.
He does his own work, so I will bring him home when
we are done. Otherwise at home, when I am doing
things, I am worried when he gets up. Now sitting
here with him beside me, I feel relaxed, not worried
about him falling. So to me, the workshop makes
me feel most happy.’ — PD Caregiver
      
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‘I feel that after he began participating in the
workshop, he feels better emotionally. In addition,
he finds himself developing confidence to do other
things. Usually when you get him to write, he only
writes for a short time span. He felt discouraged by
the appearance of his writing. They weren’t up to his
expectation. But when he started participating in
the paperclay workshop, he found confidence and
developed an interest. He shared that he enjoyed
it a lot. Gradually as he continues to work with
the clay, I noticed that he became more focused
and feels more relaxed. Unlike other activities,
the paperclay, offers a sense of looseness
[relaxation]. It is very relaxing for him. As he worked
with the paperclay, his hands received exercise.
And very naturally, he improved. He couldn’t
manipulate the clay initially, but eventually he
developed an ability to press the clay. So he felt
it is good for him.’ — PD Caregiver
‘I think it is a very good bonding session for patients
and their caregivers. Like in our case, it will not be
possible if not for the both of us working on it.
He could do the background, but the finer works,
I will fashion it. So there is a lot of collaboration.
To do something like that and to finally produce
something that looks and have some resemblance to
the original object is very fulfilling.’ — PD Caregiver
‘I think it is very good. It takes them out of
themselves when they are focused and they are
doing it. Their mind is not on their illness or on their
body. Especially when the caregiver can assist them.
I think on their own they can be very frustrated,
but with the instructors who are always around to
help and offer suggestions, and with the caregivers
doing the finer work, it is very good for their minds.
I feel that it is a very good mental and physical
activity for them.’ — PD Caregiver
      
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Parkinson’s Disease
  Tan Siok Bee, Advanced Practice Nurse
In normal ageing process, our gait can become
slower, and we may have swallowing and eating
difficulties. These are also some of the symptoms
of Parkinsonism. Parkinsonism can be due to
normal physiological ageing, drugs, stroke and
other causes. Parkinson’s disease is only one
of the many causes of Parkinsonism.
Parkinson’s disease is a chronic, usually slowly
progressive disorder of the nervous system that
affects movement (motor) and non-movement
related (non-motor) due to a breakdown of messages
in the brain. People with Parkinson have low levels
of a brain chemical called dopamine, which helps to
control the body muscles and movement. Parkinson’s
disease develops gradually, sometimes starting with
a barely noticeable tremor in just one hand. Unlike
other tremors, these tremors are typically present
when the person is at rest. However approximately
30 percent or more of people with Parkinson do not
experience tremors. But while a tremor may be the
most well-known sign of Parkinson, the disorder also
commonly causes stiffness or slowing of movement.
In the early stages of Parkinson, the face may show
little or no expression or reduced swing of the arm
on one side when walking. Speech may also become
soft or slurred.
Parkinson symptoms worsen as the condition
progresses over time. Muscles in the leg, neck
or face may look or feel stiff. People with Parkinson
may sometimes feel so stiff and frozen and unable
to move. Movement can be slow and people may
take small steps or shuffle when walking. Minor
movements such as engaging in writing, typing,
shaving or buttoning up clothes may be difficult.
Early symptoms of Parkinson may include
non-motor symptoms such as loss of sense
of smell, constipation, acting out dreams and
mood disorders (depression, anxiety).
As the disease progresses, one may experience
difficulty speaking or swallowing and may also have
balancing problems or difficulty standing up straight.
Walking difficulties can include beginning to walk
with short, shuffling steps, and have trouble starting
to walk or come to an involuntary stop. Factors such
as poor balance, walking difficulties and muscle
weakness as well as some medications can increase
the likelihood of falls which results in anxiety
and concern to people with Parkinson and their
caregivers. Other symptoms unrelated to movement
(non-motor symptoms) include anxiety and apathy,
tiredness or exhaustion, sadness or depression
and problems doing more than one task at a time.
Some may also experience slowness of thinking,
 ’ 
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difficulty concentrating, visual hallucinations or
sleep disorders (waking up frequently at night,
excessive sleepiness during the day, dream-enacting
behaviours). Others may be disturbed by pain or
tingling or cold sensation, lightheadedness on
standing, urinary difficulties and excessive sweating.
These non-motor symptoms affect the quality of
life more than the motor-related symptoms.
The causes of Parkinson are unknown. We believe
Parkinson occurs as a result of the interaction of
age-related changes, genetics and environmental
factors. Environmental factors include taking water
from Subterranean well, exposure to pesticides
and synthetic narcotic use. Ongoing exposure
to herbicides and pesticides may pose a slightly
increased risk of Parkinson.
There are effective treatments available to control
symptoms and improve daily function, albeit there
is no cure for the disease currently. Treatment has
to be individualised and medications that are
suitable for one patient may not be ideal for
another. Another important point to remember is
that the symptoms of Parkinson, most prominently
tremor, may be aggravated temporarily by stress
or stressful situations.
Parkinson affects each person differently and
symptoms can vary on different days and different
time. The rate of disease progression will vary from
person to person. Although there are many features
of Parkinson that most people with Parkinson
will share, exactly how it affects any given person
is different, and precisely what happens to one
person in the course of the disease may not
necessarily follow suit in another. Symptoms in
some people will remain very mild and will not
restrict the day-to-day activities for many years
and for some may continue to enjoy good quality
of life and mortality is not affected.
Sleep Problems in Parkinson
Sleep problems are important to recognise
in Parkinson because they are common and
often overlooked and inadequately managed.
Sleep disturbance may be due to psychological
factors, physical discomfort, excessive involuntary
movements, medication effects and underlying
sleep disorders. Accurate diagnosis and effective
management of sleep disorders can greatly improve
the quality of life.
Regular exercise can help maintain flexibility,
good posture, keep muscles strong and joints
supple and improve circulation to the heart
In Singapore, 3 out of every 1000
individuals aged 50 years and above
have Parkinson.
 ’ 
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and lungs. You may try exercises such as walking,
swimming, dancing or Tai Chi. Research has also
shown that Tai Chi helps in balance and slower rate
of decline in overall motor control. Some people
find exercise classes beneficial, and exercising in
a group can also provide an ideal opportunity to
socialise. Improving physical fitness and general
well-being will be very useful to lessen some of the
gastrointestinal, urological and sexual issues.
Eat a nutritionally balanced diet that contains plenty
of fruits, vegetables and whole grains. Eating foods
high in fibre and drinking an adequate amount of
fluids can help reduce the risk of constipation that
is common in Parkinson. A balanced diet also
provides nutrients, such as Omega-3 fatty acids,
that may be beneficial for general health.
Complementary therapies are treatments used
alongside conventional medicine. These include
acupuncture, massage therapy, yoga, Tai Chi,
meditation, hypnotherapy, aromatherapy and
many others. Some of people with Parkinson who
have used complementary therapies informed that
it is relaxing and may relieve some symptoms.
Because the cause of Parkinson is unknown,
proven ways to prevent the disease also remain
a mystery. However, some research has shown
that regular exercises and the caffeine in coffee,
tea and cola may reduce the risk of developing
Parkinson’s disease.
Learn to recognize your own symptoms and share
any observations with your doctor and healthcare
team. The level of apathy in people with Parkinson
is significantly higher than patients with other
illnesses and therefore there is a need to
continuously motivate and inspire them.
Caregivers of people of Parkinson are an important
group of people that makes coping with Parkinson
easier. They share that they can feel closer to their
families, develop new skills and experiences, and
feel good about caring for someone they care about.
With support from family, friends, support groups,
religious group and healthcare team, people
with Parkinson can have a better quality of life.
With good advice and support, Parkinson is a
manageable condition.
 ’ 
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About Parkinson
Society Singapore
  Parkinson Societ y Singapore
The Parkinson Society Singapore (PSS) was formed
on 16 December 1996 by a group of doctors and
caregivers to help people living with Parkinson.
The society was registered as a charity on 28
January 2000 and is a member of National Council
of Social Service (NCSS).
Since then, the Society has organized a number
of programmes including annual public forums,
therapeutic exercise programmes and social and
recreational activities, aimed at improving the lives
of people with Parkinson. The Society also works
closely with support groups in various hospitals
and publishes newsletters and books to raise the
awareness of Parkinson.
   
In Singapore, about 6,000 to 8,000 people have
Parkinson and related conditions and this number
is expected to go up in a rapidly aging population.
Previously known as Parkinson’s Disease Society
[20], the charity officially changed its name to
Parkinson Society Singapore in February 2014.
The drop of the word “disease” was to eradicate
the negative stigmatism of the condition and
in keeping with the latest naming nomenclature
for medical eponyms.
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To promote awareness and understanding of
Parkinson and related disorders by educating
patients, caregivers and their communities,
and by supporting them holistically in their
journey with Parkinson.
To disseminate knowledge and information
which promote better care and management
of Parkinson through books, websites,
talks and public forums.
To provide therapeutic programmes and services
that help patients sustain their functions and
total well-being.
To establish a social and community network
of support for patients and caregivers through
support groups, healthcare training and
social events.
   
Singapore’s first community-based Parkinson Centre
provides people with Parkinson and their caregivers
with the much needed support beyond those
provided in hospitals. Located within minutes from
Bishan Bus Interchange and MRT station, the Centre
is easily accessible by public transport. It is located
at the void deck of HDB block 191 Bishan Street 13.
More information on Parkinson Society Singapore
is available at
the tulip story  , 
About Nanyang
Technological University,
School of Art, Design and Media
Established in 2005 as part of Nanyang
Technological University (NTU), the School of
Art, Design and Media (ADM) has established
itself as one of Singapore’s leading creative
centres for tertiary education in art, design and
media. ADM offers a unique experience in art and
design education within an interdisciplinary and
collaborative learning environment.
ADM offers a four year Bachelor of Fine Arts (BFA)
degree in six areas: Digital Animation, Digital
Filmmaking, Photography and Digital Imaging,
Interactive Media, Product Design and Visual
Communication. Supported by inspiring and
dedicated faculty from across the globe, ADM
blends Western and Eastern approaches to art,
design and media education. It also provides a
studio-based learning environment within ADM
and possibilities for interdisciplinary studies
within NTU. Students graduate from ADM with
the knowledge and skills that will make them
successful artists and designers in the future.
In addition, students can go on to continue
their studies in art, design and media at both
Masters and PhD level, now available under our
Graduate Programmes. We also have the Centre for
Contemporary Art (CCA) at Gillman Barracks that is
linked to ADM. This is an exciting new NTU research
centre and exhibition space, giving opportunities
to learn from and work with the artists, researchers
and curators who visit the CCA.
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1. Tan, L.c.S., Venketasubramanian,N., Hong, C.Y.,
Sahadevan, S., Chin, J.J., Krishnamoorthy, E.S., Tan, A.K.Y.,
Saw, S.M., Prevalence of Parkinson's Disease In Singapore
Chinese Vs Malays Vs Indians. Neurology, 2004. 62.
2. Tan, L.C.S., Tan, A.K.Y., Tjia, H.T.L., The profile
of hospitalised patients with Parkinson's Disease.
Annals Academy of Medicine, 1998. 27(6).
3. Miller, N., et al., How do I sound to me? Perceived
changes in communication in Parkinson's disease.
Clinical Rehabilitation, 2008. 22(1): p. 14-22.
4. Simpson, J., et al., Social support and psychological
outcome in people with Parkinson's disease: evidence for a
specific pattern of associations. British Journal of Clinical
Psychology, 2006. 45(4): p. 585-590.
5. Aarsland, D., et al., The rate of cognitive decline in
Parkinson disease. Archives of Neurology, 2004. 61(12):
p. 1906-1911.
6. Richard, I.H., R.B. Schier, and R. Kurlan, Anxiety and
Parkinson's disease. The Journal of neuropsychiatry and
clinical neurosciences, 1995. 8(4): p. 383-392.
7. Carter, J.H., et al., Living with a person who has
Parkinson's disease: the spouse's perspective by stage of
disease. Movement Disorders, 1998. 13(1): p. 20-28.
8. Davey, C., et al., Falling in Parkinson's disease: the impact
on informal caregivers. Disability & Rehabilitation, 2004.
26(23): p. 1360-1366.
9. Marianne Caap-Ahlgren RN, B. and O. Dehlin, Factors
of importance to the caregiver burden experienced by family
caregivers of Parkinson’s disease patients. Aging clinical and
experimental research, 2002. 14(5): p. 371-377.
10. Tan, S.B., A.F. Williams, and M.E. Morris, Experiences
of caregivers of people with Parkinson’s disease in Singapore:
a qualitative analysis. Journal of clinical nursing, 2012.
21(15 -16): p. 2235-2246.
11. Swindells, R., et al., Eudaimonic well-being and
community arts participation. Perspectives in Public Health,
2013. 133(1): p. 60-65.
12. Starico, R.L., Arts in health: a review of medical
literature, 2004, Arts Council England London.
13. Stuckey, H.L. and J. Nobel, The connection between
art, healing, and public health: a review of current literature.
American Journal of Public Health, 2010. 100(2): p. 254-263.
14. Noice, T., H. Noice, and A.F. Kramer, Participatory arts
for older adults: a review of benefits and challenges.
The Gerontologist, 2013: p. gnt138.
15. Rubenstein, L.Z., K.R. Josephson, and A.S. Robbins,
Falls in the nursing home. Annals of internal medicine, 1994.
121(6): p. 442-451.
16. Castora-Binkley, M., et al., Impact of arts participation
on health outcomes for older adults. Journal of Aging,
Humanities, and the Arts, 2010. 4(4): p. 352-367.
17. Cohen, G., New theories and research findings on the
positive influence of music and art on health with ageing.
Arts & Health, 2009. 1(1): p. 48-62.
18. Elkis-Abuho, D.L., et al., Eects of Clay Manipulation
on Somatic Dysfunction and Emotional Distress in Patients
with Parkinson's Disease. Art Therapy: Journal of the
American Art Therapy Association, 2008. 25(3): p. 122-128.
19. Goldblatt, R., et al., Understanding clinical benefits
of modeling clay exploration with patients diagnosed with
Parkinson's disease. Arts & Health: International Journal for
Research, Policy & Practice, 2010. 2(2): p. 140.
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ResearchGate has not been able to resolve any citations for this publication.
Full-text available
This article reviews the scientific literature on the enhancement of healthy aging in older adults through active participation in the arts. Methodologies and conclusions are described for studies of dance, expressive writing, music (singing and instrumental), theatre arts, and visual arts including documentation of mental/physical improvements in memory, creativity, problem solving, everyday competence, reaction time, balance/gait, and quality of life. In addition to these gains in measures of successful aging, the article also provides (in a Supplementary Appendix) some selected examples of arts engagement for remedial purposes. Finally, it offers suggestions for expanding inquiry into this underinvestigated corner of aging research.
Full-text available
The objective of this study was to present findings from a literature review on the documented health benefits of arts programs for older adults. A systematic literature review was conducted to examine research publications on participatory arts programs for older adults and their reported impact on health outcomes. A total of 2,205 articles were found. Of these, 11 were eligible for inclusion. The review describes the effects of participation in art programs on a variety of health outcomes. The small number of empirical studies documenting the health impact and limitations in their design prohibit broad generalizations, however, findings suggest there are physical and mental health benefits for older adults from arts participation.
The focus of this outcome study was on art therapy as a support for medical treatment and palliative care. A total of 41 patients were placed in 2 matched groups: 22 patients with Parkinson's disease and 19 patients without Parkinson's disease. Each participant completed the Brief Symptom Inventory (BSI) (Derogatis, 1993) pre- and post-session, and was asked to manipulate a ball of clay and to respond to follow up questions on the experience. Quantitative and qualitative results showed a positive outcome with significant decrease in somatic and emotional symptoms in both groups. This research supports the value of an art therapeutic clay program for patients diagnosed with Parkinson's disease and recommends future studies addressing art therapy with caregivers.
Aims: This article considers eudaimonic models of psychological well-being in relation to qualitative data previously gathered as part of Manchester Metropolitan University's Invest to Save Arts in Health programme (2004-07). Methods: The research draws from 21 interviews with participants involved in Invest to Save arts projects for older people and adults with a mental health diagnosis. Using a collaborative team approach, a hybrid thematic analysis was undertaken alongside an updated literature review framed by positive psychology and with a focus on well-being. Results: The analysis identified eudaimonic themes of autonomy/intrinsic motivation and challenge to be particularly pertinent to participants' experiences of the scheme. Findings suggest that the programme provided a sense of purposeful occupation, cognitive and creative challenge and opportunities for autonomous self-expression and heightened concentration (flow). Many participants identified with the arts activities on offer and, while not necessarily aspiring to achieve any particular status, were intrinsically motivated to develop what they considered to be their innate creative potential. Some also reported that sustained engagement was important to their continued psychological well-being. Conclusions: Arts and health researchers might usefully draw from theories of well-being from positive psychology. Both fields are compatible in that they share an interest in human flourishing and understanding of wellness as more than an absence of dysfunction or disease. Further research is needed to ascertain whether the limited results presented here are representative of other populations. What does seem evident is that arts projects have a broad appeal and can be highly inclusive, accommodating participants with diverse needs. More generally the investigation raises questions about the cultural scaffolds that are in place to support eudaimonic well-being across the lifespan, as well as the consequences of restricting such opportunities for individuals and communities.
Objective: This pilot study attempted to reduce negative ruminating thoughts in patients with Parkinson's disease engaged in a creative art therapy experience.Hypothesis: The participants will significantly lower measures of depression, obsessive–compulsive symptoms, and phobic anxiety as a result of the manipulation of modeling clay.Research design: A single sample pretest–posttest research design was employed to assess the effects of modeling clay manipulation on self-report symptoms of psychopathology among Parkinson patients.Methods: A total of 22 patients (16 males, 6 females, mean age 71) diagnosed with Parkinson's disease completed the Brief Symptom Inventory pre- and post-session, asked to manipulate a ball of modeling clay, and respond to follow up questions.Main outcome and results: Three measures were included as indicators for patients diagnosed with Parkinson's disease psychological adjustment: depression, obsessive–compulsive behaviors and phobic anxiety. Quantitative results showed a positive outcome with a significant decrease in all three areas at a level similar to the average adult norm.Conclusions: The research demonstrates and supports the value of engaging the patient diagnosed with Parkinson's disease in creative expression to enhance quality of life by expanding the patient's aesthetic experience.Implications for further research: Further research is suggested for other chronic conditions that involve depression, obsessive–compulsive behaviors and phobic symptoms.
This review is about the latest theories of the underlying mechanisms that explain why music and art promote health and have positive influences on the course of illness with ageing. It is also about the latest findings demonstrating the positive effects that music and the arts in general have on health with ageing; cost savings to society associated with these positive findings will also be discussed. Why would engaging in music and the arts in general have positive effects on health? In the modern world, without a clear understanding of the underlying factors to explain effects or outcomes, science and society become doubtful and dismissive of even positive reported findings. These issues will be reviewed with research examples illustrating how they can be effectively addressed and positively influence societal and scientific perceptions of the value of music, art, and creative engagement in promoting health with ageing.
To conduct an in-depth qualitative examination of the experiences of Singaporean people caring for those with Parkinson's disease (PD). The need to provide care for people with PD will increase with the extended life expectancy of Singaporeans. Caring for people with PD in their own homes for as long as possible is argued to provide psychosocial benefits as well as benefiting the community by delayed institutionalisation and reduced healthcare costs. This study reports the qualitative exploratory component of a large mixed method sequential explanatory design. Caregivers were selected through a purposive sampling technique and stratified based on the Hoehn and Yahr disease staging. Twenty-one semi-structured interviews were conducted in the home setting. Interviews were audio-taped and transcribed verbatim. The qualitative data were analysed using Ritchie and Spencer's framework method of qualitative analysis (1994, Analyzing Qualitative Data, Routledge, London). Seventeen (81%) caregivers were women, and their ages ranged from 31 years to more than 71 years. The length of the interview ranged from 42-106 minutes. The interview transcriptions produced 1731 free nodes, and after careful scrutiny for redundancy, 11 sub-themes were identified, which were organised into four key themes. These themes pertained to: (1) Coping and adaptation, (2) Challenges of caregiving, (3) Effects of caregiving on the caregivers and the (4) Need for better caregiver support. The results of this study have provided insights into the coping and well-being of caregivers of people with PD. The progressive nature of PD placed a significant burden on caregivers' emotional well-being. The findings of this study underscore the need for formal caregiver support and education to reduce strain in caregivers targeted at every stage of PD as there is no clear pattern of disease progression. This study has provided important findings that will inform the construction of interventional strategies to reduce caregiver burden and the provision of better support services for caregivers.
This review explores the relationship between engagement with the creative arts and health outcomes, specifically the health effects of music engagement, visual arts therapy, movement-based creative expression, and expressive writing. Although there is evidence that art-based interventions are effective in reducing adverse physiological and psychological outcomes, the extent to which these interventions enhance health status is largely unknown. Our hope is to establish a foundation for continued investigation into this subject and to generate further interest in researching the complexities of engagement with the arts and health.
The objective of this study was to examine the experience of spouses caregiving for their spouse with Parkinson's disease (PD) and to determine whether their experiences differed by stage of disease. By using a cross-sectional design and mail questionnaire data from 380 spouse caregivers across 23 sites of the Parkinson Study Group, key caregiver variables were examined by stage of PD. Three categories of variables--caregiver role strain (10 measures), caregiver situation (four measures), and caregiver characteristics (four measures)--were analyzed by using t tests with Bonferroni correction. Specific types and amounts of role strain accumulated as the disease progressed, and they differed significantly between stages (p < 0.05). In the caregiving situation, the mean number of caregiving tasks tripled by stage 4/5. Negative changes in lifestyle plus decreases in predictability in caregivers' lives increased significantly in late-stage disease (p < 0.05). Caregiver characteristics of physical health and preparedness did not significantly differ across stages of disease. Depression was significantly higher by stage 4/5. Mutuality, the positive quality of the relationship as perceived by the caregiving spouse, declined beginning at stage 2. Caregiver strain is experienced across all stages of PD and accumulates significantly as the disease progresses. This study defines types and amounts of strain by stage of disease, which will be helpful in designing formal intervention trials to provide more effective help for spouse caregivers.