Belly laughs and rousing songs open a weekly choral gathering at the Struthers Parkinson's Center in Golden Valley.
All have Parkinson's disease, a degenerative condition that attacks the nervous system. There is no cure.
Even though the disease generally is not considered funny, music therapist Sandi Holten wants her patients to laugh. That helps loosen and exercise torso and face muscles rigid with stiffness, a symptom of Parkinson's.
"Hah, hah, " she prompts, "Everyone!"
"Hah, hah, take that, Parkinson's!" the patients shout back.
Then, with Holten at an electronic keyboard, they all begin to sing "Take Me Out to the Ball Game."
After an hour of vocal exercises and songs, the chorus members bid Holten goodbye until next week's session. Next on her agenda is a one-on-one session with a patient.
Art Grell, 67, is a broad-shouldered bear of a man. But he no longer has a vigorous stride. Instead, Grell takes slow, halting steps, almost a shuffle, another effect of the disease.
"A person with Parkinson's has rigidity throughout their body," Holten said. "That's one of the primary symptoms."
As Grell takes a seat, Holten asks him to hit paddles in time with the music.
She wants him to twist, loosen up, get his body moving and exercise muscles, especially those in his legs. That will help him lift his feet and restore rhythm to his gait.
Grell and his wife moved to Minnesota from Colorado after his neurologist there advised him to seek treatment at Struthers Parkinson's Center, a nationally recognized facility.
Parkinson's attacks the central nervous system and destroys neurons. Some estimates show it affects as many as 2 percent of people over 60, more men than women. The cause is unknown, but people with immediate family members who have Parkinson's are at higher risk, and some research shows a correlation with toxins in the environment.
Other symptoms include tremors, a weakened voice and mild cognitive impairment.
The therapists and medical doctors at Struthers use speech, physical and music therapy and medication to help patients with their symptoms. The center's research shows the therapy improves physical functions for more than 80 percent of patients.
Grell's voice is faint, but he said sessions with Holten lift his spirits.
"I think the music gets me going more, gets me more excited," he said.
Music therapy expanded after World War II. It helped military veterans cope with post-traumatic stress disorder.
These days, music therapists work with people of all ages and a range of conditions.
Holten's specialty is caring for people with Parkinson's. A Robbinsdale native, she has a bachelor of science in music therapy from Augsburg College and has done additional study at the Center for Biomedical Research in Music in Colorado.
Holten also is a gifted musician. But she dropped out of piano lessons in elementary school, telling her mother music wasn't going to be a big part of her life.
"She liked to rub my nose in that a little bit because I am doing something with music," Holten said.
Parkinson's erodes physical and mental functions, but many with the condition retain an active mind as their body declines. Holten admires their courage.
"That they're able to face this with hope is incredibly inspiring," she said. "And truly, they are my heroes."