The internal control of action and Parkinson's disease: a kinematic analysis of visually-guided and memory-guided prehension movements

Medication improves velocity, reaction time, and movement time but not amplitude or error during memory-guided reaching in Parkinson's disease

The motor impairments experienced by people with Parkinson's disease (PD) are exacerbated during memory-guided movements. Despite this, the effect of antiparkinson medication on memory-guided movements has not been elucidated. We evaluated the effect of antiparkinson medication on motor control during a memory-guided reaching task with short and long retention delays in participants with PD and compared performance to age-matched healthy control (HC) participants. Thirty-two participants with PD completed the motor section of the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS III) and performed a memory-guided reaching task with two retention delays (0.5 s and 5 s) while on and off medication. Thirteen HC participants completed the MDS-UPDRS III and performed the memory-guided reaching task. In the task, medication increased movement velocity, decreased movement time, and decreased reaction time toward what was seen in the HC. However, movement amplitude and reaching error were unaffected by medication. Shorter retention delays increased movement velocity and amplitude, decreased movement time, and decreased error, but increased reaction times in the participants with PD and HC. Together, these results imply that antiparkinson medication is more effective at altering the neurophysiological mechanisms controlling movement velocity and reaction time compared with other aspects of movement control.

Encoding type, medication, and deep brain stimulation differentially affect memory-guided sequential reaching movements in Parkinson's disease

Memory-guided movements, vital to daily activities, are especially impaired in Parkinson's disease (PD). However, studies examining the effects of how information is encoded in memory and the effects of common treatments of PD, such as medication and subthalamic nucleus deep brain stimulation (STN-DBS), on memory-guided movements are uncommon and their findings are equivocal. We designed two memory-guided sequential reaching tasks, peripheral-vision or proprioception encoded, to investigate the effects of encoding type (peripheral-vision vs. proprioception), medication (on- vs. off-), STN-DBS (on- vs. off-, while off-medication), and compared STN-DBS vs. medication on reaching amplitude, error, and velocity. We collected data from 16 (analyzed n = 7) participants with PD, pre- and post-STN-DBS surgery, and 17 (analyzed n = 14) healthy controls. We had four important findings. First, encoding type differentially affected reaching performance: peripheral-vision reaches were faster and more accurate. Also, encoding type differentially affected reaching deficits in PD compared to healthy controls: peripheral-vision reaches manifested larger deficits in amplitude. Second, the effect of medication depended on encoding type: medication had no effect on amplitude, but reduced error for both encoding types, and increased velocity only during peripheral-vision encoding. Third, the effect of STN-DBS depended on encoding type: STN-DBS increased amplitude for both encoding types, increased error during proprioception encoding, and increased velocity for both encoding types. Fourth, STN-DBS was superior to medication with respect to increasing amplitude and velocity, whereas medication was superior to STN-DBS with respect to reducing error. We discuss our findings in the context of the previous literature and consider mechanisms for the differential effects of medication and STN-DBS.

Use of Mobile Device Accelerometry to Enhance Evaluation of Postural Instability in Parkinson Disease

OBJECTIVE

To determine the accuracy of inertial measurement unit data from a mobile device using the mobile device relative to posturography to quantify postural stability in individuals with Parkinson disease (PD).

DESIGN

Criterion standard.

SETTING

Motor control laboratory at a clinic.

PARTICIPANTS

A sample (N=28) of individuals with mild to moderate PD (n=14) and age-matched community-dwelling individuals without PD (n=14) completed the study.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Center of mass (COM) acceleration measures were compared between the mobile device and the NeuroCom force platform to determine the accuracy of mobile device measurements during performance of the Sensory Organization Test (SOT). Analyses examined test-retest reliability of both systems and sensitivity of (1) the equilibrium score from the SOT and (2) COM acceleration measures from the force platform and mobile device to quantify postural stability across populations.

RESULTS

Metrics of COM acceleration from inertial measurement unit data and the NeuroCom force platform were significantly correlated across balance conditions and groups (Pearson r range, .35 to .97). The SOT equilibrium scores failed to discriminate individuals with and without PD. However, the multiplanar measures of COM acceleration from the mobile device exhibited good to excellent reliability across SOT conditions and were able to discriminate individuals with and without PD in conditions with the greatest balance demands.

CONCLUSIONS

Metrics employing medial-lateral movement produce a more sensitive outcome than the equilibrium score in identifying postural instability associated with PD. Overall, the output from the mobile device provides an accurate and reliable method of rapidly quantifying balance in individuals with PD. The portable and affordable nature of a mobile device with the application makes it ideally suited to use biomechanical data to aid in clinical decision making.

Implicit Motor Sequence Learning in Individuals with Parkinson Disease: A Meta-Analysis

BACKGROUND

Deficits in implicit motor sequence learning (IMSL) in individuals with Parkinson disease (PD) compared to age matched healthy controls (HC) are unclear.

OBJECTIVE

The purpose of this paper is to present results of a systematic review with a meta-analysis examining the hypothesis that IMSL is impaired in individuals with PD when compared to HC.

METHODS

Fifteen articles met our final criteria and assessed 299 individuals with PD and 244 HC. Raw mean and standard deviation data for the final block of repeated and final block of random practice trials were obtained to calculate sequence-specific learning (SSL) for individuals with PD and HC. Forest plots were used to depict the comparison of the groups by assessing standardized mean difference with random effect size.

RESULTS

A significant and moderate effect size, 0.83 was found suggesting that individuals with PD demonstrated impaired SSL of motor sequences compared to HC.

CONCLUSIONS

Individuals with PD demonstrate a deficit compared with HC in their ability to implicitly learn motor tasks. Existing research lacks detail on the factors which may alter IMSL, either negatively or positively, such as the design features of current IMSL paradigms utilized and disease-specific characteristics. Successful motor rehabilitation of functional tasks in persons with PD is highly dependent on IMSL; therefore, an improved knowledge of the influence of these additional variables is critical.

Post-Movement Beta Activity in Sensorimotor Cortex Indexes Confidence in the Estimations from Internal Models

Beta oscillations are a dominant feature of the sensorimotor system. A transient and prominent increase in beta oscillations is consistently observed across the sensorimotor cortical-basal ganglia network after cessation of voluntary movement: the post-movement beta synchronization (PMBS). Current theories about the function of the PMBS have been focused on either the closure of motor response or the processing of sensory afferance. Computational models of sensorimotor control have emphasized the importance of the integration between feedforward estimation and sensory feedback, and therefore the putative motor and sensory functions of beta oscillations may reciprocally interact with each other and in fact be indissociable. Here we show that the amplitude of sensorimotor PMBS is modulated by the history of visual feedback of task-relevant errors, and negatively correlated with the trial-to-trial exploratory adjustment in a sensorimotor adaptation task in young healthy human subjects. The PMBS also negatively correlated with the uncertainty associated with the feedforward estimation, which was recursively updated in light of new sensory feedback, as identified by a Bayesian learning model. These results reconcile the two opposing motor and sensory views of the function of PMBS, and suggest a unifying theory in which PMBS indexes the confidence in internal feedforward estimation in Bayesian sensorimotor integration. Its amplitude simultaneously reflects cortical sensory processing and signals the need for maintenance or adaptation of the motor output, and if necessary, exploration to identify an altered sensorimotor transformation.

SIGNIFICANCE STATEMENT

For optimal sensorimotor control, sensory feedback and feedforward estimation of a movement's sensory consequences should be weighted by the inverse of their corresponding uncertainties, which require recursive updating in a dynamic environment. We show that post-movement beta activity (13-30 Hz) over sensorimotor cortex in young healthy subjects indexes the evaluation of uncertainty in feedforward estimation. Our work contributes to the understanding of the function of beta oscillations in sensorimotor control, and provides further insight into how aberrant beta activity can contribute to the pathophysiology of movement disorders.

Parallel basal ganglia circuits for voluntary and automatic behaviour to reach rewards

The basal ganglia control body movements, value processing and decision-making. Many studies have shown that the inputs and outputs of each basal ganglia structure are topographically organized, which suggests that the basal ganglia consist of separate circuits that serve distinct functions. A notable example is the circuits that originate from the rostral (head) and caudal (tail) regions of the caudate nucleus, both of which target the superior colliculus. These two caudate regions encode the reward values of visual objects differently: flexible (short-term) values by the caudate head and stable (long-term) values by the caudate tail. These value signals in the caudate guide the orienting of gaze differently: voluntary saccades by the caudate head circuit and automatic saccades by the caudate tail circuit. Moreover, separate groups of dopamine neurons innervate the caudate head and tail and may selectively guide the flexible and stable learning/memory in the caudate regions. Studies focusing on manual handling of objects also suggest that rostrocaudally separated circuits in the basal ganglia control the action differently. These results suggest that the basal ganglia contain parallel circuits for two steps of goal-directed behaviour: finding valuable objects and manipulating the valuable objects. These parallel circuits may underlie voluntary behaviour and automatic skills, enabling animals (including humans) to adapt to both volatile and stable environments. This understanding of the functions and mechanisms of the basal ganglia parallel circuits may inform the differential diagnosis and treatment of basal ganglia disorders.

Balance dysfunction in Parkinson's disease

Stability and mobility in functional motor activities depend on a precise regulation of phasic and tonic muscular activity that is carried out automatically, without conscious awareness. The sensorimotor control of posture involves a complex integration of multisensory inputs that results in a final motor adjustment process. All or some of the components of this system may be dysfunctional in Parkinsonian patients, rendering postural instability one of the most disabling features of Parkinson's disease (PD). Balance control is critical for moving safely in and adapting to the environment. PD induces a multilevel impairment of this function, therefore worsening the patients' physical and psychosocial disability. In this review, we describe the complex ways in which PD impairs posture and balance, collecting and reviewing the available experimental evidence.

Motor output variability, deafferentation, and putative deficits in kinesthetic reafference in Parkinson's disease

Parkinson’s disease (PD) is a neurodegenerative disorder defined by motor impairments that include rigidity, systemic slowdown of movement (bradykinesia), postural problems, and tremor. While the progressive decline in motor output functions is well documented, less understood are impairments linked to the continuous kinesthetic sensation emerging from the flow of motions. There is growing evidence in recent years that kinesthetic problems are also part of the symptoms of PD, but objective methods to readily quantify continuously unfolding motions across different contexts have been lacking. Here we present evidence from a deafferented subject (IW) and a new statistical platform that enables new analyses of motor output variability measured as a continuous flow of kinesthetic reafferent input. Systematic increasing similarities between the patterns of motor output variability in IW and the participants with increasing degrees of PD severity suggest potential deficits in kinesthetic sensing in PD. We propose that these deficits may result from persistent, noisy, and random motor patterns as the disorder progresses. The stochastic signatures from the unfolding motions revealed levels of noise in the motor output fluctuations of these patients bound to decrease the kinesthetic signal’s bandwidth. The results are interpreted in light of the concept of kinesthetic reafference ( Von Holst and Mittelstaedt, 1950). In this context, noisy motor output variability from voluntary movements in PD leads to a returning stream of noisy afference caused, in turn, by those faulty movements themselves. Faulty efferent output re-enters the CNS as corrupted sensory motor input. We find here that severity level in PD leads to the persistence of such patterns, thus bringing the statistical signatures of the subjects with PD systematically closer to those of the subject without proprioception.

Efficacy of language-appropriate cueing on micrographia in Korean patients with Parkinson's disease

AIM

First, we objectively quantified the handwriting size of Parkinson's disease (PD) patients. Second, we investigated the efficacy of the external visual cueing on Korean handwriting in PD.

METHODS

We recruited 57 patients diagnosed with PD and 37 community-dwelling normal older adults. All participants were asked to write a target word on a blank sheet of paper. For investigating the external visual cueing, 24 PD patients wrote the target word in square grids. The size of each syllable of the word was measured using a public domain software program. In order to measure the area of a syllable, the upper, lower, left and right margins of the syllable were outlined with a rectangle. The area of selection in square pixels or in calibrated square units was used to spatially calibrate the image automatically.

RESULTS

The PD group showed significantly smaller writing size than the normal group in all syllables of the free writing. The writing size in the square grids of the PD patients was bigger than their free writing.

CONCLUSION

The present study is noteworthy, because it is the first attempt to use a software program to objectively quantify parkinsonian handwriting size. This measuring system would help clinicians monitor handwriting size throughout the disease course. From the perspective of rehabilitation, language-appropriate external visual cues might be useful in daily communication (i.e. handwriting) activities in Korean patients with PD.

Learning and switching between stimulus-saccade associations in Parkinson's disease

Making flexible associations between what we see and what we do is important for many everyday tasks. Previous work in patients with focal lesions has shown that the control of saccadic eye movements in such contexts relies on a network of areas in the frontal cerebral cortex. These regions are reciprocally connected with structures in the basal ganglia although the contribution of these sub-cortical structures to oculomotor control in complex tasks is not well understood. We report the performance of patients with idiopathic Parkinsons disease (PDs) in a test which required learning and switching between arbitrary cue-saccade rules. In Experiment 1 feedback was given following each response which reliably indicated which of the two possible rules was correct. PDs were slower to learn the first cue-saccade association presented, but did not show increased error or reaction time switch costs when switching between two rules within blocks. In a follow up experiment the feedback given by the computer was adjusted to be probabilistic such that executing a response based upon the "correct" rule only resulted in positive feedback on 80% of trials. Under these conditions patients were impaired in terms of response latencies and number of errors. In all conditions PDs showed multi-stepping/hypometria of saccades consistent with a motoric deficit in executing actions based on cognitive cues. The findings are consistent with a role for the nigrostriatal dopamine system in the reinforcement of saccade-response-outcome associations. Intact performance of PDs when associations are not stochastically reinforced suggests that striatal learning systems are complemented by cognitive representations of task rules which are unaffected in the early stages of PD.

Rhythmic movement in Parkinson's disease: effects of visual feedback and medication state

Previous studies examining discrete movements of Parkinson's disease (PD) patients have found that in addition to performing movements that were slower than those of control participants, they exhibit specific deficits in movement coordination and in sensorimotor integration required to accurately guide movements. With medication, movement speed was normalized, but the coordinative aspects of movement were not. This led to the hypothesis that dopaminergic medication more readily compensates for intensive aspects of movement (such as speed), than for coordinative aspects (such as coordination of different limb segments) (Schettino et al., Exp Brain Res 168:186-202, 2006). We tested this hypothesis on rhythmic, continuous movements of the forearm. In our task, target peak speed and amplitude, availability of visual feedback, and medication state (on/off) were varied. We found, consistent with the discrete-movement results, that peak speed (intensive aspect) was normalized by medication, while accuracy, which required coordination of speed and amplitude modulation (coordinative aspect), was not normalized by dopaminergic treatment. However, our findings that amplitude, an intensive aspect of movement, was also not normalized by medication, suggests that a simple pathway gain increase does not act to remediate all intensive aspects of movement to the same extent. While it normalized movement peak speed, it did not normalize movement amplitude. Furthermore, we found that when visual feedback was not available, all participants (PD and controls) made faster movements. The effects of dopaminergic medication and availability of visual feedback on movement speed were additive. The finding that movement speed uniformly increased both in the PD and the control groups suggests that visual feedback may be necessary for calibration of peak speed, otherwise underestimated by the motor control system.

Proprioception and motor control in Parkinson's disease

Parkinson's disease (PD) is a neurodegenerative disorder that leads to a progressive decline in motor function. Growing evidence indicates that PD patients also experience an array of sensory problems that negatively impact motor function. This is especially true for proprioceptive deficits, which profoundly degrade motor performance. This review specifically address the relation between proprioception and motor impairments in PD. It is structured around 4 themes: (a) It examines whether the sensitivity of kinaesthetic perception, which is based on proprioceptive inputs, is actually altered in PD. (b) It discusses whether failed processes of proprioceptive-motor integration are central to the motor problems in PD. (c) It presents recent findings focusing on the link between the proprioception and the balance problems in PD. And (d) it discusses the current state of knowledge of how levodopa medication and deep brain stimulation affect proprioceptive and motor function in PD. The authors conclude that a failure to evaluate and to map proprioceptive information onto voluntary and reflexive motor commands is an integral part of the observed motor symptoms in PD.

Loss of functional specificity in the dorsal striatum of chronic cocaine users

BACKGROUND

Although research into the effects of cocaine has focused on the ventral striatum, recent reports have identified a significant role for the dorsal striatum. Given the importance of the dorsal striatum in motor control, the purpose of the present study was to investigate potential sensorimotor deficits among cocaine users and the functional basis of these deficits within the striatum.

METHODS

Functional magnetic resonance imaging data were collected from 14 right-handed, non-treatment seeking chronic cocaine users and 14 age and gender matched controls during performance of two finger-sequencing paradigms that differentially activate the caudate (internally-guided) and the putamen (externally-guided) interleaved with blocks of rest. The total percent signal change in the dorsal striatum and the contribution of the left and right caudate and putamen were calculated and compared across groups and tasks.

RESULTS

Significant deficits in sensorimotor control were observed in cocaine users for both motor tasks, with the most severe impairments present during internally-guided movements. Cocaine users lacked the typical functional segregation observed in the dorsal striatum of the control subjects. The total percent signal change in the dorsal striatum was not significantly different between the groups, but cocaine users activated significantly less contralateral caudate and putamen for internally-guided versus externally-guided movements, respectively.

CONCLUSION

These data provide clear evidence that chronic cocaine users have significant motor performance deficits that are accompanied by disrupted processing within the dorsal striatum. These data suggest the effects of cocaine extend beyond the confines of the motivational domains of the ventral striatum.

A model for altered neural network dynamics related to prehension movements in Parkinson disease

In this paper, we present a neural network model of the interactions between cortex and the basal ganglia during prehensile movements. Computational neuroscience methods are used to explore the hypothesis that the altered kinematic patterns observed in Parkinson's disease patients performing prehensile movements is mainly due to an altered neuronal activity located in the networks of cholinergic (ACh) interneurons of the striatum. These striatal cells, under a strong influence of the dopaminergic system, significantly contribute to the neural processing within the striatum and in the cortico-basal ganglia loops. In order to test this hypothesis, a large-scale model of neural interactions in the basal ganglia has been integrated with previous models accounting for the cortical organization of goal directed reaching and grasping movements in normal and perturbed conditions. We carry out a discussion of the model hypothesis validation by providing a control engineering analysis and by comparing results of real experiments with our simulation results in conditions resembling these original experiments.

Brain dopamine and kinematics of graphomotor functions

Three experiments were performed in an attempt to achieve a better understanding of the effect of dopamine on handwriting. In the first experiment, kinematic aspects of handwriting movements were compared between healthy participants and patients with Parkinson's disease (PD) on their usual dopaminergic treatment and following withdrawal of dopaminergic medication. In the second experiment, the writing performance of healthy participants with a hyperechogenicity of the substantia nigra as detected by transcranial sonography (TCS) was compared with the performance of healthy participants with low echogenicity of the substantia nigra. The third experiment examined the effect of central dopamine reduction on kinematic aspects of handwriting movements in healthy adults using acute phenylalanine and tyrosine depletion (APTD). A digitising tablet was used for the assessment of handwriting movements. Participants were asked to perform a simple writing task. Movement time, distance, velocity, acceleration and measures of fluency of handwriting movements were measured. The kinematic analysis of handwriting movements revealed that alterations of central dopaminergic neurotransmission adversely affect movement execution during handwriting. In comparison to the automatic processing of handwriting movements displayed by control participants, participants with an altered dopaminergic neurotransmission shifted from an automatic to a controlled processing of movement execution. Central dopamine appears to be of particular importance with regard to the automatic execution of well-learned movements.

Bimanual coordination dysfunction in early, untreated Parkinson's disease

Bimanual coordination involves the simultaneous performance of either symmetrical (in-phase) or asymmetrical (anti-phase) movements with both hands and is known to be impaired in Parkinson's disease (PD). At present, it is unclear whether this aspect of motor function is already impaired in early stage, untreated PD patients. Therefore, we investigated the accuracy of bimanual coordination in 13 early stage, untreated PD patients and 13 age- and sex-matched healthy controls. Each subject performed bimanual coordination tasks at two different movement frequencies (1 and 1.75 Hz) and with two different phase relationships (in-phase and anti-phase). The percentage of unsuccessful trials (as a measure of overall task performance) in PD patients was significantly higher than in healthy subjects. PD patients performed high frequency in-phase and anti-phase bimanual coordination tasks less accurately with their non-dominant hand than healthy subjects. Furthermore, PD patients had more difficulty than healthy subjects in maintaining a constant phase relationship between the hands in the anti-phase condition at low movement frequency. This study demonstrates that bimanual coordination dysfunction is a very early sign of PD. Bimanual coordination tasks, in particular those involving high frequency anti-phase movements, might prove useful in the early diagnosis of PD.

Altered coordination patterns in parkinsonian patients during trunk-assisted prehension

We examined whether coordination between movement components during trunk-assisted prehension was compromised in PD patients in response to varying constraints (experiment 1: reach speed, object size, movement amplitude; experiment 2: movement sequence). In general, both PD patients and controls responded similarly to the changes in these three variables. PD patients, however, demonstrated less synchronized movements in terms of timing between onsets and offsets of aperture formation, endpoint motion and trunk motion. In addition, PD patients used a pattern different from that of controls in specifying the relative contribution of trunk and arm to the endpoint motion. A significant group difference was observed in that controls tended to synchronize the involved movement components together, whereas PD patients did not show such a trend. These data suggest that PD patients have intact parameterization capabilities, although they have a reduced capability to coordinate multiple neuromotor synergies as a single unit.

Control of aperture closure during reach-to-grasp movements in Parkinson's disease

This study examined whether the pattern of coordination between arm-reaching toward an object (hand transport) and the initiation of aperture closure for grasping is different between PD patients and healthy individuals, and whether that pattern is affected by the necessity to quickly adjust the reach-to-grasp movement in response to an unexpected shift of target location. Subjects reached for and grasped a vertical dowel, the location of which was indicated by illuminating one of the three dowels placed on a horizontal plane. In control conditions, target location was fixed during the trial. In perturbation conditions, target location was shifted instantaneously by switching the illumination to a different dowel during the reach. The hand distance from the target at which the subject initiated aperture closure (aperture closure distance) was similar for both the control and perturbation conditions within each group of subjects. However, that distance was significantly closer to the target in the PD group than in the control group. The timing of aperture closure initiation varied considerably across the trials in both groups of subjects. In contrast, aperture closure distance was relatively invariant, suggesting that aperture closure initiation was determined by spatial parameters of arm kinematics rather than temporal parameters. The linear regression analysis of aperture closure distance showed that the distance was highly predictable based on the following three parameters: the amplitude of maximum grip aperture, hand velocity, and hand acceleration. This result implies that a control law, the arguments of which include the above parameters, governs the initiation of aperture closure. Further analysis revealed that the control law was very similar between the subject groups under each condition as well as between the control and perturbation conditions for each group. Consequently, the shorter aperture closure distance observed in PD patients apparently is a result of the hypometria of their grip aperture and bradykinesia of hand transport movement, rather than a consequence of a deficit in transport-grasp coordination. It is also concluded that the perturbation of target location does not disrupt the transport-grasp coordination in either healthy individuals or PD patients.

Kinematic analysis of dopaminergic effects on skilled handwriting movements in Parkinson’s disease

Patients with Parkinson's disease (PD) exhibit impairments in the execution of highly practiced and skilled motor actions such as handwriting. The analysis of kinematic aspects of handwriting movements has demonstrated that size, speed, acceleration and stroke duration are affected in PD. Although beneficial effects of dopaminergic therapy in regard to execution of movements have been reported, the effects of pharmacological therapy on these measures have not been examined in detail. The present study has compared kinematic aspects of handwriting movements of 27 healthy subjects and 27 patients with PD both on their usual dopaminergic treatment and following withdrawal of dopaminergic medication. Healthy subjects were matched with PD patients according to age, sex, handedness and education level. A digitising tablet was used for the assessment of handwriting movements. Subjects were asked to perform a simple writing task. Movement time, distance, velocity, acceleration and measures of fluency of handwriting movements were measured. Compared with healthy subjects, the kinematics of handwriting movements in PD patients were markedly disturbed following withdrawal of dopaminergic medication. Although dopaminergic treatment in PD patients resulted in marked improvements in the kinematics of handwriting movements, PD patients did not reach an undisturbed level of performance. The results suggest that dopamine medication results in partial restoration of automatic movement execution.

Hand preshaping in Parkinson’s disease: effects of visual feedback and medication state

Previous studies in our laboratory examining pointing and reach-to-grasp movements of Parkinson's disease patients (PDPs) have found that PDPs exhibit specific deficits in movement coordination and in the sensorimotor transformations required to accurately guide movements. We have identified a particular difficulty in matching unseen limb position, sensed by proprioception, with a visible target. In the present work, we further explored aspects of complex sensorimotor transformation and motor coordination using a reach-to-grasp task in which object shape, visual feedback, and dopaminergic medication were varied. Normal performance in this task requires coordinated generation of appropriate reach, to bring the hand to the target, and differentiated grasp, to preshape the hand congruent with object form. In Experiment 1, we tested PDPs in the off-medication state. To examine the dependence of subjects on visual feedback and their ability to implement intermodal sensory integration, we required them to reach and grasp the target objects in three conditions: (1) Full Vision, (2) Object Vision with only the target object visible and, (3) No Vision with neither the moving arm nor the target object visible. PDPs exhibited two types of deficits. First, in all conditions, they demonstrated a generalized slowing of movement or bradykinesia. We consider this an intensive deficit, since it involves largely a modulation of the gain of specific task parameters: in this case, velocity of movement. Second, they were less able than controls to extract critical proprioceptive information and integrate it with vision in order to coordinate the reach and grasp components of movement. These deficits which involve the coordination of different inputs and motor components, we classify as coordinative deficits. As in our previous work, the PDPs' deficits were most marked when they were required to use proprioception to guide their hand to a visible target (Object Vision condition). But even in the full-vision condition, their performance only became fully accurate when both the target and effector (hand) were simultaneously visible. In Experiment 2, PDPs were tested on their dopaminergic replacement therapy. Dopaminergic treatment significantly ameliorated the bradykinesia of the PDPs, but produced no changes in the hand preshaping deficiencies of PDPs. These results suggest that adequate treatment of the PDPs may more readily compensate for intensive, than coordinative deficits, since the latter are likely to depend on specific and time-dependent neural interdependencies that are unlikely to be remediated simply by increasing the gain of a pathway.

Visuomotor dependency on an initial fixation target involved in the disorder of visually-guided manual movement in Parkinson's disease

Role of a central fixation target on the latencies of visually guided manual movement was analyzed on young healthy subjects, age-matched control subjects and patients with Parkinson's disease (Hoehn and Yahr stages II, III, and IV). Two paradigms were used: overlap paradigm where a central fixation target was lighted throughout the test, and gap paradigm where a central fixation target was turned off 200 ms before a peripheral target was lighted. The subject was first asked to fixate the central target then instructed to locate a peripheral target with a laser beam spot, operated with wrist flexion or extension as quickly as possible. Latencies of gap paradigm are always shorter than those of overlap task in all the groups. Latencies of both overlap and gap tasks prolonged from young to elder, from elder to PD II, from PD II to PD III and from PD III to PD IV. Also latencies were extremely prolonged in the overlap tasks and correlated with disease severity. Latencies in the gap tasks were less prolonged as compared with those in the overlap tasks. The visual fixation target prolonged the visuo-motor latency in association with severity of Parkinson's disease.

Development of Prehension Between 5 and 10 Years of Age: Distance Scaling, Grip Aperture, and Sight of the Hand

The authors investigated whether 5- to 10-year-old children (N = 75) differ from adults (N = 12) in the developmental course of distance scaling and the adaptations to the inability to see the hand during prehension movements. The children reached under a surface and grasped and lifted an object suspended through it. All children scaled velocity appropriately for movement distance, both with and without sight of the hand. However, 5- to 6-year-old children did not increase grip aperture with increased distance, whereas older children and adults did. The older children and adults spent longer after peak deceleration when they could not see the hand, and maximum grip aperture (MGA) was larger, providing an increased safety margin. Children aged 5 to 6 spent the same amount of time between peak deceleration and grasp, whether or not they could see the hand, and they failed to increase MGA when they could not see the hand. Prehension in the younger children differed from that of older children in two ways: The younger children did not integrate reach and grasp over different distances and did not use visual information about hand position to optimize accuracy.

Deficits in the evolution of hand preshaping in Parkinson's disease

Parkinson's disease (PD) results in various types of motor impairments including bradykinesia, tremor and rigidity. Recent research has implicated more fundamental processes at the source of the observed motor deficits. Among these, problems in the sequencing and/or timing of complex movements and in the execution of internally-guided tasks. Furthermore, PD patients exhibit procedural learning deficits which may complicate the interpretation of experimental results of studies involving novel sensorimotor tasks. The reach-to-grasp movement is a complex, overlearned sensorimotor task consisting of two semi-independent components, a relatively simple reach or transport phase and a more complex manipulation or prehension phase. In the present study, we used a novel technique in order to study the evolution of hand preshaping during the reach-to-grasp movement of PD patients and age-matched controls to objects of different shapes in three different spatial locations. Our results indicate that while PD patients are able to specify movement direction as well as controls, their hand preshaping exhibits substantial impairments. Other prehension measures, such as the time to peak aperture (TPA), indicate that PD patients delayed execution of the grasp until visual feedback of their hand was available. Overall, our results suggest that PD patients' internal guidance processes are severely disrupted, having to rely on visual feedback in order to modulate their hand shape to fit the contours of the target objects during a reach-to-grasp movement.

Effects of object shape and visual feedback on hand configuration during grasping

Normal subjects gradually preshape their hands during a grasping movement in order to conform the hand to the shape of a target object. The evolution of hand preshaping may depend on visual feedback about arm and hand position as well as on target shape and location at specific times during the movement. The present study manipulated object shape in order to produce differentiable patterns of finger placement along two orthogonal "dimensions" (flexion/extension and abduction/adduction), and manipulated the amount of available visual information during a grasp. Normal subjects were asked to reach to and grasp a set of objects presented in a randomized fashion at a fixed spatial location in three visual feedback conditions: Full Vision (both hand and target visible), Object Vision (only the object was visible but not the hand) and No Vision (vision of neither the hand nor the object during the movement). Flexion/extension angles of the metacarpophalangeal and proximal interphalangeal joints of the index, ring, middle and pinkie fingers as well as the abduction/adduction angles between the index-middle and middle-ring fingers were recorded. Kinematic analysis revealed that as visual feedback was reduced, movement duration increased and time to peak aperture of the hand decreased, in accord with previously reported studies. Analysis of the patterns of joint flexion/extension and abduction/adduction per object shape revealed that preshaping based on the abduction/adduction dimension occurred early during the reach for all visual feedback conditions (approximately 45% of normalized movement time). This early preshaping across visual feedback conditions suggests the existence of mechanisms involved in the selection of basic hand configurations. Furthermore, while configuration changes in the flexion/extension dimension resulting in well-defined hand configurations occurred earlier during the movement in the Object Vision and No Vision conditions (45%), those in the Full Vision condition were observed only after 75% of the movement, as the moving hand entered the central region of the visual field. The data indicate that there are at least two control mechanisms at work during hand preshaping, an early predictive phase during which grip selection is attained regardless of availability of visual feedback and a late responsive phase during which subjects may use visual feedback to optimize their grasp.

Impairment of context-adapted movement selection in a primate model of presymptomatic Parkinson's disease

The MPTP model allows the presymptomatic stage of parkinsonism to be studied in primates and hence specific behavioural manifestations of moderate nigrostriatal denervation to be identified. On the basis of the physiological literature, we hypothesized that depletion of striatal dopamine could impair the selection of context-relevant habits. To examine this hypothesis, we trained three African green monkeys to perform a simple reach-and-grasp task, including three contexts differing only in terms of the presence and position of transparent obstacles. At the end of training, the analysis of reaching trajectories showed that intact monkeys had built a repertoire of movements, from which they could select the appropriate one depending on the context. In the course of MPTP intoxication (0.3-0.4 mg/kg every 4-5 days) and before parkinsonian motor symptoms appeared, the reaction time (RT), movement time (MT) and variability of reaching trajectories increased in all monkeys. Frequently, the initial direction was not adapted to the context, and consequently the movement was either corrected online or restarted under visual assistance. These non-adapted trajectories appeared to be the main reason for the increase in both RT (because of difficulty in selecting) and MT (because of the need to make corrections). These observations indicate that moderate MPTP-induced dopamine depletion results in a deficit in the selection of context-adapted movement, which is compensated by corrections using either proprioceptive or visual feedback. Similar behavioural disorders might therefore occur in the presymptomatic stage of human Parkinson's disease.

Dissociating medial temporal and basal ganglia memory systems with a latent learning task

The medial temporal (MT) lobes and basal ganglia have both been implicated as brain substrates of associative learning. Here, we show a dissociation between medial temporal and basal ganglia damage using a latent learning task, in which prior exposure to cues, uncorrelated with each other, slows subsequent learning of an association between them. Consistent with prior work, we found a robust exposure effect in healthy controls, with exposed controls learning more slowly than non-exposed controls. This effect was abolished in medial temporal amnesia: both exposed and non-exposed amnesic patients learned at the same speed. A group of patients with basal ganglia damage due to Parkinson's disease showed a reversal of the effect: exposed subjects learned faster than non-exposed subjects. Our findings point to distinct and dissociable contributions of medial temporal lobe and basal ganglia structures to learning and memory.

Cortical and subcortical networks underlying syncopated and synchronized coordination revealed using fMRI. Functional magnetic resonance imaging

Inherent differences in difficulty between on the beat (synchronization) and off the beat (syncopation) coordination modes are well known. Synchronization is typically quite easy and, once begun, may be carried out with little apparent attention demand. Syncopation tends to be difficult, even though it has been described as a simple, phase-shifted version of a synchronized pattern. We hypothesize that syncopation, unlike synchronization, is organized on a cycle-by-cycle basis, thereby imposing much greater preparatory and attentional demands on the central nervous system. To test this hypothesis we used fMRI to measure the BOLD response during syncopation and synchronization to an auditory stimulus. We found that the distribution of cortical and subcortical areas involved in intentionally coordinating movement with an external metronome depends on the timing pattern employed. Both synchronized and syncopated patterns require activation of contralateral sensorimotor and caudal supplementary motor cortices as well as the (primarily ipsilateral) cerebellum. Moving off the beat, however, requires not only additional activation of the cerebellum but also the recruitment of another network comprised of the basal ganglia, dorsolateral premotor, rostral supplementary motor, prefrontal, and temporal association cortices. No areas were found to be more active during synchronization than syncopation. The functional role of the cortical and subcortical regions areas involved in syncopation supports the hypothesis that whereas synchronization requires little preparation and monitoring, syncopated movements are planned and executed individually on each perception-action cycle.

Impairment of pronation, supination, and body co-ordination in reach-to-grasp tasks in human Parkinson's disease (PD) reveals homology to deficits in animal models

Animal (monkey, rat, mouse) models are widely used to investigate degenerative processes and potential therapeutic treatments for human Parkinson's disease (PD). One task that has proved useful in these investigations is a reach-to-grasp task (skilled reaching) in which an animal reaches for a piece of food that it then consumes. Rats with extensive unilateral Dopamine depletions are impaired in using the contralateral limb. The qualitative features of posture, lifting and advancing the limb, pronating the paw to grasp food, and in withdrawing and supinating the paw to place the food in the mouth are impaired, as is reaching success. Humans with PD are often described as having poor manual dexterity that worsens as the disease progresses. As there have been no detailed comparisons of reaching movements in the animal models and in PD subjects, the following descriptive analysis was performed. Ten subjects with PD, eight age matched controls and 14 young normal subjects were studied as they used a natural movement of reaching for a small piece of food that they then placed in the mouth to eat. The reaching movements were described using Eshkol-Wachman Movement Notation (EWMN), supplemented with kinematic analyses. From this description, a 21-point rating scale was devised to describe the component movements of the reach. Movements included: orienting the head and eyes to the target, adjusting posture, lifting the hand, shaping and aiming the digits to the target, pronating the hand to grasping the food with a pincer grip, lifting and supinating the hand to transporting the food to the mouth, and further supinating the hand and opening the digits to place food in the mouth, and finally returning the hand to the starting position. Analysis indicated that most aspects of the reaching movements of the PD subjects were significantly different relative to both young control subjects and old control subjects. As compared to the control groups, postural and reaching components of the movements were fragmented, movements were achieved using more proximal segments of the body, and rotatory movements of the hand were limited. The PD subjects did use a pincer grasp to obtain the food, but the grasp was less independent of other digit movements than was observed in the control subjects. These results are discussed in terms of a homology to impairments displayed animal models of PD.

Limb Apraxia: Cortical or Subcortical

Ideomotor apraxia is defined as a disturbance in timing, sequencing, and spatial organization of gestural movements. Left hemisphere motor dominance reflected by ideomotor apraxia mainly refers to spatially and temporally complex movements performed outside the natural context. While clinicoanatomical studies have failed to unveil a specific lesion correlating with apraxia, white matter damage-interrupting corticocortical and corticosubcortical connections-seems crucial for the deficit to be persistent and severe. Patients with basal ganglia lesions and disorders, such as Parkinson's disease and progressive supranuclear palsy, may exhibit ideomotor apraxia. The putative roles of the basal ganglia in object-oriented action, and therefore in praxis, would include among others (a) the selection of the kinematic parameters and the direction of arm movements, (b) working as an integral part of brain systems involved in timing and representation of action sequences, (c) encoding behavioral context, and (d) working as a subcortical component of the parietofrontal circuits devoted to sensorimotor transformation (e.g., reaching). Several studies suggest that basal ganglia pathology per se may not cause overt apraxia. However, when it is combined with dysfunction of the cortical components of the neural systems involved in sequencing, sensorimotor transformation, and response selection, different types of ideomotor praxis deficits would become clinically manifested.

Dopaminergic effects on the implicit processing of distractor objects in Parkinson's disease

The aim of the present study was to assess the effects of dopaminergic medication on the selection-for-action mechanisms in Parkinson's disease (PD). PD subjects were tested after not having taken medication for at least 12 h ("Off' state) and then retested 1-2 h after medication ("On" state). A three-dimensional kinematic system (ELITE, BTS, Italy) was used to record reach-to-grasp movements to a target object placed at a reaching distance of 30 cm. The target was presented alone or in the presence of distractor objects, which could be of either the same size (compatible distractor) or a different size (incompatible distractor). PD subjects in the Off state were significantly more affected by the presence of the incompatible distractor than in the On state. These results indicate that dopaminergic medication is of benefit in reducing interference effects when distractor objects evoke motor programs that differ from the motor program elicited by the target. Results are discussed in light of the role played by the striatal and mesocortical dopaminergic systems for response selection in basal ganglia disorders.

Disruption of spatial organization and interjoint coordination in Parkinson's disease, progressive supranuclear palsy, and multiple system atrophy

Patients with basal ganglia diseases may exhibit ideomotor apraxia. To define the nature of the impairment of the action production system, we studied a repetitive gesture of slicing bread by three-dimensional computergraphic analysis in eight nondemented patients with Parkinson's disease in the "on" state, five with progressive supranuclear palsy and four with multiple system atrophy. Two patients with Parkinson's disease and two with progressive supranuclear palsy showed ideomotor apraxia for transitive movements on standard testing. A Selspott II system was used for kinematic analysis of wrist trajectories and angular motions of the shoulder and elbow joints. Patients with Parkinson's disease, progressive supranuclear palsy, and even some with multiple system atrophy exhibited kinematic deficits in the spatial precision of movement and velocity-curvature relationships; in addition, they failed to maintain proper angle/angle relationships and to apportion their relative joint amplitudes normally. Spatial disruption of wrist trajectories was more severe in patients with ideomotor apraxia. We posit that the basal ganglia are part of the parallel parieto-frontal circuits devoted to sensorimotor integration for object-oriented behavior. The severity and characteristics of spatial abnormalities of a transitive movement would therefore depend on the location and distribution of the pathologic process within these circuits.

Temporary inactivation in the primate motor thalamus during visually triggered and internally generated limb movements

To better understand the contribution of cerebellar- and basal ganglia-receiving areas of the thalamus [ventral posterolateral nucleus, pars oralis (VPLo), area X, ventral lateral nucleus, pars oralis (VLo), or ventral anterior nucleus, pars parvicellularis (VApc)] to movements based on external versus internal cues, we temporarily inactivated these individual nuclei in two monkeys trained to make visually triggered (VT) and internally generated (IG) limb movements. Infusions of lignocaine centered within VPLo caused hemiplegia during which movements of the contralateral arm rarely were performed in either task for a short period of time ( approximately 5-30 min). When VT responses were produced, they had prolonged reaction times and movement times and a higher incidence of trajectory abnormalities compared with responses produced during the preinfusion baseline period. In contrast, those IG responses that were produced remained relatively normal. Infusions centered within area X never caused hemiplegia. The only deficits observed were an increase in reaction time and movement amplitude variability and a higher incidence of trajectory abnormalities during VT trials. Every other aspect of both the VT and IG movements remained unchanged. Infusions centered within VLo reduced the number of movements attempted during each block of trials. This did not appear to be due to hemiplegia, however, as voluntary movements easily could be elicited outside of the trained tasks. The other main deficit resulting from inactivation of VLo was an increased reaction time in the VT task. Finally, infusions centered within VApc caused IG movements to become slower and smaller in amplitude, whereas VT movements remained unchanged. Control infusions with saline did not cause any consistent deficits. This pattern of results implies that VPLo and VLo play a role in the production of movements in general regardless of the context under which they are performed. They also suggest that VPLo contributes more specifically to the execution of movements that are visually triggered and guided, whereas area X contributes specifically to the initiation of such movements. In contrast, VApc appears to play a role in the execution of movements based on internal cues. These results are consistent with the hypothesis that specific subcircuits within the cerebello- and basal ganglio-thalamo-cortical systems preferentially contribute to movements based on external versus internal cues.

The reach-to-grasp movement in Parkinson's disease before and after dopaminergic medication

The aim of the present study was to assess the effects of dopaminergic medication on the organisation of the reach-to-grasp movement in Parkinson's disease. A three-dimensional kinematic system (ELITE, B/T/S Italy) was used to record reach-to-grasp movements to objects of either small (0.7 cm) or large (8 cm) diameter placed at a reaching distance of either 20 or 30 cm. Vision of the reaching limb and target was also manipulated. Parkinson's disease participants (N = 14) were assessed in 'OFF' (12 h without medication) and 'ON' (1-2 h post-administration of medication) states. In the 'ON' state, movement duration and the time spent in arm deceleration were significantly less than in the 'OFF' state. The amplitudes of peak reaching velocity, acceleration and deceleration were all higher in the 'ON' than in the 'OFF' state. Further, in the 'ON' state, the acceleration profile no longer exhibited small irregular adjustments, the number of significant correlations between parameters measured from the transport and manipulation components was greater, and the movement was more direct in both the mediolateral horizontal and vertical planes. These results indicate that dopaminergic medication is of benefit in reducing bradykinesia and in fine-tuning kinematic parameterisation of a selected reach-to-grasp action.

Visuomotor performance in patients with essential tremor

Essential tremor (ET) is the most prevalent extrapyramidal disorder, yet its diagnosis is still controversial. This article introduces new findings that pertain to this diagnostic problem. Twenty-three patients with ET were studied. Patients with parkinsonism, cerebellar signs, severe head injury, or those under neuroleptic medication were excluded. Twenty-five normal subjects served as control subjects. Visuomotor tests involving tracking and tracing along three different paths with both the right and left hands, were used. Performance was assessed by measuring test duration, directional error, the proportion of the cumulative test time during which directional error exceeded half the maximal possible level (PT50%), the mean distance from the model path, the velocity of the hand movement, and the number of tracking interruptions. In 15 of 23 patients performance was the same as in the control subjects. These patients were defined as having a "simple condition" of ET (ETs). Considerable visuomotor impairment was found in eight patients who were regarded as having a "complex condition" of ET (ETc). Patients with ETc had significantly lower tracking speed, more tracking interruptions, longer test duration, greater directional error, greater PT50%, and greater distance from path than patients with ETs or control subjects. Most patients with ET appear to have normal visuomotor capabilities (ETs) but some display significant visuomotor disturbances (ETc). Considering the presence of similar impairments in patients with early Parkinson's disease and the increased prevalence of parkinsonism in patients with ET, it is possible that preclinical parkinsonism exists in patients with ETc. Further follow up of patients with ETc is necessary to verify this possibility.

Enhanced lateral premotor activity during paradoxical gait in Parkinson's disease

Parkinson's disease (PD) patients often show marked improvement of hypokinetic gait when exposed to special stimuli. To investigate physiological mechanisms underlying this "paradoxical gait" induced by visual cues in PD patients, we examined regional cerebral blood flow changes during gait on a treadmill guided by two different visual cues, the lines oriented transversely to the direction of walk (TL) and the lines parallel to it (PL). Ten PD patients and 10 age-matched controls received injections of 99mTc-hexamethylpropyleneamine oxime twice, once during each walking condition. Brain perfusion images were obtained by single-photon emission computed tomography. When affected by TL, PD patients showed marked improvement of gait parameters, mainly reduction of cadence. In regional cerebral blood flow analysis, when TL was compared with PL, both groups had common activation in the posterior parietal cortex and cerebellar hemispheres. Especially in the right lateral premotor cortex, PD patients showed enhanced activation induced by TL to a significantly greater degree than the controls. The present study indicates that the network dedicated to visuomotor control, particularly the lateral premotor cortex, plays an important role in the development of the paradoxical gait induced by special visual stimuli in PD patients.

Micrographia in Parkinson's disease: the effect of providing external cues

OBJECTIVE

To investigate whether micrographia in patients with Parkinson's disease is lessened either by giving visual targets or by continually reminding them that they should write with a normal amplitude.

METHODS

Eleven patients with Parkinson's disease (mean age 65.4 years) were compared with 14 control subjects (mean age 67.1 years). The subjects wrote with a stylus on a graphics tablet. There were three conditions: free writing, writing with dots to indicate the required size, and writing with continuous verbal reminders ("big"). Each condition was performed twice.

RESULTS

The patients wrote with a more normal amplitude when given either the visual cues or the auditory reminders. This improvement persisted when, shortly afterwards, the patients wrote freely without external cues. The increase in amplitude was achieved mainly by an increase in movement time rather than in peak velocity.

CONCLUSION

Whereas the visual cues directly specified the required amplitude the auditory reminders did not. One effect of external cues is that they draw attention to the goal, and thus encourage the patients to write less automatically.

Visuomotor functions of the lateral pre-motor cortex

Recent studies have provided new insights into the visuomotor functions of the dorsal and ventral regions of the lateral pre-motor cortex. Anatomical and physiological investigations in non-human primates have demonstrated that these regions have differing patterns of cortical connectivity and distinctive neuronal responses. Brain-imaging techniques and lesion studies have begun to probe the functions of homologous regions in humans.