Deficits in adaptive upper limb control in response to trunk perturbations in Parkinson's disease

Spatial-orientation priming impedes rather than facilitates the spontaneous control of hand-retraction speeds in patients with Parkinson's disease

Background

Often in Parkinson’s disease (PD) motor-related problems overshadow latent non-motor deficits as it is difficult to dissociate one from the other with commonly used observational inventories. Here we ask if the variability patterns of hand speed and acceleration would be revealing of deficits in spatial-orientation related decisions as patients performed a familiar reach-to-grasp task. To this end we use spatial-orientation priming which normally facilitates motor-program selection and asked whether in PD spatial-orientation priming helps or hinders performance.

Methods

To dissociate spatial-orientation- and motor-related deficits participants performed two versions of the task. The biomechanical version (DEFAULT) required the same postural- and hand-paths as the orientation-priming version (primed-UP). Any differences in the patients here could not be due to motor issues as the tasks were biomechanically identical. The other priming version (primed-DOWN) however required additional spatial and postural processing. We assessed in all three cases both the forward segment deliberately aimed towards the spatial-target and the retracting segment, spontaneously bringing the hand to rest without an instructed goal.

Results and Conclusions

We found that forward and retracting segments belonged in two different statistical classes according to the fluctuations of speed and acceleration maxima. Further inspection revealed conservation of the forward (voluntary) control of speed but in PD a discontinuity of this control emerged during the uninstructed retractions which was absent in NC. Two PD groups self-emerged: one group in which priming always affected the retractions and the other in which only the more challenging primed-DOWN condition was affected. These PD-groups self-formed according to the speed variability patterns, which systematically changed along a gradient that depended on the priming, thus dissociating motor from spatial-orientation issues. Priming did not facilitate the motor task in PD but it did reveal a breakdown in the spatial-orientation decision that was independent of the motor-postural path.

Basal ganglia contribution to the initiation of corrective submovements

We investigated the neural processes, with a focus on subcortical circuits, which govern corrective submovements in visually targeted action. During event-related fMRI, subjects moved a cursor to capture targets presented at varying movement amplitudes. Movements were performed in a rehearsed null and a novel viscous (25% random trials) torque field. Movement error feedback was provided after each trial. The viscous field invoked a significantly larger error at the end of the primary movement. Subjects compensated by producing more corrections than they had in the null condition. Corrective submovements were appropriately scaled such that terminal error was similar between the two conditions. Parametric analysis identified two regions where the BOLD signal correlated with the number of submovements per trial: a cerebellar region similar to the one noted in the task contrast and the contralateral dorsal putamen. A separate parametric analysis identified brain regions where activity correlated with movement amplitude. This identified the same cerebellar region as above, bilateral parietal cortex, and left motor and premotor cortex. Our data indicate that the basal ganglia and cerebellum play complementary roles in regulating ongoing actions when precise updating is required. The basal ganglia have a key role in contextually-based motor decision-making, i.e. for deciding if and when to correct a given movement by initiating corrective submovements, and the cerebellum is more generally involved in amplifying and refining the command signals for movements of different amplitudes.

On-line corrections for visuomotor errors

This study was designed to determine how visual feedback mediates error corrections during reaching. We used visuomotor rotations to dissociate a cursor, representing finger position, from the actual finger location. We then extinguished cursor feedback at different distances from the start location to determine whether corrections were based on error extrapolation from prior cursor information. Results indicated that correction amplitude varied with the extent of cursor feedback. A second experiment tested specific aspects of error information that might mediate corrections to visuomotor rotations: rotation angle, distance between the finger and cursor positions and the duration of cursor exposure. Results showed that corrections did not depend on the amplitude of the rotation angle or the amount of time the cursor was shown. Instead, participants corrected for the cursor-finger distance, at the point where cursor feedback was last-seen. These findings suggest that within-trial corrections and inter-trial adaptation might employ different mechanisms.

Validation studies of the human movement analysis panel for hand/arm performance

The human movement analysis panel (HMAP) measures separable components of arm motion and simple and complex finger coordination. HMAP testing takes 30min to administer. In separate experiments we have validated the HMAP against the standard grooved pegboard and measures of gait speed, and demonstrated important learning effects over both short durations of days, and longer intervals of months to years in normal subjects of different ages. Stepwise regression demonstrated the strongest correlation between the HMAP complex motor times and pegboard both-hand removal (R(2)=0.52, p=0.002 for dominant and R(2)=0.33, p=0.02 for non-dominant hands). The most consistent and sensitive measure of HMAP motor performance overall was the complex motor time. The HMAP is a short-duration, easily administered, objective quantitative test of motor function, with potential applications in aging, and in Parkinson's Disease and related motor disorders. The HMAP has a smaller version used in primates, so that measurements made in primate models of disease and its treatment are directly comparable to analogous clinical measurements made in the corresponding human disease.

Dopamine replacement therapy does not restore the ability of Parkinsonian patients to make rapid adjustments in motor strategies according to changing sensorimotor contexts

The ability of dopamine replacement to restore rapid motor adjustments in Parkinson's disease (PD) was investigated. Medicated and non-medicated patients performed finger-to-nose movements while simultaneously bending the trunk forward, without vision. Trunk motion was blocked unexpectedly, necessitating rapid adjustments in arm trajectories. Patients exhibited irregular hand paths, plateaus in hand velocity, and prolonged movement times, which were significantly greater in perturbed trials. Medication improved kinematics but perturbation-induced disturbances persisted and did not approximate the levels of non-perturbed trials nor those of controls. Dopaminergic replenishment in PD may therefore have limited restorative benefits for rapid context-specific motor control.