Altered premotor cortical oscillations during repetitive movement in persons with Parkinson's disease

Characterizing neurocognitive impairments in Parkinson's disease with mobile EEG when walking and stepping over obstacles

The neural correlates that help us understand the challenges that Parkinson's patients face when negotiating their environment remain under-researched. This deficit in knowledge reflects the methodological constraints of traditional neuroimaging techniques, which include the need to remain still. As a result, much of our understanding of motor disorders is still based on animal models. Daily life challenges such as tripping and falling over obstacles represent one of the main causes of hospitalization for individuals with Parkinson's disease. Here, we report the neural correlates of naturalistic ambulatory obstacle avoidance in Parkinson's disease patients using mobile EEG. We examined 14 medicated patients with Parkinson's disease and 17 neurotypical control participants. Brain activity was recorded while participants walked freely, and while they walked and adjusted their gait to step over expected obstacles (preset adjustment) or unexpected obstacles (online adjustment) displayed on the floor. EEG analysis revealed attenuated cortical activity in Parkinson's patients compared to neurotypical participants in theta (4-7 Hz) and beta (13-35 Hz) frequency bands. The theta power increase when planning an online adjustment to step over unexpected obstacles was reduced in Parkinson's patients compared to neurotypical participants, indicating impaired proactive cognitive control of walking that updates the online action plan when unexpected changes occur in the environment. Impaired action planning processes were further evident in Parkinson's disease patients' diminished beta power suppression when preparing motor adaptation to step over obstacles, regardless of the expectation manipulation, compared to when walking freely. In addition, deficits in reactive control mechanisms in Parkinson's disease compared to neurotypical participants were evident from an attenuated beta rebound signal after crossing an obstacle. Reduced modulation in the theta frequency band in the resetting phase across conditions also suggests a deficit in the evaluation of action outcomes in Parkinson's disease. Taken together, the neural markers of cognitive control of walking observed in Parkinson's disease reveal a pervasive deficit of motor-cognitive control, involving impairments in the proactive and reactive strategies used to avoid obstacles while walking. As such, this study identified neural markers of the motor deficits in Parkinson's disease and revealed patients' difficulties in adapting movements both before and after avoiding obstacles in their path.

Rate control deficits during pinch grip and ankle dorsiflexion in early-stage Parkinson's disease

BACKGROUND

Much of our understanding of the deficits in force control in Parkinson's disease (PD) relies on findings in the upper extremity. Currently, there is a paucity of data pertaining to the effect of PD on lower limb force control.

OBJECTIVE

The purpose of this study was to concurrently evaluate upper- and lower-limb force control in early-stage PD and a group of age- and gender-matched healthy controls.

METHODS

Twenty individuals with PD and twenty-one healthy older adults participated in this study. Participants performed two visually guided, submaximal (15% of maximum voluntary contractions) isometric force tasks: a pinch grip task and an ankle dorsiflexion task. PD were tested on their more affected side and after overnight withdrawal from antiparkinsonian medication. The tested side in controls was randomized. Differences in force control capacity were assessed by manipulating speed-based and variability-based task parameters.

RESULTS

Compared with controls, PD demonstrated slower rates of force development and force relaxation during the foot task, and a slower rate of relaxation during the hand task. Force variability was similar across groups but greater in the foot than in the hand in both PD and controls. Lower limb rate control deficits were greater in PD with more severe symptoms based on the Hoehn and Yahr stage.

CONCLUSIONS

Together, these results provide quantitative evidence of an impaired capacity in PD to produce submaximal and rapid force across multiple effectors. Moreover, results suggest that force control deficits in the lower limb may become more severe with disease progression.

Clinical utility of paced finger tapping assessment in idiopathic normal pressure hydrocephalus

Background

The Finger Tapping (F-T) test is useful for assessing motor function of the upper limbs in patients with idiopathic normal pressure hydrocephalus (iNPH). However, quantitative evaluation of F-T for iNPH has not yet been established. The purpose of this study was to investigate the usefulness of the quantitative F-T test and optimal measurement conditions as a motor evaluation and screening test for iNPH.

Methods

Sixteen age-matched healthy controls (mean age 73 ± 5 years; 7/16 male) and fifteen participants with a diagnosis of definitive iNPH (mean age 76 ± 5 years; 8/15 male) completed the study (mean ± standard deviation). F-T performance of the index finger and thumb was quantified using a magnetic sensing device. The performance of repetitive F-T by participants was recorded in both not timing-regulated and timing-regulated conditions. The mean value of the maximum amplitude of F-T was defined as M-Amplitude, and the mean value of the maximum velocity of closure of F-T was defined as cl-Velocity.

Results

Finger Tapping in the iNPH group, with or without timing control, showed a decrease in M-Amplitude and cl-Velocity compared to the control group. We found the only paced F-T with 2.0 Hz auditory stimuli was found to improve both M-Amplitude and cl-Velocity after shunt surgery.

Conclusion

The quantitative assessment of F-T with auditory stimuli at the rate of 2.0 Hz may be a useful and potentially supplemental screening method for motor assessment in patients with iNPH.

Motor cortex excitability is reduced during freezing of upper limb movement in Parkinson's disease

Whilst involvement of the motor cortex in the phenomenon of freezing in Parkinson's disease has been previously suggested, few empiric studies have been conducted to date. We investigated motor cortex (M1) excitability in eleven right-handed Parkinson's disease patients (aged 69.7 ± 9.6 years, disease duration 11.2 ± 3.9 years, akinesia-rigidity type) with verified gait freezing using a single-pulse transcranial magnetic stimulation (TMS) repetitive finger tapping paradigm. We delivered single TMS pulses at 120% of the active motor threshold at the 'ascending (contraction)' and 'descending (relaxation)' slope of the tap cycle during i) regular tapping, ii) the transition period of the three taps prior to a freeze and iii) during freezing of upper limb movement. M1 excitability was modulated along the tap cycle with greater motor evoked potentials (MEPs) during 'ascending' than 'descending'. Furthermore, MEPs during the 'ascending' phase of regular tapping, but not during the transition period, were greater compared to the MEPs recorded throughout a freeze. Neither force nor EMG activity 10-110 s before the stimulus predicted MEP size. This piloting study suggests that M1 excitability is reduced during freezing and the transition period preceding a freeze. This supports that M1 excitability is critical to freezing in Parkinson's disease.

Finger tapping to different styles of music and changes in cortical oscillations

Music has been a therapeutic strategy proposed to improve impaired movement performance, but there remains a lack of understanding of how music impacts motor cortical activity. Thus, the purpose of this study is to use a time-frequency analysis (i.e., wavelet) of electroencephalographic (EEG) data to determine differences in motor and auditory cortical activity when moving to music at two different rates. Twenty healthy young adults tapped their index finger while electroencephalography was collected. There were three conditions (tapping in time with a tone and with two contrasting music styles), and each condition was repeated at two different rates (70 and 140 beats per minute). A time-frequency Morlet wavelet analysis was completed for electrodes of interest over the sensorimotor areas (FC3, FC4, FCz, C3, C4, Cz) and the primary auditory areas (T7, T8). Cluster-based permutation testing was applied to the electrodes of interest for all conditions. Results showed few differences between cortical oscillations when moving to music versus a tone. However, the two music conditions elicited a variety of distinct responses, particularly at the slower movement rate. These results suggest that music style and movement rate should be considered when designing therapeutic applications that include music to target motor performance.

Disruptions of cortico-kinematic interactions in Parkinson's disease

The cortical role of the motor symptoms reflected by kinematic characteristics in Parkinson's disease (PD) is poorly understood. In this study, we aim to explore how PD affects cortico-kinematic interactions. Electroencephalographic (EEG) and kinematic data were recorded from seven healthy participants and eight participants diagnosed with PD during a set of self-paced finger tapping tasks. Event-related desynchronization (ERD) was compared between groups in the α (8-14 Hz), low-ß (14-20 Hz), and high-ß (20-35 Hz) frequency bands to investigate between-group differences in the cortical activities associated with movement. Average kinematic peak amplitudes and latencies were extracted alongside Sample Entropy (SaEn), a measure of signal complexity, as variables for comparison between groups. These variables were further correlated with average EEG power in each frequency band to establish within-group interactions between cortical motor functions and kinematic motor output. High ß-band power correlated with mean kinematic peak latency and signal complexity in the healthy group, while no correlation was found in the PD group. Also, the healthy group demonstrated stronger ERD in the broad ß-band than the PD participants. Our results suggest that cortical ß-band power in healthy populations is graded to finger tapping latency and complexity of movement, but this relationship is impaired in PD. These insights could help further enhance our understanding of the role of cortical ß-band oscillations in healthy movement and the possible disruption of that relationship in PD. These outcomes can provide further directions for treatment and therapeutic applications and potentially establish cortical biomarkers of Parkinson's disease.

Mobile EEG reveals functionally dissociable dynamic processes supporting real-world ambulatory obstacle avoidance: Evidence for early proactive control

The ability to safely negotiate the world on foot takes humans years to develop, reflecting the extensive cognitive demands associated with real-time planning and control of walking. Despite the importance of walking, methodological limitations mean that surprisingly little is known about the neural and cognitive processes that support ambulatory motor control. Here, we report mobile EEG data recorded from 32 healthy young adults during real-world ambulatory obstacle avoidance. Participants walked along a path while stepping over expected and unexpected obstacles projected on the floor, allowing us to capture the dynamic oscillatory response to changes in environmental demands. Compared to obstacle-free walking, time-frequency analysis of the EEG data revealed clear neural markers of proactive and reactive forms of movement control (occurring before and after crossing an obstacle), visible as increases in frontal theta and centro-parietal beta power respectively. Critically, the temporal profile of changes in frontal theta allowed us to arbitrate between early selection and late adaptation mechanisms of proactive control. Our data show that motor plans are updated as soon as an upcoming obstacle appears, rather than when the obstacle is reached. In addition, regardless of whether motor plans required updating, a clear beta rebound was present after obstacles were crossed, reflecting the resetting of the motor system. Overall, mobile EEG recorded during real-world walking provides novel insight into the cognitive and neural basis of dynamic motor control in humans, suggesting new routes to the monitoring and rehabilitation of motor disorders such as dyspraxia and Parkinson's disease.

Transitions between repetitive tapping and upper limb freezing show impaired movement-related beta band modulation

OBJECTIVE

Freezing phenomena in idiopathic Parkinson's disease (PD) constitute an important unaddressed therapeutic need. Changes in cortical neurophysiological signatures may precede a single freezing episode and indicate the evolution of abnormal motor network processes. Here, we hypothesize that the movement-related power modulation in the beta-band observed during regular finger tapping, deteriorates in the transition period before upper limb freezing (ULF).

METHODS

We analyzed a 36-channel EEG of 13 patients with PD during self-paced repetitive tapping of the right index finger. In offline analysis, we compared the transition period immediately before ULF ('transition') with regular tapping regarding movement-related power modulation and interregional phase synchronization.

RESULTS

From time-frequency analyses, we observed that the tap cycle related beta-band power modulation over the left sensorimotor area was diminished in the transition period before ULF. Furthermore, increased beta-band power was observed in the transition period compared to regular tapping centered over the left centro-parietal and right frontal areas. Phase synchronization between the left fronto-parietal areas and the left sensorimotor area was elevated during transition compared to regular tapping.

CONCLUSION

Together, these results indicate that diminished beta band power modulation and increased phase synchronization precede ULF.

SIGNIFICANCE

We demonstrate that pathological cortical motor processing is present in the transition phase from regular tapping to an ULF episode.

Event-related desynchronization of alpha and beta band neural oscillations predicts speech and limb motor timing deficits in normal aging

Normal aging is associated with decline of motor timing mechanisms implicated in planning and execution of movement. Evidence from previous studies has highlighted the relationship between neural oscillatory activities and motor timing processing in neurotypical younger adults; however, it remains unclear how normal aging affects the underlying neural mechanisms of movement in older populations. In the present study, we recorded EEG activities in two groups of younger and older adults while they performed randomized speech and limb motor reaction time tasks cued by temporally predictable and unpredictable sensory stimuli. Our data showed that older adults were significantly slower than their younger counterparts during speech production and limb movement, especially in response to temporally unpredictable sensory stimuli. This behavioral effect was accompanied by significant desynchronization of alpha (7-12 Hz) and beta (13-25 Hz) band neural oscillatory activities in older compared with younger adults, primarily during the preparatory pre-motor phase of responses for speech production and limb movement. In addition, we found that faster motor reaction times in younger adults were significantly correlated with weaker desynchronization of pre-motor alpha and beta band neural activities irrespective of stimulus timing and response modality. However, the pre-motor components of alpha and beta activities were timing-specific in older adults and were more strongly desynchronized in response to temporally predictable sensory stimuli. These findings highlight the role of alpha and beta band neural oscillations in motor timing processing mechanisms and reflect their functional deficits during the planning phase of speech production and limb movement in normal aging.

Music Form but Not Music Experience Modulates Motor Cortical Activity in Response to Novel Music

External cues, such as music, improve movement performance in persons with Parkinson’s disease. However, research examining the motor cortical mechanisms by which this occurs is lacking. Research using electroencephalography in healthy young adults has revealed that moving to music can modulate motor cortical activity. Moreover, motor cortical activity is further influenced by music experience. It remains unknown whether these effects extend to corticomotor excitability. Therefore, the primary aim of this study was to determine the effects of novel music on corticomotor excitability using transcranial magnetic stimulation (TMS) in a pilot study of healthy young adults. A secondary aim of this study was to determine the influence of music experience on corticomotor excitability. We hypothesized that corticomotor excitability will change during music conditions, and that it will differ in those with formal music training. Motor evoked potentials (MEPs) were recorded from the first dorsal interosseous using single-pulse TMS in three conditions: (1) No Music, (2) Music Condition I, and (3) Music Condition II. Both pieces were set to novel MIDI piano instrumentation and part-writing conventions typical of early nineteenth-century Western classical practices. Results revealed Music Condition II (i.e., more relaxing music) compared to rest increased MEP amplitude (i.e., corticomotor excitability). Music Condition II as compared to Music Condition I (i.e., more activating music) reduced MEP variability (i.e., corticomotor variability). Finally, years of formal music training did not significantly influence corticomotor excitability while listening to music. Overall, results revealed that unfamiliar music modulates motor cortical excitability but is dependent upon the form of music and possibly music preference. These results will be used to inform planned studies in healthy older adults and people with Parkinson’s disease.

Repetitive finger movement and circle drawing in persons with Parkinson's disease

Little is known regarding how repetitive finger movement performance impacts other fine motor control tasks, such as circle drawing, in persons with Parkinson's disease (PD). Previous research has shown that impairments in repetitive finger movements emerge at rates near to and above 2 Hz in most persons with PD. Thus, the purpose of this study was to compare circle drawing performance in persons with PD that demonstrate impairment in repetitive finger movement and those that do not. Twenty-two participants with PD and twelve healthy older adults completed the study. Only participants with PD completed the repetitive finger movement task. From the kinematic data for the repetitive finger movement task, participants were grouped into Hasteners and Non-Hasteners. Participants with PD and the healthy older adults completed a series of circle drawing tasks at two different target sizes (1 cm and 2 cm) and three pacing conditions (Self-paced, 1.25 Hz, and 2.5 Hz). Kinematic and electromyography data were recorded and compared between groups. Results revealed that, in general, persons with PD demonstrate impairments in circle drawing and associated electromyography activity compared to healthy older adults. Moreover, persons with PD that hasten during repetitive finger movements demonstrate significantly increased movement rate during circle drawing, while those persons with PD that do not hasten demonstrate a significant increase in width variability. This suggests that differing motor control mechanisms may play a role in the performance of fine motor tasks in persons with PD. Continued research is needed to better understand differences in circle drawing performance among persons with PD to inform future development of patient-centered treatments.

Influence of Music Style and Rate on Repetitive Finger Tapping

Auditory cues, including music, are commonly used in the treatment of persons with Parkinson's disease. Yet, how music style and movement rate modulate movement performance in persons with Parkinson's disease have been neglected and remain limited in healthy young populations. The purpose of this study was to determine how music style and movement rate influence movement performance in healthy young adults. Healthy participants were asked to perform repetitive finger movements at two pacing rates (70 and 140 beats per minute) for the following conditions: (a) a tone only, (b) activating music, and (c) relaxing music. Electromyography, movement kinematics, and variability were collected. Results revealed that the provision of music, regardless of style, reduced amplitude variability at both pacing rates. Intermovement interval was longer, and acceleration variability was reduced during both music conditions at the lower pacing rate only. These results may prove beneficial for designing therapeutic interventions for persons with Parkinson's disease.

The influence of moving with music on motor cortical activity

Although there is a growing interest in using music to improve movement performance in various populations, there remains a need to better understand how music influences motor cortical activity. Listening to music is tightly linked to neural processes within the motor cortex and can modulate motor cortical activity in healthy young adult (HYAs). There is limited evidence regarding how moving to music modulates motor cortical activity. Thus, the purpose of this study was to explore the influence of moving to music on motor cortical activity in HYAs. Electroencephalography was collected while 32 HYAs tapped their index finger in time with a tone and with two contrasting music styles. Two movement rates were presented for each condition. Power spectra were obtained from data collected over the primary sensorimotor region and supplemental motor area and were compared between conditions. Results revealed a significant difference between both music conditions and the tone only condition for both the regions. For both music styles, power was increased in the beta band for low movement rates and increased in the alpha band for high movement rates. A secondary analysis determining the effect of music experience on motor cortical activity revealed a significant difference between musicians and non-musicians. Power in the beta band was increased across all conditions. The results of this study provide the initial step towards a more complete understanding of the neurophysiological underpinnings of music on movement performance which may inform future studies and therapeutic strategies.