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

The coin rotation test: a reliable and valid test in people with Parkinson's disease

PURPOSE

To investigate: (1) the interrater, and test-retest reliability of the coin rotation test (CRT) in people with Parkinson's Disease (PwPD); (2) the minimum detectable change in the CRT; (3) the concurrent and known-groups validity of the CRT; and (4) the cut-off times that best discriminate PwPD from healthy people and functionally dependent PwPD from functionally independent PwPD.

METHOD

Forty-eight PwPD and 33 healthy people were included. The CRT was administered with the nine-hole peg test, Movement Disorders Society Sponsored Unified Parkinson's Disease Rating Scale, Hoehn and Yahr Scale, Parkinson's Disease Questionnaire-8, and Schwab and England Scale.

RESULTS

The CRT had excellent interrater and test-retest reliability. Minimal detectable changes were 5.96 and 8.23 s for the dominant and non-dominant hand, respectively. The CRT correlated with other outcome measures. Significant differences in the CRT times were found between PwPD and healthy people, and between functionally dependent PwPD and functionally independent PwPD. The cut-off times of 12.66 s on the dominant hand and 15.76 s on the non-dominant best discriminated PwPD from healthy people, while 22.99 s on the dominant hand and 23.48 s on the non-dominant best discriminated functionally dependent PwPD from functionally independent PwPD.

CONCLUSIONS

The CRT is a reliable, and clinically available tool for assessing manual dexterity in PwPD.Implications for rehabilitationThe coin rotation test is a reliable, valid, and clinically available tool for assessing manual dexterity in Parkinson's Disease.The minimal detectable changes of the coin rotation test are 5.96 s for dominant hand and 8.23 s for the non-dominant hand, which may useful for clinicians and researchers to detect in any true change in manual dexterity after any intervention.The coin rotation test correlated with Parkinson's Disease-specific measurement tools.The coin rotation test times may detect impaired manual dexterity between people with Parkinson's Disease and healthy people, and between functionally dependent and functionally independent in Parkinson's Disease population.

Reaching and Grasping Movements in Parkinson's Disease: A Review

Parkinson's disease (PD) is known to affect the brain motor circuits involving the basal ganglia (BG) and to induce, among other signs, general slowness and paucity of movements. In upper limb movements, PD patients show a systematic prolongation of movement duration while maintaining a sufficient level of endpoint accuracy. PD appears to cause impairments not only in movement execution, but also in movement initiation and planning, as revealed by abnormal preparatory activity of motor-related brain areas. Grasping movement is affected as well, particularly in the coordination of the hand aperture with the transport phase. In the last fifty years, numerous behavioral studies attempted to clarify the mechanisms underlying these anomalies, speculating on the plausible role that the BG-thalamo-cortical circuitry may play in normal and pathological motor control. Still, many questions remain open, especially concerning the management of the speed-accuracy tradeoff and the online feedback control. In this review, we summarize the literature results on reaching and grasping in parkinsonian patients. We analyze the relevant hypotheses on the origins of dysfunction, by focusing on the motor control aspects involved in the different movement phases and the corresponding role played by the BG. We conclude with an insight into the innovative stimulation techniques and computational models recently proposed, which might be helpful in further clarifying the mechanisms through which PD affects reaching and grasping movements.

Impaired reach-to-grasp kinematics in parkinsonian patients relates to dopamine-dependent, subthalamic beta bursts

Excessive beta-band oscillations in the subthalamic nucleus are key neural features of Parkinson’s disease. Yet the distinctive contributions of beta low and high bands, their dependency on striatal dopamine, and their correlates with movement kinematics are unclear. Here, we show that the movement phases of the reach-to-grasp motor task are coded by the subthalamic bursting activity in a maximally-informative beta high range. A strong, three-fold correlation linked beta high range bursts, imbalanced inter-hemispheric striatal dopaminergic tone, and impaired inter-joint movement coordination. These results provide new insight into the neural correlates of motor control in parkinsonian patients, paving the way for more informative use of beta-band features for adaptive deep brain stimulation devices.

Anxiety and cognitive load affect upper limb motor control in Parkinson's disease during medication phases

Anxiety is among the most debilitating nonmotor symptoms of Parkinson's disease (PD). This study aimed to determine how PD patients with low and high levels of anxiety (LA-PD and HA-PD, respectively) compare with age- and sex-matched controls at the level of motor control of reach-to-grasp movements during single- and dual-task conditions with varying complexity. Reach-to-grasp movement kinematics were assessed in 20 LA-PD, 20 HA-PD, and 20 sex- and age-matched healthy controls under single- as well as easy and difficult dual-task conditions. Assessment of PD patients was performed during both the on- and off-drug phases. The results obtained during dual-task conditions reveal deficits in both reach and grasp components for all three groups (e.g., decreased peak velocity and delayed maximum hand opening). However, these deficits were significantly greater in the PD groups, especially in the HA-PD group. Although dopaminergic medication improved reach kinematics, it had no effect on grasp kinematics. The results of our study indicated that high levels of anxiety may enhance the inefficiency of upper limb motor control in PD patients, especially during high demanding cognitive conditions, and should, therefore, be considered in the assessment and planning of interventions for upper limb function in these patients.

Altered Recruitment of Motor Cortex Neuronal Activity During the Grasping Phase of Skilled Reaching in a Chronic Rat Model of Unilateral Parkinsonism

Parkinson's disease causes prominent difficulties in the generation and execution of voluntary limb movements, including regulation of distal muscles and coordination of proximal and distal movement components to achieve accurate grasping. Difficulties with manual dexterity have a major impact on activities of daily living. We used extracellular single neuron recordings to investigate the neural underpinnings of parkinsonian movement deficits in the motor cortex of chronic unilateral 6-hydroxydopamine lesion male rats performing a skilled reach-to-grasp task the. Both normal movements and parkinsonian deficits in this task have striking homology to human performance. In lesioned animals there were several differences in the activity of cortical neurons during reaches by the affected limb compared with control rats. These included an increase in proportions of neurons showing rate decreases, along with increased amplitude of their average rate-decrease response at specific times during the reach, suggesting a shift in the balance of net excitation and inhibition of cortical neurons; a significant increase in the duration of rate-increase responses, which could result from reduced coupling of cortical activity to specific movement components; and changes in the timing and incidence of neurons with pure rate-increase or biphasic responses, particularly at the end of reach when grasping would normally be occurring. The changes in cortical activity may account for the deficits that occur in skilled distal motor control following dopamine depletion, and highlight the need for treatment strategies targeted toward modulating cortical mechanisms for fine distal motor control in patients.SIGNIFICANCE STATEMENT We show for the first time in a chronic lesion rat model of Parkinson's disease movement deficits that there are specific changes in motor cortex neuron activity associated with the grasping phase of a skilled motor task. Such changes provide a possible mechanism underpinning the problems with manual dexterity seen in Parkinson's patients and highlight the need for treatment strategies targeted toward distal motor control.

Reliability, validity and responsiveness of the squares test for manual dexterity in people with Parkinson's disease

OBJECTIVE

Impaired manual dexterity is one of the major disorder in people with Parkinson's Disease (PwPD). However, there is limited research examining the measurement properties, especially the validity and responsiveness of the tools used to assess manual dexterity. The aim of this study was to examine reliability, validity, and responsiveness of the Squares Test (ST) in PwPD.

PATIENTS AND METHODS

Fifty-seven PwPD and 50 healthy people, all of whom were right-handed, were recruited. The ST, Nine-Hole Peg Test, Unified Parkinson's Disease Rating Scale (UPDRS), and Hoehn and Yahr scale were performed in ON state. For responsiveness analysis, the ST and UPDRS motor score (UPDRS-III) were also performed in OFF state.

RESULTS

The ST showed excellent test-retest reliability. The ST was found to correlate significantly with other outcome measures, which indicated good concurrent validity. PwPD demonstrated significantly lower scores of the ST than healthy people, which demonstrated satisfactory known-groups validity. The ST had excellent discriminant validity. The ST scores of 52 for more affected hand and 62 for less affected hand were shown to best discriminate between PwPD and healthy people. The ST is high internal responsiveness based on standardized effect size and standardized response mean (0.79 and 1.88, respectively for more affected hand and 0.85 and 1.83, respectively for less affected hand), and also PwPD had better performance based on the ST in ON state than in OFF state (p < 0.001 for both hands). Moderate correlations were found between the change scores of the ST and UPDRS-III, which reflected adequate external responsiveness.

CONCLUSIONS

The ST is a reliable, valid and responsive measurement tool for assessing manual dexterity in PwPD.

Fine Motor Function Skills in Patients with Parkinson Disease with and without Mild Cognitive Impairment

AIMS

The objective of this study was to investigate the relation between impaired fine motor skills in Parkinson disease (PD) patients and their cognitive status, and to determine whether fine motor skills are more impaired in PD patients with mild cognitive impairment (MCI) than in non-MCI patients.

METHODS

Twenty PD MCI and 31 PD non-MCI patients (mean age 66.7 years, range 50-84, 36 males/15 females), all right-handed, took part in a motor performance test battery. Steadiness, precision, dexterity, velocity of arm-hand movements, and velocity of wrist-finger movements were measured and compared across groups and analyzed for confounders (age, sex, education, severity of motor symptoms, and disease duration). Statistical analysis included t tests corrected for multiple testing, and a linear regression with stepwise elimination procedure was used to select significant predictors for fine motor function.

RESULTS

PD MCI patients performed significantly worse in precision (p < 0.05), dexterity (p < 0.05), and velocity (arm-hand movements; p < 0.05) compared to PD non-MCI patients. The fine motor function skills were confounded by age.

CONCLUSIONS

Fine motor skills in PD MCI patients are impaired compared to PD non-MCI patients. Investigating the relation between the fine motor performance and MCI in PD might be a relevant subject for future research.

Earlier and greater hand pre-shaping in the elderly: a study based on kinematic analysis of reaching movements to grasp objects

BACKGROUND

Elderly people are less able to manipulate objects skilfully than young adults. Although previous studies have examined age-related deterioration of hand movements with a focus on the phase after grasping objects, the changes in the reaching phase have not been studied thus far. We aimed to examine whether changes in hand shape patterns during the reaching phase of grasping movements differ between young adults and the elderly.

METHODS

Ten healthy elderly adults and 10 healthy young adults were examined using the Simple Test for Evaluating Hand Functions and kinetic analysis of hand pre-shaping reach-to-grasp tasks. The results were then compared between the two groups. For kinetic analysis, we measured the time of peak tangential velocity of the wrist and the inter-fingertip distance (the distance between the tips of the thumb and index finger) at different time points.

RESULTS

The results showed that the elderly group's performance on the Simple Test for Evaluating Hand Functions was significantly lower than that of the young adult group, irrespective of whether the dominant or non-dominant hand was used, indicating deterioration of hand movement in the elderly. The peak tangential velocity of the wrist in either hand appeared significantly earlier in the elderly group than in the young adult group. The elderly group also showed larger inter-fingertip distances with arch-like fingertip trajectories compared to the young adult group for all object sizes.

CONCLUSIONS

To perform accurate prehension, elderly people have an earlier peak tangential velocity point than young adults. This allows for a longer adjustment time for reaching and grasping movements and for reducing errors in object prehension by opening the hand and fingers wider. Elderly individuals gradually modify their strategy based on previous successes and failures during daily living to compensate for their decline in dexterity and operational capabilities.

Fast Detector/First Responder: Interactions between the Superior Colliculus-Pulvinar Pathway and Stimuli Relevant to Primates

Primates are distinguished from other mammals by their heavy reliance on the visual sense, which occurred as a result of natural selection continually favoring those individuals whose visual systems were more responsive to challenges in the natural world. Here we describe two independent but also interrelated visual systems, one cortical and the other subcortical, both of which have been modified and expanded in primates for different functions. Available evidence suggests that while the cortical visual system mainly functions to give primates the ability to assess and adjust to fluid social and ecological environments, the subcortical visual system appears to function as a rapid detector and first responder when time is of the essence, i.e., when survival requires very quick action. We focus here on the subcortical visual system with a review of behavioral and neurophysiological evidence that demonstrates its sensitivity to particular, often emotionally charged, ecological and social stimuli, i.e., snakes and fearful and aggressive facial expressions in conspecifics. We also review the literature on subcortical involvement during another, less emotional, situation that requires rapid detection and response-visually guided reaching and grasping during locomotion-to further emphasize our argument that the subcortical visual system evolved as a rapid detector/first responder, a function that remains in place today. Finally, we argue that investigating deficits in this subcortical system may provide greater understanding of Parkinson's disease and Autism Spectrum disorders (ASD).

Use of Jebsen Taylor Hand Function Test in evaluating the hand dexterity in people with Parkinson's disease

OBJECTIVES

To investigate the test-retest reliability of JTT in older patients with Parkinson's disease (PD); and to compare the Jebsen Taylor Hand Function Test (JTT) scores between PD and healthy subjects.

STUDY DESIGN

Cross-sectional comparative study.

METHODS

Fifteen PD and fifteen healthy subjects performed the JTT and the time taken to complete the JTT was recorded.

RESULTS

Test-retest reliabilities of JTT subtests and total score of both dominant and non-dominant hand were good to excellent (ICCs = 0.77-0.97) except J5 checkers which had moderate reliability. PD subjects required significantly longer time to finish subtests and the whole JTT (p < 0.05), except the subtest J1 writing of dominant hand that showed marginal significance (p = 0.059).

CONCLUSION

JTT is a reliable and easily available assessment tool for assessing the hand function of PD subjects. PD subjects took a longer time to complete the JTT, suggesting that they have deficits in gross and fine functional dexterity.

Effects of a Single Hand-Exercise Session on Manual Dexterity and Strength in Persons with Parkinson Disease: A Randomized Controlled Trial

OBJECTIVE

To evaluate the effects on manual dexterity, hand grip, and pinch strength of a single intervention focused on hand exercises.

DESIGN

Randomized, controlled, blinded study.

PATIENTS

Sixty people with Parkinson disease (PD) were recruited; 30 participants were allocated to a brief exercise session and 30 to a control group.

INTERVENTIONS

Participants randomized to the experimental group received a 15-minute exercise session focused on hand training using therapeutic putty. Participants allocated to the control group performed active upper limb exercises.

MAIN OUTCOME MEASUREMENTS

Measures of manual dexterity (assessed by the Purdue Pegboard Test and the Chessington Occupational Therapy Neurologic Assessment Battery dexterity task) and strength (hand grip and pinch strength) were recorded at baseline and after the intervention.

RESULTS

Participants had significantly improved manual dexterity values (P < .05) after the intervention. They also had increased hand grip (P < .001) and pinch strength (P < .05).

CONCLUSIONS

A single hand-exercise session showed an improvement in manual dexterity and strength in persons with PD.

Predicting object size from hand kinematics: a temporal perspective

Research on reach-to-grasp movements generally concentrates on kinematics values that are expression of maxima, in particular the maximum aperture of the hand and the peak of wrist velocity. These parameters provide a snapshot description of movement kinematics at a specific time point during reach, i.e., the maximum within a set of value, but do not allow to investigate how hand kinematics gradually conform to target properties. The present study was designed to extend the characterization of object size effects to the temporal domain. Thus, we computed the wrist velocity and the grip aperture throughout reach-to-grasp movements aimed at large versus small objects. To provide a deeper understanding of how joint movements varied over time, we also considered the time course of finger motion relative to hand motion. Results revealed that movement parameters evolved in parallel but at different rates in relation to object size. Furthermore, a classification analysis performed using a Support Vector Machine (SVM) approach showed that kinematic features taken as a group predicted the correct target size well before contact with the object. Interestingly, some kinematics features exhibited a higher ability to discriminate the target size than others did. These findings reinforce our knowledge about the relationship between kinematics and object properties and shed new light on the quantity and quality of information available in the kinematics of a reach-to-grasp movement over time. This might have important implications for our understanding of the action-perception coupling mechanism.

Scaling and coordination deficits during dynamic object manipulation in Parkinson's disease

The ability to reach for and dynamically manipulate objects in a dexterous fashion requires scaling and coordination of arm, hand, and fingertip forces during reach and grasp components of this behavior. The neural substrates underlying dynamic object manipulation are not well understood. Insight into the role of basal ganglia-thalamocortical circuits in object manipulation can come from the study of patients with Parkinson's disease (PD). We hypothesized that scaling and coordination aspects of motor control are differentially affected by this disorder. We asked 20 PD patients and 23 age-matched control subjects to reach for, grasp, and lift virtual objects along prescribed paths. The movements were subdivided into two types, intensive (scaling) and coordinative, by detecting their underlying self-similarity. PD patients off medication were significantly impaired relative to control subjects for both aspects of movement. Intensive deficits, reduced peak speed and aperture, were seen during the reach. Coordinative deficits were observed during the reach, namely, the relative position along the trajectory at which peak speed and aperture were achieved, and during the lift, when objects tilted with respect to the gravitational axis. These results suggest that basal ganglia-thalamocortical circuits may play an important role in fine motor coordination. Dopaminergic therapy significantly improved intensive but not coordinative aspects of movements. These findings are consistent with a framework in which tonic levels of dopamine in the dorsal striatum encode the energetic cost of a movement, thereby improving intensive or scaling aspects of movement. However, repletion of brain dopamine levels does not restore finely coordinated movement.

Parkinson's disease patients show impaired corrective grasp control and eye-hand coupling when reaching to grasp virtual objects

The effect of Parkinson's disease (PD) on hand-eye coordination and corrective response control during reach-to-grasp tasks remains unclear. Moderately impaired PD patients (n=9) and age-matched controls (n=12) reached to and grasped a virtual rectangular object, with haptic feedback provided to the thumb and index fingertip by two 3-degree of freedom manipulanda. The object rotated unexpectedly on a minority of trials, requiring subjects to adjust their grasp aperture. On half the trials, visual feedback of finger positions disappeared during the initial phase of the reach, when feedforward mechanisms are known to guide movement. PD patients were tested without (OFF) and with (ON) medication to investigate the effects of dopamine depletion and repletion on eye-hand coordination online corrective response control. We quantified eye-hand coordination by monitoring hand kinematics and eye position during the reach. We hypothesized that if the basal ganglia are important for eye-hand coordination and online corrections to object perturbations, then PD patients tested OFF medication would show reduced eye-hand spans and impoverished arm-hand coordination responses to the perturbation, which would be further exasperated when visual feedback of the hand was removed. Strikingly, PD patients tracked their hands with their gaze, and their movements became destabilized when having to make online corrective responses to object perturbations exhibiting pauses and changes in movement direction. These impairments largely remained even when tested in the ON state, despite significant improvement on the Unified Parkinson's Disease Rating Scale. Our findings suggest that basal ganglia-cortical loops are essential for mediating eye-hand coordination and adaptive online responses for reach-to-grasp movements, and that restoration of tonic levels of dopamine may not be adequate to remediate this coordinative nature of basal ganglia-modulated function.

The organization of digit contact timing during grasping

While the process of hand preshaping during grasping has been studied for over a decade, there is relatively little information regarding the organization of digit contact timing (DCT). This dearth of information may be due to the assumption that DCT while grasping exhibits few regularities or to the difficulty in obtaining information through traditional movement recording techniques. In this study, we employed a novel technique to determine the time of digit contacts with the target object at a high precision rate in normal healthy participants. Our results indicate that, under our task conditions, subjects tend to employ a radial to ulnar pattern of DCT which may be modulated by the shape of the target object. Moreover, a number of parameters, such as the total contact time, the frequency of first contacts by the thumb and index fingers and the number of simultaneous contacts, are affected by the relative complexity of the target object. Our data support the notion that a great deal of information about the object's physical features is obtained during the early moments of the grasp.

Neural bases of hand synergies

The human hand has so many degrees of freedom that it may seem impossible to control. A potential solution to this problem is “synergy control” which combines dimensionality reduction with great flexibility. With applicability to a wide range of tasks, this has become a very popular concept. In this review, we describe the evolution of the modern concept using studies of kinematic and force synergies in human hand control, neurophysiology of cortical and spinal neurons, and electromyographic (EMG) activity of hand muscles. We go beyond the often purely descriptive usage of synergy by reviewing the organization of the underlying neuronal circuitry in order to propose mechanistic explanations for various observed synergy phenomena. Finally, we propose a theoretical framework to reconcile important and still debated concepts such as the definitions of “fixed” vs. “flexible” synergies and mechanisms underlying the combination of synergies for hand control.

Classification of hand preshaping in persons with stroke using Linear Discriminant Analysis

OBJECTIVE

This study describes the analysis of hand preshaping using Linear Discriminant Analysis (LDA) to predict hand formation during reaching and grasping tasks of the hemiparetic hand, following a series of upper extremity motor intervention treatments. The purpose of this study is to use classification of hand posture as an additional tool for evaluating the effectiveness of therapies for upper extremity rehabilitation such as virtual reality (VR) therapy and conventional physical therapy. Classification error for discriminating between two objects during hand preshaping is obtained for the hemiparetic and unimpaired hands pre and post training.

METHODS

Eight subjects post stroke participated in a two-week training session consisting of upper extremity motor training. Four subjects trained with interactive VR computer games and four subjects trained with clinical physical therapy procedures of similar intensity. Subjects' finger joint angles were measured during a kinematic reach to grasp test using CyberGlove® and arm joint angles were measured using the trackSTAR™ system prior to training and after training.

RESULTS

The unimpaired hand of subjects preshape into the target object with greater accuracy than the hemiparetic hand as indicated by lower classification errors. Hemiparetic hand improved in preshaping accuracy and time to reach minimum error.

CONCLUSION

Classification of hand preshaping may provide insight into improvements in motor performance elicited by robotically facilitated virtually simulated training sessions or conventional physical therapy.

Assessment of reach-to-grasp trajectories toward stationary objects

BACKGROUND

Patients with pronounced spasticity reveal difficulties in hand opening during the approaching grasping phase. The general description and assessment procedures of reach-to-grasp movement for rehabilitation purposes is still not established. There is a necessity to develop a universal methodology to describe the approaching phase in grasping which would allow clinical evaluation of movement pathologies.

METHODS

In the paper, the evaluation of approaching trajectories assessed during grasping by healthy subjects is described. The experiment, undertaken by 7 healthy volunteers, consisted of grasping three different stationary objects positioned in various poses by a robot. 3D recordings of the hand and fingertip trajectories were performed. The kinematic trajectories of the hand and finger markers were analysed in order to evaluate the reach-to-grasp movement.

FINDINGS

The results of the kinematic analysis suggest that the reach-to-grasp movement of a healthy subject can be divided into 3 dominant phases (hand acceleration, hand deceleration, and final closure of the fingers).

INTERPRETATION

The presented evaluation method can provide relevant information on the modalities the hand preshapes and approaches toward the object in order to obtain a stable grasp. The potential use of the approach for rehabilitation purposes is discussed.

Attention and reach-to-grasp movements in Parkinson's disease

The role of attention in grasping movements directed at common objects has not been examined in Parkinson's disease (PD), though these movements are critical to activities of daily living. Our primary objective was to determine whether patients with PD demonstrate automaticity in grasping movements directed toward common objects. Automaticity is assumed when tasks can be performed with little or no interference from concurrent tasks. Grasping performance in three patient groups (newly diagnosed, moderate, and advanced/surgically treated PD) on and off of their medication or deep brain stimulation was compared to performance in an age-matched control group. Automaticity was demonstrated by the absence of a decrement in grasping performance when attention was consumed by a concurrent spatial-visualization task. Only the control group and newly diagnosed PD group demonstrated automaticity in their grasping movements. The moderate and advanced PD groups did not demonstrate automaticity. Furthermore, the well-known effects of pharmacotherapy and surgical intervention on movement speed and muscle activation patterns did not appear to reduce the impact of attention-demanding tasks on grasping movements in those with moderate to advanced PD. By the moderate stage of PD, grasping is an attention-demanding process; this change is not ameliorated by dopaminergic or surgical treatments. These findings have important implications for activities of daily living, as devoting attention to the simplest of daily tasks would interfere with complex activities and potentially exacerbate fatigue.

Deep brain stimulation of the subthalamic nucleus facilitates coordination of hand preshaping in Parkinson's disease

Several studies have found that Parkinson's disease (PD) disrupts the organization of complex motor sequences regardless of the influence of parkinsonian medications. A clear candidate for the neural bases of such deficits, which we term "coordinative," is the failure to integrate propioceptive and visual information by cortico-striatal circuits in a timed fashion. Recent reports, however, have indicated that deep-brain stimulation of the subthalamic nucleus (STN DBS) may result in an improvement in coordinative deficits beyond the amelioration of "intensive deficits" such as bradykinesia and scaling errors. The present study examined the spatio-temporal organization underlying the shaping of the hand during reaching to grasp objects differing in shape. Six PD patients ON and OFF their STN DBS when OFF their concomitant medications and six age-matched controls participated in this study. STN DBS improved the coordination involved in preshaping the hand while grasping. We discuss these results in light of our earlier work with PD patients on and off dopamine replacement therapy.

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.

Changes of procedural learning in Chinese patients with non-demented Parkinson disease

To study procedural learning changes in patients with non-demented Parkinson disease (PD) but without depression. The Nissen serial reaction time task (SRTT) software version II (as a task of procedural learning), the Wechsler Memory Scale-Chinese version (WMS-CR), and two tasks of implicit memory were applied to 20 PD patients with a Hoehn-Yahr score at I-II degrees and 20 matched healthy controls were enrolled for the Nissen Version test. In the explicit WMS-CR and the implicit (word stem completion and degraded picture naming) tasks, the patients' scores fell within normal limits. In the SRTT, healthy controls displayed significantly reduced response times and error rates across the blocks of repeated sequence trials. In contrast, PD patients only showed a reduction in error rates but no change in response times. Impairment of nigrostriatal pathways selectively affects the performance in visuo-motor learning tasks such as the SRTT, but not in both the explicit tasks of WMS-CR and the implicit tasks.

Impaired anticipatory control of force sharing patterns during whole-hand grasping in Parkinson's disease

We examined the coordination of multi-digit grasping forces as they developed during object grasping and lifting. Ten subjects with Parkinson's disease (PD; OFF and ON medication) and ten healthy age-matched control subjects lifted a manipulandum that measured normal forces at each digit and the manipulandum's position. The center of mass (CM) was changed from trial to trial in either a predictable (blocked) or unpredictable (random) order. All subjects modulated individual fingertip forces to counterbalance forces exerted by the thumb and minimize object tilt after lift-off. However, subjects with PD OFF exhibited an impaired ability to use anticipatory mechanisms resulting in less differentiated scaling of individual finger forces to the object CM location. Remarkably, these between-group differences in force modulation dissipated as subjects reached peak grip forces during object lift, although these occurred significantly later in subjects with PD OFF than controls and PD ON. Analysis of the tilt of the object during lift revealed all subjects had similar deviations of the object from the vertical, the direction of which depended on CM location. Thus these findings in subjects with PD indicate that: (a) PD-induced impairments in anticipatory force mechanisms appear to be greatly increased in multi-digit grasping as opposed to previous reports from two-digit grasping; (b) inaccurate scaling of fingertip force amplitude and sharing patterns before object lift is recovered during object lift; (c) the implementation of appropriate force amplitude and sharing among the digits during the lift occurs significantly later than for controls; (d) medication improves the temporal recovery of multi-digit force coordination. These results are discussed within the framework of PD-related deficits in sensorimotor integration and control of multi-degrees of freedom movement.

A "good parent" function of dopamine: transient modulation of learning and performance during early stages of training

While extracellular dopamine (DA) concentrations are increased by a wide category of salient stimuli, there is evidence to suggest that DA responses to primary and conditioned rewards may be distinct from those elicited by other types of salient events. A reward-specific mode of neuronal responding would be necessary if DA acts to strengthen behavioral response tendencies under particular environmental conditions or to set current environmental inputs as goals that direct approach responses. As described in this review, DA critically mediates both the acquisition and expression of learned behaviors during early stages of training, however, during later stages, at least some forms of learned behavior become independent of (or less dependent upon) DA transmission for their expression.

Snakes as agents of evolutionary change in primate brains

Current hypotheses that use visually guided reaching and grasping to explain orbital convergence, visual specialization, and brain expansion in primates are open to question now that neurological evidence reveals no correlation between orbital convergence and the visual pathway in the brain that is associated with reaching and grasping. An alternative hypothesis proposed here posits that snakes were ultimately responsible for these defining primate characteristics. Snakes have a long, shared evolutionary existence with crown-group placental mammals and were likely to have been their first predators. Mammals are conservative in the structures of the brain that are involved in vigilance, fear, and learning and memory associated with fearful stimuli, e.g., predators. Some of these areas have expanded in primates and are more strongly connected to visual systems. However, primates vary in the extent of brain expansion. This variation is coincident with variation in evolutionary co-existence with the more recently evolved venomous snakes. Malagasy prosimians have never co-existed with venomous snakes, New World monkeys (platyrrhines) have had interrupted co-existence with venomous snakes, and Old World monkeys and apes (catarrhines) have had continuous co-existence with venomous snakes. The koniocellular visual pathway, arising from the retina and connecting to the lateral geniculate nucleus, the superior colliculus, and the pulvinar, has expanded along with the parvocellular pathway, a visual pathway that is involved with color and object recognition. I suggest that expansion of these pathways co-occurred, with the koniocellular pathway being crucially involved (among other tasks) in pre-attentional visual detection of fearful stimuli, including snakes, and the parvocellular pathway being involved (among other tasks) in protecting the brain from increasingly greater metabolic demands to evolve the neural capacity to detect such stimuli quickly. A diet that included fruits or nectar (though not to the exclusion of arthropods), which provided sugars as a neuroprotectant, may have been a required preadaptation for the expansion of such metabolically active brains. Taxonomic differences in evolutionary exposure to venomous snakes are associated with similar taxonomic differences in rates of evolution in cytochrome oxidase genes and in the metabolic activity of cytochrome oxidase proteins in at least some visual areas in the brains of primates. Raptors that specialize in eating snakes have larger eyes and greater binocularity than more generalized raptors, and provide non-mammalian models for snakes as a selective pressure on primate visual systems. These models, along with evidence from paleobiogeography, neuroscience, ecology, behavior, and immunology, suggest that the evolutionary arms race begun by constrictors early in mammalian evolution continued with venomous snakes. Whereas other mammals responded by evolving physiological resistance to snake venoms, anthropoids responded by enhancing their ability to detect snakes visually before the strike.

Extended habit training reduces dopamine mediation of appetitive response expression

A wide range of behaviors is impaired after disruption of dopamine (DA) transmission, yet behaviors that are reflexive, automatic, or elicited by salient cues often remain intact. Responses triggered by strong external cues appear to be DA independent. Here, we examined the possibility that a single behavior may become DA independent as a result of extended training. Rats were trained to execute a head-entry response to a cue signaling food delivery. Vulnerability of the response to D1 or D2 receptor blockade was assessed on day 3, 7, or 17 of 28-trial-per-day training. During the early stages of training, the D1 receptor antagonist R(+)-7-chloro-8-hydroxy-3-methyl-1-phenyl-2,3,4,5-tetrahydro-1H-3-benzazepine hydrochloride (SCH 23390) increased response latencies; however, the same behavior was unaffected by SCH 23390 in animals tested during the later stages of training. Other aspects of behavior such as locomotion and head-entry responses during the uncued intertrial interval remained vulnerable to SCH 23390 throughout the experiment. This D1-mediated response was unaffected by the D2 antagonist raclopride, even at a dose that strongly suppressed locomotion. The results provide strong evidence that a D1-dependent behavior becomes less dependent on DA with extended training. A number of fundamental neurobiological changes occur as behaviors become learned habits; at least for some responses, this change involves a shift from D1-mediated to D1-independent responding.

Visual search deficits in Parkinson's disease are attenuated by bottom-up target salience and top-down information

Patients with Parkinson's disease (PD), a degenerative disorder primarily affecting the nigrostriatal dopamine system, exhibit deficits in selecting task-relevant stimuli in the presence of irrelevant stimuli, such as in visual search tasks. However, results from previous studies suggest that these deficits may vary as a function of whether selection must rely primarily on the "bottom-up" salience of the target relative to background stimuli, or whether "top-down" information about the identity of the target is available to bias selection. In the present study, moderate-to-severe medicated PD patients and age-matched controls were tested on six visual search tasks that systematically varied the relationship between bottom-up target salience (feature search, noisy feature search, conjunction search) and top-down target knowledge (Target Known versus Target Unknown). Comparison of slope and intercepts of the RT x set size function provided information about the efficiency of search and non-search (e.g., decision, response) components, respectively. Patients exhibited higher intercepts than controls as bottom-up target salience decreased, however these deficits were disproportionately larger under Target Unknown compared to Target Known conditions. Slope differences between PD and controls were limited to the Target Unknown Conjunction condition, where patients exhibited a shallower slope in the target absent condition, indicating that they terminated search earlier. These results suggest that under conditions of high background noise, medicated PD patients were primarily impaired in decision and/or response processes downstream from the target search itself, and that the deficit was attenuated when top-down information was available to guide selection of the target signal.

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.

Estimation of hand preshaping during human grasping

A new method for evaluating hand preshaping during reaching-to-grasp movement is proposed. The method makes use of all five fingers in estimation of prehension. The investigation was performed on six healthy subjects grasping three different objects at various positions and orientations. The objects were presented to the subjects by means of a robot, which also induced perturbations in both object position and orientation. Positions of markers attached to the finger-tips and dorsum of the hand were recorded by means of a 3D optical tracking system. In the data analysis, the adjacent fingertips were interconnected, thus obtaining a planar pentagon whose various characteristics were investigated and discussed. New parameters for the evaluation of finger preshaping, such as pentagon surface area, angle between the pentagon and hand normal vectors, and the angle between the pentagon and object normal vectors were introduced. The proposed pentagon approach is expected to be useful in future work when examining grasping abilities of subjects with neuromuscular disorders.

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.

Pallidal deep brain stimulation and L-dopa do not improve qualitative aspects of skilled reaching in Parkinson's disease

OBJECTIVE

To determine effects of dopaminergic medication and pallidal deep brain stimulation (DBS) on skilled reach in Parkinson's disease (PD).

BACKGROUND

PD is a neurodegenerative disorder affecting motor control. While speed and execution of movements are improved by L-dopa, not all motor symptoms are alleviated. Little is known about the effects of DBS or medication on reaching.

DESIGN METHOD

Eight PD patients with unilateral pallidal DBS reached with the contra-lateral hand for a piece of food, placing it in the mouth, and returning to starting position. Testing was performed on no treatment, medication only, DBS only, and combined treatment. Reaches were digitally recorded and analyzed on a 21 point scale adapted from Eshkol-Wachman Notation. Analysis was blinded, with patients compared to age-matched controls.

RESULTS

Patients were tested 6-13 months after surgery. All showed significant improvement clinically and in UPDRS (III) scores. The following data were obtained on the reaching scale: normal controls 16.5-21.0 (mean 18.3), no treatment 3.0-12.5 (mean 7.4), medication only 7.0-14.0 (mean 10.3), DBS only 4.5-16.0 (mean 9.2), combined treatment 4.0-15.0 (mean 9.5). The difference between controls and all treatment groups was statistically significant (P<0.005). All aspects of reach were compromised. No significant differences were found among the four conditions.

CONCLUSIONS

This study is consistent with accumulating evidence that some aspects of motor performance in PD patients, such as reaching, are resistant to L-dopa. Also, pallidal DBS does not improve those parameters that are resistant to L-dopa, either alone or in combination with medication.