Parkinsonian arm movements as altered by task difficulty

Reverse Visually Guided Reaching in Patients with Parkinson’s Disease

In addition to motor symptoms such as difficulty in movement initiation and bradykinesia, patients with Parkinson’s disease (PD) display nonmotor executive cognitive dysfunction with deficits in inhibitory control. Preoperative psychological assessments are used to screen for impulsivity that may be worsened by deep brain stimulation (DBS) of the subthalamic nucleus (STN). However, it is unclear whether anti-Parkinson’s therapy, such as dopamine replacement therapy (DRT) or DBS, which has beneficial effects on motor function, adversely affects inhibitory control or its domains. The detrimental effects of STN-DBS are more apparent when tasks test the inhibition of habitual prepotent responses or involve complex cognitive loads. Our goal was to use a reverse visually guided reaching (RVGR) task, a hand-based version of the antisaccade task, to simultaneously measure motor performance and response inhibition in subjects with PD. We recruited 55 healthy control subjects, 26 PD subjects receiving treatment with DRTs, and 7 PD subjects receiving treatment with STN-DBS and DRTs. In the RVGR task, a cursor moved opposite to the subject’s hand movement. This was compared to visually guided reaching (VGR) where the cursor moved in the same direction as the subject’s hand movement. Reaction time, mean speed, and direction errors (in RVGR) were assessed. Reaction times were longer, and mean speeds were slower during RVGR compared to VGR in all three groups but worse in untreated subjects with PD. Treatment with DRTs, DBS, or DBS + DRT improved the reaction time and speed on the RVGR task to a greater extent than VGR. Additionally, DBS or DBS + DRT demonstrated an increase in direction errors, which was correlated with decreased reaction time. These results show that the RVGR task quantifies the benefit of STN-DBS on bradykinesia and the concomitant reduction of proactive inhibitory control. The RVGR task has the potential to be used to rapidly screen for preoperative deficits in inhibitory control and to titrate STN-DBS, to maximize the therapeutic benefits on movement, and minimize impaired inhibitory control.

Robotic Assessment of Upper Limb Function in a Nonhuman Primate Model of Chronic Stroke

Stroke is a leading cause of death and disability worldwide and survivors are frequently left with long-term disabilities that diminish their autonomy and result in the need for chronic care. There is an urgent need for the development of therapies that improve stroke recovery, as well as accurate and quantitative tools to measure function. Nonhuman primates closely resemble humans in neuroanatomy and upper limb function and may be crucial in randomized pre-clinical trials for testing the efficacy of stroke therapies. To test the feasibility of robotic assessment of motor function in a NHP model of stroke, two cynomolgus macaques were trained to perform a visually guided reaching task and were also assessed in a passive stretch task using the Kinarm robot. Strokes were then induced in these animals by transiently occluding the middle cerebral artery, and their motor performance on the same tasks was assessed after recovery. Relative to pre-stroke performance, post-stroke hand movements of the affected limb became slower and less accurate. Regression analyses revealed both recovered and compensatory movements to complete movements in different spatial directions. Lastly, we noted decreased range of motion in the elbow joint of the affected limb post-stroke associated with spasticity during passive stretch. Taken together, these studies highlight that sensorimotor deficits in reaching movements following stroke in cynomolgus macaques resemble those in human patients and validate the use of robotic assessment tools in a nonhuman primate model of stroke for identifying and characterizing such deficits.

Subcortical Involvement in Formulaic Language: Studies on Bilingual Individuals With Parkinson's Disease

Purpose An impoverished production of routinized expressions, namely, formulaic language, has been reported for monolingual speakers with Parkinson's disease (PD). Little is known regarding how formulaic expressions might be manifested in individuals with neurological damage who speak more than one language. This study investigated the processing of formulaic language across first language (L1) and second language (L2) in bilingual individuals with PD. Method Eleven Korean-English bilingual speakers with PD, who acquired Korean as L1 and English as L2, were recruited for this study. Two matched control groups composed of 11 healthy Korean-English bilingual individuals and 11 healthy native English speakers were included for comparison. Their performance on three structured tasks (comprehension, completion, and judgment-correction) and conversational speech was measured and compared across groups for analyses. Results The bilingual speakers with PD had significantly impaired comprehension of formulaic language in L1 and had lower proportions of formulaic expressions in their L1 conversational speech compared with the bilingual controls. Regarding L2, both bilingual groups with and without PD were comparable in their English performance across all tasks. Both groups performed significantly poorer in L2 structured tasks than the native English speakers. Spontaneous production of formulaic language in English (L2 for bilingual individuals) was similar across all three groups. Conclusions The results of this study contribute to the growing body of literature on impoverishment of formulaic language production following subcortical dysfunction. Additionally, findings here demonstrate a selective impairment of formulaic language performance in L1 but not L2 for bilinguals with PD, further supporting the role of the basal ganglia in native language.

Movement Speed-Accuracy Trade-Off in Parkinson's Disease

Patients with Parkinson's disease (PD) often have difficulties generating rhythmic movements, and also difficulties on movement adjustments to accuracy constraints. In the reciprocal aiming task, maintaining a high accuracy comes with the cost of diminished movement speed, whereas increasing movement speed disrupts end-point accuracy, a phenomenon well known as the speed-accuracy trade-off. The aim of this study was to examine how PD impacts speed-accuracy trade-off during rhythmic aiming movements by studying the structural kinematic movement organization and to determine the influence of dopamine replacement therapy on continuous movement speed and accuracy. Eighteen patients with advanced idiopathic Parkinson's disease performed a reciprocal aiming task, where the difficulty of the task was manipulated through target width. All patients were tested in two different sessions: ON-medication and OFF-medication state. A control group composed of healthy age-matched participants was also included in the study. The following variables were used for the analyses: Movement time, Error rate, effective target width, and Performance Index. Percentage of acceleration time and percentage of non-linearity were completed with kinematics patterns description using Rayleigh-Duffing model. Both groups traded off speed against accuracy as the constraints pertaining to the latter increased. The trade-off was more pronounced with the PD patients. Dopamine therapy allowed the PD patients to move faster, but at the cost of movement accuracy. Surprisingly, the structural kinematic organization did not differ across group nor across medication condition. These results suggest that PD patients, when involved in a reciprocal aiming task, are able to produce rhythmic movements. PD patients' overall slowing down seems to reflect a global adaptation to the disease in the absence of a structurally altered kinematic organization.

Pointing with the ankle: the speed-accuracy trade-off

This study investigated the trade-off between speed and accuracy in pointing movements with the ankle during goal-directed movements in dorsal-plantar (DP) and inversion-eversion (IE). Nine subjects completed a series of discrete pointing movements with the ankle between spatial targets of varying difficulty. Six different target sets were presented, with a range of task difficulty between 2.2 and 3.8 bits of information. Our results demonstrated that for visually evoked, visually guided discrete DP and IE ankle pointing movements, performance can be described by a linear function, as predicted by Fitts' law. These results support our ongoing effort to develop an adaptive algorithm employing the speed-accuracy trade-off concept to control our pediatric anklebot while delivering therapy for children with cerebral palsy.

Cortical correlates of fitts' law

Fitts’ law describes the fundamental trade-off between movement accuracy and speed: it states that the duration of reaching movements is a function of target size (TS) and distance. While Fitts’ law has been extensively studied in ergonomics and has guided the design of human–computer interfaces, there have been few studies on its neuronal correlates. To elucidate sensorimotor cortical activity underlying Fitts’ law, we implanted two monkeys with multielectrode arrays in the primary motor (M1) and primary somatosensory (S1) cortices. The monkeys performed reaches with a joystick-controlled cursor toward targets of different size. The reaction time (RT), movement time, and movement velocity changed with TS, and M1 and S1 activity reflected these changes. Moreover, modifications of cortical activity could not be explained by changes of movement parameters alone, but required TS as an additional parameter. Neuronal representation of TS was especially prominent during the early RT period where it influenced the slope of the firing rate rise preceding movement initiation. During the movement period, cortical activity was correlated with movement velocity. Neural decoders were applied to simultaneously decode TS and motor parameters from cortical modulations. We suggest that sensorimotor cortex activity reflects the characteristics of both the movement and the target. Classifiers that extract these parameters from cortical ensembles could improve neuroprosthetic control.

Hypometria and bradykinesia during drawing movements in individuals with Parkinson's disease

To address the hypothesis that Parkinson's disease (PD) patients have deficits in controlling acceleration, a drawing task was used in which target size, frequency, and weight of pen were manipulated. In accordance with previous results, it was found that, relative to controls, PD patients produced movements at the required frequency, but moved significantly slower, produced less acceleration, and drew smaller-than-required stroke sizes. This resulted in smaller-than-required movement amplitudes, suggesting that hypometria and bradykinesia in drawing and/or handwriting are related. Patients were found to perform similarly to controls when the target size was 1 cm. However, their performance became more dissimilar at greater stroke lengths. In addition to the aforementioned effects it was found that movement amplitude error was less when the pen was 20 times heavier than the normal pen and that the increased load may dampen abnormal limb-stiffness characteristics induced by PD.

Distal and proximal prehension is differentially affected by Parkinson's disease. The effect of conscious and subconscious load cues

Prehension movements consist of distal (grasp) and proximal (reach, lift) components. The proximal lifting movements (achieved at the wrist) of patients with Parkinson's disease (PD) are characterized by bradykinesia. With respect to the distal component, PD patients show pathologically high grip forces (generated by the fingers) and slowing of force development indicative of disturbed sensorimotor adjustments during prehension. Combining kinematic and force analyses of prehension movements, we investigated whether PD differentially affects the adjustments of the distal or proximal prehension components to current load conditions. First, PD patients (n = 12) and healthy, age-matched control subjects grasped and lifted light and heavy objects without any load cues. Then, they were presented with cues that indicated changes in object load. These load cues were either consciously perceived or rendered subconscious through use of the technique of metacontrast masking. Consistent with the functional organization of the basal ganglia, patients with PD could adapt distal prehension components (grip force) to current load conditions using both types of cues. However, they were impaired in adjusting proximal prehension components (lift velocity). While controls were able to normalize lift velocity with the help of both conscious and subconscious load cues, the PD patients could use neither form of cue, and retained a pathological overshoot in lift velocity. Our results demonstrate that visuomotor integration during prehension movements differs at distal and more proximal joints and that deficits in this integration are pronounced for the latter in Parkinson's disease.

Motor Deficits in Parkinsonian Reaching: Dopa-Sensitivity Influenced by Real-World Task Constraint

Parkinson's disease (PD) patients can perform many daily activities, but movement deficits are evident. Those deficits may be increased when the required movement is constrained in accuracy. Variable improvements in performance with PD medication have been demonstrated, and sensitivity to task constraint has been evident in some studies. The authors quantified both specific movement deficits and improvements for PD patients in a reaching task. PD patients (N=8) both on and off medication showed a need for greater ongoing control in movements with higher task-accuracy constraints. Increased task-accuracy constraints further compromised movement timing and structure among PD patients who were off medication, suggesting that unmedicated PD patients may typically compensate by using more conscious control of movement, resulting in increased slowing and segmentation of components when higher task accuracy is required.

A neural network model of Parkinson's disease bradykinesia

Parkinson's disease (PD) is caused by dopamine (DA) depletion consequent to cell degeneration in the substantia nigra pars compacta (SNc) and the ventral tegmental area (VTA). Although computational analyses of PD have focused on DA depletion in DA-recipient parts of the basal ganglia, there is also extensive DAergic innervation of the frontal and parietal cortex as well as the spinal cord. To understand PD bradykinesia, a comprehensive network model is needed to study how patterns of DA depletion at key cellular sites in the basal ganglia, cortex and spinal cord contribute to disordered neuronal and spinal cord activity and other PD symptoms. We extend a basal ganglia-cortico-spinal circuit for control of voluntary arm movements by incorporating DAergic innervation of cells in the cortical and spinal components of the circuit. The resultant model simulates successfully several of the main reported effects of DA depletion on neuronal, electromyographic (EMG), and movement parameters of PD bradykinesia.

Movement precues in planning and execution of aiming movements in Parkinson's disease

Two experiments tested how changing a planned movement affects movement initiation and execution in idiopathic Parkinson's disease (PD) patients. In Experiment 1, PD patients, elderly controls, and young adults performed discrete aiming movements to one of two targets on a digitizer. A precue (80% valid cue and 20% invalid cue of all trials) reflecting the subsequent movement direction was presented prior to the imperative stimulus. All groups produced slower reaction times (RTs) to the invalid precue condition. Only the subgroup of patients with slowest movement time showed a significant prolongation of movement for the invalid condition. This suggests that, in the most impaired patients, modifying a planned action also affects movement execution. In Experiment 2, two-segment aiming movements were used to increase the demand on movement planning. PD patients and elderly controls underwent the two precue conditions (80% valid, 20% invalid). Patients exhibited longer RTs than the controls. RT was similarly increased for the invalid condition in both groups. The patients, however, exhibited longer movement times, lower peak velocities, and higher normalized jerk scores of the first segment in the invalid condition compared to the valid condition. Conversely, the controls showed no difference between the valid and invalid cue conditions. Thus, PD patients demonstrated substantially pronounced movement slowness and variability when required to change a planned action. The results from both experiments suggest that modifying a planned action may continue beyond the initiation phase into the execution phase in PD patients.