Deficits in sensorimotor control during precise hand movements in Huntington's disease

Rethinking Movement Disorders

At present, clinical practice and research in movement disorders (MDs) focus on the "normalization" of altered movements. In this review, rather than concentrating on problems and burdens people with MDs undoubtedly have, we highlight their hidden potentials. Starting with current definitions of Parkinson's disease (PD), dystonia, chorea, and tics, we outline that solely conceiving these phenomena as signs of dysfunction falls short of their complex nature comprising both problems and potentials. Such potentials can be traced and understood in light of well-established cognitive neuroscience frameworks, particularly ideomotor principles, and their influential modern derivatives. Using these frameworks, the wealth of data on altered perception-action integration in the different MDs can be explained and systematized using the mechanism-oriented concept of perception-action binding. According to this concept, MDs can be understood as phenomena requiring and fostering flexible modifications of perception-action associations. Consequently, although conceived as being caught in a (trough) state of deficits, given their high flexibility, people with MDs also have high potential to switch to (adaptive) peak activity that can be conceptualized as hidden potentials. Currently, clinical practice and research in MDs are concerned with deficits and thus the "deep and wide troughs," whereas "scattered narrow peaks" reflecting hidden potentials are neglected. To better delineate and utilize the latter to alleviate the burden of affected people, and destigmatize their conditions, we suggest some measures, including computational modeling combined with neurophysiological methods and tailored treatment. © 2024 International Parkinson and Movement Disorder Society.

Impaired Isometric Force Matching in Upper and Lower Limbs Revealed by Quantitative Motor Assessments in Huntington's Disease

BACKGROUND

Assessment of motor symptoms in Huntington's disease (HD) is based on the Unified-HD-Rating-Scale-Total-Motor-Score (UHDRS-TMS). Its categorical and rater-dependent nature reduces the ability to detect subtle changes and often placebo effects have been observed in trials. We have previously shown that impairments in isometric force matching can be detected by quantitative motor (Q-Motor) assessments of tongue protrusion forces (glossomotography) in HD.

OBJECTIVE

We aimed to investigate whether similar impairments in isometric force matching can be detected in tasks assessing hand and foot force coordination and whether correlations with clinical measures and the disease burden score can be found.

METHODS

Using a pre-calibrated force transducer, the ability of subjects to generate and maintain isometric forces at different target levels displayed on a monitor was assessed. Target forces applied in the hand were 1.5 and 5 Newton [N] and in feet 1, 5, and 10 N. Subjects with HD (n = 31) and age-matched controls (n = 22) were recruited from the HD out-patient clinic.

RESULTS

All paradigms distinguished controls from HD. The static coefficient of variability (%) was the most robust measure across all matching tasks. Correlations with clinical measures, such as the UHDRS-TMS, TFC, and the DBS were found.

CONCLUSIONS

Assessment of hand and foot force matching tasks was feasible and provided quantitative objective measures for severity of motor phenotype in HD. Since both upper and lower extremity motor function are relevant for everyday activities, these measures should be further assessed as candidates for developing functionally meaningful quantitative motor tasks.

Sensory processing in Huntington's disease

OBJECTIVE

An intriguing electrophysiological feature of patients with Huntington's disease (HD) is the delayed latency and decreased amplitude of somatosensory long-latency evoked potentials (LLeps). We investigated whether such dysfunction was associated with delayed conscious perception of the sensory stimulus.

METHODS

Sixteen HD patients and 16 control subjects faced a computer screen showing the Libet's clock (Libet et al., 1983). In Rest trials, subjects had to memorize the position of the clock handle at perception of either electrical or thermal stimuli (AW). In React, additionally, they were asked to make a fist with their right hand, in a simple reaction time task (SRT). LLseps were recorded from Cz in both conditions.

RESULTS

LLeps negative peak latency (N2) and SRT were abnormally delayed in patients in all conditions. AW was only abnormally prolonged in the React condition but the time difference between AW and the negative peak of the LLeps was not different in the two groups. There was a significant negative correlation between SRT and AW or LLeps amplitude in patients but not in healthy subjects.

CONCLUSION

Our HD patients did not show abnormalities in conscious perception of sensory stimuli but their LLeps abnormalities were more marked when they had to react. This is compatible with failure to detect stimulus salience rather than with a cognitive defect.

SIGNIFICANCE

HD patients at early stages of the disease have preserved subjective perception of sensation but faulty sensorimotor integration.

Temporary Nerve Block at Selected Digits Revealed Hand Motor Deficits in Grasping Tasks

Peripheral sensory feedback plays a crucial role in ensuring correct motor execution throughout hand grasp control. Previous studies utilized local anesthesia to deprive somatosensory feedback in the digits or hand, observations included sensorimotor deficits at both corticospinal and peripheral levels. However, the questions of how the disturbed and intact sensory input integrate and interact with each other to assist the motor program execution, and whether the motor coordination based on motor output variability between affected and non-affected elements (e.g., digits) becomes interfered by the local sensory deficiency, have not been answered. The current study aims to investigate the effect of peripheral deafferentation through digital nerve blocks at selective digits on motor performance and motor coordination in grasp control. Our results suggested that the absence of somatosensory information induced motor deficits in hand grasp control, as evidenced by reduced maximal force production ability in both local and non-local digits, impairment of force and moment control during object lift and hold, and attenuated motor synergies in stabilizing task performance variables, namely the tangential force and moment of force. These findings implied that individual sensory input is shared across all the digits and the disturbed signal from local sensory channel(s) has a more comprehensive impact on the process of the motor output execution in the sensorimotor integration process. Additionally, a feedback control mechanism with a sensation-based component resides in the formation process for the motor covariation structure.

Quantifying feedforward control: a linear scaling model for fingertip forces and object weight

The ability to predict the optimal fingertip forces according to object properties before the object is lifted is known as feedforward control, and it is thought to occur due to the formation of internal representations of the object's properties. The control of fingertip forces to objects of different weights has been studied extensively by using a custom-made grip device instrumented with force sensors. Feedforward control is measured by the rate of change of the vertical (load) force before the object is lifted. However, the precise relationship between the rate of change of load force and object weight and how it varies across healthy individuals in a population is not clearly understood. Using sets of 10 different weights, we have shown that there is a log-linear relationship between the fingertip load force rates and weight among neurologically intact individuals. We found that after one practice lift, as the weight increased, the peak load force rate (PLFR) increased by a fixed percentage, and this proportionality was common among the healthy subjects. However, at any given weight, the level of PLFR varied across individuals and was related to the efficiency of the muscles involved in lifting the object, in this case the wrist and finger extensor muscles. These results quantify feedforward control during grasp and lift among healthy individuals and provide new benchmarks to interpret data from neurologically impaired populations as well as a means to assess the effect of interventions on restoration of feedforward control and its relationship to muscular control.

Coordination of fingertip forces during precision grip in premanifest Huntington's disease

Precision grip control is important for accurate object manipulation and requires coordination between horizontal (grip) and vertical (load) fingertip forces. Manifest Huntington's disease (HD) subjects demonstrate excessive and highly variable grip force and delayed coordination between grip and load forces. Because the onset of these impairments is unknown, we examined precision grip control in premanifest HD (pre-HD) subjects. Fifteen pre-HD and 15 age- and sex-matched controls performed the precision grip task in a seated position. Subjects grasped and lifted an object instrumented with a force transducer that measured horizontal grip and vertical load forces. Outcomes were preload time, loading time, maximum grip force, mean static grip force, and variability for all measures. We compared outcomes across groups and correlated grip measures with the Unified Huntington's Disease Rating Scale and predicted age of onset. Variability of maximum grip force (P < .0001) and variability of static grip force (P < .00001) were higher for pre-HD subjects. Preload time (P < .007) and variability of preload time (P < .006) were higher in pre-HD subjects. No differences were seen in loading time across groups. Variability of static grip force (r(2) = 0.23) and variability of preload time (r(2) = 0.59) increased with predicted onset and were correlated with tests of cognitive function. Our results indicate that pre-HD patients have poor regulation of the transition between reach and grasp and higher variability in force application and temporal coordination during the precision grip task. Force and temporal variability may be good markers of disease severity because they were correlated with predicted onset of disease.

Basal ganglia mechanisms underlying precision grip force control

The classic grasping network has been well studied but thus far the focus has been on cortical regions in the control of grasping. Sub-cortically, specific nuclei of the basal ganglia have been shown to be important in different aspects of precision grip force control but these findings have not been well integrated. In this review, we outline the evidence to support the hypothesis that key basal ganglia nuclei are involved in parameterizing specific properties of precision grip force. We review literature from different areas of human and animal work that converges to build a case for basal ganglia involvement in the control of precision gripping. Following on from literature showing anatomical connectivity between the basal ganglia nuclei and key nodes in the cortical grasping network, we suggest a conceptual framework for how the basal ganglia could function within the grasping network, particularly as it relates to the control of precision grip force.

Optimal compensation for temporal uncertainty in movement planning

Motor control requires the generation of a precise temporal sequence of control signals sent to the skeletal musculature. We describe an experiment that, for good performance, requires human subjects to plan movements taking into account uncertainty in their movement duration and the increase in that uncertainty with increasing movement duration. We do this by rewarding movements performed within a specified time window, and penalizing slower movements in some conditions and faster movements in others. Our results indicate that subjects compensated for their natural duration-dependent temporal uncertainty as well as an overall increase in temporal uncertainty that was imposed experimentally. Their compensation for temporal uncertainty, both the natural duration-dependent and imposed overall components, was nearly optimal in the sense of maximizing expected gain in the task. The motor system is able to model its temporal uncertainty and compensate for that uncertainty so as to optimize the consequences of movement.

Many recent models of motor planning are based on the idea that the CNS plans movements to minimize “costs” intrinsic to motor performance. A minimum variance model would predict that the motor system plans movements that minimize motor error (as measured by the variance in movement) subject to the constraint that the movement be completed within a specified time limit. A complementary model would predict that the motor system minimizes movement time subject to the constraint that movement variance not exceed a certain fixed threshold. But neither of these models is adequate to predict performance in everyday tasks that include external costs imposed by the environment where good performance requires that the motor system select a tradeoff between speed and accuracy. In driving to the airport to catch a plane, for example, there are very real costs associated with driving too fast and also with being just a bit too late. But the “optimal” tradeoff depends on road conditions and also on how important it is to catch the plane. We examine motor performance in analogous experimental tasks where we impose arbitrary monetary costs on movements that are “late” or “early” and show that humans systematically trade off risk and reward so as to maximize their expected monetary gain.

Huntington's disease affects movement termination

Huntington's disease (HD) is a neurodegenerative disease affecting the striatum and associated with deficits in voluntary movement in early stages. The final portion of aiming movements is particularly affected in HD and one hypothesis is that this deficit is linked to attention or terminal control requirements. Sixteen patients with early HD and 16 age-matched controls were examined in aiming movements. Four conditions manipulated movement termination requirements (discrete movements with a complete stop vs. cyclical back-and-forth movements) and the presence of flankers around the target. Reducing movement termination requirements significantly attenuated deficits in the final movement phase in patients. The presence of flankers around the target affected the initial portion of movements but did not affect the two groups differentially. These results indicate that terminal control requirements affect voluntary movements in HD. This suggests that frontostriatal systems are involved in movement termination.

The effect of subthalamic nucleus deep brain stimulation on precision grip abnormalities in Parkinson's disease

We have studied grip force performance in a group of 10 patients who were in a stable state after implantation of bilateral stimulating electrodes in the subthalamic nuclei (Stn) to counter drug-resistant or drug-induced symptoms of advanced Parkinson's disease. The patients were required to use a precision grip to lift an object which recorded grip force development and lift dynamics. Lifting was performed with stimulation on and with stimulation off under optimal medication. Post-operatively, dyskinesia was absent in all patients in both conditions, but in the 'off' state the patients showed the profound bradykinesia and excessive levels of grip force development associated with Parkinson's disease from its early stages. In the stimulation 'on' state both the rate of grip force development and the speed of the lifting phase were increased significantly. The excessive levels of grip force present in the stimulation 'off' state, and present from the early stages of the disease, however, were even more marked with Stn stimulation on. It is suggested that this results from a failure to modify stored motor programs developed over a long period under the influence of bradykinesia, leading to an inappropriately prolonged duration of grip force development when this influence is removed by Stn stimulation. Thus although Stn stimulation achieved a dramatic improvement in the mobility of the patients in general, and in the dynamics of hand movements specifically, by improving rates of force development and lifting dynamics, it does not restore, and may even worsen, the ability to match lifting parameters to actual conditions.

Early Huntington's disease affects movements in transformed sensorimotor mappings

This study examined the effect of transformed visual feedback on movement control in Huntington's disease (HD). Patients in the early stages of HD and controls performed aiming movements towards peripheral targets on a digitizing tablet and emphasizing precision. In a baseline condition, HD patients were slower but showed few precision problems in aiming. When visual feedback was inverted in both vertical and horizontal axes, patients showed problems in initial and terminal phases of movement where feedback is most critical. When visual feedback was inverted along a single axis as in a mirror-inversion, HD patients showed large deviations and over-corrections before adaptation. Adaptation was similar in both groups. These results suggest that HD impairs on-line error correction in novel movements.

Sensorimotor mapping affects movement correction deficits in early Huntington's disease

Huntington's disease (HD) is associated with early voluntary movement problems linked to striatal dysfunction. In pointing movements, HD increases the irregularity of the terminal part of movements, suggesting a dysfunction in error feedback control. We tested this hypothesis in movements requiring continuous feedback control. Patients in the early stages of HD and controls traced as fast and accurately as possible circles within a 5-mm annulus on a digitizing tablet when visual feedback of the hand and the circle was direct or indirect (through a monitor). Patients deviated more often from the annulus and showed larger corrections toward the circle than controls when using indirect visual feedback but not with direct visual feedback. When velocity requirements were removed, patients showed little change in these control problems. These results suggest that HD does not affect error feedback control in all movements and that the striatal contribution to voluntary movement is sensitive to sensorimotor mapping.

Grip force behavior in Gilles de la Tourette syndrome

We analyzed predictive and reactive grip force behavior in 15 patients with Gilles de la Tourette syndrome (GTS) and 15 sex- and age-matched healthy control subjects. Nine patients were without medication; six patients were on medication. In a first experiment, participants lifted and held instrumented objects of different weight. In a second experiment, participants performed vertical point-to-point and continuous arm movements at different frequencies with a hand-held object. In a third experiment, preparatory and reactive grip force responses to sudden load perturbations were analyzed when a weight was dropped into a hand-held cup either by the subject or unexpectedly by the experimenter. Compared to the healthy subjects, GTS patients had increased grip forces relative to the load force in all tasks. Despite this finding, they adjusted the grip force to changes in load force (due to either a change in the mass lifted or accelerating the mass during continuous movements) in the same way as healthy subjects. The temporal coupling between grip and load force profiles was also similar in patients and healthy controls, and they displayed normal anticipation of impact forces when they dropped a weight into a hand-held cup. We found no significant effect of medication on the performance of GTS patients, regardless of the task performed. These results are consistent with deficient sensory-motor processing in Gilles de la Tourette syndrome.

Support-specific modulation of grip force in individuals with hemiparesis

OBJECTIVE

To investigate whether use of auxiliary sensory input will result in modulated grip force.

DESIGN

Case-control study.

SETTING

Free-standing acute inpatient rehabilitation hospital.

PARTICIPANTS

Six people with unilateral hemiparesis due to unilateral stroke and 6 control subjects without neurologic disorders.

INTERVENTIONS

Seated subjects lifted and transported the same object under 3 different conditions: with no support, with the target arm positioned on a freely moving skateboard, and with a finger from the subject's contralateral hand lightly touching the wrist of the target arm.

MAIN OUTCOME MEASURES

Peak grip force and temporal coupling between the grip force and lift-off of the object.

RESULTS

All subjects were able to better regulate grip force when provided with additional sensory input. Light finger touch resulted in decreased grip force, as did skateboard use ( P <.05). Subjects with hemiparesis showed 2 times longer latency between grip-force application and lift-off of the object ( P <.05).

CONCLUSIONS

Statistically significant grip-force reduction was noted with both support aids. These findings could have implications in clinical and rehabilitative areas.

Intact ability to learn internal models of arm dynamics in Huntington's disease but not cerebellar degeneration

Two different compensatory mechanisms are engaged when the nervous system senses errors during a reaching movement. First, on-line feedback control mechanisms produce in-flight corrections to reduce errors in the on-going movement. Second, these errors modify the internal model with which the motor plan is transformed into motor commands for the subsequent movements. What are the neural mechanisms of these compensatory systems? In a previous study, we reported that while on-line error correction was disturbed in patients with Huntington's disease (HD), it was largely intact in patients with cerebellar degeneration. Here we altered dynamics of reaching and studied the effect of error in one trial on the motor commands that initiated the subsequent trial. We observed that in patients with cerebellar degeneration, motor commands changed from trial-to-trial by an amount that was comparable to control subjects. However, these changes were random and were uninformed by the error in the preceding trial. In contrast, the change in motor commands of HD patients was strongly related to the error in the preceding trial. This error-dependent change had a sensitivity that was comparable to healthy controls. As a result, HD patients exhibited no significant deficits in adapting to novel arm dynamics, whereas cerebellar subjects were profoundly impaired. These results demonstrate a double dissociation between on-line and trial-to-trial error correction suggesting that these compensatory mechanisms have distinct neural bases that can be differentially affected by disease.

Grip force behavior during object manipulation in neurological disorders: Toward an objective evaluation of manual performance deficits

The control of prehensile finger forces is an essential feature of skilled manual performance. The basic aspects of healthy grip force behavior have been well documented. In healthy subjects, grip force is precisely adjusted to the mechanical object properties. Grip force is always slightly higher than the minimum necessary to prevent the object from slipping. When we move a hand-held object, grip force is modulated in parallel with movements-induced load fluctuations without an obvious delay. The absence of a temporal delay between grip and load force profiles suggests that the central nervous system is able to predict the load variations before the intended manipulation and consequently regulates grip force in anticipation. Feedback from the grasping fingertips is used to adjust the level of applied fingertip force efficiently to the actual loading requirements. Pathologic grip force control affects the efficiency of produced force and the precision of the temporal coupling between grip and load force profiles. Here, we review the characteristics of pathologic grip force behavior in various neurological disorders. Detailed examination of grip force control is simple and well suited for the objective evaluation of impaired motor function of the hand and its rehabilitation.

Objective assessment of motor slowness in Huntington's disease: clinical correlates and 2-year follow-up

Functional disability of patients with Huntington's disease (HD) is determined by impairment of voluntary motor function rather than the presence of chorea. However, only few attempts have been made to quantify this motor impairment. By using a simple reaction time paradigm, we measured the time needed for movement initiation (akinesia) and execution (bradykinesia) in 76 HD patients and 127 controls. Akinesia and bradykinesia were already evident in early stages and increased linearly with increasing disease stage. Quantified motor slowness correlated with clinical impairment of voluntary movements but also with cognitive impairment and medication use. In patients without severe cognitive impairment, quantified motor slowness reflected clinical motor impairment more purely. During 1.9 years follow-up (range, 0.8-3.8 years), quantified akinesia and bradykinesia progressed concomitantly with progression of clinical impairment of voluntary movements, cognition, and functional capacity. However, rate of change in motor slowness did not discriminate between patients whose disease stage remained stable and those whose disease stage progressed. We conclude that the reaction time paradigm may be used to quantify akinesia and bradykinesia in HD, at least in patients without severe cognitive impairment. Although reaction and movement times increased in time, these measures failed to detect functionally important changes during our follow-up period.

Grip force abnormalities in de novo Parkinson's disease

In recent years it has been shown that a variety of movement disorders are associated with abnormalities of the fine motor control of the hand. In Parkinson's disease (PD), these changes consist of a slowing of the rate of grip force development and the use of abnormally large grip forces both during lifting and static holding of an object. It has been suggested, however, that these changes are a direct effect of the patient's levodopa medication or associated with levodopa induced dyskinesias. Accordingly, we examined the performance of de novo Parkinson patients in a precision lifting task. All patients (n = 6) were newly diagnosed and showed rigidity, bradykinesia, or both, but were unaffected by tremor or dyskinesia. None of the patients had received antiparkinson medication. Grip force was abnormally high in both the lifting and hold phases. This exaggeration was equal in magnitude to that observed previously in medicated patients. Thus we conclude that the abnormalities in grip force observed here are intrinsic features of PD and not the result of dopamine medication or its side effects.

Coordination of fingertip forces during precision grasping in multiple system atrophy

While the pathology and autonomic nervous system components of multiple system atrophy (MSA) have been well described, little is known about the associated motor dysfunction. One prominent feature of MSA is parkinsonism, although ataxias and pyramidal tract signs are frequently present. To investigate the nature of motor deficits in MSA, a natural grip-lift movement requiring a precision grasp was used to examine force coordination. Subjects were asked to grasp an instrumented object using the fingertips of the thumb and index finger and lift it 10 cm above the table surface. Subjects with MSA demonstrated a prolonged duration between object contact and initiation of the lifting drive that increased with the weight of the object. During this period these subjects produced large grasping forces generating a significant portion of the eventual grip force employed to hold the object. In contrast, control subjects generated grip and load forces in parallel after establishing contact with the object. Therefore, subjects with MSA showed a disrupted performance on both the sequential (grasp, then lift) and simultaneous (grip and load force development) portions of this task. Only after initiation of the vertical lifting drive did subjects with MSA generate forces in a similar manner to control subjects. These findings demonstrate that subjects with MSA exhibit a disrupted coordination of grasp and could suggest a general deficit in motor control resulting from multi-focal neural degeneration.

Grip force control during object manipulation in cerebral stroke

OBJECTIVE

To analyze impairments of manipulative grip force control in patients with chronic cerebral stroke and relate deficits to more elementary aspects of force and grip control.

METHODS

Nineteen chronic stroke patients with fine motor deficits after unilateral cerebral lesions were examined when performing 3 manipulative tasks consisting of stationary holding, transport, and vertical cyclic movements of an instrumented object. Technical sensors measured the grip force used to stabilize the object in the hand and the object accelerations, from which the dynamic loads were calculated.

RESULTS

Many patients produced exaggerated grip forces with their affected hand in all types of manipulations. The amount of finger displacement in a grip perturbation task emerged as a highly sensitive measure for predicting the force increases. Measures of grip strength and maximum speed of force changes could not account for the impairments with comparable accuracy. In addition to force economy, the precision of the coupling between grip and load forces was impaired. However, no temporal delays were typically observed between the grip and load force profiles during cyclic movements.

CONCLUSIONS

Impaired sensibility and sensorimotor processing, evident by delayed reactions in the perturbation task, lead to an excessive increase of the safety margin between the actual grip force and the minimum force necessary to prevent object slipping. In addition to grip force scaling, cortical sensorimotor areas are responsible for smoothly and precisely adjusting grip forces to loads according to predictions about movement-induced loads and sensory experiences. However, the basic feedforward mechanism of grip force control by internal models appears to be preserved, and thus may not be a cortical but rather a subcortical or cerebellar function, as has been suggested previously.

Sensorimotor integration in movement disorders

Although current knowledge attributes movement disorders to a dysfunction of the basal ganglia-motor cortex circuits, abnormalities in the peripheral afferent inputs or in their central processing may interfere with motor program execution. We review the abnormalities of sensorimotor integration described in the various types of movement disorders. Several observations, including those of parkinsonian patients' excessive reliance on ongoing visual information during movement tasks, suggest that proprioception is defective in Parkinson's disease (PD). The disturbance of proprioceptive regulation, possibly related to the occurrence of abnormal muscle-stretch reflexes, might be important for generating hypometric or bradykinetic movements. Studies with somatosensory evoked potentials (SEPs), prepulse inhibition, and event-related potentials support the hypothesis of central abnormalities of sensorimotor integration in PD. In Huntington's disease (HD), changes in SEPs and long-latency stretch reflexes suggest that a defective gating of peripheral afferent input to the brain might impair sensorimotor integration in cortical motor areas, thus interfering with the processing of motor programs. Defective motor programming might contribute to some features of motor impairment in HD. Sensory symptoms are frequent in focal dystonia and sensory manipulation can modify the dystonic movements. In addition, specific sensory functions (kinaesthesia, spatial-temporal discrimination) can be impaired in patients with focal hand dystonia, thus leading to a "sensory overflow." Sensory input may be abnormal and trigger focal dystonia, or defective "gating" may cause an input-output mismatch in specific motor programs. Altogether, several observations strongly support the idea that sensorimotor integration is impaired in focal dystonia. Although elemental sensation is normal in patients with tics, tics can be associated with sensory phenomena. Some neurophysiological studies suggest that an altered "gating" mechanism also underlies the development of tics. This review underlines the importance of abnormal sensorimotor integration in the pathophysiology of movement disorders. Although the physiological mechanism remains unclear, the defect is of special clinical relevance in determining the development of focal dystonia.

Movement control of manipulative tasks in patients with Gilles de la Tourette syndrome

When a hand-held object is moved, grip and load force are accurately coordinated for establishing grasp stability. In the present work, the question was raised whether patients with Gilles de la Tourette syndrome (TS), who show tic-like movements, are impaired in grip-load force control when executing a manipulative task. To this end, we assessed force regulation during action patterns that required rhythmical unimanual or bimanual (iso-directional/anti-directional) movements. Results showed that the profile of grip-load force ratio was characterized by maxima and minima that were realized at upward and downward hand positions, respectively. TS patients showed increased force ratios during unimanual and bimanual movements, compared with control subjects, indicative of an inaccurate specification of the precision grip. Functional imaging data complemented the behavioural results and revealed that secondary motor areas showed no (or greatly reduced) activation in TS patients when executing the movement tasks as compared with baseline conditions. This indicates that the metabolic level in the secondary motor areas was equal during rest and task performance. At the neuronal level, this observation suggests that these cortical areas were continuously involved in movement preparation. Based on these data, we conclude that the ongoing activation of secondary motor areas may be explained by the TS patients' involuntary urges to move. Accordingly, interference will prevent an accurate planning of voluntary behaviour. Together, these findings reveal modulations in movement organization in patients with TS and exemplify degrading consequences for manual function.

Precision grip deficits in cerebellar disorders in man

OBJECTIVE

To investigate the effect of a variety of cerebellar pathologies on a functional motor task (lifting an object in a precision grip).

METHODS

The study involved 8 patients with unilateral damage in the region of the posterior inferior cerebellar artery (PICA), 6 with damage in the region of the superior cerebellar artery (SUPCA), 12 patients with familiar or idiopathic cortical cerebellar degeneration, and 45 age-matched normal subjects. Subjects lifted an object of unpredictable load (internally guided task) or responded to a sudden load increase while holding the object steadily (externally guided task).

RESULTS

Damage to the dentate nucleus (SUPCA) or its afferent input (cerebellar atrophy) resulted in disruption of the close coordination normally seen between proximal muscles (lifting the object) and the fingers (gripping the object) during a self-paced lift. Both the SUPCA group and, more markedly, the atrophy group, showed exaggerated levels of grip force. All patients showed a normal rate of grip force development. Damage in the PICA region had no significant effect on any of the measured lifting parameters. All patient groups retained the ability to scale grip force to different object loads. The automatic grip force response to unexpected load increase of a hand held object showed normal latency and time course in all patient groups. The response was modulated by the rate of the load change. Response magnitude was exaggerated in the atrophy patients at all 3 rates tested.

CONCLUSIONS

Disturbances associated with cerebellar disorders differed from those seen following damage to the basal ganglia, with no evidence of slowed rates of grip force development. Disruption of temporal coordination between the proximal muscles (lifting) and the fingers (gripping) in a lift was apparent, supporting the role of the cerebellum in coordinating the timing of multi-joint movement sequences. Exaggeration of grip force levels was found in association with damage to the dentate nucleus or, in particular, to its afferent input. This could support a role or the cerebellum in sensorimotor processing, but might also represent a failure to time correctly the duration of grip force generation.