Studies on induced exacerbation of Parkinsonian rigidity: The effect of contralateral voluntary activity

Neuromechanical Assessment of Activated vs. Resting Leg Rigidity Using the Pendulum Test Is Associated With a Fall History in People With Parkinson's Disease

Leg rigidity is associated with frequent falls in people with Parkinson’s disease (PD), suggesting a potential role in functional balance and gait impairments. Changes in the neural state due to secondary tasks, e.g., activation maneuvers, can exacerbate (or “activate”) rigidity, possibly increasing the risk of falls. However, the subjective interpretation and coarse classification of the standard clinical rigidity scale has prohibited the systematic, objective assessment of resting and activated leg rigidity. The pendulum test is an objective diagnostic method that we hypothesized would be sensitive enough to characterize resting and activated leg rigidity. We recorded kinematic data and electromyographic signals from rectus femoris and biceps femoris during the pendulum test in 15 individuals with PD, spanning a range of leg rigidity severity. From the recorded data of leg swing kinematics, we measured biomechanical outcomes including first swing excursion, first extension peak, number and duration of the oscillations, resting angle, relaxation index, maximum and minimum angular velocity. We examined associations between biomechanical outcomes and clinical leg rigidity score. We evaluated the effect of increasing rigidity through activation maneuvers on biomechanical outcomes. Finally, we assessed whether either biomechanical outcomes or changes in outcomes with activation were associated with a fall history. Our results suggest that the biomechanical assessment of the pendulum test can objectively quantify parkinsonian leg rigidity. We found that the presence of high rigidity during clinical exam significantly impacted biomechanical outcomes, i.e., first extension peak, number of oscillations, relaxation index, and maximum angular velocity. No differences in the effect of activation maneuvers between groups with clinically assessed low rigidity were observed, suggesting that activated rigidity may be independent of resting rigidity and should be scored as independent variables. Moreover, we found that fall history was more common among people whose rigidity was increased with a secondary task, as measured by biomechanical outcomes. We conclude that different mechanisms contributing to resting and activated rigidity may play an important yet unexplored functional role in balance impairments. The pendulum test may contribute to a better understanding of fundamental mechanisms underlying motor symptoms in PD, evaluating the efficacy of treatments, and predicting the risk of falls.

Long-term follow-up review of cases of Parkinson's disease after unilateral or bilateral thalamotomy

Follow-up reviews were carried out on 86 of 103 patients with Parkinson's disease who underwent unilateral or bilateral ventrolateral (VL) thalamotomy in the period from 1964 to 1969. Of these 86 patients, 64 received unilateral surgery, and 22 bilateral surgery. The follow-up periods were at least 10 years from the operation (from the second intervention in cases with bilateral procedures). In the group that received unilateral surgery, no progression after surgery was seen in three of six patients classified preoperatively in Grade I (Hoehn and Yahr's Grade 1), nine of 20 patients in Grade IIa (Hoehn and Yahr's Grade 2), 13 of 23 patients in Grade IIb (Hoehn and Yahr's Grade 3), and six of 15 patients in Grade III (Hoehn and Yahr's Grade 4). In the group that received bilateral surgery, one of three patients in Grade I and one of 11 patients in Grade IIa before the second intervention maintained continuous full social activities for over 10 years after the second surgery without any medication. In addition, eight of 11 patients classified preoperatively in Grade IIa and five of eight patients in Grade IIb seemed to show no progression after the second operation; four of 22 patients stopped taking their medication because of improvement in their symptoms. No patient who received bilateral surgery had progression of the disease to death. Observations suggested the efficacy of thalamic surgery, not only for improvement of motor symptoms but also for reducing progression of the disease, although no control study was made. Thalamotomy is still used to treat Parkinson's disease as an alternative to current medical treatments, such as L-dopa therapy.