A computer model of rigidity and related motor dysfunction in Parkinson's disease

Motor cortical plasticity and its correlation with motor symptoms in Parkinson's disease

Background

The relationship between abnormal cortical plasticity and parkinsonian symptoms remains unclear in Parkinson's disease (PD).

Objective

We studied the relationship between their symptoms and degree of Long-term potentiation (LTP)-like effects induced by quadripulse magnetic stimulation (QPS) over the primary motor cortex, which has a small inter-individual variability in humans.

Methods

Participants were 16 PD patients (drug-naïve or treated with L-DOPA monotherapy) and 13 healthy controls (HC). LTP-like effects by QPS were compared between three conditions (HC､PD with or without L-DOPA). In PD, correlation analyses were performed between clinical scores (MDS-UPDRS, MMSE and MoCA-J) and the degree of LTP-like effects induced by QPS.

Results

In PD, QPS-induced LTP-like effect was reduced and restored by L-DOPA. The degree of the LTP was negatively correlated with MDS-UPDRS Part I and III scores, but not with MMSE and MoCA-J. In the sub-scores, upper limb bradykinesia and rigidity showed a negative correlation with the LTP-like effect whereas the tremor had no correlation.

Conclusions

Our results suggest that motor cortical plasticity relate with mechanisms underlying bradykinesia and rigidity in the upper limb muscles. LTP induced by QPS may be used as an objective marker of parkinsonian symptoms.

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Quadripulse magnetic stimulation (QPS) was applied to early PD patients.

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L-DOPA restored QPS-induced LTP of the primary motor cortex in early PD patients.

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The degree of LTP was negatively correlated with the severity of motor symptoms.

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Upper limb bradykinesia and rigidity had a strong negative correlation with LTP.

New scale for assessing spasticity based on the pendulum test

Quantified assessment of spasticity is essential for the rehabilitation of persons with paralysis. We introduce the new SPAsticity Scale (SPAS), which we found highly correlated with the Modified Ashworth Score (MAS); yet, with a delicate gradation of spasticity compared to the MAS. The parameters defining the SPAS show the level and the type of spasticity (flexion or extension). The SPAS is based on a complex model of the pendulum type oscillations of the lower leg, which includes the spastic torques. The data to calculate SPAS were collected by a wearable instrument with two inertial measurement units and two EMG recording units in subjects with a complete chronic spinal cord injury.

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.

Modeling musculoskeletal kinematic and dynamic redundancy using null space projection

The coordination of the human musculoskeletal system is deeply influenced by its redundant structure, in both kinematic and dynamic terms. Noticing a lack of a relevant, thorough treatment in the literature, we formally address the issue in order to understand and quantify factors affecting the motor coordination. We employed well-established techniques from linear algebra and projection operators to extend the underlying kinematic and dynamic relations by modeling the redundancy effects in null space. We distinguish three types of operational spaces, namely task, joint and muscle space, which are directly associated with the physiological factors of the system. A method for consistently quantifying the redundancy on multiple levels in the entire space of feasible solutions is also presented. We evaluate the proposed muscle space projection on segmental level reflexes and the computation of the feasible muscle forces for arbitrary movements. The former proves to be a convenient representation for interfacing with segmental level models or implementing controllers for tendon driven robots, while the latter enables the identification of force variability and correlations between muscle groups, attributed to the system’s redundancy. Furthermore, the usefulness of the proposed framework is demonstrated in the context of estimating the bounds of the joint reaction loads, where we show that misinterpretation of the results is possible if the null space forces are ignored. This work presents a theoretical analysis of the redundancy problem, facilitating application in a broad range of fields related to motor coordination, as it provides the groundwork for null space characterization. The proposed framework rigorously accounts for the effects of kinematic and dynamic redundancy, incorporating it directly into the underlying equations using the notion of null space projection, leading to a complete description of the system.

Interaction between muscle tone, short-range stiffness and increased sensory feedback gains explains key kinematic features of the pendulum test in spastic cerebral palsy: A simulation study

The pendulum test is a sensitive clinical assessment of spasticity where the lower leg is dropped from the horizontal position and features of limb motion are recorded. Three key kinematic features are associated with the degree of severity of spasticity in children with cerebral palsy: decreased initial limb excursion, reduced number of limb oscillations, and a non-vertical resting limb angle. While spasticity is attributed to increased velocity-dependent resistance to motion, prior models simulating increased sensorimotor feedback of muscle velocity fail to explain the key pendulum test kinematic outcomes in spastic individuals. Here we hypothesized that increased muscle tone, causing a transient increase in muscle force, i.e. short-range stiffness, could account for reduced first swing excursion and non-vertical resting limb angle. We further hypothesized that hyperreflexia modeled based on muscle fiber force, and not velocity, feedback would be necessary to reduce the number of oscillations because of its interaction with transiently increased muscle force due to short-range stiffness. We simulated the lower leg as a torque-driven single-link pendulum. Muscle tone was modeled as a constant baseline joint torque, short-range stiffness torque was dependent on the level of muscle tone, and delayed sensory feedback torque to simulate reflex activity was based on either muscle velocity or force. Muscle tone and transient short-range stiffness were necessary to simulate decreased initial swing excursion and non-vertical resting leg angle. Moreover, the reduction in the number of oscillations was best reproduced by simulating stretch reflex activity in terms of force, and not velocity, feedback. Varying only baseline muscle torque and reflex gain, we simulated a range of pendulum test kinematics observed across different levels of spasticity. Our model lends insight into physiological mechanisms of spasticity whose contributions can vary on an individual-specific basis, and potentially across different neurological disorders that manifest spasticity as a symptom.

Patterns of FOS expression in the spinal cord and periaqueductal grey matter of 6OHDA-lesioned rats

A less well-known feature of Parkinson disease is that up to 40% of patients experience distinct sensory disturbances, including hyperalgesia and chronic pain. There is a limited understanding of the neural mechanisms that generate these symptoms, however. This study explores the patterns of Fos expression (a well-known marker for changes in cell activity) in the spinal cord and periaqueductal grey matter (PaG), two major sensory (nociceptive) centers, of hemiParkinsonian rats. The medial forebrain bundle (mfb; major tract carrying dopaminergic nigrostriatal axons) was injected with either 6OHDA or saline (controls). A week later, some rats were subjected to mechanical stimulation (pinching) of the hindpaw for 2 h, whereas others received no stimulation. Thereafter, brains were processed using routine tyrosine hydroxylase (marker for dopaminergic cells) or Fos immunocytochemistry. In the PaG, there were many more Fos(+) cells in the 6OHDA-lesioned than in the Control group, in both the stimulation and, in particular, the non-stimulation cases. In the spinal cord, there were also more Fos(+) cells in the 6OHDA-lesioned than in the Control group, but in the stimulation cases only. Overall, the results show distinct changes in Fos expression in the spinal cord and PaG of 6OHDA-lesioned rats, suggesting a substrate for some of the abnormal sensory (nociceptive) circuits that may be evident in parkinsonian cases.

Modeling the Parkinson's tremor and its treatments

In this paper, we discuss modeling issues of the Parkinson's tremor. Through the work we have employed physiological structure as well as functioning of the parts in brain that are involved in the disease. To obtain more practical similarity, random behaviors of the connection paths are also considered. Medication or treatment of the disease both by drug prescription and electrical signal stimulation are modeled based on the same model introduced for the disease itself. Two new medication strategies are proposed based on the model to reduce the side effects caused by the present drug prescription.

Effect of Vim thalamic DBS in Parkinson’s disease on F wave duration

F waves were recorded from abductor hallucis muscle in eight Parkinsonian patients with deep brain stimulation (DBS) electrodes surgically implanted in their Vim thalamic nucleus in two conditions of DBS ON and OFF. Patients with relatively anteriorly located electrodes exhibited a significant reduction in F wave duration and also in the UPDRS rigidity score of the corresponding foot when the DBS was ON. In contrast, patients with relatively posteriorly located electrodes exhibited no significant difference in F wave duration in the two DBS ON and OFF conditions. The rigidity UPDRS score in the corresponding foot diminished very little in the latter group. Both groups had great improvement in their tremor at rest UPDRS score in that foot when the DBS was ON. Vim surgery is generally accepted to affect tremor mechanisms. However, surgical intervention in anterior parts of Vim has been reported to affect rigidity mechanisms. This correspondence of these two symptoms of rigidity and tremor with the two locations of anterior and relatively posterior Vim may indicate the contribution of mechanisms of rigidity, but not tremor, in enhancement of F wave duration and hyper excitability of spinal motoneuron.