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

Multi-muscle synergies in preparation for gait initiation in Parkinson's disease

OBJECTIVE

We investigated changes in indices of muscle synergies prior to gait initiation and the effects of gaze shift in patients with Parkinson's disease (PD). A long-term objective of the study is to develop a method for quantitative assessment of gait-initiation problems in PD.

METHODS

PD patients without clinical signs of postural instability and two control groups (age-matched and young) performed a gait initiation task in a self-paced manner, with and without a quick prior gaze shift produced by turning the head. Muscle groups with parallel scaling of activation levels (muscle modes) were identified as factors in the muscle activation space. Synergy index stabilizing center of pressure trajectory in the anterior-posterior and medio-lateral directions (indices of stability) was quantified in the muscle mode space. A drop in the synergy index in preparation to gait initiation (anticipatory synergy adjustment, ASA) was quantified.

RESULTS

Compared to the control groups, PD patients showed significantly smaller synergy indices and ASA for both directions of the center of pressure shift. Both PD and age-matched controls, but not younger controls, showed detrimental effects of the prior gaze shift on the ASA indices.

CONCLUSIONS

PD patients without clinically significant posture or gait disorders show impaired stability of the center of pressure and its diminished adjustment during gait initiation.

SIGNIFICANCE

The indices of stability and ASA may be useful to monitor pre-clinical gait disorders, and lower ASA may be relevant to emergence of freezing of gait in PD.

The synergic control of multi-finger force production: stability of explicit and implicit task components

Manipulating objects with the hands requires the accurate production of resultant forces including shear forces; effective control of these shear forces also requires the production of internal forces normal to the surface of the object(s) being manipulated. In the present study, we investigated multi-finger synergies stabilizing shear and normal components of force, as well as drifts in both components of force, during isometric pressing tasks requiring a specific magnitude of shear force production. We hypothesized that shear and normal forces would evolve similarly in time and also show similar stability properties as assessed by the decomposition of inter-trial variance within the uncontrolled manifold hypothesis. Healthy subjects were required to accurately produce total shear and total normal forces with four fingers of the hand during a steady-state force task (with and without visual feedback) and a self-paced force pulse task. The two force components showed similar time profiles during both shear force pulse production and unintentional drift induced by turning the visual feedback off. Only the explicitly instructed components of force, however, were stabilized with multi-finger synergies. No force-stabilizing synergies and no anticipatory synergy adjustments were seen for the normal force in shear force production trials. These unexpected qualitative differences in the control of the two force components-which are produced by some of the same muscles and show high degree of temporal coupling-are interpreted within the theory of control with referent coordinates for salient variables. These observations suggest the existence of two classes of neural variables: one that translates into shifts of referent coordinates and defines changes in magnitude of salient variables, and the other controlling gains in back-coupling loops that define stability of the salient variables. Only the former are shared between the explicit and implicit task components.

Optimizing Fingernail Imaging Calibration for 3D Force Magnitude Prediction

This paper discusses the optimization of a fingernail imaging system for predicting fingerpad force. The effects of lighting coloration, calibration grid, and force prediction model on the registration process and force prediction accuracy of fingernail imaging are investigated. White and green LEDs are found to produce statistically similar effects on registration error and force prediction results across all three directions of force. Two calibration grids are implemented, with no statistically significant difference in either registration or force prediction between the Cartesian and cylindrical grid designs. Of the five force prediction models investigated, a principal component regression model based on the pixel intensity eigenvectors estimates the force with the greatest accuracy. This EigenNail Magnitude Model simultaneously estimates force in all three directions with RMS error with 95 percent confidence interval of 0.55 ± 0.02 N (7.6 percent of the full force range). These results indicate a set of optimal parameter choices for the calibration of a fingernail imaging system.

Prehension synergies and hand function in early-stage Parkinson's disease

We explored the multi-digit synergies and hand performance in object manipulations and pressing tasks in patients with early-stage Parkinson's disease (PD) and healthy controls. Synergies were defined as inter-trials co-variation patterns among forces/moments produced by individual digits that stabilized a resultant mechanical variable. The subjects performed three main tasks: pressing (steady-state force production followed by a force pulse into the target), prehension (manipulation of a handheld instrumented handle imitating the action of taking a sip from a glass), and functional object manipulation (moving a glass with water as quickly and accurately as possible along a chain of targets). The PD patients were slower compared to controls in all three tasks. Patients showed smaller synergy indices in the pressing and prehension tasks. In the prehension tasks, patients showed elevated grip force at steady states with smaller grip force modulation during the handle motion. PD patients showed smaller feed-forward synergy adjustments in preparation to the quick action in the pressing and (to a smaller degree) prehension tasks. Synergy indices correlated with the time index of performance in the functional glass-with-water task, whereas none of the indices correlated with the Unified PD Rating Scale part III-motor scores. We interpret the results as pointing at an important role of subcortical structures in motor synergies and their feed-forward adjustments to action.

Motor output variability, deafferentation, and putative deficits in kinesthetic reafference in Parkinson's disease

Parkinson’s disease (PD) is a neurodegenerative disorder defined by motor impairments that include rigidity, systemic slowdown of movement (bradykinesia), postural problems, and tremor. While the progressive decline in motor output functions is well documented, less understood are impairments linked to the continuous kinesthetic sensation emerging from the flow of motions. There is growing evidence in recent years that kinesthetic problems are also part of the symptoms of PD, but objective methods to readily quantify continuously unfolding motions across different contexts have been lacking. Here we present evidence from a deafferented subject (IW) and a new statistical platform that enables new analyses of motor output variability measured as a continuous flow of kinesthetic reafferent input. Systematic increasing similarities between the patterns of motor output variability in IW and the participants with increasing degrees of PD severity suggest potential deficits in kinesthetic sensing in PD. We propose that these deficits may result from persistent, noisy, and random motor patterns as the disorder progresses. The stochastic signatures from the unfolding motions revealed levels of noise in the motor output fluctuations of these patients bound to decrease the kinesthetic signal’s bandwidth. The results are interpreted in light of the concept of kinesthetic reafference ( Von Holst and Mittelstaedt, 1950). In this context, noisy motor output variability from voluntary movements in PD leads to a returning stream of noisy afference caused, in turn, by those faulty movements themselves. Faulty efferent output re-enters the CNS as corrupted sensory motor input. We find here that severity level in PD leads to the persistence of such patterns, thus bringing the statistical signatures of the subjects with PD systematically closer to those of the subject without proprioception.

Impaired Object Handling during Bimanual Task Performance in Multiple Sclerosis

We investigated the kinetic features of manual dexterity and fine motor control during a task that resembles an activity of daily living in 30 persons with relapsing-remitting multiple sclerosis (PwMS). Specifically, a novel two-transducer system was used to measure time and grip-load forces during a bimanual task that is similar to opening and closing a jar. We hypothesized that PwMS would have increased grip force production, deteriorations in kinetic timing, and preserved grip-load coupling indices compared to healthy controls (i.e., young and older adults). Increased grip force production and deterioration in timing indices were confirmed in PwMS. Abnormal grip-load coupling was exhibited by PwMS, in contrast to healthy participants. The correlation between task time and self-reported disability scores suggests that objective measurement of impaired upper-extremity movements relates to perception of overall function.

Characterizing coordination of grasp and twist in hand function of healthy and post-stroke subjects

The goal of this study was to characterize the coordination of grasp and twist in hand function of normal and post-stroke subjects using a two degree of freedom hand robot. Results of the analysis of data from eight control subjects indicated that normal grip coordination involves the linear modulation of grip force with load torque. Thus, there was a high correlation between grip force and load torque. Also, the force generated by the thumb was highly correlated with the force generated by the index, middle and ring fingers. Finally, the safety margin used to stabilize grasp and avoid slip was consistent across normal subjects. In contrast, results from chronic post-stroke subjects indicated that they generally: (1) exerted excessive grip force to stabilize grasp using their ipsilesional hand; (2) lost the close amplitude coupling between grip force and load torque; and (3) lost the close modulation of the thumb force with finger force. These results suggest that our methods may provide objective, quantitative means of characterizing coordination problems following stroke.

Time perception impairs sensory-motor integration in Parkinson's disease

It is well known that perception and estimation of time are fundamental for the relationship between humans and their environment. However, this temporal information processing is inefficient in patients with Parkinson' disease (PD), resulting in temporal judgment deficits. In general, the pathophysiology of PD has been described as a dysfunction in the basal ganglia, which is a multisensory integration station. Thus, a deficit in the sensorimotor integration process could explain many of the Parkinson symptoms, such as changes in time perception. This physiological distortion may be better understood if we analyze the neurobiological model of interval timing, expressed within the conceptual framework of a traditional information-processing model called "Scalar Expectancy Theory". Therefore, in this review we discuss the pathophysiology and sensorimotor integration process in PD, the theories and neural basic mechanisms involved in temporal processing, and the main clinical findings about the impact of time perception in PD.

Dopaminergic modulation of motor coordinaton in Parkinson's disease

BACKGROUND

We applied the idea of synergies and the framework of the uncontrolled manifold hypothesis to explore the effects of dopamine replacement therapy on finger interaction and coordination in patients with early-stage Parkinson's disease (PD).

METHODS

Eight patients performed single-finger and multi-finger force production tasks with both the dominant and non-dominant hand before (off-drug) and after (on-drug) taking their dopaminergic medications. Synergy indices were defined as co-varied adjustments of commands to fingers that stabilized the total force produced by the hand.

RESULTS

PD patients showed significantly lower maximal finger forces off-drug compared to the on-drug condition, while indices of finger individuation (enslaving) were unchanged. The synergy indices were weaker during steady-state force production off-drug compared to on-drug. Anticipatory adjustments of synergies prior to the quick force pulse initiation were delayed and reduced off-drug as compared to the on-drug condition. These drug effects were observed in both the symptomatic and asymptomatic hands of the patients whose symptoms were limited to one side of the body.

CONCLUSIONS

The study demonstrates dopaminergic modulation of motor coordination in PD and supports that the analysis of different components of multi-finger synergies offers a set of indices sensitive to the effects of dopamine replacement therapy in early-stage PD. The results suggest an important role of the basal ganglia in synergy formation and in feed-forward synergy adjustments. Future studies using these methods may yield more objective, quantitative biomarker(s) of motor coordination impairments in PD, and better understanding of subcortical involvement in the neural control of natural actions.

Force coordination during bimanual task performance in Parkinson's disease

We investigated within- and between-hand grip-load force coordination in medically managed Parkinson's disease (PD) patients during bimanual tasks involving realistic actions. Increased grip force production and evidence of bradykinesia were expected in PD patients. Force coordination indices were also expected to be reduced in PD, due to impaired anticipatory force control. Increased grip force, bradykinesia, and abnormal load force production were exhibited in PD patients as compared to healthy controls. Indices of between-hand load force coordination, but not between-hand grip force coordination, were reduced in PD patients. Discrepancies in the strength of within-hand force coordination with respect to hand action were also noted in PD patients. Increased grip force production, in conjunction with abnormal load force production, may result in reduced fine motor control in PD patients during daily activities. Integrating quantitative analyses of realistic motor function in clinic may assist clinicians in evaluating the effectiveness of medical intervention in PD patients.

Impaired anticipatory control of grasp during obstacle crossing in Parkinson's disease

During self-paced walking, people with Parkinson's disease maintain anticipatory control during object grasping. However, common functional tasks often include carrying an object while changing step patterns mid-path and maneuvering over obstacles, increasing task complexity and attentional demands. Thus, the present study investigated the effect of Parkinson's disease on the modulation of grasping force changes as a function of gait-related inertial forces. Subjects with Parkinson's disease maintained the ability to scale and to couple over time their grip and inertial forces while walking at irregular step lengths, but were unable to maintain the temporal coupling of grasping forces compared to controls during obstacle crossing. We suggest that this deterioration in anticipatory control is associated with the increased demands of task complexity and attention during obstacle crossing.

Changes in multifinger interaction and coordination in Parkinson's disease

In this study, we tested several hypotheses related to changes in finger interaction and multifinger synergies during multifinger force production tasks in Parkinson's disease. Ten patients with Parkinson's disease, mostly early stage, and 11 healthy control subjects participated in the study. Synergies were defined as covaried adjustment of commands to fingers that stabilized the total force produced by the hand. Both Parkinson's disease patients and control subjects performed accurate isometric force production tasks with the fingers of both the dominant and nondominant hands. The Parkinson's disease patients showed significantly lower maximal finger forces and higher unintended force production (enslaving). These observations suggest that changes in supraspinal control have a major effect on finger individuation. The synergy indexes in the patients were weaker in both steady-state and cyclic force production tasks compared with the controls. These indexes also were stronger in the left (nondominant) hand in support of the dynamic-dominance hypothesis. Half of the patients could not perform the cyclic task at the highest frequency (2 Hz). Anticipatory adjustments of synergies prior to a quick force pulse production were delayed and reduced in the patients compared with the controls. Similar differences were observed between the asymptomatic hands of the patients with symptoms limited to one side of the body and matched hands of control subjects. Our study demonstrates that the elusive changes in motor coordination in Parkinson's disease can be quantified objectively, even in patients at a relatively early stage of the disease. The results suggest an important role of the basal ganglia in synergy formation and demonstrate a previously unknown component of impaired feedforward control in Parkinson's disease reflected in the reduced and delayed anticipatory synergy adjustments.

Early switching between movement types: indication of predictive control?

In everyday life, we frequently alternate between performing discrete and rhythmic movements. When performing a periodic movement, two distinct movement types can be distinguished: highly harmonic vs. discrete-like. The harmonicity of the movement is used to classify it as one or the other. We asked: (1) whether the frequency at which a periodic movement is performed affects the harmonicity of the resultant movement; and (2) what underlies switching between these movement types. To answer these questions, we studied horizontal flexion/extension forearm movements in 13 young adults over a wide range of frequencies. Movements were performed either at a fixed frequency, or at gradually increasing or decreasing target frequencies. We found movement harmonicity to depend on the frequency of the movement. Furthermore, we found a reverse hysteresis behavior, where participants switched movement type in anticipation of the future-required frequency. These findings suggest that predictive control is employed in switching between movement types.

Proprioception and motor control in Parkinson's disease

Parkinson's disease (PD) is a neurodegenerative disorder that leads to a progressive decline in motor function. Growing evidence indicates that PD patients also experience an array of sensory problems that negatively impact motor function. This is especially true for proprioceptive deficits, which profoundly degrade motor performance. This review specifically address the relation between proprioception and motor impairments in PD. It is structured around 4 themes: (a) It examines whether the sensitivity of kinaesthetic perception, which is based on proprioceptive inputs, is actually altered in PD. (b) It discusses whether failed processes of proprioceptive-motor integration are central to the motor problems in PD. (c) It presents recent findings focusing on the link between the proprioception and the balance problems in PD. And (d) it discusses the current state of knowledge of how levodopa medication and deep brain stimulation affect proprioceptive and motor function in PD. The authors conclude that a failure to evaluate and to map proprioceptive information onto voluntary and reflexive motor commands is an integral part of the observed motor symptoms in PD.

Coordination of grasping and walking in Parkinson's disease

Studies on grasp control underlying manual dexterity in people with Parkinson disease (PD) suggest that anticipatory grasp control is mainly unaffected during discrete tasks using simple two-digit grasp. Nevertheless, impaired hand function during daily activities is one of the most disabling symptoms of PD. As many daily grasping activities occur during functional movements involving the whole body, impairments in anticipatory grasp control might emerge during a continuous dynamic task such as object transport during walking. In this case, grasp control must be coordinated along with multiple body segments. The present study investigated the effect of PD on anticipatory grasp control and intersegmental coordination during walking with a hand-held object. Nine individuals with idiopathic PD (tested OFF and ON medication) and nine healthy age-matched controls carried a grip instrument between their right thumb and index finger during self-paced and fast walking. Although the amplitude of grip forces was higher in standing and walking for subjects with PD, both subjects with PD and control subjects coupled grip and inertial force changes in an anticipatory fashion while walking. However, gait-induced motions of the object relative to that of the trunk (i.e., dampening) was reduced in subjects with PD. Medication increased the dampening in all subjects with PD. We suggest that these differences are associated with impairments in intersegmental coordination.

The effect of eating utensil weight on functional arm movement in people with Parkinson’s disease: a controlled clinical trial

Objective: To investigate the effect of eating utensil weight on kinematic performance in people with Parkinson’s disease.

Design: A counterbalanced repeated-measures design.

Setting: A motor control laboratory in a university setting.

Subjects: Eighteen adults with Parkinson’s disease and 18 age-matched controls.

Experimental conditions: Each participant performed a food transfer task using spoons of three different weights: lightweight (35 g), control (85 g) and weighted (135 g). Kinematic variables of arm movement were derived and compared between conditions.

Main measures: Kinematic variables of arm movement, including movement time, peak velocity and number of movement units.

Results: Utensil weights significantly affected the movement kinematics

of all participants. Both groups had fewer movement units in the lightweight condition (Parkinson’s disease group: 22.18, controls: 19.89) than in the weighted condition (Parkinson’s disease group: 22.68, controls: 21.36), suggesting smoother movement in the former condition. In addition, both groups had higher peak velocity in the lightweight than in the weighted condition.

Conclusions: Our findings suggest that a lightweight utensil may facilitate smoother and higher-velocity arm movement than a weighted one in people with Parkinson’s disease.

Sensorimotor memory of object weight distribution during multidigit grasp

We studied the ability to transfer three-digit force sharing patterns learned through consecutive lifts of an object with an asymmetric center of mass (CM). After several object lifts, we asked subjects to rotate and translate the object to the contralateral hand and perform one additional lift. This task was performed under two weight conditions (550 and 950 g) to determine the extent to which subjects would be able to transfer weight and CM information. Learning transfer was quantified by measuring the extent to which force sharing patterns and peak object roll on the first post-translation trial resembled those measured on the pre-translation trial with the same CM. We found that the overall gain of fingertip forces was transferred following object rotation, but that the scaling of individual digit forces was specific to the learned digit-object configuration, and thus was not transferred following rotation. As a result, on the first post-translation trial there was a significantly larger object roll following object lift-off than on the pre-translation trial. This suggests that sensorimotor memories for weight, requiring scaling of fingertip force gain, may differ from memories for mass distribution.

The use of kinetics as a marker for manual dexterity after stroke and stroke recovery

Stroke is the leading cause of severe, long-term disability among older adults in the United States. Unimanual motor performance of the hemiparetic limb is clearly compromised, and these declines are well documented. An often overlooked aspect of motor function for patients with stroke is the effect of unilateral motor dysfunction on bimanual motor activities. Diminished bimanual function resulting from upper extremity hemiparesis necessarily limits the patient's daily functioning. In this review we describe a bimanual dexterity task that replicates many daily activities and outline how kinetic analysis of this task may provide insight into diminished bimanual function of patients with stroke and how these variables may be useful in assessing level of recovery and rate of motor recovery associated with behavioral interventions intended to improve upper extremity function. It is argued that the use of objective kinetic measures to quantify hand function may facilitate the clinical adoption of behavioral interventions for stroke, such as constraint-induced movement therapy and other repetitive task practice-based interventions.

Biased wrist and finger coordination in Parkinsonian patients during performance of graphical tasks

Handwriting impairments in Parkinson's disease (PD) have been associated with micrographia, i.e. diminished letter size. However, dyscoordination of the wrist and fingers may also contribute to handwriting deterioration in PD. To investigate this hypothesis, right-handed PD patients and controls were tested in performance of three types of cyclic wrist and finger movements: drawing of two lines and a circle. The line drawing was performed with either simultaneous flexion and extension of the wrist and fingers (equivalent pattern resulting in a right-tilted line) or with wrist flexion/extension accompanied with finger extension/flexion (nonequivalent pattern resulting in a left-tilted line). Circle drawing required a specific phase difference between wrist and finger motions. Movements were performed with an inkless pen on a digitizer-tablet at two frequency levels. Consistent deformations of the circle into right-tilted ovals and lower variability in equivalent compared with nonequivalent lines revealed preference to produce right-tilted shapes. This preference became more apparent with increased movement speed and it was amplified in PD patients. Analysis revealed that the circle deformation emerged mainly due to reduction in relative phase, while wrist and finger amplitudes remained unchanged. The results suggest that PD causes deficit characterized by strong tendency to produce certain coordination patterns between wrist and finger motions. This deficit may significantly contribute to handwriting impairments in PD by reducing the dexterity in the production of the variety of shapes of the cursive letters. Furthermore, the deficiency revealed in wrist and finger coordination may represent a more general deficit affecting control of various multi-joint movements in PD.