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Daniels RJ, Grenet D, Knight CA. Impaired performance of rapid grip in people with Parkinson's disease and motor segmentation. Hum Mov Sci 2024; 95:103201. [PMID: 38507858 DOI: 10.1016/j.humov.2024.103201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
Bradykinesia, or slow movement, is a defining symptom of Parkinson's disease (PD), but the underlying neuromechanical deficits that lead to this slowness remain unclear. People with PD often have impaired rates of motor output accompanied by disruptions in neuromuscular excitation, causing abnormal, segmented, force-time curves. Previous investigations using single-joint models indicate that agonist electromyogram (EMG) silent periods cause motor segmentation. It is unknown whether motor segmentation is evident in more anatomically complex and ecologically important tasks, such as handgrip tasks. Aim 1 was to determine how handgrip rates of force change compare between people with PD and healthy young and older adults. Aim 2 was to determine whether motor segmentation is present in handgrip force and EMG measures in people with PD. Subjects performed rapid isometric handgrip pulses to 20-60% of their maximal voluntary contraction force while EMG was collected from the grip flexors and extensors. Dependent variables included the time to 90% peak force, the peak rate of force development, the duration above 90% of peak force, the number of segments in the force-time curve, the number of EMG bursts, time to relaxation from 90% of peak force, and the peak rate of force relaxation. People with PD had longer durations and lower rates of force change than young and older adults. Six of 22 people with PD had motor segmentation. People with PD had more EMG bursts compared to healthy adults and the number of EMG bursts covaried with the number of segments. Thus, control of rapid movement in Parkinson's disease can be studied using isometric handgrip. People with PD have impaired rate control compared to healthy adults and motor segmentation can be studied in handgrip.
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Affiliation(s)
- Rebecca J Daniels
- Department of Kinesiology and Applied Physiology, University of Delaware, 211AC The Tower at STAR, 100 Discovery Blvd, Newark, DE, USA.
| | - David Grenet
- Department of Psychology, Concordia University, 7141 Sherbrooke St. W, Montreal, QC H4B 1R6, Canada.
| | - Christopher A Knight
- Department of Kinesiology and Applied Physiology, University of Delaware, 344 The Tower at STAR, 100 Discovery Blvd, Newark, DE, USA.
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Luft F, Sharifi S, Mugge W, Schouten AC, Bour LJ, van Rootselaar AF, Veltink PH, Heida T. Deficits in tapping accuracy and variability in tremor patients. J Neuroeng Rehabil 2019; 16:54. [PMID: 31064378 PMCID: PMC6505201 DOI: 10.1186/s12984-019-0528-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/30/2019] [Indexed: 12/02/2022] Open
Abstract
Background The basal ganglia and cerebellum are brain structures involved in movement initiation, execution and termination. They are thought to be involved in the tremor generation and movement deficits in Parkinson’s disease (PD) and essential tremor (ET). Especially in PD, maintaining cyclic movement, such as walking or tapping can be significantly disturbed. Providing external cues improves timing of these movements in PD but its effect on ET has not yet been studied in depth. The aim of this study is to evaluate the usefulness of a bimanual tapping task as a tool during clinical decision making. Method Hand movements and tremor was recorded using accelerometers and EMG (m. extensor carpi ulnaris) from PD and ET patients and healthy controls during a bimanual tapping task as a way to distinguish PD from ET. All subjects performed the tapping task at two different frequencies, 2 Hz and 4 Hz, with and without the presence of auditory cues. Results No significant intra-group differences were found in the patient groups. Acceleration data revealed significantly less accurate tapping and more variable tapping in PD than in ET and healthy controls. ET subjects tapped less accurate and with a greater variability than healthy controls during the 4 Hz tapping task. Most interestingly the tapping accuracy improved in PD patients when kinetic tremor was recorded with EMG during the task. Conclusion Providing ET and PD patients with an external cue results in different tapping performances between patient groups and healthy controls. Furthermore, the findings suggest that kinetic tremor in PD enables patients to perform the task with a greater accuracy. So far this has not been shown in other studies.
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Affiliation(s)
- Frauke Luft
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands.
| | - Sarvi Sharifi
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Winfred Mugge
- Department of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - Alfred C Schouten
- Department of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - Lo J Bour
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne-Fleur van Rootselaar
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter H Veltink
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - Tijtske Heida
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
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López-Blanco R, Velasco MA, Méndez-Guerrero A, Romero JP, Del Castillo MD, Serrano JI, Benito-León J, Bermejo-Pareja F, Rocon E. Essential tremor quantification based on the combined use of a smartphone and a smartwatch: The NetMD study. J Neurosci Methods 2018; 303:95-102. [PMID: 29481820 DOI: 10.1016/j.jneumeth.2018.02.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND The use of wearable technology is an emerging field of research in movement disorders. This paper introduces a clinical study to evaluate the feasibility, clinical correlation and reliability of using a system based in smartwatches to quantify tremor in essential tremor (ET) patients and check its acceptance as clinical monitoring tool. NEW METHOD The system is based on a commercial smartwatch and an Android smartphone. An investigational Android application controls the process of recording raw data from the smartwatch three-dimensional gyroscopes. Thirty-four ET patients were consecutively enrolled in the experiments and assessed along one year. Arm tremor was videofilmed and scored using the Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS). Tremor intensity was quantified with the root mean square of angular velocity measured in the patients' wrists. RESULTS Eighty-two assessments with smartwatches were performed. Spearman's correlation coefficients (ρ) between clinical tremor (FTM-TRS) scores and smartwatch measures for tremor intensity were 0.590 at rest; ρ = 0.738 in steady posture; ρ = 0.189 in finger-to-nose maneuvers; and ρ = 0.652 in pouring water task. Smartwatch reliability was checked by intraclass realiability coefficients: 0.85, 0.95, 0.91, 0.95 respectively. Most of patients showed good acceptance of the system. COMPARISON WITH EXISTING METHOD(S) This commodity hardware contributes to quantify tremor objectively in a consulting-room by customized Android smart devices as clinical monitoring tool. CONCLUSIONS The NetMD system for tremor analysis is feasible, well-correlated with clinical scores, reliable and well-accepted by patients to tremor follow-up. Therefore, it could be an option to objectively quantify tremor in ET patients during their regular follow-up.
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Affiliation(s)
- Roberto López-Blanco
- Healthcare Research Institute (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain; Neurology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares Madrid, Spain.
| | | | | | - Juan Pablo Romero
- Faculty of Biosanitary Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain; Brain Damage Service, Hospital Beata Maria Ana, Madrid, Spain
| | | | | | - Julián Benito-León
- Healthcare Research Institute (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain; Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Center of Biomedical Network Research on Neurodegenerative Dseases (CIBERNED), Spain; Medicine Department, Faculty of Medicine, Universidad Complutense Madrid (UCM), Spain
| | - Félix Bermejo-Pareja
- Medicine Department, Faculty of Medicine, Universidad Complutense Madrid (UCM), Spain; Clinical Research Unit, University Hospital, "12 de Octubre", Madrid, Spain
| | - Eduardo Rocon
- Centro de Automática y Robótica (CAR), CSIC-UPM, Madrid, Spain
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Ruonala V, Pekkonen E, Airaksinen O, Kankaanpää M, Karjalainen PA, Rissanen SM. Levodopa-Induced Changes in Electromyographic Patterns in Patients with Advanced Parkinson's Disease. Front Neurol 2018; 9:35. [PMID: 29459845 PMCID: PMC5807331 DOI: 10.3389/fneur.2018.00035] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 01/15/2018] [Indexed: 11/13/2022] Open
Abstract
Levodopa medication is the most efficient treatment for motor symptoms of Parkinson's disease (PD). Levodopa significantly alleviates rigidity, rest tremor, and bradykinesia in PD. The severity of motor symptoms can be graded with UPDRS-III scale. Levodopa challenge test is routinely used to assess patients' eligibility to deep-brain stimulation (DBS) in PD. Feasible and objective measurements to assess motor symptoms of PD during levodopa challenge test would be helpful in unifying the treatment. Twelve patients with advanced PD who were candidates for DBS treatment were recruited to the study. Measurements were done in four phases before and after levodopa challenge test. Rest tremor and rigidity were evaluated using UPDRS-III score. Electromyographic (EMG) signals from biceps brachii and kinematic signals from forearm were recorded with wireless measurement setup. The patients performed two different tasks: arm isometric tension and arm passive flexion-extension. The electromyographic and the kinematic signals were analyzed with parametric, principal component, and spectrum-based approaches. The principal component approach for isometric tension EMG signals showed significant decline in characteristics related to PD during levodopa challenge test. The spectral approach on passive flexion-extension EMG signals showed a significant decrease on involuntary muscle activity during the levodopa challenge test. Both effects were stronger during the levodopa challenge test compared to that of patients' personal medication. There were no significant changes in the parametric approach for EMG and kinematic signals during the measurement. The results show that a wireless and wearable measurement and analysis can be used to study the effect of levodopa medication in advanced Parkinson's disease.
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Affiliation(s)
- Verneri Ruonala
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Eero Pekkonen
- Department of Clinical Neurosciences, Neurology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Olavi Airaksinen
- Department of Physical Medicine and Rehabilitaton, Kuopio University Hospital, Kuopio, Finland
| | - Markku Kankaanpää
- Department of Physical Medicine and Rehabilitaton, Tampere University Hospital, Tampere, Finland
| | - Pasi A Karjalainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Saara M Rissanen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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Oliveira RDA, Sande de Souza LAP. Single-Joint Movements in Parkinson's Disease: A Pulse-Width and Pulse-Height Theory Review. J Mot Behav 2016; 49:235-243. [PMID: 27588412 DOI: 10.1080/00222895.2016.1204261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The process by which the brain controls single-joint movements (SJM) is still not well understood. Some studies have defined rules describing the duration and magnitude of the agonist and antagonist muscles. Therefore, the purpose of this study was to analyze scientific publications about the electromyographic characteristics of SJM performed by patients with Parkinson's disease. A bibliographical review of the years 1989-2015 was performed using keywords such as electromyography, upper limb, and Parkinson's disease. After applying the inclusion criteria, 8 articles were included for analysis. The literature indicates that despite the lack of studies, it is possible to assume that considering the SJM, those with Parkinson's disease only control the magnitude of electromyography activation, being consistent only with the pulse-height theory control.
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Affiliation(s)
- Rafael de Almeida Oliveira
- a Physical Education , Laboratory of Biomechanics and Motor Control, Federal University of Triangulo Mineiro , Uberaba , Brazil
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Abstract
OBJECTIVE To determine the relationship between resting tremor (RT) and action tremor (AT) in Parkinson's disease (PD) patients. METHODS A retrospective study of RT and AT severity was conducted in 100 PD patients. The severity rating for each type of tremor in the upper extremities was assessed. The disparity in tremor severity between extremities for each tremor type was compared to that of the other two to identify commonalities in the laterality of the tremor manifestation. RESULTS Overall, RT is predictive of AT on the same side, but not the opposing side of the body. Patients with less intense resting right upper limb (RRU) tremor and moderately intense RRU tremor were significantly more likely to have an action right upper limb (ARU) tremor (-1.53, P = 0.020; -1.88, P = 0.005, respectively). Similarly, patients with less intense resting left upper limb (RLU) tremor and moderately intense RLU tremors were significantly more likely to have an action left upper limb (ALU) tremor (-3.49, P = 0.000; -1.86, P = 0.017, respectively). In addition, RRU and ALU tremors were associated with an increase in RLU and ARU tremors, respectively. CONCLUSION Tremors are common findings in PD patients, and often impair quality of life. By identifying and classifying the relationship between resting and ATs in PD patients, our study sheds light onto the importance of better understanding and future management of this debilitating symptomology.
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Affiliation(s)
- Abdul Qayyum Rana
- Parkinson's Clinic of Eastern Toronto and Movement Disorders Center, Toronto, Ontario, Canada
| | - Mohamad Saleh
- Parkinson's Clinic of Eastern Toronto and Movement Disorders Center, Toronto, Ontario, Canada
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Lentz L, Zhao Y, Kelly MT, Schindeldecker W, Goetz S, Nelson DE, Raike RS. Motor behaviors in the sheep evoked by electrical stimulation of the subthalamic nucleus. Exp Neurol 2015; 273:69-82. [DOI: 10.1016/j.expneurol.2015.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 07/22/2015] [Accepted: 07/25/2015] [Indexed: 12/25/2022]
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Senova S, Querlioz D, Thiriez C, Jedynak P, Jarraya B, Palfi S. Using the Accelerometers Integrated in Smartphones to Evaluate Essential Tremor. Stereotact Funct Neurosurg 2015; 93:94-101. [PMID: 25720954 DOI: 10.1159/000369354] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 10/26/2014] [Indexed: 11/19/2022]
Abstract
Background/Aims: Evaluation of tremor constitutes a crucial step from the diagnosis to the initial treatment and follow-up of patients with essential tremor. The severity of tremor can be evaluated using clinical rating scales, accelerometry, or electrophysiology. Clinical scores are subjectively given, may be affected by intra- and interevaluator variations due to different experience, delays between consultations, and subtle changes in tremor severity. Existing medical devices are not routinely used: they are expensive, time-consuming, not easily accessible. We aimed at showing that a smartphone application using the accelerometers embedded in smartphones is effective for quantifying the tremor of patients presenting with essential tremor. Methods: We developed a free iPhone/iPod application, Itremor, and evaluated different parameters on 8 patients receiving deep brain stimulation of the ventral intermediate nucleus of the thalamus: average and maximum accelerations, time above 1 g of acceleration, peak frequency, typical magnitude of tremor, for postural and action tremors, on and off stimulation. Results: We demonstrated good correlations between the parameters measured with Itremor and clinical score in all conditions. Itremor evaluation enabled higher discriminatory power and degree of reproducibility than clinical scores. Conclusion: Itremor can be used for routine objective evaluation of essential tremor, and may facilitate adjustment of the treatment. © 2015 S. Karger AG, Basel.
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Affiliation(s)
- Suhan Senova
- Neurosurgery Department, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Henri-Mondor Albert-Chenevier, Université Paris 12 UPEC, Faculté de Médecine, Créteil, France
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Heida T, Wentink EC, Marani E. Power spectral density analysis of physiological, rest and action tremor in Parkinson's disease patients treated with deep brain stimulation. J Neuroeng Rehabil 2013; 10:70. [PMID: 23834737 PMCID: PMC3722015 DOI: 10.1186/1743-0003-10-70] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 06/14/2013] [Indexed: 12/04/2022] Open
Abstract
Background Observation of the signals recorded from the extremities of Parkinson’s disease patients showing rest and/or action tremor reveal a distinct high power resonance peak in the frequency band corresponding to tremor. The aim of the study was to investigate, using quantitative measures, how clinically effective and less effective deep brain stimulation protocols redistribute movement power over the frequency bands associated with movement, pathological and physiological tremor, and whether normal physiological tremor may reappear during those periods that tremor is absent. Methods The power spectral density patterns of rest and action tremor were studied in 7 Parkinson’s disease patients treated with (bilateral) deep brain stimulation of the subthalamic nucleus. Two tests were carried out: 1) the patient was sitting at rest; 2) the patient performed a hand or foot tapping movement. Each test was repeated four times for each extremity with different stimulation settings applied during each repetition. Tremor intermittency was taken into account by classifying each 3-second window of the recorded angular velocity signals as a tremor or non-tremor window. Results The distribution of power over the low frequency band (<3.5 Hz – voluntary movement), tremor band (3.5-7.5 Hz) and high frequency band (>7.5 Hz – normal physiological tremor) revealed that rest and action tremor show a similar power-frequency shift related to tremor absence and presence: when tremor is present most power is contained in the tremor frequency band; when tremor is absent lower frequencies dominate. Even under resting conditions a relatively large low frequency component became prominent, which seemed to compensate for tremor. Tremor absence did not result in the reappearance of normal physiological tremor. Conclusion Parkinson’s disease patients continuously balance between tremor and tremor suppression or compensation expressed by power shifts between the low frequency band and the tremor frequency band during rest and voluntary motor actions. This balance shows that the pathological tremor is either on or off, with the latter state not resembling that of a healthy subject. Deep brain stimulation can reverse the balance thereby either switching tremor on or off.
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Affiliation(s)
- Tjitske Heida
- Department of Electrical Engineering, Mathematics and Computer Science, MIRA Institute for Biomedical Engineering and Technical Medicine, Biomedical Signals and Systems group, University of Twente, Enschede, The Netherlands.
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Ridgel AL, Muller MD, Kim CH, Fickes EJ, Mera TO. Acute effects of passive leg cycling on upper extremity tremor and bradykinesia in Parkinson's disease. PHYSICIAN SPORTSMED 2011; 39:83-93. [PMID: 22030944 DOI: 10.3810/psm.2011.09.1924] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Previous studies have shown that single bouts of high-rate active cycling (> 80 rpm) improve upper extremity motor function in individuals with Parkinson's disease (PD). It is unknown if passive leg cycling produces a similar effect on upper extremity function. This article examines whether passive leg cycling can promote immediate changes in upper tremor and bradykinesia in PD and if pedaling rates have variable effects. METHODS Twenty individuals with mild-to-moderate idiopathic PD completed 4 sessions, with each session taking place 1 week apart. In the second to fourth sessions, a motorized bicycle was set to passively rotate the subjects' legs at rates of 60, 70, or 80 rpm for 30 minutes. Quantitative upper extremity motor assessments were completed immediately before and after each session. RESULTS Passive leg cycling was shown to reduce tremor and bradykinesia in PD. However, the rate of passive cycling did not affect the degree of improvement in bradykinesia or tremor. CONCLUSION These findings suggest that lower extremity passive cycling can promote changes in upper extremity motor function in individuals with PD.
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Affiliation(s)
- Angela L Ridgel
- Department of Exercise Physiology, Kent State University, Kent, OH, USA.
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Abstract
The objective was to design, build, and assess Kinesia, a wireless system for automated assessment of Parkinson's disease (PD) tremor. The current standard in evaluating PD is the Unified Parkinson's Disease Rating Scale (UPDRS), a qualitative ranking system typically completed during an office visit. Kinesia integrates accelerometers and gyroscopes in a compact patient-worn unit to capture kinematic movement disorder features. Objectively quantifying PD manifestations with increased time resolution should aid in evaluating efficacy of treatment protocols and improve patient management. In this study, PD subjects performed the tremor subset of the UPDRS motor section while wearing Kinesia. Quantitative kinematic features were processed and highly correlated to clinician scores for rest tremor (r(2) = 0.89), postural tremor (r(2) = 0.90), and kinetic tremor (r(2) = 0.69). The quantitative features were used to develop a mathematical model that predicted tremor severity scores for new data with low errors. Finally, PD subjects indicated high clinical acceptance.
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Affiliation(s)
- Joseph P Giuffrida
- Division of Movement Disorders, Cleveland Medical Devices Inc., Cleveland, Ohio 44103, USA.
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Abstract
Brain imaging represents a potent tool to characterize biomarkers, biological traits that are pathognomonic for specific neurological and neuropsychiatric disorders. Positron emission tomography (PET) and single photon emission computed tomography (SPECT) are imaging techniques used to identify alterations in the density and distribution of neurotransmitters, neuroreceptors, and transporters in specific regions of the brains of people with these disorders. Brain imaging research currently facilitates the elucidation of dysfunction of dopamine, serotonin, acetylcholine, and other substances in people with Alzheimer's and Parkinson's diseases, schizophrenia, alcoholism and other substance abuse disorders, attention deficit/hyperactivity disorder, and the syndromes of restless legs, Lesch-Nyhan, Rett, and Tourette. Thus, brain imaging research offers great potential for the diagnosis, treatment, prevention, and cure of neurological and neuropsychiatric disorders. Brain imaging research also facilitates new drug development and helps establish therapeutic doses of novel drugs. In particular, studies of specific receptors, such as the dopamine D2 receptor, before and after the administration of doses of drugs that occupy these D2 receptors, provide the means to determine receptor occupancy. For example, an optimal dose of D2 antagonist antipsychotics produces occupancy of 65% to 80% of D2 receptors, while a greater dose carries a risk of extrapyramidal side effects.
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Affiliation(s)
- Dean F Wong
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of Nuclear Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-0807, USA.
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Journée HL, Postma AA, Sun M, Staal MJ. Detection of tremor bursts by a running second order moment function and analysis using interburst histograms. Med Eng Phys 2007; 30:75-83. [PMID: 17280862 DOI: 10.1016/j.medengphy.2006.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Revised: 12/07/2006] [Accepted: 12/15/2006] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Conventional linear signal processing techniques are not always suitable for the detection of tremor bursts in clinical practice due to inevitable noise from electromyographic (EMG) bursts. This study introduces (1) a non-linear analysis technique based on a running second order moment function (SOMF) and (2) auto- and cross-interburst interval histograms (IBIH) showing distributions of interburst interval EMG bursts of pathological tremors illustrating an application of the SOMF. MATERIALS AND METHODS EMG recordings from extensors and flexors of two patients with Parkinson's disease with a rest tremor and from a healthy subject during sustained muscular contraction were preliminary analyzed in a pilot study. The SOMF was obtained by repeated second order moment calculations within a window of fixed width W (time scale parameter) plotted as a function of time. Minimum SOMF values indicate local "moments of inertia" of each EMG burst. Bursts were detected and located when minimum SOMF values were below level L (decision parameter). Optimal settings of parameters W and L were calculated empirically for pathological tremor EMGs. Auto- and cross-IBIHs were obtained from minimum SOMF values of detected bursts. RESULTS Tremor frequency and phase relation between EMG bursts from auto- and cross-IBIHs agreed with those derived from spectral analysis. Burst detection by SOMF has a high sensitivity and selectivity even with noisy background. CONCLUSION The SOMF is appropriate for detection of individual EMG bursts of pathological tremors. The technique is sensitive to non-stationary changes of tremor bursts regardless of their amplitude. IBIHs provide a measure of tremor frequency and phase difference between EMG bursts.
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Affiliation(s)
- Henricus Louis Journée
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands.
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Kraus PH, Lemke MR, Reichmann H. Kinetic tremor in Parkinson's disease--an underrated symptom. J Neural Transm (Vienna) 2006; 113:845-53. [PMID: 16804646 DOI: 10.1007/s00702-005-0354-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2005] [Accepted: 06/25/2005] [Indexed: 10/25/2022]
Abstract
Since the first description of the disorder which we now call "Parkinson's Disease" (PD) much has changed not only because of new therapeutic possibilities. Initially only the rest tremor was described. Today it is generally accepted that PD can be accompanied by different forms of tremor. Nevertheless the kinetic tremor is hardly examined and no attention is paid to it in clinical rating scales although it can already be found in old published drawings of PD-patients. To date instrumented investigations do not capture the most common kinetic tremor of PD that seems to be frequent under everyday life conditions. In order to assess the significance of kinetic tremor in PD, tremor during a spiral drawing task was investigated in an open study involving 870 patients. The results indicate that a combination of rest, postural and kinetic tremors constitute the most frequent tremor constellation in PD.
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Affiliation(s)
- P H Kraus
- Department of Neurology, St. Josef-Hospital, University of Bochum, Bochum, Germany.
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Raethjen J, Pohle S, Govindan RB, Morsnowski A, Wenzelburger R, Deuschl G. Parkinsonian action tremor: interference with object manipulation and lacking levodopa response. Exp Neurol 2005; 194:151-60. [PMID: 15899252 DOI: 10.1016/j.expneurol.2005.02.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Revised: 02/11/2005] [Accepted: 02/18/2005] [Indexed: 10/25/2022]
Abstract
It has been postulated that Parkinsonian action tremor is distinct from classical resting tremor and that it may contribute to a loss of manual dexterity in Parkinson's disease. We analyzed pinch grip coordination in 20 patients with Parkinson's disease. An object with and without an additional 500 g weight was grasped, lifted and held for a short time with opposed thumb and index finger. Force sensors recorded the force exerted by both fingers. Spectral analysis of the force traces was performed. Transition times between grasping and lifting the object were measured. 18 age matched normal volunteers served as a control group. While holding the object, there were force oscillations in the 3.5-6.5 Hz band indicating (reemerging) classical Parkinsonian tremor in 65% of the patients. This was reduced to 15-20% under levodopa. Oscillations in the 6-15 Hz band were found in 30% (50% with weight) of the patients, remaining unchanged under levodopa, and in 10% (20% with weight) of the normal controls. During lift initiation, 6-15 Hz oscillations were found in all patients and the majority of controls. The band power was positively correlated with the movement transition times in the severely akinetic patients and was significantly higher than in controls. It remained unchanged under levodopa. Our data confirm that Parkinsonian action tremor activated during complex voluntary movements is distinct from classical resting tremor. It does not show a clear levodopa response but affects dextrous movement coordination when associated with clinically severe overall akinesia.
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Affiliation(s)
- J Raethjen
- Department of Neurology, University of Kiel, Schittenhelmstrasse 10, 24105 Kiel, Germany
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Goetz CG, Kompoliti K. Parkinson's disease. Neurodegenerative Diseases. Cambridge University Press; 2010. pp. 561-74. [DOI: 10.1017/cbo9780511544873.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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Max L, Gracco VL. Coordination of oral and laryngeal movements in the perceptually fluent speech of adults who stutter. J Speech Lang Hear Res 2005; 48:524-42. [PMID: 16197270 DOI: 10.1044/1092-4388(2005/036)] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2003] [Revised: 07/06/2004] [Accepted: 11/09/2004] [Indexed: 05/04/2023]
Abstract
This work investigated whether stuttering and nonstuttering adults differ in the coordination of oral and laryngeal movements during the production of perceptually fluent speech. This question was addressed by completing correlation analyses that extended previous acoustic studies by others as well as inferential analyses based on the within-subject central tendency and variability of acoustic and physiological indices of oral-laryngeal control and coordination. Stuttering and nonstuttering adults produced the target /p/ as the medial consonant in C(1)V(1)#C(2)V(2)C(3) sequences (C = consonant; V = vowel or diphthong; # = word boundary) embedded in utterances differing in length and location of the target movements. No between-groups differences were found for across- or within-subject correlations between acoustic measures of stop gap and voice onset time (VOT). However, the acoustic data did show longer durations for devoicing interval and VOT in the stuttering versus nonstuttering individuals, in the absence of a difference for a proportional measure specifically reflecting oral-laryngeal relative timing. Analyses of combined kinematic and electroglottographic data revealed that the stuttering individuals' speech was also characterized by (a) longer durations from bilabial closing movement onset and peak velocity to V(1) vocal fold vibration offset and (b) greater within-subject variability for dependent variables that were physiological indices of devoicing interval and VOT, but again no between-groups differences were found for specific indices of oral-laryngeal relative timing. Overall, findings suggest that, for the production of voiceless bilabial stops in perceptually fluent speech, stuttering and nonstuttering adults differ in the duration of intervals defined by events within as well as across the oral and laryngeal subsystems, but the groups show similar patterns of relative timing for the involved oral and laryngeal movements.
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Affiliation(s)
- Ludo Max
- University of Connecticut, Department of Communication Sciences, Storrs, CT 06269, USA.
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Strambi SK, Rossi B, De Michele G, Sello S. Effect of medication in Parkinson's disease: a wavelet analysis of EMG signals. Med Eng Phys 2004; 26:279-90. [PMID: 15121053 DOI: 10.1016/j.medengphy.2004.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2003] [Revised: 11/08/2003] [Accepted: 01/08/2004] [Indexed: 10/26/2022]
Abstract
The improvements in the motor ability in patients with Parkinson's disease due to antiparkinsonian medication is well-known and widely documented. Recent results, based both on kinematic parameters and standard electromyographic (EMG) signal analysis, clearly indicated that the medication reduced, as expected, the clinical signs of Parkinson's disease, but did not restore agonist burst duration modulation with distance in elbow flexion movements. The main aim of the present work is to shed more light on this medication effect using a wavelet analysis approach on multiple EMG signals recorded both on shoulder and elbow muscles in ballistic or rapid movements. The wavelet cross-correlation information allows us to evidence some important quantitative features of the EMG signals due to medication.
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Flament D, Vaillancourt DE, Kempf T, Shannon K, Corcos DM. EMG remains fractionated in Parkinson's disease, despite practice-related improvements in performance. Clin Neurophysiol 2003; 114:2385-96. [PMID: 14652099 DOI: 10.1016/s1388-2457(03)00254-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We studied the ability of patients with Parkinson's disease to improve their performance in a motor task requiring both speed and accuracy in the execution of elbow flexion movements. Our goal was to investigate the changes in electromyographic activity associated with the changes in movement performance. METHODS Eleven patients on anti-Parkinsonian medication were tested. The patients were selected for being bradykinetic, having little or no resting tremor or dyskinesias, and being in stages II or III of the Hoehn and Yahr rating scale. RESULTS The untrained patients displayed multiple bursts of agonist activity, characteristic of Parkinsonian EMG recordings. All patients improved their performance by increasing peak velocity while maintaining movement accuracy within strict boundaries. With practice, the patients' performance changed in a manner similar to that which has been previously observed for performance curves in neurologically normal subjects. As movement duration decreased (i.e. peak velocity increased), we observed a slight decrease in the number of agonist bursts and an increase in the average burst duration. However, the patients continued to generate a fractionated, multi-burst agonist pattern. CONCLUSIONS We conclude that Parkinsonian patients benefit from practice by improving their performance but remain fundamentally impaired in the generation of muscle activation patterns. This study has shown that the generation of fractionated, multiple short bursts of EMG activity that is characteristic of movements made by Parkinsonian patients is not normalized by practice.
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Affiliation(s)
- D Flament
- Department of Physical Medicine and Rehabilitation, Rush Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA
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Kumru H, Summerfield C, Valldeoriola F, Valls-Solé J. Effects of subthalamic nucleus stimulation on characteristics of EMG activity underlying reaction time in Parkinson's disease. Mov Disord 2003; 19:94-100. [PMID: 14743367 DOI: 10.1002/mds.10638] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We examined the effects of high-frequency deep brain stimulation of the subthalamic nucleus (STN-DBS) on characteristics of electromyographic (EMG) activity of the agonist muscle in 8 patients with Parkinson's disease (PD). Patients were examined during STN-DBS (ON), and 30 minutes after switching off both stimulators (OFF). They were asked to make a ballistic movement in paradigms of simple reaction time (SRT) and choice reaction time (CRT) tasks. Onset of movement (MOVonset) was measured as the latency of the initial displacement from baseline of the signal from an accelerometer attached to the dorsum of the hand. In the associated EMG activity, recorded from wrist extensor muscles, we measured onset latency (EMGonset), size of the first EMG burst (EMGsize), and number of EMG bursts (EMGbursts) counted between EMGonset and task execution. MOVonset and EMGonset were significantly shorter in ON than in OFF conditions in CRT. EMGsize was larger, EMGbursts were reduced, and peak of the acceleration profile was larger in ON compared with OFF conditions in both SRT and CRT. Our results indicate that STN-DBS induces a significant improvement in motor performance of reaction time tasks in PD patients. Such improvement is associated with a change in features of the EMG activity suggesting an increase in the excitability of the motor pathways engaged in ballistic movements.
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Affiliation(s)
- Hatice Kumru
- Servei de Neurologia, Hospital Clínic, Departament de Medicina, Facultad de Medicina, Universitat de Barcelona, Institut d'Investigació Biomèdica August Pi i Sunyer, Spain
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De Michele G, Sello S, Carboncini MC, Rossi B, Strambi SK. Cross-correlation time-frequency analysis for multiple EMG signals in Parkinson's disease: a wavelet approach. Med Eng Phys 2003; 25:361-9. [PMID: 12711233 DOI: 10.1016/s1350-4533(03)00034-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Using a wavelet analysis approach, it is possible to investigate better the transient and intermittent behavior of multiple electromyographic (EMG) signals during ballistic movements in Parkinsonian patients. In particular, a wavelet cross-correlation analysis on surface signals of two different shoulder muscles allows us to evidence the related unsteady and synchronization characteristics. With a suitable global parameter extracted from local wavelet power spectra, it is possible to accurately classify the subjects in terms of a reliable statistic and to study the temporal evolution of the Parkinson's disease level. Moreover, a local intermittency measure appears as a new promising index to distinguish the low-frequency behavior from normal subjects to Parkinsonian patients.
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Abstract
Individuals with Parkinson's disease show dramatic improvements in their ability to move when medicated. However, the neural cause of this improvement is unclear. One hypothesis is that neural activation patterns, as measured by surface electromyography (EMG), are normalized by medication. We tested this hypothesis by investigating the effect of medication on the electromyographic (EMG) patterns recorded when individuals with idiopathic Parkinson's disease performed elbow flexion movements over three movement distances while off and on antiparkinsonian medication. When the subjects were off medication, they lacked the ability to modulate the agonist EMG burst duration with changes in movement distance. The ability to modulate agonist EMG burst duration is characteristic of the EMG patterns observed in healthy subjects. Also, multiple agonist bursts were exhibited during the acceleration phase. As expected, medication diminished the clinical signs of Parkinson's disease, increased movement speed, and increased the magnitude of the first agonist burst. Medication did not restore agonist burst duration modulation with movement distance, did not change the frequency of agonist bursting, and did not alter the timing of the antagonist activation. These results show that medication does not alter the temporal profile of EMG activation.
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Affiliation(s)
- Julie A Robichaud
- School of Kinesiology, University of Illinois at Chicago, Chicago, Illinois 60608, USA.
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Abstract
Clinical diagnosis of Parkinson's disease (PD) is not always coincident with pathological findings. A better characterization of the disease from the results of studies in various areas of neuroscience can help in improving the rate of diagnostic certainty. Neurophysiology is among the techniques with better chances to furnish specific diagnostic cues on motor aspects of the disease. Neurophysiology provides quantifiable data using non-invasive, relatively inexpensive, methods. Neurophysiological tests can be applied with no previous preparation, and repeated many times without dangerous consequences. To be rewarding, however, neurophysiological examination should be done in close cooperation between the clinician who detects relevant specific signs, and the neurophysiologist who devises the most demonstrative methods to document those signs. In this review, we describe the neurophysiological correlate of symptoms and signs in patients with PD, and particularly their pathophysiological meaning, with special focus on those that could be more helpful to the neurologists in establishing differences with respect to other diseases presenting with parkinsonism.
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Affiliation(s)
- Josep Valls-Solé
- Unitat d'EMG, Servei de Neurologia, Hospital Clínic, Departament de Medicina, Universitat de Barcelona, Institut d'Investigació Biomèdica August Pi i Sunyer. Villarroel, 170. Barcelona, Spain.
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Abstract
Studies of electromyographic (EMG) patterns during movements in Parkinson's disease (PD) have often yielded contradictory results, making it impossible to derive a set of rules to explain how muscles are activated to perform different movement tasks. We sought to clarify the changes in modulation of EMG parameters associated with control of movement distance during fast movements in patients with PD. Specifically, we studied surface EMG activity during rapid elbow flexion movements over a wide range of distances (5-72 degrees) in 14 patients with relatively mild symptoms of PD and 14 control subjects of similar age, sex, height, and weight. The PD group exhibited several changes in EMG modulation including impaired modulation of agonist burst duration; increased number of agonist bursts; reduced scaling of agonist EMG magnitude in the more severely impaired subjects; and increased temporal overlap of the antagonist and agonist signals in the most severely impaired subjects. These findings suggest that progressive motor dysfunction in PD is accompanied by increasing deficits in modulating muscle activation. These results help clarify previous disparate and sometimes contradictory results of EMG patterns in subjects with PD.
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Affiliation(s)
- K D Pfann
- School of Kinesiology, University of Illinois at Chicago, 60608-1516, USA.
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