Brain, Vol 120, Issue 6 977-990, Copyright © 1997 by Oxford University Press
C Rickards and FW Cody
The effects upon the trajectories of practised slow (approximately 9
degrees/s) voluntary wrist-extension movements of applying vibration to the
tendon of an antagonist muscle (flexor carpi radialis) during the course of
the movement have been studied in patients with idiopathic Parkinson's
disease and age-matched healthy individuals. In both patient and control
groups, flexor vibration elicited undershooting of wrist-extension
movements. Wrist extensor and flexor surface EMG recordings indicated that,
in patients and controls, such undershooting resulted principally from
sustained reductions in extensor (prime mover) activity. Small vibration
reflexes were commonly elicited in the wrist flexors which, in both
Parkinson's disease and healthy subjects, were usually otherwise virtually
quiescent during these slow extension movements. The amplitudes of such
vibration reflexes did not differ systematically between patient and
control groups and appeared inadequate to have exerted an appreciable
braking action upon the extension trajectories. However, the extent of
vibration-induced undershooting was, on average, significantly less in the
Parkinson's disease group. In a subgroup of patients with asymmetrical
parkinsonism the effects of antagonist vibration upon wrist movements of
the more and less affected limb were compared. The degree of
vibration-induced undershooting was significantly smaller on the more
affected side. This finding suggests that disturbed proprioceptive guidance
of voluntary movements in Parkinson's disease is related to the severity of
clinical motor deficits. A small number Parkinson's disease patients were
studied 'ON' and 'OFF' their routine anti-parkinsonian medication. A
non-significant tendency was found for vibration-induced errors to be less
marked in the 'OFF' state. In a separate series of experiments, under
isometric conditions, vibration-induced EMG changes were recorded whilst
subjects attempted to maintain a steady (15% maximum) voluntary wrist
extensor effort. Results in control subjects suggested that prolonged
flexor vibration produced significant tonic reflex reciprocal inhibition of
the extensor muscles. However, the strength of reflex inhibition appeared
sufficient to account for only a small fraction of the undershooting
observed during the movement tasks. Thus, our results are consistent with
the existence of an abnormality of higher-level proprioceptive integration
in Parkinson's disease in which there is a mismatch of sensory
(proprioceptive) and motor (corollary discharge) information.
ARTICLES
Proprioceptive control of wrist movements in Parkinson's disease. Reduced muscle vibration-induced errors
Department of Neurology, Manchester Royal Infirmary, UK.
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