Brain, Vol 121, Issue 9 1771-1784, Copyright © 1998 by Oxford University Press
SJ Fellows, J Noth and M Schwarz
In order to investigate sensorimotor processing and force development in
Parkinson's disease, 16 patients, four patients with hemiparkinsonism and
12 age-matched normal subjects were assessed during lifting and holding of
an object in a precision grip between thumb and forefinger, or holding the
object in this grip at a fixed height above a table. In the former case,
object loading could be changed between lifts without warning. In the
latter case, unexpected step load changes to the object were applied to the
object with a torque motor. All procedures could be applied with or without
visual control of the hand and the object. Normal subjects lifted an
unpredictable load employing the grip force parameters used in the
preceding lift. If a load change was encountered, the parameters became
adapted to the new conditions during the lift, modulating grip forces to
match the loading. Parkinsonian patients retained this strategy and the
ability to regulate grip forces according to load. Under all conditions,
however, parkinsonian subjects developed abnormally high grip forces in
both the lift and the hold phase, although the ratio of these forces
remained normal. Lifting height was normal in parkinsonian subjects, but
the duration of the lifting task was significantly prolonged, due to a
marked slowing in the rate of grip force development in the lead-up to
object lift-off and to prolongation of the movement phase. Forewarning of
object loading, with or without visual control, did not reduce timing
deficits or improve the rate of grip force development. However, it did
allow parkinsonian subjects to reduce the safety margin significantly.
Responses to step load changes imposed during holding without visual
control showed minor abnormalities in the parkinsonian patients: onset
latencies and EMG activity in the first dorsal interosseus and thenar
muscles were normal up to 140 ms after displacement. Subsequent EMG
activity in the first dorsal interosseus remained largely normal, but
activity later in the slip response (140-210 ms), subject to voluntary
influence, was reduced in the thenar muscle. Differences were less marked
under visual conditions, but remained significant. We concluded that the
internal parameter set for lifting an object in a precision grip and the
automatic processes adapting precision grip to actual conditions are intact
in Parkinson's disease. However, parkinsonian subjects generate abnormally
high grip forces and require longer than normal subjects to complete a
lift, particularly with lighter loads. This deterioration in performance
reflects both reduced effectiveness of sensorimotor processing and
impairment in the rate of force development in Parkinson's disease.
ARTICLES
Precision grip and Parkinson's disease
Neurologische Klinik, Universitatsklinikum der RWTH Aachen, Germany.
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