DISTURBANCE OF SEQUENTIAL MOVEMENTS IN PATIENTS WITH PARKINSONS-DISEASE
DISTURBANCE OF SEQUENTIAL MOVEMENTS IN PATIENTS WITH PARKINSONS-DISEASE
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DOI：
10.1093/brain/110.2.361
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发表时间：
1987-04-01
期刊：
影响因子：
14.5
通讯作者：
MARSDEN, CD
中科院分区：
文献类型：
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作者：
BENECKE, R;ROTHWELL, JC;MARSDEN, CD
对10例帕金森病患者进行了以下两个单一动作序列的检查，并与9名年龄相仿的正常人进行了比较。(1)拇指和手指对30 N的力（“挤压”）等长相对，然后等张肘屈曲（“屈曲”）15 °。（2）用左手“挤压”，然后用右肘“弯曲”。(3)拇指和手指的等张对置（“切”）通过90度。（4）肘关节等张“屈”后，同臂等长“挤"。受试者被要求尽可能快地移动，并在第一次运动结束后立即开始第二次运动。当每个动作单独进行时，患者比正常人慢。当连续执行两个动作时，速度进一步降低。这是由于（1）每个分量运动（尤其是第二分量运动）的运动持续时间增加，以及（2）第一和第二分量运动之间的停顿增加。在正常人和患者中，在所研究的四个序列中的任何一个序列中，执行第一次和第二次运动所需的时间之间都没有相关性。正因为如此，我们认为，序列的两个组成部分仍然在两个独立的运动程序的控制下。当执行顺序任务时，正常受试者自动选择的两个单独的运动的发作之间的间隔约230毫秒，即使在任务中，第一个运动的持续时间小于200毫秒。如果正常受试者被指示开始第二个运动的间隔小于200毫秒，第二个运动的速度要慢得多。帕金森病患者自动选择了更长的400-500 ms的发作间期。此外，他们在序列中从第一个运动切换到第二个运动时表现出困难。我们认为，帕金森病患者在尝试进行两个快速连续运动时所表现出的问题可以被视为在整体运动计划中从一个运动程序切换到另一个运动程序的能力不足。
The following sequences of two single movements were examined in 10 patients with Parkinson''s disease and compared with the performance of 9 normal subjects of similar age. (1) Isometric opposition of thumb and fingers to a force of 30 N (''squeeze''), followed by isotonic elbow flexion (''flex'') through 15.degree. with the same arm. (2) ''Squeeze'' with the left hand followed by ''flex'' with the right elbow. (3) Isotonic opposition of thumb and fingers (''cut'') through 90.degree. followed by isotonic ''flex'' with the same arm. (4) Isotonic elbow ''flex'' followed by isometric ''squeeze'' with the same arm. All movements were self-paced. Subjects were given instructions to move as rapidly as possible and to start the second movement immediately after the end of the first. Patients were slower than normal when each single movement was performed separately. There was a further decrease in speed when two movements were executed sequentially. This was due (1) to an increase in movement duration of each of the component movements, especially the second, and (2) to an increase in the pause between the first and second movements. In both normals and patients, there was no correlation between the times taken to perform the first and second movements of any of the four sequences that were studied. Because of this we suggest that the two components of the sequence remained under the control of two separate motor programs. When performing the sequential tasks, normal subjects automatically chose an interval between the onsets of the two separate movements of about 230 ms, even in tasks in which the duration of the first movement was less than 200 ms. If normal subjects were instructed to begin the second movement with an interonset interval of less than 200 ms, the speed of the second movement was much slower. Patients wiht Parkinson''s disease automatically chose a much longer interonset interval of 400-500 ms. In addition, they exhibited difficulty in switching from the first to the second movement in the sequence. We suggest that the problems exhibited by patients with Parkinson''s disease when they try to perform two rapid sequential movements can be seen as a deficit in the capacity to switch from one motor program to another within an overall motor plan.