Precision grip and Parkinson's disease
Precision grip and Parkinson's disease
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DOI：
10.1093/brain/121.9.1771
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发表时间：
1998-09-01
期刊：
影响因子：
14.5
通讯作者：
Schwarz, M
中科院分区：
文献类型：
--
作者：
Fellows, SJ;Noth, J;Schwarz, M
为了研究帕金森病的感觉运动处理和力量发展，16例患者，4例偏侧帕金森综合征患者和12名年龄匹配的正常人进行了评估，在提升和保持一个物体在拇指和食指之间的精确的抓地力，或保持在这个抓地力在一个固定的高度以上的一张桌子的对象。在前一种情况下，物体装载可以在没有警告的情况下在升降机之间改变。在后一种情况下，对对象的意外阶跃负载变化通过转矩电机施加到对象。所有程序都可以在有或没有手和物体的视觉控制的情况下应用。正常受试者解除了不可预测的负荷，采用在前面的电梯中使用的握力参数。如果遇到负载变化，参数在提升过程中会适应新的条件，调节抓地力以匹配负载。帕金森病患者保留了这种策略和根据负荷调节握力的能力。然而，在所有条件下，帕金森病患者在举起和保持阶段都会产生异常高的握力，尽管这些力量的比例保持正常。在帕金森病患者中，提升高度是正常的，但是提升任务的持续时间显著延长，这是由于在物体升空之前的握力发展速率显著减慢以及运动阶段的延长。物体负荷的预警，有或没有视觉控制，并没有减少时间赤字或提高握力发展的速度。然而，它确实允许帕金森病患者显著降低安全范围。在没有视觉控制的情况下，帕金森病患者对保持过程中施加的阶跃负荷变化的反应显示出轻微的异常：位移后140 ms内，第一背侧骨间肌和鱼际肌的发作潜伏期和EMG活动正常。随后在第一背侧骨间肌的肌电图活动基本上保持正常，但活动在滑动反应（140-210毫秒），受自愿的影响，在鱼际肌肉减少。视觉条件下的差异不太明显，但仍然显着。我们的结论是，内部参数设置为提高一个物体在一个精确的抓地力和自动化的过程，适应精确的抓地力的实际条件是完整的帕金森氏病。然而，帕金森病患者产生异常高的握力，需要比正常人更长的时间来完成一个电梯，特别是与较轻的负载。这种表现的恶化反映了帕金森病感觉运动处理有效性的降低和力量发展速度的损害。
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.