François Viallet

Impairment of posturo-kinetic co-ordination during initiation of forward oriented stepping movements in parkinsonian patients

In order to differentiate between a specific impairment affecting gait initiation and a non-specific deficit in the postural adjustment which occurs prior to any forward oriented stepping movement, 3 forward oriented movements (FOMs), performed by a group of parkinsonian patients and a group of healthy age-matched subjects, were compared in the present study. These FOMs all consisted of initiating 1 step, but differed in their respective planning characteristics. The first consisted of initiating normal walking. The second consisted of initiating a single step, while the third was a visually guided task, consisting of placing the foot just behind a mark on the ground. In all 3 FOMs, the postural phase, i.e., the time elapsing between the initial shift of the center of pressure (CP) and the onset of the first step, was significantly longer in the patients than in the healthy subjects, whereas the duration of the subsequent movement phase, i.e., that of the first step, was within the same range in both groups. The horizontal reaction forces that led to a forward center of gravity (CG) acceleration during the postural phase were markedly reduced in the patients in all 3 FOMs, and the maximal velocity of the iliac crest marker, which corresponds approximately to that of the CG, decreased significantly in the patients. In addition, the length of the first step was significantly shorter in the patients than in the healthy subjects, in all 3 FOMs. The EMG pattern differed significantly between the patients and the healthy subjects; the amplitudes of the early tibialis anterior (TA) and vastus lateralis (VL) activations often decreased and were unilateral rather than bilateral. In addition, the gastrocnemius medialis (GM) burst associated with foot lift-off at the end of the postural phase was either absent or greatly reduced, thus suggesting that the co-ordination between the preparatory postural adjustment of the whole body and the actual stepping movement was impaired. The present results suggested that the lengthening of the postural phase is a common deficit in all FOM tasks in parkinsonian patients and is due to the impaired production of the requisite propulsive forces providing the forward acceleration of the CG. Consequently, a shortening of the first step length occurs. However, the step length is reduced less in the FOM tasks which provide some information about the goal of the first step (single step, visually guided step) than in a normal walking task, during which such information is missing. This suggests that although the stepping movement can be improved with the aid of any sensory cue about the end of the step in patients with Parkinsons disease, the postural phase will always be prolonged whichever FOM task they perform.

Acquisition of anticipatory postural adjustments in a bimanual load-lifting task: normal and pathological aspects.

Abstractu2002Anticipatory adjustments of forearm posture are associated with a voluntary load-lifting movement in bimanual load-lifting tasks. Three aspects of these adjustments are analyzed: their goal, their central organization, and their acquisition. The goal of the anticipatory adjustment in this task is to minimize the perturbation of forearm posture that occurs during unloading. The central organization is based on two parallel controls responsible, respectively, for the lifting movement of the moving forearm and the anticipatory postural adjustment of the postural forearm, their coordination depending on a central timing signal. The acquisition of the anticipatory postural adjustment was tested using a paradigm where the voluntary movement performed by one hand triggered, via an electronic switch, the load release of the postural forearm. It was achieved after 40–60 trials and was not graded as a function of the voluntary movement parameters, but of the disturbance of the postural arm about to occur. The learned anticipation was not transferred when, after a first acquisition session with one forearm as the postural forearm, a second learning session was performed with the other forearm as the postural forearm. The acquisition was tested in Parkinsonian and in hemiparetic patients with capsular lesion. The highest acquisition deficit was observed in hemiparetic patients, when the contralateral forearm was the postural forearm; the deficit was less important when the ipsilateral arm was postural. Surprisingly, the anticipatory postural adjustments in hemiparetic patients were rather well preserved when the natural load-lifting task was tested. These results suggest that the basal-ganglia SMA circuit and M1 premotor areas are important in the acquisition process.

Coordination of axial rotation and step execution: deficits in Parkinson's disease

To determine why parkinsonian patients (PP) present some difficulties to initiate locomotion, a diagonal step has been investigated in two tasks in five control subjects (CS) and in ten PP. In the first task, the subjects had to perform one diagonal step without change in their orientation (WR); in the second task, they had to perform one diagonal step with a body rotation in the step direction (RO). The defended hypothesis is that the gait initiation deficits in Parkinson disease are a consequence of their difficulties to coordinate al the component of a complex movement. The analysed parameters were the duration of the postural and movement phases, the step length and velocity, and the amplitude of the horizontal ground reaction forces during each phase. Compared to CS, the PP showed a lengthening of the postural phase, a decrease in the step length and velocity and a reduction of the horizontal forces. The comparisons between the performances obtained in the WR versus those obtained the RO show in CS that the performances remained unchanged, whereas in PP the performances were significantly more altered in the RO. It illustrates the specific deficit occurring in PP while performing complex tasks where coordination between several components has to be achieved simultaneously.

Preparatory postural adjustments in Parkinsonian patients with postural instability

BACKGROUNDnPostural instability is a common problem in patients with Parkinsons disease. This paper reports results of a study undertaken to investigate some of the possible mechanisms responsible for this instability.nnnMETHODSnPreparatory postural adjustments associated with a lateral leg raising task were studied in five parkinsonian patients and four age-matched controls. Recordings included ground reaction forces, kinematics, and surface EMG activity from multiple leg muscles.nnnRESULTSnIn normal subjects there was a well-defined sequence of events preceding the onset of leg elevation, beginning with a transfer of centre of foot pressure (CP), initially toward the moving leg and then back to the support side, followed by displacement of the trunk toward the support side. In the more severely affected parkinsonian patients, the amplitude of the initial displacement of CP was markedly reduced. The interval between the earliest force changes and the onset of leg elevation was prolonged and the relative timing of the kenematic adjustments during this interval was disrupted. In addition the alternating burst and periods of inhibition observed in the EMG recordings from the normal subjects were replaced by continuous tonic EMG activity.nnnCONCLUSIONSnThese observations suggest that abnormalities in programming preparatory postural adjustments may contribute to postural instability in some patients with advanced Parkinsons disease.

Motor impairment after unilateral electrolytic lesions of the substantia nigra in baboons: Behavioral data with quantitative and kinematic analysis of a pointing movement

Unilateral electrolytic lesions of the substantia nigra (SN) were carried out stereotaxically on 4 baboons which had been previously trained to perform a visually guided pointing movement. For a few days after operation, all animals exhibited a behavioral impairment affecting the contralateral body half and consisting of dystonic flexed posture and akinesia. The animals were thus unable to perform the pointing task with the contralateral hand. After a delay which depended on the extent of the SN lesion, the animals began to make the pointing movement again. Postoperative changes were then observed only on the side opposite the SN lesion. These consisted of an increase in the latency and particularly the duration of the movement without any change in the accuracy. The kinematic analysis of the hand trajectory showed that the contralateral increase in the movement duration corresponded to a regular decrease in the velocities. Study of the recovery over 120 days after SN lesion showed a progressive improvement which was faster with regard to movement duration than to movement latency. These data clearly point to the functional role of the SN in the initiation and particularly in the execution of movement. Quantitative and kinematic analysis of this pointing movement makes it possible to detect and quantify very closely the changes in movement program and execution induced by a SN lesion. This experimental model will be useful for pharmacological in vivo studies allowing a more specific assessment of the functional role of the neurotransmitters involved in SN dysfunction.

The Use of Advance Information for Motor Preparation in Parkinson's Disease: Effects of Cueing and Compatibility between Warning and Imperative Stimuli

The ability of 13 Parkinsonian patients and 11 age-matched control subjects to process and use two components of the information given prior to a voluntary movement was studied using reaction time (RT) tasks. This advance information about the direction of a pointing movement was given using a double stimulation paradigm with an auditory warning signal (WS) which occurred prior to a visual imperative signal (IS). The first component of the information was given by the WS at the beginning of each trial, and the second component was the WS-IS compatibility during series of trials. The subjects were tested with three RT paradigms: a cued simple (CS) task, a cued choice (NC) task, and a priming choice (P) task. The results show that the normal subjects used both the lateral cue and the WS-IS compatibility to shorten their RTs, whereas the Parkinsonian patients were able to use the lateral warning signal, but their ability to use the degree of compatibility stimuli was impaired. These data suggest that when dealing with lateral cues in a RT task, Parkinsonian patients have no difficulty in identifying a stimulus and selecting the appropriate response, but that this is no longer so in the case of stimulus compatibility. This impairment may be due to attentional disorders involving a dysfunction affecting the medial premotor system, which includes the basal ganglia and may be responsible for the feedforward movement control deficits associated with Parkinsons disease.

Axial synergies in parkinsonian patients during voluntary trunk bending

During upper trunk movements, the axial kinematic synergies (opposite movements of upper and lower segments) preserve the balance by minimizing the antero-posterior center of gravity (CG) shift due to the movement. Forward and backward upper trunk movements were analyzed in a population of parkinsonian patients (PD) that were subject to falling, in order to determine whether an impaired control of the kinematic synergies might explain the falling. Ten PD (stage III-IV of the Hoehn and Yahr classification; Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology 1967;17;427-432) were compared to seven age-matched control subjects (CS). Kinematic analysis and force platform recordings were carried out. Principal Component (PC) analysis was performed to measure the coupling between hip, knee and ankle joint angles during the movement. (1) In both PD and CS, the first principal component (PC1) was found to account for 98% or more of the joint angles changes, which indicates that there exists a strong coupling between the angles during the movement; however, the part of the movement not accounted for by PC1 was twice as high in PD as in CS. (2) The intertrial variability between the angle ratios was about twice as high in PD as in CS. (3) The absolute value of the antero-posterior CG shift occurring during the movement significantly increased in PD in the case of backward movements, both fast and slow. (4) As a high correlation was found between actual CG shift and its estimation based on the observed interjoint coordination, the increased CG shift in PD was related to unproper set of ratios between joint angles. It was concluded that the control of the kinematic synergy is preserved on the whole in PD, with an increased variability and unproper set of the ratios between joint angular changes. This may lead to CG shifts to beyond the support surface, especially in backward bending. Copyright 1998 Elsevier Science B.V.

The role of visual reafferents during a pointing movement: comparative study between open-loop and closed-loop performances in monkeys before and after unilateral electrolytic lesion of the sustantia nigra

SummaryIn order to elucidate the compensatory role of visual feedback during movement, two experiments were designed to compare the motor performances of Papio papio baboons depending on whether the animals were able to visually control the limb trajectory (visual closed-loop condition) or not (visual open-loop condition). The visuomotor task used consisted of making trained pointing movements towards a stationary target. In experiment A, the baboons were successively presented with these two experimental conditions. The abolition of visual control was found to cause no change in either reaction time (RT) or movement time (MT), but brought about extensive pointing errors. It was also associated with a conspicuous increase in the mean velocity and the mean length of the trajectories. In experiment B, two groups of baboons were used. The monkeys in the first group were required to perform under closed loop conditions. The second group performed the pointing movement under open loop conditions. Once criterion was reached by each animal, a unilateral electrolytic lesion of the substantia nigra (SN) was performed. A comparison between the post operative performances of the animals in the two groups showed that suppression of visual cues resulted in a lengthening of the RT and a slowing of the movement speed. Moreover when visual feedback was lacking, the amplitude of the movement decreased and the finger fell short of the target. During the last post operative period, suppression of visual feedback brought about a more rapid return of RTs to their preoperative level and a more durable slowing of movement speed than with normal vision. The discussion deals with the role of visual feed-back in the control of movement preparation and execution, and with the change in mode of motor control caused by lesion of the SN. Partial exclusion of the SN might bring about a shift from the feedforward to a feedback mode relying more heavily on visual cues.

Bilateral and side-related reaction time impairments in patients with unilateral cerebral lesions of a medial frontal region involving the supplementary motor area

Human subjects (nine patients with unilateral brain lesions of a medial frontal region involving the supplementary motor area, SMA, and 10 controls) performed two reaction time (RT) tasks in response to the presentation of a luminous signal: an aimed movement towards a spatially defined target involving hand lifting and pointing with the index finger, and a no-aimed movement consisting of the hand lifting phase completed by the stabilization of the limb posture without any pointing. When compared with controls, the patients exhibited a bilateral RT increase which was more pronounced in the hand contralateral to the lesion. Moreover, comparison between the two tasks showed that this contralateral RT impairment was more marked in the no-aiming than in the aiming task. These results suggest that unilateral lesions of a medial frontal region involving the SMA cause two types of RT impairment in these motor tasks. The first may concern a supramotor function which acts bilaterally and initiates the motor programme of the limb movement as the first step of preparatory processes. The second component of this RT impairment would concern a supplementary motor function which consists of the feed forward control of the coupling between the hand lifting and the appropriate posture, just before the triggering of the limb movement. This interpretation leads to the hypothesis that the SMA region, and the medial motor system in general, may have a dual motor function.

Unilateral Electrolytic and 6-Ohda Lesions of the Substantia Nigra in Baboons: Behavioural and Biochemical Data

The role of the substantia nigra (SN) in the control of motor activity has mainly been analyzed through clinical data on Parkinson’s disease in human subjects (Marsden, 1982). This disease has been known for a long time to involve progressive degeneration of the pigmented neurons in the SN (Tretiakoff, 1919; Hassler, 1938). Identification of the nigrostriatal dopaminergic projection (Anden et al., 1964) from these pigmented neurons gave rise to studies in which striatal dopamine (DA) deficit was proved to be responsible for the onset of the symptoms of Parkinsonism, particularly akinesia and rigidity (Hornyckiewicz, 1966; Bernheimer et al., 1973). Besides these clinical observations on human patients, a body of experimental work has been published on animals (see Schultz, 1982) discussing the functional role of the SN.