Effect of External Feedback on Bimanual Coordination Control in Patients with Parkinson's Disease.

Eonho Kim,Chang-Ha Im,Yong-Gwan Song

doi:10.3390/ijerph182010927

Abstract

Bimanual coordination control requires task-specific control of the spatial and temporal characteristics of the coupling of both upper limbs. The present study examined the effects of external feedback (i.e., auditory signal) on bimanual coordination movement during patients with Parkinson’s disease (PD). Twelve PD patients in advanced stages and 12 early stages of untreated PD patients, and 12 age-matched normal adults were instructed to perform bimanual coordination control using preference (1 Hz) and fast (1.75 Hz) speeds with metronome auditory cue. The results demonstrated that the advanced PD patients showed reduced synchronized bimanual coordination control during the anti-phase movement compared with other two groups. Moreover, the decreased movement accuracy was exhibited not only at the preference speed, but also more particularly at the fast speed with anti-phase rather than in-phase movement. This suggests that PD results in impairments in scaling the bimanual movement speed and amplitude of limb, and these deficits were more pronounced as a function of movement control speed. Overall, the current data provide evidence of the pathophysiology of the basal ganglia on the bimanual coordination movement.

Highlights

The results demonstrated that the advanced Parkinson’s disease (PD) patients showed reduced synchronized bimanual coordination control during the anti-phase movement compared with other two groups
We hypothesized that external feedback would help improve the performance of bimanual coordination movement in patients with PD
The results of this study demonstrate that bimanual coordination movement dysfunction is a very early motor impairment in PD

Summary

Introduction

Major symptoms of motor disorders due to Parkinson’s disease (PD) include persistent resting tremor of the limbs, rigidity of the muscles during passive movement, posture instability, and bradykinesia with slowness of movement. Many voluntary movements such as bimanual coordination require the simultaneous integration of movements of the two upper limbs with task-specific control of the spatial and temporal characteristics [1]. A typical example is bimanual coordination, comprising in-phase movements with both hands, with the right hand moving clockwise, and the left hand counterclockwise (symmetrically). Anti-phase movements, both hands simultaneously move either clockwise or counterclockwise (asymmetrical). When performing bimanual movement tasks, patients with PD and healthy subjects prefer to have the same temporal structure (i.e., symmetrical bimanual movements) of motions for both arms [2,3], and symmetrically coordinated motions in the same direction are more performed [4]

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