Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
J Parkinsons Dis. 2020;10(4):1675-1693. doi: 10.3233/JPD-202112.
The supplementary motor area (SMA) is implicated in both motor initiation and stereotypic multi-limb movements such as walking with arm swing. Gait in Parkinson's disease exhibits starting difficulties and reduced arm swing, consistent with reduced SMA activity.
We tested whether enhanced arm swing could improve Parkinson gait initiation and assessed whether increased SMA activity during preparation might facilitate such improvement.
Effects of instructed arm swing on cortical activity, muscle activity and kinematics were assessed by ambulant EEG, EMG, accelerometers and video in 17 Parkinson patients and 19 controls. At baseline, all participants repeatedly started walking after a simple auditory cue. Next, patients started walking at this cue, which now meant starting with enhanced arm swing. EEG changes over the putative SMA and leg motor cortex were assessed by event related spectral perturbation (ERSP) analysis of recordings at Fz and Cz.
Over the putative SMA location (Fz), natural PD gait initiation showed enhanced alpha/theta synchronization around the auditory cue, and reduced alpha/beta desynchronization during gait preparation and movement onset, compared to controls. Leg muscle activity in patients was reduced during preparation and movement onset, while the latter was delayed compared to controls. When starting with enhanced arm swing, these group differences virtually disappeared.
Instructed arm swing improves Parkinson gait initiation. ERSP normalization around the cue indicates that the attributed information may serve as a semi-internal cue, recruiting an internalized motor program to overcome initiation difficulties.
补充运动区（SMA）既与运动起始有关，也与刻板的多肢体运动有关，如带有手臂摆动的行走。帕金森病的步态表现出起始困难和手臂摆动减少，与 SMA 活动减少一致。
我们测试了增强手臂摆动是否可以改善帕金森步态的起始，并评估了在准备过程中增加 SMA 活动是否可以促进这种改善。
通过在 17 名帕金森病患者和 19 名对照者中进行 ambulant EEG、EMG、加速度计和视频评估，研究了指令性手臂摆动对皮质活动、肌肉活动和运动学的影响。在基线时，所有参与者都在简单的听觉提示后反复开始行走。接下来，患者在该提示下开始行走，现在意味着开始增强手臂摆动。通过在 Fz 和 Cz 记录的事件相关光谱扰动（ERSP）分析评估假定 SMA 和腿部运动皮质的 EEG 变化。
与对照组相比，在假定的 SMA 位置（Fz），自然 PD 步态起始在听觉提示周围显示出增强的 alpha/theta 同步，并且在准备和运动起始期间的 alpha/beta 去同步减少。与对照组相比，患者在准备和运动起始期间的腿部肌肉活动减少，而后者延迟。当开始增强手臂摆动时，这些组间差异几乎消失。
指令性手臂摆动可改善帕金森步态的起始。提示周围的 ERSP 归一化表明，归因信息可以作为半内部提示，招募内化的运动程序来克服起始困难。
