Proprioceptive control of wrist movements in Parkinson's disease. Reduced muscle vibration-induced errors.

The effects upon the trajectories of practised slow (approximately 9 degrees/s) voluntary wrist-extension movements of applying vibration to the tendon of an antagonist muscle (flexor carpi radialis) during the course of the movement have been studied in patients with idiopathic Parkinson's disease and age-matched healthy individuals. In both patient and control groups, flexor vibration elicited undershooting of wrist-extension movements. Wrist extensor and flexor surface EMG recordings indicated that, in patients and controls, such undershooting resulted principally from sustained reductions in extensor (prime mover) activity. Small vibration reflexes were commonly elicited in the wrist flexors which, in both Parkinson's disease and healthy subjects, were usually otherwise virtually quiescent during these slow extension movements. The amplitudes of such vibration reflexes did not differ systematically between patient and control groups and appeared inadequate to have exerted an appreciable braking action upon the extension trajectories. However, the extent of vibration-induced undershooting was, on average, significantly less in the Parkinson's disease group. In a subgroup of patients with asymmetrical parkinsonism the effects of antagonist vibration upon wrist movements of the more and less affected limb were compared. The degree of vibration-induced undershooting was significantly smaller on the more affected side. This finding suggests that disturbed proprioceptive guidance of voluntary movements in Parkinson's disease is related to the severity of clinical motor deficits. A small number Parkinson's disease patients were studied 'ON' and 'OFF' their routine anti-parkinsonian medication. A non-significant tendency was found for vibration-induced errors to be less marked in the 'OFF' state. In a separate series of experiments, under isometric conditions, vibration-induced EMG changes were recorded whilst subjects attempted to maintain a steady (15% maximum) voluntary wrist extensor effort. Results in control subjects suggested that prolonged flexor vibration produced significant tonic reflex reciprocal inhibition of the extensor muscles. However, the strength of reflex inhibition appeared sufficient to account for only a small fraction of the undershooting observed during the movement tasks. Thus, our results are consistent with the existence of an abnormality of higher-level proprioceptive integration in Parkinson's disease in which there is a mismatch of sensory (proprioceptive) and motor (corollary discharge) information.