Dystonia Associated with Idiopathic Slow Orthostatic Tremor.

BACKGROUND: We aimed to characterize the clinical and electrophysiological features of patients with slow orthostatic tremor. CASE REPORT: The clinical and neurophysiological data of patients referred for lower limb tremor on standing were reviewed. Patients with symptomatic or primary orthostatic tremor were excluded. Eight patients were identified with idiopathic slow 4-8 Hz orthostatic tremor, which was associated with tremor and dystonia in cervical and upper limb musculature. Coherence analysis in two patients showed findings different to those seen in primary orthostatic tremor. DISCUSSION: Slow orthostatic tremor may be associated with dystonia and dystonic tremor.

The effect of gym training on multiple outcomes in Parkinson's disease: a pilot randomised waiting-list controlled trial.

There is accumulating evidence for the benefits of exercise in Parkinson's disease (PD), but less is known about group exercise interventions. We evaluated the effect of gym-training programme on people with PD. Thirty-two adults with mild to moderate PD, not currently exercising formally, were randomised to an immediate 20-week biweekly gym training programme at a local leisure complex, or a 10-week programme starting 10 weeks later. Assessments at baseline (T1), 10 weeks (T2) and 20 weeks (T3) included reaction time, motor performance (UPDRS), quality of life and illness perceptions. Experiences of the programme were assessed via questionnaire and a focus group. Overall UPDRS motor function score did not change over time. However, gym training was associated with significant improvements in reaction times and some timed tests in the immediate training group (T1-T2). The delayed group showed similar improvements following gym training (T2-T3). Participants reported enjoyment, obtaining social benefits, and increased confidence. However, the questionnaire measures did not show improvements in subjective health ratings or illness perceptions. Although benefits were not apparent in the questionnaire measures or overall UPDRS scores, our findings suggest that a 10-week gym training programme in a community setting can provide some benefits for people with PD.

An investigation of co-speech gesture production during action description in Parkinson's disease.

INTRODUCTION: Parkinson's disease (PD) can impact enormously on speech communication. One aspect of non-verbal behaviour closely tied to speech is co-speech gesture production. In healthy people, co-speech gestures can add significant meaning and emphasis to speech. There is, however, little research into how this important channel of communication is affected in PD. METHODS: The present study provides a systematic analysis of co-speech gestures which spontaneously accompany the description of actions in a group of PD patients (N = 23, Hoehn and Yahr Stage III or less) and age-matched healthy controls (N = 22). The analysis considers different co-speech gesture types, using established classification schemes from the field of gesture research. The analysis focuses on the rate of these gestures as well as on their qualitative nature. In doing so, the analysis attempts to overcome several methodological shortcomings of research in this area. RESULTS: Contrary to expectation, gesture rate was not significantly affected in our patient group, with relatively mild PD. This indicates that co-speech gestures could compensate for speech problems. However, while gesture rate seems unaffected, the qualitative precision of gestures representing actions was significantly reduced. CONCLUSIONS: This study demonstrates the feasibility of carrying out fine-grained, detailed analyses of gestures in PD and offers insights into an as yet neglected facet of communication in patients with PD. Based on the present findings, an important next step is the closer investigation of the qualitative changes in gesture (including different communicative situations) and an analysis of the heterogeneity in co-speech gesture production in PD.

Object affordance and spatial-compatibility effects in Parkinson's disease.

Movement in Parkinson's disease (PD) is strongly influenced by sensory stimuli. Here, we investigated two features of visual stimuli known to affect response times in healthy individuals; the spatial location of an object (the spatial effect) and its action-relevance (the 'affordance' effect). Poliakoff et al. (2007) found that while PD patients show normal spatial effects, they do not show an additional affordance effect. Here we investigated whether these effects are driven by facilitation or inhibition, and whether the affordance effect emerges over a longer time-course in PD. Participants (24 PD and 24 controls) viewed either a lateralised door handle (affordance condition), a lateralised abstract stimulus (spatial condition), or a centrally presented baseline stimulus (baseline condition), and responded to a colour change in the stimulus occurring after 0 msec, 500 msec or 1000 msec. The colour change indicated whether to respond with the left or right hand, which were either spatially compatible or incompatible with the lateralised stimulus orientation in the affordance and spatial conditions. The baseline condition allowed us to assess whether compatibility effects were driven by facilitation of the compatible response or inhibition of the incompatible response. The results indicate that stimulus orientation elicited faster responses from the nearest hand. For controls, the affordance effect was stronger and driven by facilitation, whilst the spatial condition was driven by inhibition. In contrast, the affordance and spatial-compatibility effects did not differ between conditions in the PD group and both were driven by facilitation. This suggests that the PD group responded as if all stimuli were action-relevant, and may have implications for understanding the cueing of movement in PD.