ABSTRACT
INTRODUCTION: Clinical assessment of hand bradykinesia in Parkinson's disease (PD) focuses mainly on the frequency, amplitude and rhythm of movements, thereby subjectively evaluating the correct performance of hand movements. The aim of the study was to quantify hand bradykinesia with kinematic data in different Parkinsonian syndromes. PATIENTS AND METHODS: This retrospective study compared patients with idiopathic PD (IPD, n = 18), atypical Parkinson's syndrome (APS, n = 17), secondary Parkinson's syndrome (SPS, n = 18) and healthy controls (C, n = 18). All patients were receiving the best medical treatment. Hand movements were recorded using an ultrasound-system (Zebris®, Isny, Germany). Subjects were asked to perform pronation/supination of the forearm (diadochokinesis), flexion/extension of the hand (hand tapping) and tapping of the index finger. Mean amplitude, mean frequency and mean variability of movements were determined. RESULTS: APS patients had significant complex hand movement disability with reduced amplitude and frequency in combination with increased motion variability in all movement tasks. The key disturbance in the IPD group concerned the rhythm in hand tapping and index finger tapping in combination with moderately reduced velocity and range of motion in all conditions. The cyclical hand movement characteristics in SPS patients showed movement slowness with normal amplitude and variability in all motor conditions. CONCLUSION: Our results suggest that computerized quantitative analysis of cyclical hand movements can characterize and identify different representations of hand bradykinesia in different Parkinsonian disorders and hence may help clinicians to accurately assess therapeutic targets and outcome of interventions.
Subject(s)
Biological Clocks , Hand/physiopathology , Hypokinesia/physiopathology , Models, Biological , Movement , Parkinson Disease/physiopathology , Psychomotor Performance , Aged , Computer Simulation , Humans , Hypokinesia/etiology , Male , Middle Aged , Parkinson Disease/complications , Pilot ProjectsABSTRACT
OBJECTIVES: Idiopathic Parkinson's disease (IPD) is associated with postural disturbances and falls. The assessment of postural instability by the pull test may lead to inconclusive results. Static posturography measurements may give more reliable information regarding the differential diagnosis of Parkinson syndromes. PATIENTS AND METHODS: We compared results of the pull test and static posturography (sway area in eyes-open/eyes-closed conditions) in healthy controls (C) and patients with akinetic-rigid IPD (n=18), atypical Parkinson syndromes (APS; n=18) and secondary Parkinson syndromes (SPS; n=17). RESULTS: Static posturography and the pull test results did not differ significantly between controls and patients with akinetic-rigid IPD. APS patients had significantly greater postural sway areas when tested with eyes open compared to controls (APS: 16.89 vs C: 6.89 mm, p≤0.001) and IPD patients (APS: 16.89 vs IPD: 9.55 mm, p=0.005). The correlation in the APS group between the pull test and sway area in the eyes-open condition was significant (r=0.526, p=0.025). With eyes closed, postural instability in APS patients was not significantly increased (+2%, p=.847). SPS patients were more unstable under the eyes-closed condition compared to controls (sway area SPS: 26.29 vs C: 8.79 mm, p≤0.001), IPD patients (sway area SPS: 26.29 vs IPD: 11.06 mm, p≤0.001) and APS patients (sway area SPS: 26.29 vs APS: 17.28 mm, p=0.027), without a significant correlation to the pull test. The sway area in the SPS patients increased significantly by 67% (p=0.001) under the eyes-closed condition. CONCLUSION: Static posturography may be a helpful tool for the differentiation of Parkinson syndromes.