Effect of Movement Frequency on Repetitive Finger Movements in Patients with Parkinson's Disease

Performance of repetitive hand movements in patients with Parkinson's disease (PD) is characterized by slowness, reduced movement amplitude, and hesitation or arrests in ongoing movement. Currently, the factors and mechanisms contributing to impaired performance of these types of movement remain poorly understood. This study examined the effects of movement frequency and medication on the performance of unconstrained index finger flexion movements in patients with PD and matched control subjects. Movements were synchronized with an auditory tone as the frequency of the tone was increased from 1 to 3 Hz in 0.25 Hz increments. Movement performance was quantified based upon finger kinematics and electromyography (EMG) recorded from the index finger flexors and extensors. The principal finding was that patients with PD showed a dramatic reduction in movement amplitude, an increase in movement frequency, and a loss of phase when the movement frequency reached or exceeded 2 Hz. This deficit was not significantly improved with medications. In contrast, all control subjects could synchronize to 3 Hz. These findings show that movement frequency is a major determinant of hypokinesia during repetitive movements and may contribute to hesitations and movement arrest during clinical testing of bradykinesia in the upper limb of patients with PD. (C) 2009 Movement Disorder Society