Multijoint movement control in Parkinson's disease.

Impairments in the performance of complex actions in Parkinson's disease (PD) patients are well documented. The aim of the present study was to investigate potential mechanisms that may be contributing to impaired movement performance in PD patients. PD patients and age-matched control subjects performed rapid pointing movements to a series of four tabletop targets. The height of the table was adjusted until the targets could be achieved with arm movements in the horizontal plane. The targets were arranged such that target 1 required elbow extension only and targets 2-4 required increasing amounts of horizontal shoulder flexion in addition to the elbow extension. While the control subjects accelerated and decelerated the elbow and shoulder joints simultaneously regardless of the target location, the PD patients decomposed motion during the acceleration phase by accelerating first the shoulder and then the elbow joint. For PD patients this decomposition of arm segments was associated with greater coactivation of the muscles about the elbow when elbow extension and shoulder flexion were simultaneously required (targets 2-4), in contrast to the single joint action. The control subjects decreased elbow joint coactivation while the patients increased it across the four targets. The resulting peak interaction torques at both the elbow and shoulder joints occurred relatively later for the PD patients. The coactivation patterns observed in PD patients may reduce the ability to take advantage of interaction torques and may also contribute to joint motion decomposition.