Changes in multifinger interaction and coordination in Parkinson's disease.

In this study, we tested several hypotheses related to changes in finger interaction and multifinger synergies during multifinger force production tasks in Parkinson's disease. Ten patients with Parkinson's disease, mostly early stage, and 11 healthy control subjects participated in the study. Synergies were defined as covaried adjustment of commands to fingers that stabilized the total force produced by the hand. Both Parkinson's disease patients and control subjects performed accurate isometric force production tasks with the fingers of both the dominant and nondominant hands. The Parkinson's disease patients showed significantly lower maximal finger forces and higher unintended force production (enslaving). These observations suggest that changes in supraspinal control have a major effect on finger individuation. The synergy indexes in the patients were weaker in both steady-state and cyclic force production tasks compared with the controls. These indexes also were stronger in the left (nondominant) hand in support of the dynamic-dominance hypothesis. Half of the patients could not perform the cyclic task at the highest frequency (2 Hz). Anticipatory adjustments of synergies prior to a quick force pulse production were delayed and reduced in the patients compared with the controls. Similar differences were observed between the asymptomatic hands of the patients with symptoms limited to one side of the body and matched hands of control subjects. Our study demonstrates that the elusive changes in motor coordination in Parkinson's disease can be quantified objectively, even in patients at a relatively early stage of the disease. The results suggest an important role of the basal ganglia in synergy formation and demonstrate a previously unknown component of impaired feedforward control in Parkinson's disease reflected in the reduced and delayed anticipatory synergy adjustments.