Coordination of manipulative forces in Parkinson's disease

The coordination of manipulative forces was examined in 10 subjects with Parkinson's disease (PD) both OFF and ON medication while they grasped and lifted a small object using the precision grip. The development of grip (squeeze) force and load (vertical lifting) force was recorded and compared to a group of age-matched control subjects. Subjects with PD often exhibited a prolonged delay between the first digit contact with the object and initiation of the lifting drive. These subjects also exhibited stepwise increases in force, with regular oscillations in the force rates. However, once the vertical drive began, the main increase in grip and load force generally was in parallel and most other temporal aspects of the force coordination were similar to those of the control subjects. The extent to which the movement initiation was delayed was related to the stage of the disease, and most subjects improved ON medication. When the object was held in the air, subjects with PD used a grip force level which was similar to that of the control subjects, and all subjects adjusted their grip force according to the surface texture. Furthermore, they exhibited proper reflexive corrections to sudden changes in load (object perturbations), suggesting intact sensorimotor integration. We conclude that the most obvious impairments in the coordination of this task were delayed initiation of the grip-lift sequence and tremor-like oscillations superimposed on otherwise normal force.