The effects of auditory cues and weighted pens on handwriting in individuals with Parkinson's disease.

BACKGROUND: Micrographia, or small handwriting, is a common symptom of Parkinson's disease (PD). Weighted pens have previously been recommended to improve handwriting, but there is limited research supporting their effectiveness. Additionally, previous research has demonstrated that music as an auditory cue can reduce variability in fine motor movements, but its effect on handwriting in people with PD remains unknown. PURPOSE: This study explored potential handwriting interventions for people with PD by evaluating the effectiveness of weighted pens and auditory cues on handwriting. STUDY DESIGN: This was a pilot cohort study. METHODS: Eight older adults with PD used a standard pen and a weighted pen to write continuous cursive "l"s on 1.5-cm-lined paper for a total of 10 seconds while listening to auditory cues in 4 conditions: control (silence), metronome, activating music, and relaxing music. Kinematic data were measured with sensors attached to the tip of each pen, and muscle activity was measured with electromyography sensors adhered to the extensor digitorum communis and first dorsal interosseous. RESULTS: When writing with the standard pen, peak-to-peak time was reduced in the metronome (control = 0.807 ± 0.121 seconds, metronome = 0.701 ± 0.100 seconds, p = 0.024) and activating (control = 0.807 ± 0.121 seconds, activating = 0.691 ± 0.113 seconds, p = 0.009) conditions compared to the control condition. Furthermore, the weighted pen increased the variability of distance between letter peaks (standard = 0.187 ± 0.010, weighted = 0.482 ± 0.065, p = 0.033) and the variability of time needed to complete each letter (standard = 0.176 ± 0.010, weighted = 0.187 ± 0.016, p = 0.042) compared to the standard pen. Finally, area under the curve of the extensor digitorum communis was reduced in the metronome (metronome = 66.03 ± 25.74 mV, control = 88.98 ± 30.40 mV, p = 0.034) and activating music (activating = 66.49 ± 26.02 mV, control = 88.98 ± 30.40 mV, p = 0.012) conditions compared to control when writing with the standard pen. CONCLUSIONS: These results suggest that weighted pens may not improve handwriting in novice users, but auditory cues appear beneficial. This can inform future directions in the research and clinical application of handwriting interventions for persons with PD.

The Feasibility of Group Therapeutic Singing Telehealth for Persons with Parkinson's Disease in Rural Iowa.

Introduction: Group therapeutic singing (GTS) may be an effective treatment for voice and respiratory impairments in persons with Parkinson's disease (PD). However, it remains unknown if GTS can be effectively delivered through telemedicine. Methods: Participants with PD from rural areas were recruited to complete a prerecorded GTS program, once a week for 8 weeks. Voice and respiratory outcome measures were collected 1 week before and 1 week after intervention. Results: Ten participants were enrolled in the study. One participant dropped at week 3. Five participants attended all eight sessions, two participants completed seven sessions, and one participant completed six sessions for 93.75% compliance. Statistical analysis for the data collected from the eight participants enrolled in the study revealed that voice outcome measures improved but did not reach significance. However, respiratory outcome measures significantly improved. Discussion: Results suggest that prerecorded GTS is feasible. Moreover, results are in keeping with results from a previous study using the exact same intervention with an in person therapist. Thus, this pilot work suggests that the use of prerecorded GTS may be a viable treatment option for those with limited access to care.

Repetitive Finger Movement and Dexterity Tasks in People With Parkinson's Disease.

BACKGROUND: Little is known regarding how repetitive finger movement performance, an assessment of bradykinesia (slowness of movement), is related to fine-motor dexterity tasks in people with Parkinson's disease (PD). OBJECTIVE: This pilot study examined the relationship between the performance of fine-motor dexterity tasks and repetitive finger movement in people with PD. METHOD: Forty-six participants with PD completed an acoustically cued repetitive finger movement task (1-3 Hz). Movement amplitude, movement rate difference, and coefficient of variation were obtained for each tone rate. Participants also completed a buttoning and Purdue pegboard assembly task. Buttoning time and number of assemblies were recorded. RESULTS: A significant association was found between movement rate difference and movement rate difference coefficient of variation and buttoning performance in which higher movement rate and higher variability were associated with slower buttoning times. No significant associations between any of the repetitive finger movement outcome measures and Purdue pegboard assembly performance were revealed. CONCLUSION: Changes in movement amplitude and movement rate may influence fine-motor dexterity tasks differently. Thus, it is important to consider the quantitative assessment of both movement rate and movement amplitude because they may indicate differential clinical applications in the treatment of people with PD.

How Should Pushing Off or the Use of Assistive Devices Be Incorporated in the Timed Up and Go for Persons With Parkinson Disease?

OBJECTIVES: To determine (1) the relationship between assisted timed Up and Go (TUG) performance and the Parkinson's Disease Questionnaire-39 (PDQ-39), and (2) whether adjusting the TUG score (adding time) improves the relationship between TUG performance and the PDQ-39 in persons with Parkinson disease (PD) who use assistive devices or push off, or both. DESIGN: Cross-sectional. SETTING: Twenty participating National Parkinson Foundation Centers of Excellence. PARTICIPANTS: Data were obtained from participants (N=6624) without exclusion at the 20 participating sites. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The relationship between TUG scores and PDQ-39 mobility scores was determined using the method of linear least squares. Adjusted scores were determined through minimizing the sum of the squared error. RESULTS: The correlation between assisted TUG scores and PDQ-39 mobility scores was slightly lower (R(2)=.384) compared with the correlation between nonassisted TUG scores and PDQ-39 mobility scores (R(2)=.409). Adjusting assisted TUG performance scores for push off and for use of an assistive device resulted in a modest increase in correlation (R(2)=.399). CONCLUSIONS: Applying adjustments to assisted TUG may provide clinically important information for evaluating balance, mobility, and falls, and for determining the most effective therapeutic strategies for persons with PD.

Defining the clinically meaningful difference in gait speed in persons with Parkinson disease.

BACKGROUND AND PURPOSE: Gait dysfunction is a common target for pharmacological, behavioral, and surgical interventions in persons with Parkinson disease. However, the responsiveness of gait speed, that is, clinically important difference, is not well described in the literature for this population. The purpose of this study was to determine the magnitude of meaningful difference in gait speed using multiple methods of assessment and utilizing a large sample of participants inclusive of various stages of disease severity. METHODS: Gait speed was measured using an instrumented walkway in 324 ambulatory persons with idiopathic Parkinson disease. Cross-sectional analysis of the clinically important difference for gait speed was performed using distribution- and anchor-based approaches: disability (Schwab and England Activities of Daily Living Scale), disease stage (Modified Hoehn and Yahr Scale), and severity (Unified Parkinson's Disease Rating Scale). RESULTS: Using distribution-based analyses and effect size metrics, the small important difference in gait speed was 0.06 m/s, moderate was 0.14 m/s, and large was 0.22 m/s. Applying previously established cut-points for small, moderate, and large change in the motor scale score, the associated changes in gait speed that might be expected are 0.02, 0.06, and 0.10 m/s. DISCUSSION AND CONCLUSIONS: Our data revealed that the clinically important difference in gait speed among persons with Parkinson disease on medication ranged from 0.05 m/s to 0.22 m/s by distribution-based analysis and ranged from 0.02 m/s to 0.18 m/s per level within the anchor-based metrics. These data will aid in evaluating the effectiveness of interventions to improve gait speed in persons with Parkinson disease.Video Abstract available. See video (Supplemental Digital Content 1, http://links.lww.com/JNPT/A77) for more insights from the authors.

Timed up and go, cognitive, and quality-of-life correlates in Parkinson's disease.

OBJECTIVE: To examine the relationship between Timed Up and Go (TUG) performance, verbal executive function (EF) performance, and quality-of-life (QOL) measures in Parkinson's disease (PD). DESIGN: Cross-sectional. SETTING: Sixteen movement disorder centers from across the United States. PARTICIPANTS: Patients with PD (N=1964). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: TUG test, immediate and delayed 5-word recall, verbal fluency, PD QOL Questionnaire. RESULTS: TUG performance and verbal EF performance were significantly associated with, and predictors of, QOL measures, having the greatest association and predictability with the mobility domain of the QOL measures. CONCLUSIONS: The TUG test and verbal EF tests have QOL correlates, making the combined evaluation of mobility, cognitive, and QOL decline a potential examination tool to evaluate the sequelae of PD.

Exploring a neuroplasticity model of music therapy.

BACKGROUND: Given that music therapists work across a wide range of disabilities, it is important that therapists have at least a fundamental understanding of the neurophysiology associated with the client/patient populations that they serve. Yet, there is a large gap of evidence regarding the neurophysiological changes associated with applying music as therapy. OBJECTIVE: The purpose of this article is to provide music therapists with a general background in neuroplasticity principles that can be applied to the use of music therapy with multiple populations. METHODS: This article will review literature on neuroplasticity and literature supporting the specific attributes of music therapy that apply to neuroplasticity. Finally, examples of how to use neuroplasticity principles to explain and support clinical music therapy will be provided. RESULTS: Using the material presented in this review, music therapists will be equipped with information to effectively communicate why music therapy works using three neuroplasticity principles; increase in dopamine, neural synchrony, and a clear signal. CONCLUSION: Music therapy is a powerful tool to enhance neuroplasticity in the brain.

Using the Timed Up & Go test in a clinical setting to predict falling in Parkinson's disease.

OBJECTIVE: To investigate the ability of the Timed Up & Go test to identify patients with Parkinson's disease at risk for a fall. DESIGN: Cross-sectional cohort study. SETTING: Sixteen participating National Parkinson's Foundation Centers of Excellence. PARTICIPANTS: A query yielded a total of 2985 records (1828 men and 1157 women). From these, 884 were excluded because of a lack of crucial information (age, diagnosis, presence of deep brain stimulation, disease duration, inability of performing the Timed Up & Go test without assistance) at the time of testing, leaving 2097 patients included in the analysis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The primary outcome measure for this study was falls. The chief independent variable was the Timed Up & Go test. RESULTS: The initial model examined the prediction of falls from the Timed Up & Go test, adjusting for all study covariates. The estimated models in the imputed data sets represented a significant improvement above chance (χ(2) range [df=17], 531.29-542.39, P<.001), suggesting that 74% of participants were accurately classified as a faller or nonfaller. The secondary model in which the question of whether the effect of Timed Up & Go test was invariant across disease severity demonstrated 75% of participants were accurately classified as a faller or nonfaller. Additional analysis revealed a proposed cut score of 11.5 seconds for discrimination of those who did or did not fall. CONCLUSIONS: The findings suggest that the Timed Up & Go test may be an accurate assessment tool to identify those at risk for falls.

Oxygen consumption, oxygen cost, heart rate, and perceived effort during split-belt treadmill walking in young healthy adults.

During split-belt treadmill walking the speed of the treadmill under one limb is faster than the belt under the contralateral limb. This unique intervention has shown evidence of acutely improving gait impairments in individuals with neurologic impairment such as stroke and Parkinson's disease. However, oxygen use, heart rate and perceived effort associated with split-belt treadmill walking are unknown and may limit the utility of this locomotor intervention. To better understand the intensity of this new intervention, this study was undertaken to examine the oxygen consumption, oxygen cost, heart rate, and rating of perceived exertion associated with split-belt treadmill walking in young healthy adults. Fifteen participants completed three sessions of treadmill walking: slow speed with belts tied, fast speed with belts tied, and split-belt walking with one leg walking at the fast speed and one leg walking at the slow speed. Oxygen consumption, heart rate, and rating of perceived exertion were collected during each walking condition and oxygen cost was calculated. Results revealed that oxygen consumption, heart rate, and perceived effort associated with split-belt walking were higher than slow treadmill walking, but only oxygen consumption was significantly lower during both split-belt walking than fast treadmill walking. Oxygen cost associated with slow treadmill walking was significantly higher than fast treadmill walking. These findings have implications for using split-belt treadmill walking as a rehabilitation tool as the cost associated with split-belt treadmill walking may not be higher or potentially more detrimental than that associated with previously used treadmill training rehabilitation strategies.

Comparison of auditory cueing in toe tapping and gait in persons with Parkinson's disease.

Introduction: Much research has examined the relationship between bradykinesia and gait impairment in persons with Parkinson's disease (PD). Specifically, impairments in repetitive movements of the upper extremity have been associated with freezing of gait. Studies examining lower extremity repetitive movements are limited. Moreover, the use of external cueing has been a treatment strategy for both bradykinesia and gait, but information on how cues should be used is lacking. The purpose of this study was to compare the effects of auditory cueing on one side versus both sides for bilateral repetitive toe tapping and gait, and to determine if there was a relationship between toe tapping and gait. We hypothesize that there will be no difference between the cueing conditions, but that there will be a significant association between repetitive toe tapping performance and gait performance. Methods: Twenty-seven persons with PD completed a toe tapping task in which the more affected side was cued at 70 beats per minute (BPM), the less affected side was cued at 70 BPM, and both sides were cued at 140 BPM. The same cueing conditions were completed for the gait task. Inter movement interval and amplitude data was collected and analyzed for the toe tapping task. Stance time, swing time, step length, and step width were collected and analyzed for the gait task. Results: Results revealed a significant difference in movement performance between the single side cueing conditions and both sides cued condition for inter movement interval (toe tapping), stance time (gait), step length (gait), and step width (gait). Moreover, results revealed a significant association between inter movement interval and stance time and step length. Discussion: These results would suggest that cueing both sides is better than only one side and that there is a relationship between toe tapping and gait performance when both sides are cued in persons with PD. This study adds to the literature exploring possible shared mechanisms between bradykinesia and gait in persons with PD.

Differences in motor inhibition in young and older musicians and non-musicians at rest.

Introduction: Older adults experience a decline in motor inhibition. These declines have been implicated in instrumental activities of daily living. However, studies have revealed that older musicians have behavioral and neurophysiological enhancements in various motor domains compared to non-musicians. This suggests that music training may delay the decline in motor inhibition with aging. Nevertheless, motor inhibition has not been studied in young or older musicians and non-musicians. Thus, the present study aimed to investigate the neurophysiological differences in motor inhibition in aging musicians and non-musicians. Methods: A total of 19 healthy young adult musicians, 16 healthy young non-musicians, 13 healthy older adult musicians, and 16 healthy older adult non-musicians were recruited for the study. Transcranial magnetic stimulation single-pulse (SP) and short interval cortical inhibition (SICI) were performed at rest and then converted into inhibition percentage. Results: We did not observe significant differences between young and older musicians and non-musicians in resting SP MEP. Older adults had lower resting SICI MEP than young adults. Older adults (36%) had a greater percentage of inhibition than young adults (16%). However, when controlling for background EMG activity, musicians had a lower inhibition percentage than non-musicians. Discussion: The results revealed that, despite the greater use of spinal mechanisms, decreased SICI, and increased inhibition percentage in older adults, motor inhibitory circuitry remains intact and functional in both young and older musicians and non-musicians. Future studies will reveal whether there are differences in motor inhibition during movement in musicians across a person's lifespan.

Postural instability and gait impairment during obstacle crossing in Parkinson's disease.

OBJECTIVE: To examine whether Parkinson's disease (PD) affects gait behavior and stability while walking over an obstacle. DESIGN: Parallel group comparisons were completed in which participants completed 5 trials of normal walking and 5 trials of obstacle crossing while gait kinematics and kinetics were collected. SETTING: University biomechanics laboratory. PARTICIPANTS: Individuals with PD (n=10) and age- and sex-matched healthy older adults (n=10). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Gait parameters, obstacle clearance parameters, and center of mass motion were calculated during normal walking and obstacle crossing. RESULTS: Results revealed that decrements in gait performance in individuals with PD were amplified during obstacle crossing, suggesting that due to disease-related degradation, individuals with PD chose a more conservative strategy for obstacle crossing. Moreover, an increased duration of single limb support (18% increase), a decrease in anteroposterior range of motion (20% decrease), and an increase in mediolateral range of motion (36% increase, though not significant) coupled with the reduction in the distance between the center of pressure and center of mass (mean of 21% decrease across toe-off and heel strike) and increase in margin of stability (31% increase at toe-off and 71% increase at heel strike) may suggest that deficits in muscle strength and balance may contribute to this impairment. CONCLUSIONS: Persons with PD alter their behavior to reduce the mechanical demands and increase dynamic stability during obstacle avoidance tasks.

Determinants of exercise behaviour in persons with Parkinson's disease.

BACKGROUND: Exercise shows promise for improving physical and cognitive functioning, quality of life, and mood in individuals with Parkinson's disease (PD). Structured interviews have suggested potential factors influencing participation in exercise in this population, but no studies have examined if they predict exercise behaviour. METHODS: Thirty persons with PD completed the International Physical Activity Questionnaire and a semi-structured interview. Time spent exercising was calculated by summing responses for recreation, sport, and leisure-time physical activity. Predictors of exercise were assessed via interview. In addition, participants were asked about what types of exercise they engaged in and what types of exercise they would be interested in trying. Regression analyses were used to identify the factors that predicted time spent exercising, as well as determining factors in low vs. high exercisers (≥150 min per week). RESULTS: Positive predictors of exercise were being male (ß= -0.52, p = 0.01; χ2 = 4.84, p = 0.03), married (ß = 0.32, p = 0.03; χ2 = 5.60, p = 0.02), and enjoyment of exercise (ß = 0.36, p = 0.02). Fear of falling (ß = -0.41, p = 0.01; χ2 = 4.29, p = 0.04), negative perception of health (ß = -0.41, p = 0.02), perception of PD symptoms (χ2 = 12.45, p < 0.001), bad weather (χ2 = 5.06, p = 0.02), and lack of an exercise partner (χ2 = 13.39, p < 0.001) were negative predictors of exercise. CONCLUSIONS: Results from this study suggest that exercise programmes should work to make activities enjoyable, safe, and adaptable to the abilities of the individual. Programmes should also include social engagement.Implications for rehabilitationParkinson's exercise programmes should be enjoyable.Parkinson's exercise programmes should include both social engagement and social support.Parkinson's exercise programmes should be safe and adaptable to the abilities of the participants.Parkinson's exercise programmes should aim to improve balance and reduce fear of falling.Individual exercise programmes can also be successful, many people with PD exercise alone with the most common form being walking.

Finger tapping to different styles of music and changes in cortical oscillations.

Music has been a therapeutic strategy proposed to improve impaired movement performance, but there remains a lack of understanding of how music impacts motor cortical activity. Thus, the purpose of this study is to use a time-frequency analysis (i.e., wavelet) of electroencephalographic (EEG) data to determine differences in motor and auditory cortical activity when moving to music at two different rates. Twenty healthy young adults tapped their index finger while electroencephalography was collected. There were three conditions (tapping in time with a tone and with two contrasting music styles), and each condition was repeated at two different rates (70 and 140 beats per minute). A time-frequency Morlet wavelet analysis was completed for electrodes of interest over the sensorimotor areas (FC3, FC4, FCz, C3, C4, Cz) and the primary auditory areas (T7, T8). Cluster-based permutation testing was applied to the electrodes of interest for all conditions. Results showed few differences between cortical oscillations when moving to music versus a tone. However, the two music conditions elicited a variety of distinct responses, particularly at the slower movement rate. These results suggest that music style and movement rate should be considered when designing therapeutic applications that include music to target motor performance.

The Effects of Group Therapeutic Singing on Cortisol and Motor Symptoms in Persons With Parkinson's Disease.

The inclusion of music into the treatment plan for persons with Parkinson's disease (PD) may be a viable strategy to target multiple motor symptoms. However, potential mechanisms to explain why music has an impact on multiple motor symptoms in persons with PD remain understudied. The purpose of this study was to examine the acute effects of 1 h of group therapeutic singing (GTS) on physiological measures of stress and clinical motor symptoms in persons with PD. We posit that improvement in motor symptoms after GTS may be related to stress reduction. Seventeen participants with PD completed 1 h of GTS and eight participants completed 1 h of a quiet reading (control session). Cortisol was collected via passive drool immediately before and after the singing and control session. The Unified Parkinson's Disease Rating Scale (UPDRS) Part-III (motor examination) was also video-recorded immediately before and after the singing and control session and scored by two raters masked to time and condition. Secondary outcome measures for quality of life, depression, and mood were collected. Results revealed no significant change in cortisol or motor UPDRS scores, as well as no significant relationship between cortisol and motor UPDRS scores. There was a trend for the singing group to report feeling less sad compared to the control group after the 1-h session (effect size = 0.86), and heart rate increased in the singing group while heart rate decreased in the control group after the 1-h session. These results suggest that an acute session of GTS is not unduly stressful and promotes the use of GTS for persons with PD. Multiple mechanisms may underlie the benefits of GTS for persons with PD. Further exploring potential mechanisms by which singing improves motor symptoms in persons with PD will provide greater insight on the therapeutic use of music for persons with PD.

Effects of Levodopa on Impairments to High-Level Vision in Parkinson's Disease.

Studies have reported that Parkinson's disease (PD) is associated with impairments on cognitive visual tasks. However, the effects of dopamine on cognitive vision remain equivocal. The purpose of this study was to examine performance on cognitive vision tasks in persons with PD and the effects of levodopa on these tasks. Fourteen individuals with PD and 14 age- and sex-matched healthy older adults completed the study. Participants with PD completed the visual tasks following a 12-h withdrawal of dopaminergic medication and again 1 h after taking 1.5 times their normal dose of levodopa. Healthy older adults completed the visual tasks twice using the same session format. Five complex visual tasks were completed, including line discrimination, object discrimination, facial discrimination, visual working memory, and object rotation. The Unified Parkinson's Disease Rating Scale was also collected off and on medication. Participants with PD performed significantly worse than the healthy older adults across all five visual tasks. There were no significant differences in performance between the off and on medication state in persons with PD. This finding indicates either that dopamine deficiency may not be responsible for cognitive visual impairments in PD or that cognitive visual impairments in PD might simply be the result of deficits in more basic visual processing.

Music Form but Not Music Experience Modulates Motor Cortical Activity in Response to Novel Music.

External cues, such as music, improve movement performance in persons with Parkinson's disease. However, research examining the motor cortical mechanisms by which this occurs is lacking. Research using electroencephalography in healthy young adults has revealed that moving to music can modulate motor cortical activity. Moreover, motor cortical activity is further influenced by music experience. It remains unknown whether these effects extend to corticomotor excitability. Therefore, the primary aim of this study was to determine the effects of novel music on corticomotor excitability using transcranial magnetic stimulation (TMS) in a pilot study of healthy young adults. A secondary aim of this study was to determine the influence of music experience on corticomotor excitability. We hypothesized that corticomotor excitability will change during music conditions, and that it will differ in those with formal music training. Motor evoked potentials (MEPs) were recorded from the first dorsal interosseous using single-pulse TMS in three conditions: (1) No Music, (2) Music Condition I, and (3) Music Condition II. Both pieces were set to novel MIDI piano instrumentation and part-writing conventions typical of early nineteenth-century Western classical practices. Results revealed Music Condition II (i.e., more relaxing music) compared to rest increased MEP amplitude (i.e., corticomotor excitability). Music Condition II as compared to Music Condition I (i.e., more activating music) reduced MEP variability (i.e., corticomotor variability). Finally, years of formal music training did not significantly influence corticomotor excitability while listening to music. Overall, results revealed that unfamiliar music modulates motor cortical excitability but is dependent upon the form of music and possibly music preference. These results will be used to inform planned studies in healthy older adults and people with Parkinson's disease.

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.

Repetitive finger movement and circle drawing in persons with Parkinson's disease.

Little is known regarding how repetitive finger movement performance impacts other fine motor control tasks, such as circle drawing, in persons with Parkinson's disease (PD). Previous research has shown that impairments in repetitive finger movements emerge at rates near to and above 2 Hz in most persons with PD. Thus, the purpose of this study was to compare circle drawing performance in persons with PD that demonstrate impairment in repetitive finger movement and those that do not. Twenty-two participants with PD and twelve healthy older adults completed the study. Only participants with PD completed the repetitive finger movement task. From the kinematic data for the repetitive finger movement task, participants were grouped into Hasteners and Non-Hasteners. Participants with PD and the healthy older adults completed a series of circle drawing tasks at two different target sizes (1 cm and 2 cm) and three pacing conditions (Self-paced, 1.25 Hz, and 2.5 Hz). Kinematic and electromyography data were recorded and compared between groups. Results revealed that, in general, persons with PD demonstrate impairments in circle drawing and associated electromyography activity compared to healthy older adults. Moreover, persons with PD that hasten during repetitive finger movements demonstrate significantly increased movement rate during circle drawing, while those persons with PD that do not hasten demonstrate a significant increase in width variability. This suggests that differing motor control mechanisms may play a role in the performance of fine motor tasks in persons with PD. Continued research is needed to better understand differences in circle drawing performance among persons with PD to inform future development of patient-centered treatments.

Sedentary Behavior and Quality of Life in Individuals With Parkinson's Disease.

Background. Sedentary behavior is a growing public health concern and may have particular relevance for the Parkinson disease (PD) population. However, the influence of sedentary time on factors associated with quality of life (QOL) in PD is unknown. The primary purpose of this study was to examine relationships between sedentary behaviors and markers of PD-specific QOL. A secondary purpose was to examine relationships between physical activity behaviors and QOL. Methods. We assessed sedentary and active behaviors using objective and interview measures and examined relationships between these behaviors and a measure of PD-specific QOL in individuals with PD. Results. Results demonstrated that sedentary time was significantly related to several aspects of QOL, including perceived deficits in the domains of mobility, cognitive processing, and communication. Additionally, results showed that time spent watching television was more strongly associated with lower levels of QOL than other more engaging sedentary activities. For physical activity, relationships between objective measures and QOL were weaker and only significantly associated with mobility. Time spent doing housework was associated with lower levels of QOL, whereas time spent in recreational activity was associated with lower levels of discomfort. Discussion. These results suggest that targeting decreases in sedentary behaviors (eg, reducing time spent watching television, breaking up prolonged bouts of sedentary time) may be effective for improving QOL in individuals with PD.