Motor Control Deficits in Parkinson's Disease

帕金森病的运动控制缺陷

基本信息

批准号：
8109852
负责人：
Howard Poizner
金额：
$ 33.12万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
1997
资助国家：
美国
起止时间：
1997-07-01 至 2013-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8109852
关键词：
Affective Area Basal Ganglia Behavior Behavioral Body Surface Complex Data Deep Brain Stimulation Disease Dopamine Dopaminergic Agents Electrodes Environment Feedback Functional disorder Grant Hand Health Impairment Implanted Electrodes Knowledge Learning Limb structure Literature Location Maps Mechanics Medical Modality Motor Movement Operative Surgical Procedures Outcome Output Parkinson Disease Patients Performance Pharmaceutical Preparations Pharmacotherapy Play Prior Therapy Process Proprioception Quality of life Relative (related person)Replacement Therapy Robot Role Scheme Sensory Signal Transduction Speed Structure of subthalamic nucleus System Technology Testing Therapeutic Touch sensation Vision Visual arm deep brain stimulator design functional restoration grasp implantation improved motor control motor learning novel research study retinal rods sensory integration skills virtual virtual reality visual feedback visual motor

项目摘要

DESCRIPTION (provided by applicant): Understanding the range of dysfunctions in Parkinson's disease (PD), and the degrees to which they are reversible by pharmacological or electrophysiological treatments, can both increase our understanding of PD therapies and help illuminate critical functions of basal ganglia-cortical circuits in the control of movement. Our previous findings have led us to hypothesize that a major difficulty for patients with Parkinson disease (PD) is in assembling and using new sensorimotor mappings or coordinations. These processes play a major role both in ongoing motor performance and in the acquisition of new skills, and, preliminary data indicate, are not normalized with dopamine (DA) replacement therapy. The present proposal presents seven experiments that are designed to confirm and extend this hypothesis and to investigate the degrees to which deep brain stimulation to the subthalamic nucleus (STN DBS) and DA replacement therapy are able to remediate deficits in sensorimotor control, coordination, and learning. To contrast the effects of these therapies in the same patients, PD patients will be tested ON versus OFF DA replacement prior to their having surgically implanted electrodes, and again after surgery ON and OFF deep brain stimulation (and off medications). The first 4 experiments examine the integration of visual and proprioceptive information, which may be particularly deficient in PD. Subjects will reach to 3D targets presented either visually or kinesthetically with a robot arm under various conditions of visual feedback. The next experiment introduces the requirement that subjects learn to move within a virtual environment as a prerequisite to establishing the new sensorimotor coordinations necessary for accurate target acquisition. Subjects are required to master distortions that create discrepancies between the apparent (virtual) and real (proprioceptively signaled) location of their arms. By dissociating movements from their normal sensory correspondences, subjects' abilities to reconfigure their sensorimotor coordinations will be challenged. The final 2 experiments challenge subjects by requiring them to integrate different motor acts into a complex motor sequence and to be able to compensate for a mechanical perturbation during such an action. By examining a full range of behaviors, and requiring coordinated motor acts, utilization of variable sensory information to guide behavior, and the learning new sensorimotor correspondences, a more systematic assessment of motor control in PD and its benefit by treatment can be obtained. The proposed approach of using such contemporary technologies as 3D immersive virtual realities and robot-guided 3D reaching in examining the degree to which medical versus surgical therapies can ameliorate dysfunctions in PD is unique. PUBLIC HEALTH RELEVANCE: A major question in the treatment of Parkinson's disease is the degree to which different therapies can ameliorate the range of dysfunctions that are a product of the disorder. Surgical implantation of deep brain stimulators, especially those targeted to the subthalamic nucleus, is an increasingly important modality for treatment and restoring function and quality of life in Parkinson's disease. The proposed studies will compare which deficits in sensorimotor control and learning deep brain stimulation therapy versus dopaminergic replacement therapy can reverse and which they cannot, and thus should fill an important gap in the literature that can inform treatment decisions.

描述（由申请人提供）：了解帕金森氏病（PD）中功能障碍的范围，以及通过药理或电生理学治疗可逆的程度，既可以提高我们对PD疗法的理解，又可以帮助照亮运动基础神经节疗法的关键功能。我们以前的发现使我们假设对帕金森氏病（PD）患者组装和使用新的感觉运动映射或协调的主要困难。这些过程在持续的运动性能和新技能的获取以及初步数据表明，未通过多巴胺（DA）替代疗法归一化。本提案介绍了七个实验，旨在确认和扩展这一假设，并研究深层脑刺激对丘脑下核（STN DBS）和DA替代疗法的程度，能够补救感觉运动控制，协调性和学习的缺陷。为了对比这些疗法在同一患者中的作用，将在手术植入电极之前对PD患者进行测试，而在DA替换中进行了测试，并在手术后再次进行手术后的脑刺激（和药物外药物）。前4个实验检查了视觉和本体感受信息的整合，这可能在PD中尤其不足。在各种视觉反馈条件下，受试者将在视觉或动力学上达到3D目标。下一个实验介绍了受试者学会在虚拟环境中移动的要求，以此作为建立准确目标获取所需的新的感觉运动协调的先决条件。需要受试者来掌握扭曲，以在其手臂的明显（虚拟）和真实（敏感的）位置之间造成差异。通过将运动与正常的感觉对应关系分离，将挑战受试者重新配置其感觉运动协调的能力。最后2个实验通过要求将不同的运动动作整合到复杂的运动序列中，并能够在此类动作过程中补偿机械扰动来挑战。通过检查各种行为，需要协调的运动行为，利用可变的感觉信息来指导行为以及学习新的感觉运动对应关系，可以获得PD中的运动控制及其通过治疗的益处的更系统的评估。在检查医学与手术疗法可以减轻PD中的功能障碍的程度方面，使用3D沉浸式虚拟现实和机器人引导的3D达到的拟议方法是独一无二的。公共卫生相关性：治疗帕金森氏病的一个主要问题是不同疗法可以改善该疾病产物的功能障碍范围。深脑刺激剂的手术植入，尤其是针对丘脑下核的外科植入剂，是帕金森氏病中治疗和恢复功能和生活质量的日益重要的方式。拟议的研究将比较哪些在感觉运动控制和学习深脑刺激疗法与多巴胺能替代疗法的缺陷可以逆转且不能逆转，因此应填补文献中可以为治疗决策提供依据的重要差距。

项目成果

期刊论文数量（49）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Rhythmic movement in Parkinson's disease: effects of visual feedback and medication state.

DOI：
10.1007/s00221-011-2685-0
发表时间：
2011-06
期刊：
EXPERIMENTAL BRAIN RESEARCH
影响因子：
2
作者：
Levy-Tzedek, S.;Krebs, H. I.;Arle, J. E.;Shils, J. L.;Poizner, H.
通讯作者：
Poizner, H.

Scaling and coordination deficits during dynamic object manipulation in Parkinson's disease.

帕金森病动态物体操纵过程中的尺度和协调缺陷。

DOI：
10.1152/jn.00041.2014
发表时间：
2014
期刊：
Journal of neurophysiology
影响因子：
2.5
作者：
Snider,Joseph;Lee,Dongpyo;Harrington,DeborahL;Poizner,Howard
通讯作者：
Poizner,Howard

Deficits in the evolution of hand preshaping in Parkinson's disease.

帕金森病手部预成形的进化缺陷。

DOI：
10.1016/s0028-3932(03)00150-7
发表时间：
2004
期刊：
Neuropsychologia
影响因子：
2.6
作者：
Schettino,LuisF;Rajaraman,Viswanathan;Jack,David;Adamovich,SergeiV;Sage,Jacob;Poizner,Howard
通讯作者：
Poizner,Howard

Adaptation of a haptic robot in a 3T fMRI.

触觉机器人在 3T fMRI 中的适应。