Measurement of upper limb kinematics and joint angle patterns during deep brain stimulation for parkinson’s disease

Therapeutic benefits of subthalamic nucleus (STN) deep brain stimulation (DBS) for motor symptoms of Parkinson´s disease (PD) are well-documented. However, the mechanisms underlying motor improvement with DBS remain poorly understood. We tested the hypothesis that STN-DBS-related improvements in voluntary arm movement kinematics are mediated by changes in the velocity and temporal sequencing of proximal joint angles. We evaluated a 56 year old male and 66 year old female with idiopathic Parkinson´s disease chronically implanted with bilateral STN-DBS. Patients performed a button press task while off medication in the DBS-on and DBS-off conditions. Movements of the upper limb were recorded using a 3D motion analysis system, and detailed kinematic measures were obtained for the arm and forearm. As expected, reaction and movement times were improved in the DBS-on compared to DBSoff condition. The two subjects differed with regards to the magnitude of their changes in peak linear velocity and peak angular velocities (shoulder flexion extension, shoulder abduction adduction and elbow flexion extension). Surprisingly, both PD patients increased the frequency with which they used a preferred sequence of shoulder and elbow joint activations when in the DBS-on condition. This preferred pattern was adopted with twice the frequency than in the DBS-off condition, and with increased frequency relative to a control group of 9 age-matched controls. These results suggest that STN-DBS may improve movement execution at the cost of flexibility in movement execution strategy.