Another Round Pointer Finger Drawing a Circle Motion

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Open Access

Peer-reviewed

Enquiry Article

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

• Elizabeth 50. Stegemöller,
• Andrew Zaman,
• Jennifer Uzochukwu

x

• Published: September 23, 2019
• https://doi.org/10.1371/periodical.pone.0222862

Figures

Abstract

Picayune is known regarding how repetitive finger motion performance impacts other fine motor control tasks, such as circumvolve cartoon, in persons with Parkinson's disease (PD). Previous research has shown that impairments in repetitive finger movements sally at rates near to and in a higher place ii Hz in virtually persons with PD. Thus, the purpose of this study was to compare circle drawing performance in persons with PD that demonstrate damage in repetitive finger movement and those that do not. 20-2 participants with PD and twelve healthy older adults completed the study. Only participants with PD completed the repetitive finger movement chore. From the kinematic data for the repetitive finger motion task, participants were grouped into Hasteners and Not-Hasteners. Participants with PD and the healthy older adults completed a serial of circumvolve drawing tasks at two different target sizes (ane cm and ii cm) and three pacing weather (Cocky-paced, 1.25 Hz, and ii.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 action compared to salubrious older adults. Moreover, persons with PD that hasten during repetitive finger movements demonstrate significantly increased motility rate during circumvolve cartoon, while those persons with PD that practise not hasten demonstrate a pregnant increment 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 sympathize differences in circle cartoon performance among persons with PD to inform future development of patient-centered treatments.

Commendation: Stegemöller EL, Zaman A, Uzochukwu J (2019) Repetitive finger move and circle drawing in persons with Parkinson's disease. PLoS Ane xiv(nine): e0222862. https://doi.org/10.1371/journal.pone.0222862

Editor: J. Lucas McKay, Emory University, Us

Received: May 29, 2019; Accepted: September 9, 2019; Published: September 23, 2019

Copyright: © 2019 Stegemöller et al. This is an open access commodity distributed under the terms of the Artistic Commons Attribution License, which permits unrestricted utilise, distribution, and reproduction in any medium, provided the original writer and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests be.

Introduction

Enquiry has shown that persons with Parkinson's illness (PD) demonstrate impairments in fine motor tasks, such equally writing tasks. Handwriting and circle drawing are small, dull, and oftentimes illegible [1–v]. These changes in writing may exist a consequence of other PD symptoms such as tremor, rigidity, or bradykinesia, slowness of move. However, bradykinesia may have the greatest bear on on functional disability in persons with PD [6,7]. While repetitive movements, such as finger tapping, are used in the clinical assessment of bradykinesia, in that location is no assessment of other fine motor tasks on the motor Unified Parkinson's Disease Rating Scale (UPDRS, part iii). Patients are asked nearly fine motor tasks in other portions of the UPDRS (i.eastward. part ii). Thus, subjective report from the patient combined with observed repetitive finger motion by the neurologist often results in the express assessment of fine motor tasks. However, trivial is known regarding how repetitive movement operation impacts writing tasks, such equally circle cartoon, in persons with PD. A better understanding of how repetitive movements impact fine motor tasks may improve the cess of persons with PD.

Previous research from our group has shown that impairments in simple repetitive finger movements sally at rates nearly to and above 2 Hz in most persons with PD, and this impairment is not improved with medication [8,9]. Moreover, research from our grouping has shown that impairments in repetitive finger movements are associated with a decline in performance on the Purdue pegboard assembly task and buttoning, as well equally quality of life [x,11]. Taken together, this may suggest that impairments in repetitive finger movement may also affect other fine motor movements that impact quality of life, such as circle drawing. 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 who do not.

Writing functioning oft becomes worse when persons with PD are asked to write with increasing demands, such as larger or faster than normal [5,12, thirteen]. Moreover, changes in muscle activity may contribute to small and slow handwriting in persons with PD [5,fourteen,15]. Thus, in this study kinematic and electromyography (EMG) information were collected while persons with PD and salubrious older adults (HOAs) drew circles at a modest (1 cm) and large (2 cm) size and at a self-paced, slow paced (1.25 Hz), and fast paced (2.5 Hz) rate. Given that impairments in repetitive finger movements, which are characterized by an increment in move rate and a decrease in movement amplitude, emerge at pacing rates almost to and above 2 Hz [8,ix], we hypothesize that participants with PD that demonstrate impairments in repetitive finger motility volition perform worse 1) when writing the small circles and ii) when writing at the faster pacing rate when compared to healthy older adults.

Methods

Participants

Twenty-two participants diagnosed with idiopathic PD (mean age 68 ± 11 years; 9/22 male person, and 20/22 right handed) and 12 HOAs (mean age 71 ± nine years; 2/12 male; 12/12 right handed) completed the report. Participants with PD reported an average disease duration of 8.3 ± five.4 years and fifty% of the participants reported that the right side was their more afflicted side. All participants with were tested 1 to one.5 hours after taking their regular Parkinsonian medication. All participants gave their written informed consent prior to inclusion in the study, and the Iowa State Academy Institutional Review Board canonical the procedures.

Process

A standard diameter ballpoint pen and two sheets of lined paper were provided. One sheet of paper had lines spaced 1cm apart, and the other had lines spaced 2cm apart. Participants were instructed to describe repetitive circles clockwise, without lifting the pen, on the sheets of paper matching the size of the lines with their dominant mitt. The circles were drawn over one another so that there was no lateral movement of the pen. For both sizes, participants were asked to depict the circles in time with a pacing tone that was presented at either 1.25 Hz or 2.five Hz, in which the apex of the circle was synchronized to each tone. Participants were also asked to draw circles at their self-selected step with no pacing tone. Thus, there were a total of vi conditions were completed: 1) small (1cm)/cocky-paced, 2) modest/one.25 Hz, 3) pocket-size/2.5 Hz, four) large (2 cm)/self-paced, v) large/ane.25 Hz, and 6) large/2.5 Hz. Participants completed 20 circles per condition, and the order of each condition was randomized amid participants. Pen kinematics were recorded at 200 Hz from an electromagnetic sensor (Ascension), placed almost the tip of the ballpoint pen. Bipolar EMG sensors (Delsys) were placed on the index finger extensor (extensor digitorum communis (EDC)), and flexor (beginning dorsal interosseous (FDI)) of the hand used to write.

Participants with PD also completed an unconstrained repetitive finger motility task using their most affected mitt. A pacing tone that began at a rate of ane.0 Hz and incremented by 0.25 Hz until reaching 3.0 Hz with fifteen tones at each charge per unit was presented (Fig 1). Participants were asked to tap their index finger in time with the pacing tone while the arm and mitt was secured in the pronated position. Three trials were collected. This task has been used previously to assess impairments in repetitive finger movements at rates near to and above 2 Hz in persons with PD [8,nine]. Finger movement was collected using a goniometer, data conquering board (Micro 1401, Cambridge Electronic Design, United kingdom), and software (Spike2, CED). Signals were digitized at a sampling charge per unit of 100Hz.

Information assay

For the circumvolve drawing task, circumvolve height, circle width, and motion rate were obtained. A digital representation of the circumvolve drawing was reproduced from the pen sensor information using a project-specific Coffee program. Each time the private reached their apex in the circumvolve signified the start of a new circle. Circle height was adamant as the anterior to posterior diameter of the circle, and circle width was determined as the medial to lateral diameter of the circle. Movement rate was calculated equally the time from reaching the apex of i circle to reaching the apex of the adjacent circle. Hateful and standard mistake values were obtained for each kinematic outcome mensurate for each condition. The coefficient of variation (CV), standard difference divided by the mean, was also calculated for each outcome measure for each condition.

Tiptop EMG and EMG area nether the bend were obtain for both the EDC and FDI muscles. The root mean square was calculated for the EMG signal and filtered with a 20 to 500 Hz band-pass filter, and a 59-61Hz notch filter. Peak EMG amplitude was calculated by averaging the height EMG amplitude for each written circumvolve and averaged for each condition. EMG area under the curve was calculated by adding the trapezoidal area between successive points for the elapsing of the trial and averaged for each condition. The CV was too calculated for each EMG outcome mensurate for each status.

Only participants with PD completed the repetitive finger movement chore. For this task, meridian flexion was obtained for each motility and meridian-amplitude and movement rate difference (MRΔ) were determined. Peak-amplitude was normalized to the aamplitude at one.0 Hz. MRΔ was calculated as the divergence between the actual move rate and tone rate. For each participant with PD, height amplitude and MRΔ was averaged across all tone rates less than ii.0 Hz and for all tone rates of 2.0 Hz and greater, returning two values of peak amplitude and MRΔ for each participant with PD. From this data, participants with PD were categorized into two groups based on their movement rate when the pacing tone exceeded 2 Hz or in a higher place, Hasteners (due north = nine) and Non-Hasteners (n = 13). For the entire sample (northward = 22), the standard deviation for MRΔ at 1 Hz was calculated. Participants that moved faster than two standard deviations for at to the lowest degree 3 consecutive tone rates at 2 Hz or above were categorized into the Hasteners group [9]. All other participants were categorized into the Non-Hastener group. See Table 1 for demographics and repetitive finger movement information for each PD grouping.

Statistical assay

All data was normally distributed. To make up one's mind if in that location were differences between PD groups, independent t-tests were completed for age, and chi foursquare tests were completed for gender, handedness, and most affected side. To determine if at that place were differences between repetitive finger motility performance, a 2x2 repeated measures analysis of variance (ANOVA) was completed for both tiptop amplitude and MRΔ. The inside group factor was pacing rate (< 2.0 Hz vs. > 2.0 Hz), and the betwixt group gene was group (Hasteners vs. Non-Hasteners). Postal service hoc analysis was completed using independent t-tests with Bonferroni correction.

To determine the effects of circle size on movement rate and motion charge per unit CV, separate 2 (1 cm vs. 2 cm) x 3 (Hasteners vs. Not-Hasteners vs. HOAs) repeated measure ANOVAs were completed for the self-paced, 1.25 Hz, and 2.5 Hz conditions. To determine the furnishings of pacing rate on circle meridian and circle pinnacle CV, separate iii (self-paced vs.1.25 Hz vs. 2.five Hz) x 3 (Hasteners vs. Non-Hasteners vs. HOAs) repeated measure ANOVAs were completed for small (1 cm) and large (ii cm) circles. To determine the effects of pacing rate on circle width and circle width CV, separate 3 (self-paced vs.1.25 Hz vs. 2.5 Hz) x 3 (Hasteners vs. Non-Hasteners vs. HOAs) repeated measure ANOVAs were also completed for modest and large circles. Mail hoc analysis was completed using Tukey's Honestly Significant Deviation test when a main effect of group or interaction effect was revealed.

Similarly, to determine the effects of circumvolve size on EMG activity and EMG CV between Hasteners and Non-Hasteners, split 2 (ane cm vs. 2 cm) ten 3 (Hasteners vs. Non-Hasteners vs. HOAs) repeated measure out ANOVAs were completed for the cocky-paced, one.25 Hz, and 2.5 Hz weather for each outcome measure (peak EDC, meridian FDI, EDC area, and FDI area). To determine the effects of pacing charge per unit on EMG action and EMG CV, separate iii (cocky-paced vs.1.25 Hz vs. 2.5 Hz) x 3 (Hasteners vs. Non-Hasteners vs. HOAs) repeated measure ANOVAs were also completed for modest and large circles for each effect measure. Post hoc analysis was completed using Tukey'southward Honestly Meaning Difference test if a principal effect of group or interaction effect was revealed. If a main outcome of pacing rate was revealed, post hoc analysis was completed using paired t-tests with Bonferroni correction.

Results

Table 1 shows comparisons between groups for age, gender, handedness, and most afflicted side. Results revealed a significant difference in gender (p = 0.04), indicating a higher percentage of males in the hastener grouping. For the most affected side, analysis was completed to determine if the number of participants with their dominant hand as their nearly affected side was different between groups. Given that participants were using their ascendant hand to write, whether information technology was the about affected side may influence results. However, hastener and not-hastener groups did not differ in which side of the body was more afflicted by PD (p = 0.fifteen).

Fig 1A shows a representative sample of repetitive finger borer performance for one participant in the Hastener group and one participant in the Non-Hastener group. The MRΔ at rates above 2 Hz was much higher in the participant who hastened compared to the participant that did not. Table 1 shows grouping kinematic information from the repetitive finger motility task. For peak amplitude, results revealed no main result of pacing rate (F(1) = 1.37, p = 0.25), no main effect of grouping (F(one) = 0.056, p = 0.46), and no interaction effect (F(1) = 0.03, p = 0.87). In contrast, for MRΔ, results revealed a chief effect of pacing charge per unit (F(1) = 8.57, p = 0.008), a main issue of grouping (F(1) = 39.84, p < 0.001), and an interaction effect (F(one) = ten.34, p = 0.004). Confirming the group of PD participants, mail service hoc analysis revealed significant differences in MRΔ betwixt the Hastener and Not-Hastener groups at pacing rates above 2.0 Hz (t(20) = 5.20, p < 0.001), but not at pacing rate below 2.0 Hz (t(20) = 1.20, p = 0.06). This indicates that the hasteners moved faster at rates above 2.0 Hz than the not-hasteners.

Fig 1B shows a representative sample of circle drawing performance for one participant in the Hastener group, 1 participant in the Not-Hastener grouping, and i HOA for each pacing rate and each circle size. In general, the PD Hastener produces smaller circles than both the PD Non-Hastener and HOA across all conditions. However, the PD Non-Hastener grouping demonstrated more than variable functioning, particularly for the larger circles.

Fig two shows the effects of circumvolve size on movement rate amidst groups. Overall, the Hastener group moved faster than the Non-Hastener grouping for both circle sizes and beyond all pacing rates. For circle size (ane cm vs. 2 cm), all groups tended to movement faster when writing the smaller circumvolve. Statistical results revealed a meaning effect of size (F(i) = 8.452, p = 0.007) and group (F(two) = 5.598, p = 0.009), but no interaction effect (F(2) = 1.321, p = 0.282) for the self-paced condition (Fig 1A). For the pacing charge per unit of 1.25 Hz, a main effect of group (F(1) = 3.953, p = 0.030) was revealed, simply there was no significant difference for circumvolve size (F(ii) = ii.179, p = 0.151) and no interaction effect (F(two) = 0.144, p = 0.867) (Fig 1B). For the pacing rate of 2.5 Hz, results revealed a main consequence of size (F(1) = seven.923, p = 0.009) and a main effect of group (F(2) = 3.764, p = 0.035). At that place was no interaction issue (F(ii) = 0.017, p = 0.983) (Fig 1C). Post hoc comparisons between groups revealed significant differences betwixt the Hastener grouping and Not-Hastener group for the self-paced (p = 0.007), i.25 Hz (p = 0.047), and 2.5 Hz (p = 0.038) atmospheric condition. Post hoc comparisons also revealed meaning departure between the Hastener grouping and the HOA group for the 1.25 Hz status (p = 0.048). No other comparisons were meaning (p > 0.140). For movement rate CV, results revealed no significant primary effects of size or group and no interaction effect across all pacing rates (Size: F(i) < 1.575, p > 0.219; Group: F(two) < .0.339, p > 0.715; Interaction: F(2) < 1.444, p > 0.252).

Fig two.

Motion rate for the PD Hastener, PD Non-Hastener, and HOA groups for cocky-paced (A), paced at 1.25 Hz (B), and paced at 2.five Hz (C) conditions for both minor and large circle sizes. The dotted line represents the intended pace. Horizontal brackets represent significant differences between groups. Vertical brackets represent a meaning issue of circle size. *p < 0.05, **p < 0.01.

https://doi.org/ten.1371/periodical.pone.0222862.g002

Fig 3A and 3B show the effects of pacing rate on circumvolve summit amongst groups. Across all pacing rates and both circle sizes, elevation was smaller than the given lined cue (1 cm for small and 2 cm for large) for all groups. In general, the pinnacle of the circle increased when provided an auditory pacing cue for minor circle, but decreased for big circle. Statistical results revealed a main effect of rate for the large circle simply (F(i) = 3.252, p = 0.045). No master effect of pacing rate was revealed for the small-scale circle (F(1) = 1.635, p = 0.204), and no main effect of grouping was revealed for either the minor (F(two) = 2.316, p = 0.116) or large (F(2) = 1.383, p = 0.266) circles. Moreover, no interaction effects were revealed for either circle size [small: (F(2) = ane.146, p = 0.343); large: (F(two) = 0.471, p = 0.756)]. Post hoc results revealed a pregnant difference in height for large circles between the self-paced and two.v Hz conditions but (p = 0.015). No other comparisons were meaning (p > 0.12). For circumvolve elevation CV, results revealed no significant main effects of pacing rate or group and no interaction effect across both sizes (Charge per unit: F(1) < iii.771, p > 0.062; Grouping: F(2) < .2.901, p > 0.070; Interaction: F(2) < 1.241, p > 0.304).

Fig 3.

Circumvolve height for all iii pacing weather condition for the PD Hastener, PD Non-Hastener, and HOA groups for the small (A) and big (B) circumvolve sizes. The dotted line represents the intended height. Brackets bespeak a meaning difference in pacing condition amid all groups. Circle width for all iii pacing conditions for the PD Hastener, PD Not-Hastener, and HOA groups for the small (C) and large (D) circle sizes. Brackets indicate significant grouping differences. *p < 0.05, **p < 0.01.

https://doi.org/10.1371/journal.pone.0222862.g003

Fig 3C and 3D prove the effects of pacing rate on circle width among groups. Note that no lined cues were provided for width. For circumvolve width, both PD groups (Hasteners and Not-Hasteners) were smaller compared to the HOA grouping, just no consistent pattern was observed across pacing rate. Statistical results revealed a main effect of group for both the small (F(1) = 7.379, p = 0.002) and big (F(1) = 6.180, p = 0.0.006) circles. No primary effects of pacing charge per unit (Small: F(2) = 0.268, p = 0.765; Large: F(2) = i.025, p = 0.365) or interaction furnishings (Modest: F(2) = 0.379, p = 0.823; Large: F(2) = 0.i.849, p = 0.131) were revealed. Mail service hoc comparisons revealed pregnant differences betwixt the Hastener and HOA groups for both small (p = 0.003) and large (p = 0.013) circles and between the Not-Hastener and HOA groups for both the small (p = 0.015) and large (p = 0.013) groups. No other comparisons were pregnant (p > 0.663). For circle width CV, results revealed a significant main outcome of group for both the small (F(2) = four.512, p = 0.019) and big (F(2) = 3.813, p = 0.033) circles (Fig 4). No primary effect of pacing rate (F(1) < 2.702, p > 0.111) or interaction (F(2) > 1.011, p < 0.376) was revealed for either small or large circles. Postal service hoc results revealed a meaning divergence in circumvolve width CV between the Non-Hastener and HOA grouping for both the small (p = 0.015) and large (p = 0.037) circles. No other comparisons were significant (p > 0.107).

Fig 4.

Width coefficient of variation for all three pacing conditions for the PD Hastener, PD Non-Hastener, and HOA groups for the small (A) and large (B) circumvolve sizes. Brackets indicate significant grouping differences. *p < 0.05.

https://doi.org/10.1371/journal.pone.0222862.g004

Tabular array 2 shows the mean and standard error for all EMG consequence measures. Statistical results for the effect of circle size amid groups revealed just one main effect of size for the i.25 Hz pacing condition for tiptop FDI amplitude (F(1) = v.687, p = 0.025). No other master effects of size or group and no other interaction effects were revealed. Statistical results for the upshot of pacing charge per unit amid groups revealed a primary effect of pacing charge per unit for both the small and large circles for EDC area (Small: F(2) = iv.757, p = 0.013; Large: F(2) = 21.348, p < 0.001) and FDI area (Small: F(two) = 4.242, p = 0.002; Large: F(2) = three.646, p = 0.033). No other master effects of size or group and no other interaction effects were revealed. Post hoc results revealed a significant difference in EDC surface area between the self-paced and 1.25 Hz weather (p = 0.001), the self-paced and two.5 Hz conditions (p < 0.001), and the one.25 Hz and 2.5 Hz atmospheric condition (p < 0.001). For FDI expanse, significant differences were revealed betwixt the cocky-paced and 2.5 Hz weather condition (p = 0.016) and the 1.25 Hz and 2.five Hz weather condition (p = 0.015). No other comparisons were significant (p > 0.017, Bonferonni corrected).

Table three shows the mean and standard fault for all EMG CV effect measures. Statistical results for the issue of circle size amid groups revealed a primary effect of group for the self-paced status (F(two) = 5.911, p = 0.008) and a primary upshot of size for the 1.25 Hz pacing condition (F(i) = 3.408, p = 0.007), both for peak EDC amplitude. A significant interaction result for peak EDC amplitude for the ane.25 Hz condition was also revealed (F(2) = 6.860, p = 0.004). No other master effects or interaction furnishings were revealed. Mail service hoc results for the self-paced grouping comparisons revealed significant differences between the Hastener and HOA groups (p = 0.027) and between the Not-Hastener and HOA groups (p = 0.014). In that location was no significant difference between the Hastener and Non-Hastener groups (p = 0.993). Statistical results for the effect of pacing rate among groups revealed a main effect of pacing rate for the pocket-size circles for meridian EDC amplitude (F(ane) = 5.262, p = 0.031) and a main effect of group for the large circumvolve for peak EDC amplitude (F(ii) = 7.636, p = 0.002). An interaction effect was revealed for the small-scale circumvolve for meridian FDI amplitude (F(ii) = five.112, p = 0.014), EDC area (F(2) = viii.164, p = 0.002), and FDI area (F(2) = eight.094, p = 0.002). No other main effects of pacing charge per unit or group and no other interaction effects were revealed. Mail service hoc results for the large circle group comparisons revealed a pregnant difference between the Hastener and HOA groups (p = 0.023) and the Non-Hastener and HOA groups (p = 0.003). Although there was a primary effect of pacing rate for the small circle, there were no meaning differences in peak EDC amplitude between rates (p > 0.04, Bonferonni corrected).

Discussion

The purpose of this study was to compare circumvolve cartoon operation in persons with PD who demonstrated harm in repetitive finger motion and those who did not. The results propose that, in general, persons with PD demonstrate differences in circle cartoon and associated EMG activity compared to HOAs. Circle width and peak EDC CV were significantly smaller for both PD groups compared to HOAs. However, there were some differences between the PD Hastener and PD Non-Hastener groups. Results revealed that the PD Hastener group had a significantly faster move rate when writing circles (across both circle sizes and all pacing rates) compared to the PD Non-Hastener and HOA groups. Still, circle width CV (both modest and large circles) was significantly larger in the PD Non-Hastener grouping compared to the HOA group. Thus, these results suggest that differences in repetitive finger tapping performance in persons with PD may as well translate to differences in circle drawing performance.

Previous enquiry has shown that when persons with PD are asked to write under increased processing need, such every bit dual task or at a fast stride, performance deteriorates [five,12,xiii,sixteen]. Specifically, persons with PD tend to undershoot the target size, suggesting that amplitude of movement (i.e. height) is most affected by increased processing demand [5,12]. In this study, all participants undershot the target size, and in that location were no differences in circle height among groups. In general, participants undershot the larger circle size to a greater extent than the small circle size (~17% for small circles; ~28% for big circles). Withal, circumvolve height was significantly smaller in the 2.5 Hz condition compared to the self-paced condition. This suggests that both a large target size and a fast pacing rate may increase processing demand resulting in undershooting circle height. In this report, there were no differences in circle elevation between persons with PD and HOAs. The lack of difference among groups in our results may be due to the presence of lined newspaper that provided a visual cue for circle height. Previous research has shown that visual cues, lined paper, improve handwriting at sizes like to those used in this study [17–nineteen]. Taken together, visual cues may ameliorate circle writing tasks, merely target size and pacing rate may be factors to consider when evaluating performance on writing tasks.

In dissimilarity to circle acme, at that place was no visual cue provided for circle width. Both PD groups had a significantly smaller circle width compared to HOAs, which may be expected as visual cues amend performance as discussed previously. However, peradventure a more than interesting result from this written report is that the PD Non-Hastener group demonstrated more variability in circle width than the HOA group. Upon inspection of the data (run into Fig 1), participants in the PD Non-Hastener group tended to take a preference to produce right-tilted circumvolve shapes, especially for the large circle, while those in the PD Hastener group did non. In that location was no measure circle shape specifically in this study, but the increment in width variability in the PD Non-Hastener group may exist a consequence of this shape divergence. Previous research has shown similar findings in persons with PD and suggests that the correct-tilted shape may be due to a deficiency in wrist and finger coordination [1]. Still, the PD Hastener group did non demonstrate an increase in width variability or prove of right-tilted circle cartoon. Boosted research is needed to determine the underlying cause of differences in circle drawing performance between the PD Hastener and PD Non-Hastener groups.

Participants in the Hastener grouping moved significantly faster than participants in the Non-Hastener and HOA groups regardless of circumvolve size and pacing charge per unit. The largest difference in motion rate betwixt the PD groups was observed during the self-paced condition. There was approximately a 1.0 Hz divergence in movement rate in the self-paced status compared to approximately a 0.5 Hz difference in both the i.25 Hz and 2.5 pacing conditions. This may suggest than an auditory cue may improve timing regulation to some extent in those participants who hasten, but not fully. Performance between PD groups also differed between the two pacing conditions of 1.25 Hz and 2.v Hz. For the i.25 Hz pacing status, both PD groups moved faster than the intended tone. In contrast, for the 2.5 Hz pacing condition, the PD Hastener group moved faster that the intended tone, while the PD Non-Hastener group moved slower than the tone. This observation may be due to the simple fact that the PD Hastener group moved on average 0.5 Hz faster than the PD Not-Hastener group regardless of the pacing rate.

Previous behavioral and electrophysiological enquiry has shown evidence that control of fine motor motility changes near movement rates of ii.0 Hz [20–23]. This modify in control is thought to represent the modify from detached to continuous movement and is associated with changes in beta band oscillations recorded over the sensorimotor cortex [20]. Inquiry has shown an association between aberrant beta ring oscillations and impairments in repetitive finger motility operation at rates virtually to and above ii.0 Hz in persons with PD [22,23]. In repetitive finger movement, 2.0 Hz is approximate the rate in which motility performance switched from discrete to continuous movement. Moreover, circle drawing may exist considered a continuous motion. Thus, persons with PD that demonstrate hastening at rates almost to and above 2.0 Hz (continuous motility) may accept aberrant control of other continuous movement that is evident in other fine motor tasks, including circle drawing. Indeed, the behavioral results of this written report may back up this notion, but future inquiry using additional brain imaging techniques during writing tasks in persons with PD are needed.

Limitations

All participants with PD in this written report were tested in their optimal medicated state. While it has been shown that medication does not improve repetitive finger move operation at rates near to and in a higher place 2.0 Hz [8], medication has been shown to improve handwriting in persons with PD [iv]. Continued inquiry is needed to examine the effects of medication on handwriting in PD Hasteners and PD Non-Hasteners. In addition, not all participants used the more affect side to consummate the drawing chore. Thus, in some participants, finger tapping and circle cartoon were done with dissimilar hands. Notwithstanding, there were no differences between PD groups on the percentage of participants with the dominant hand as the well-nigh afflicted side. Nonetheless, this study provides prove for future inquiry aimed at understanding fine motor command in persons with PD.

Conclusion

This study revealed that persons with PD that demonstrate impairments in repetitive finger movements, specifically hastening, also demonstrate increased movement charge per unit during circle drawing, while those persons with PD that do not hasten demonstrate impairments in width variability. This suggests that at that place may be differing impairments beyond individuals with PD when writing speedily. Further research is needed to amend understand differences in writing operation among persons with PD so that more patient-centered treatments for writing, and potentially other fine motor skills, tin exist developed.

Supporting data

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Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0222862

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