Background:The supplementary motor area (SMA) is implicated in both motor initiation and stereotypic multi-limb movements such as walking with arm swing. Gait in Parkinson’s disease exhibits starting difficulties and reduced arm swing, consistent with reduced SMA activity. Objective:We tested whether enhanced arm swing could improve Parkinson gait initiation and assessed whether increased SMA activity during preparation might facilitate such improvement. Methods:Effects of instructed arm swing on cortical activity, muscle activity and kinematics were assessed by ambulant EEG, EMG, accelerometers and video in 17 Parkinson patients and 19 controls. At baseline, all participants repeatedly started walking after a simple auditory cue. Next, patients started walking at this cue, which now meant starting with enhanced arm swing. EEG changes over the putative SMA and leg motor cortex were assessed by event related spectral perturbation (ERSP) analysis of recordings at Fz and Cz. Results:Over the putative SMA location (Fz), natural PD gait initiation showed enhanced alpha/theta synchronization around the auditory cue, and reduced alpha/beta desynchronization during gait preparation and movement onset, compared to controls. Leg muscle activity in patients was reduced during preparation and movement onset, while the latter was delayed compared to controls. When starting with enhanced arm swing, these group differences virtually disappeared. Conclusion:Instructed arm swing improves Parkinson gait initiation. ERSP normalization around the cue indicates that the attributed information may serve as a semi-internal cue, recruiting an internalized motor program to overcome initiation difficulties.

中文翻译：

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指导手臂摆动后帕金森步态启动改善的运动前皮质肌肉动力学。


背景：辅助运动区（SMA）与运动启动和刻板的多肢运动（例如手臂摆动行走）有关。帕金森病患者的步态表现出起步困难和手臂摆动减少，这与 SMA 活动减少一致。目的：我们测试了增强手臂摆动是否可以改善帕金森步态启动，并评估准备过程中增加 SMA 活性是否可以促进这种改善。方法：通过动态脑电图、肌电图、加速度计和视频，对 17 名帕金森患者和 19 名对照者进行指导手臂摆动对皮质活动、肌肉活动和运动学的影响进行评估。在基线时，所有参与者在听到简单的听觉提示后反复开始行走。接下来，患者根据这个提示开始行走，这意味着从增强手臂摆动开始。通过对 Fz 和 Cz 记录进行事件相关频谱扰动 (ERSP) 分析来评估假定的 SMA 和腿部运动皮层的 EEG 变化。结果：与对照组相比，在假定的 SMA 位置 (Fz) 上，自然 PD 步态启动显示听觉提示周围的 α/θ 同步增强，并且步态准备和运动开始期间的 α/β 不同步减少。患者的腿部肌肉活动在准备和运动开始期间减少，而后者与对照组相比延迟。当开始增强手臂摆动时，这些群体差异几乎消失了。结论：指导手臂摆动可改善帕金森步态的启动。围绕提示的 ERSP 标准化表明，归因信息可以作为半内部提示，招募内化的运动程序来克服启动困难。