Cocontraction (the simultaneous activation of antagonist muscles around a joint) provides the nervous system with a way to adapt the mechanical properties of the limb to changing task requirements—both in statics and during movement. However, relatively little is known about the conditions under which the motor system modulates limb impedance through cocontraction. The goal of this study was to test for a possible relationship between cocontraction and movement accuracy in multi-joint limb movements. The electromyographic activity of seven single- and double-joint shoulder and elbow muscles was recorded using surface electrodes while subjects performed a pointing task in a horizontal plane to targets that varied randomly in size. Movement speed was controlled by providing subjects with feedback on a trial-to-trial basis. Measures of cocontraction were estimated both during movement and during a 200-ms window immediately following movement end. We observed an inverse relationship between target size and cocontraction: as target size was reduced, cocontraction activity increased. In addition, trajectory variability decreased and endpoint accuracy improved. This suggests that, although energetically expensive, cocontraction may be a strategy used by the motor system to facilitate multi-joint arm movement accuracy. We also observed a general trend for cocontraction levels to decrease over time, supporting the idea that cocontraction and associated limb stiffness are reduced over the course of practice.

In recent studies of human motor learning, subjects learned to move the arm while grasping a robotic device that applied novel patterns of forces to the hand. Here, we examined the generality of force field learning. We tested the idea that contextual cues associated with grasping a novel object promote the acquisition and use of a distinct internal model, associated with that object. Subjects learned to produce point-to-point arm movements to targets in a horizontal plane while grasping a robotic linkage that applied either a velocity-dependent counter-clockwise or clockwise force field to the hand. Following adaptation, subjects let go of the robot and were asked to generate the same movements in free space. Small but reliable after-effects were observed during the first eight movements in free space, however, these after-effects were significantly smaller than those observed for control subjects who moved the robot in a null field. No reduction in retention was observed when subjects subsequently returned to the force field after moving in free space. In contrast, controls who reached with the robot in a NF showed much poorer retention when returning to a force field. These findings are consistent with the idea that contextual cues associated with grasping a novel object may promote the acquisition of a distinct internal model of the dynamics of the object, separate from internal models used to control limb dynamics alone.

Background and ObjectivesTo review the current evidence on the options available for initiating dopaminergic treatment of motor symptoms in early-stage Parkinson disease and provide recommendations to clinicians.MethodsA multidisciplinary panel developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine–compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence.ResultsInitial treatment with levodopa provides superior motor benefit compared to treatment with dopamine agonists, whereas levodopa is more likely than dopamine agonists to cause dyskinesia. The comparison of different formulations of dopamine agonists yielded little evidence that any one formulation or method of administration is superior. Long-acting forms of levodopa and levodopa with entacapone do not appear to differ in efficacy from immediate-release levodopa for motor symptoms in early disease. There is a higher risk of impulse control disorders associated with the use of dopamine agonists than levodopa. Recommendations on initial therapy for motor symptoms are provided to assist the clinician and patient in choosing between treatment options and to guide counseling, prescribing, and monitoring of efficacy and safety.