The effect of unilateral posteroventral pallidotomy on the kinematics of the reach to grasp movement

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Objectiveto assess postoperative effects of unilateral posteroventral pallidotomy on the organisation of upper limb movement.MethodsA three dimensional kinematic system (ELITE, B [vertical bar] T [vertical bar] S [vertical bar] Italy) was used to record reach to grasp movements to objects of either small (0.7 cm) or large (8 cm) diameter placed at a reaching distance of either 20 or 30 cm. Four patients with Parkinson's disease were assessed in "off" (12 hours without medication) and "on" (1 hour after administration of medication) preoperatively and postoperatively.ResultsDuration of the movement and the time spent in arm deceleration were significantly reduced after surgery. However, movement patterning according to object size was adversely affected. Postoperatively, all four patients showed an abnormal pattern of a longer movement duration, and three showed a longer time of reaching arm deceleration, for reach to grasp movements to the large object than for those to the small object.ConclusionPosteroventral pallidotomy seems to be beneficial in reducing bradykinesia of upper limb movements but may have "costs" to movement patterning, particularly for reach to grasp movements to objects of differing sizes. This study raises interesting questions about the role of the globus pallidus interna in coordinating stimulus bound visual information with appropriate motor patterning.(J Neurol Neurosurg Psychiatry 1998;65:479-487)

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