PERIORAL BIOMECHANICS, KINEMATICS, AND ELECTROPHYSIOLOGY IN PARKINSON'S DISEASE

Abstract

This investigation quantitatively characterized the orofacial biomechanics, labial kinematics, and associated electromyography (EMG) patterns in individuals with Parkinson's disease (PD) as a function of anti-PD medication state. Passive perioral stiffness, a clinical correlate of rigidity, was sampled using a face-referenced OroSTIFF system in 10 mildly diagnosed PD and 10 age/sex-matched control elderly. Labial movement amplitudes and velocities were evaluated using a 4-dimensional computerized motion capture system. Associated perioral EMG patterns were sampled to examine the characteristics of perioral muscles and compensatory muscular activation patterns during repetitive syllable productions. This study identified several trends that reflect various characteristics of perioral system differences between PD and control subjects: 1. The presence of high tonic EMG patterns after administration of dopaminergic treatment indicated an up-regulation of the central mechanism, which may serve to regulate orofacial postural control. 2. Multilevel regression modeling showed greater perioral stiffness in PD subjects, confirming the clinical correlate of rigidity in these patients. 3. Similar to the clinical symptoms in the upper and lower limb, a reduction of range of motion (hypokinesia) and velocity (bradykinesia) was evident in the PD orofacial system. Administration of dopaminergic treatment improved hypokinesia and bradykinesia. 4. A significant correlation was found between perioral stiffness and the range of labial movement, indicating these two symptoms may result in part from a common neural substrate. 5. As speech rate increased, PD speakers down-scaled movement amplitude and velocity compared to the control subjects, reflecting a compensatory mechanism to maintain target speech rates. 6. EMG from orbicularis oris inferior (OOIm) and depressor labii inferioris (DLIm) muscles revealed a limited range of muscle activation level in PD speakers, reflecting the underlying changes in motor unit firing behavior due to basal ganglia dysfunction. The results of this investigation provided a quantitative description of the perioral stiffness, labial kinematics, and EMG patterns in PD speakers. These findings indicate that perioral stiffness may provide clinicians a quantitative biomechanical correlate to medication response, movement aberrations, and EMG compensatory patterns in PD. The utilization of these objective assessments will be helpful in diagnosing, assessing, and monitoring the progression of PD to examine the efficacy of pharmacological, neurosurgical, and behavioral interventions.