Zenere Lucia [Neuroimaging Research Unit, Division of Neuroscience IRCCS San Raffaele Scientific Institute, Milan, Italy]
Sarasso Elisabetta [Neuroimaging Research Unit, Division of Neuroscience IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy]
Gardoni Andrea [Neuroimaging Research Unit, Division of Neuroscience IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy]
Grassi Andrea [Neuroimaging Research Unit, Division of Neuroscience IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy]
Balestrino Roberta [Neurology Unit; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy]
Emedoli Daniele [Department of Rehabilitation and Functional Recovery, IRCCS Ospedale San Raffaele, Milan, Italy] Basaia Silvia [Neuroimaging Research Unit, Division of Neuroscience IRCCS San Raffaele Scientific Institute, Milan, Italy]
Sibilla Elisa [Neuroimaging Research Unit, Division of Neuroscience IRCCS San Raffaele Scientific Institute, Milan, Italy] Canu Elisa [Neuroimaging Research Unit, Division of Neuroscience; Neurology Unit IRCCS San Raffaele Scientific Institute, Milan, Italy]
Malcangi Massimo [Neurology Unit; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy] Volontè Maria Antonietta [Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy]
Corbetta Davide [Department of Rehabilitation and Functional Recovery, IRCCS Ospedale San Raffaele, Milan, Italy] Filippi Massimo [Neuroimaging Research Unit, Division of Neuroscience; Neurology Unit; Neurorehabilitation Unit; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy]
Agosta Federica [Neuroimaging Research Unit, Division of Neuroscience; Neurology Unit IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy]
Thirty-seven PD and 30 age- and sex-matched healthy controls were included. Hand dexterity was assessed using the Purdue Pegboard Test (PPT). To obtain objective kinematic data, we developed tests involving common gesture using smartphone (tap, swipe, slide), and handwriting tests consisting of copy of text and pre-writing tasks (e.g. repetitive loops or coloring a figure). Handwriting was performed on a touchscreen with a pen. All subjects performed a fMRI task consisting of alternatively open and close their hand (hand tapping). Patients with PD were randomized into two training groups receiving 8 weeks of rehabilitation (2/week, 1 hour/session). Both groups performed exercises stimulating speed and amplitude of handwriting, tap, swipe and slide movements. One group performed the exercises in a real setting (pen and paper, wooden table), the other used technological devices (tablet and smartphone). In this preliminary analysis, patients in both groups were considered together.
At baseline, patients with PD showed a worse manual dexterity as measured by PPT and a worse motor performance in terms of reduced movement speed and amplitude of swipe, slide and tapping movements on the smartphone as well as reduced handwriting speed and amplitude relative to healthy controls. During the hand tapping task, PD patients showed a reduced activity of motor-related brain areas, particularly in the supplementary motor area and cerebellum. After 8 weeks of rehabilitation, patients with PD showed improved speed and amplitude during both handwriting and smartphone tasks, an increased activity of cerebellar areas and a reduced activity of fronto-temporal areas.
It is not surprising that patients with PD showed altered handwriting and reduced ability to use a smartphone. Nevertheless, few studies focused on the rehabilitation of handwriting and touchscreen skills in PD. Our results showed the potential benefits of physiotherapy in improving not only movement speed and amplitude, but also in promoting a more efficient brain activity. Technological devices with customized software can provide quantitative measures of handwriting and dexterity to objectively and precisely quantifying bradykinesia in PD. Moreover, a specific training for the upper limb can reduce the impact of bradykinesia and promote neural plasticity.
Funding: Italian Ministry of Health grant number GR-2018-12366005
References:
