Motor output variability, deafferentation, and putative deficits in kinesthetic reafference in Parkinson's disease.

Parkinson's disease (PD) is a neurodegenerative disorder defined by motor impairments that include rigidity, systemic slowdown of movement (bradykinesia), postural problems, and tremor. While the progressive decline in motor output functions is well documented, less understood are impairments linked to the continuous kinesthetic sensation emerging from the flow of motions. There is growing evidence in recent years that kinesthetic problems are also part of the symptoms of PD, but objective methods to readily quantify continuously unfolding motions across different contexts have been lacking. Here we present evidence from a deafferented subject (IW) and a new statistical platform that enables new analyses of motor output variability measured as a continuous flow of kinesthetic reafferent input. Systematic increasing similarities between the patterns of motor output variability in IW and the participants with increasing degrees of PD severity suggest potential deficits in kinesthetic sensing in PD. We propose that these deficits may result from persistent, noisy, and random motor patterns as the disorder progresses. The stochastic signatures from the unfolding motions revealed levels of noise in the motor output fluctuations of these patients bound to decrease the kinesthetic signal's bandwidth. The results are interpreted in light of the concept of kinesthetic reafference ( Von Holst and Mittelstaedt, 1950). In this context, noisy motor output variability from voluntary movements in PD leads to a returning stream of noisy afference caused, in turn, by those faulty movements themselves. Faulty efferent output re-enters the CNS as corrupted sensory motor input. We find here that severity level in PD leads to the persistence of such patterns, thus bringing the statistical signatures of the subjects with PD systematically closer to those of the subject without proprioception.