[ZucchiniFlower]

No, it’s not “alien hand”, thank goodness, but it’s upsetting to me. I’m right handed and my bad side is the right side. I don’t have resting tremor; I do have bradykinesia, rigidity, and dystonia, and sometimes action tremor.

I keep dropping things with my left hand. I dropped a pill bottle this morning and my baclofen landed on the floor. I dropped two bottles at work today; luckily, they were empty.

My left hand doesn’t seem weak. The only thing I can think of is that when I drop something I’m also doing something with my right hand. In other words, I’m multitasking on autopilot.

I’m able to hold two large bottles in each hand without a problem, but when I do that I’m focusing on what I’m doing, being careful not to drop them.

It seems that simultaneous activity is problematic unless I focus on what I’m doing and if I go slowly. If I quickly grab things without focusing on the activity, or if I’m distracted, I can’t use both hands at once.

I’m right handed, so my focus is more on my right hand because the major activity is being done with that hand. The left hand is an ‘also ran’, so it makes sense that it’s the left hand that fails.
Right after I drop something, my left hand feels discombobulated, like it's not working at all.

Any of this seem familiar?

~Zucchini

[jcitron]

Hi Zucchini,

I have this issue too on occasion, and like you might leftside is my good side. As you've seen here before, I am an avid piano player. There are times when my so-called good left hand decides to be the goofy one and not do what I'm telling it to do. The only time this goes away is when I focus my energy on it to make sure it obeys. After fighting the hand, both hands feel stupid and can't get their act together. I wonder if this is the dystonia side of the PD where the muscles decide that they're not going to listen to their master.

Recently I've developed some muscle twitching in my left hand. This was in the fat-meat part of the hand that connects to the thumb. I sat there for nearly an hour yesterday watching the muscles pull and twitch, causing my thumb and index finger to tremor.

What's going on here? Is it that the syndrome is now spreading to the other side so both sides are now affected by it. I sure hope not.

John

[made it up]

Hi Zucchini and John,
Zucchini, my first thought was that it could be from trying to do two things at once.
It's something an OT with a special interest in PD told me not to do.
I think there's some truth in it too.
For me when I'm stumbling (I only have trouble with my gait these days) if someone says something which they usually do like "are you okay" just the simple act of trying to process those words let alone reply is enough to make my stumble worse.
John, do you have tremor dominant PD?
Is it a resting tremor? If so maybe it's pretty standard.
Anyone else have any ideas?
Lee

[jcitron]

Originally Posted by made it up

Hi Zucchini and John,
Zucchini, my first thought was that it could be from trying to do two things at once.
It's something an OT with a special interest in PD told me not to do.
I think there's some truth in it too.
For me when I'm stumbling (I only have trouble with my gait these days) if someone says something which they usually do like "are you okay" just the simple act of trying to process those words let alone reply is enough to make my stumble worse.
John, do you have tremor dominant PD?
Is it a resting tremor? If so maybe it's pretty standard.
Anyone else have any ideas?
Lee

Hi Lee,

I actually have very little tremor, but it happens once in awhile in my right hand, arm, and even my foot. I'm mostly spastic with some bradikinesia with my right side. This is what surprised me when my left hand decided to do the dance like that.

Trying to do too many things at once... that's the story of my life! Unfortunately when playing the piano, you have to do more than one thing otherwise there's no music.

John

[ZucchiniFlower]

Interesting thought about piano playing, John. I'm having trouble typing these days, and reading and playing music uses the same pathways. When I was learning how to touch type one summer, I found that my sight reading for the piano was much improved. I'm sure I was building new brain circuits with typing which I could use for piano playing. I'm going to try to play on the piano here at work.

John, what position is your good hand in when it tremors? When I meditate, my hands rest on my thighs, with palms up. And during meditation, the fingers on my right hand tremor. I thought that was resting tremor, but my neuro said it was postural tremor because of the position of my hand.

I've continued to drop things and knock things over. In lab, I'm very cautious with every movement that I make and it's enhausting.

My typing is so poor lately. I think it may be from lack of sleep. My sleep schedule has been erratic, and I'm sure that makes symptoms worse.

Made it Up, I, too think it's simultaneous activity that's the culprit. I need to focus on everything I do, not just one thing. Or, better, not use my left hand as much. Thanks.

[ZucchiniFlower]

John and Made it Up, please try this test. I read about it in a terrific review article about bradykinesia.

Using your writing hand draw an outline on a picture. Then try it again while squeezing a ball with your other hand.

When I do it, I immediately have trouble with my right writing hand and it's a huge effort to draw the outline, and I'm very slow.

Squeezing a ball is not a complicated action. Yet, my brain cannot accomodate it. Can yours?

I have trouble with repetitive movements. Like brushing my teeth.

The article is:

Brain, Vol. 124, No. 11, 2131-2146, November 2001
© 2001 Oxford University Press

--------------------------------------------------------------------------------

Review article

Pathophysiology of bradykinesia in Parkinson's disease
.
A. Berardelli1, J. C. Rothwell2, P. D. Thompson3 and M. Hallett4

I have the PDF on my computer if this link isn't accessible to you:

http://brain.oxfordjournals.org/cgi/...ll/124/11/2131

I found it:

"Simultaneous, sequential or repetitive movements

If any additional complexity is added to a simple movement, either by repeating the movement or by combining it with other tasks, bradykinesia becomes more prominent. Clinical tests of bradykinesia often make use of this phenomenon. Repetitive sequential movement involving isolated finger movements, hand opening/closing or wrist pronation/supination become smaller (hypokinesia) and slower with repetition of the movement (`fatigue') (Agostino et al., 1998Go). Schwab and colleagues asked patients to squeeze a sphygmomanometer bulb in one hand and outline a drawing with the other (Schwab et al., 1954Go). They had much more difficulty if they had to do both tasks together than if each one was performed alone. Indeed, in most cases, patients tended to alternate between the tasks rather than perform them at the same time."

Experimental studies have analysed these features of bradykinesia in some detail. In essence, they show that bradykinesia is more than the slowness seen in simple single movements. There are additional problems in combining or sustaining complex movements. Benecke and colleagues examined rapid elbow flexion movements combined with a simultaneous or sequential hand movement performed with either the same or the opposite arm (Benecke et al., 1986Go, 1987Go). In contrast to normal subjects, in whom there was no decrement of performance when two tasks were combined, patients with Parkinson's disease showed (i) a marked slowing of movement over and above that seen in each task alone when both had to be performed together, and (ii) a longer pause between each element of a sequential task. Indeed, these two extra deficits correlated better with clinical measures of bradykinesia than the slowness in each simple movement.

Similar problems in performing simultaneous movements have been described in bilateral reaching (Stelmach and Worringham, 1988Go; Castiello and Bennett, 1997Go) and cranking tasks (Johnson et al., 1998Go). In sequential movements, prolonged pauses between each element have been observed in everyday movements, such as rising from a chair to pick up an object or drinking from a cup (Bennett et al., 1995Go). Elements of fatigue have also been reported in longer-lasting sequences of movements (Berardelli et al., 1986aGo; Agostino et al., 1992Go, 1994Go).


What is the nature of the extra deficits in performance of complex movements?

The problem of combining tasks or switching from one task to another is not confined to movement. It can be observed in cognitive tasks or combined cognitive and motor tasks (Brown and Marsden, 1991Go; Oliveira et al., 1998Go). Such observations are important since they indicate that the extra deficit seen in complex movements is not necessarily a purely motor problem. They raise the possibility that global processing mechanisms, perhaps involving attention, are also a factor. Brown and Marsden suggested that patients either have a limited processing resource that interferes with their ability to run more than one task at the same time, or that they have difficulty in switching this resource between tasks (Brown and Marsden, 1991Go). An alternative is that the global resource is the same in patients, but that tasks are performed less automatically than in normal subjects. In this case, each task would consume more of the processing resource, and lead to difficulties in performing several tasks at once, or in switching between tasks. Effectively, patients may be trying to compensate for lack of basal ganglia input by devoting more resources to each single task they perform. When required to perform more than one task at once, this becomes a limiting factor.

[jcitron]

Originally Posted by ZucchiniFlower

Interesting thought about piano playing, John. I'm having trouble typing these days, and reading and playing music uses the same pathways. When I was learning how to touch type one summer, I found that my sight reading for the piano was much improved. I'm sure I was building new brain circuits with typing which I could use for piano playing. I'm going to try to play on the piano here at work.

John, what position is your good hand in when it tremors? When I meditate, my hands rest on my thighs, with palms up. And during meditation, the fingers on my right hand tremor. I thought that was resting tremor, but my neuro said it was postural tremor because of the position of my hand.

I've continued to drop things and knock things over. In lab, I'm very cautious with every movement that I make and it's enhausting.

My typing is so poor lately. I think it may be from lack of sleep. My sleep schedule has been erratic, and I'm sure that makes symptoms worse.

Made it Up, I, too think it's simultaneous activity that's the culprit. I need to focus on everything I do, not just one thing. Or, better, not use my left hand as much. Thanks.

That's an interesting observation about the touch-typing and music sight reading. I too used to touch type, and I still can to some extent. I do think it has to do with thinking about each key (note) that is pressed it reinforces the connection between the fingers and the brain.

I too have had aweful spells of poor typing, and it's also on those days when my hands don't want to work either. It's like they're calling it quits and want to walk away from it all. I wouldn't doubt that the lack of sleep doesn't add insult to injury.

Now that you mention it, I think my tremor is more of a postural tremor as well. Mine seems to happen when my hand is placed on my lap or on the table, although I did have a tremor in my right hand today and it wasn't in either place. It was at my side as I was talking with my manager.

John

[jcitron]

Thank you for the article, Zucchini Flower. I'll try the ball and draw test when I'm home. With my piano playing, when things are off, I can't seem to get the fingers straight. My right hand trills will stop or the Alberti bass pattern will freeze up while I focus on the melody. This would be similar to the bulb-draw test that the doctors did wouldn't you think?

Anyway it's worth a try. I'm curious as to what the results will be.

John

Originally Posted by ZucchiniFlower

John and Made it Up, please try this test. I read about it in a terrific review article about bradykinesia.

Using your writing hand draw an outline on a picture. Then try it again while squeezing a ball with your other hand.

When I do it, I immediately have trouble with my right writing hand and it's a huge effort to draw the outline, and I'm very slow.

Squeezing a ball is not a complicated action. Yet, my brain cannot accomodate it. Can yours?

I have trouble with repetitive movements. Like brushing my teeth.

The article is:

Brain, Vol. 124, No. 11, 2131-2146, November 2001
© 2001 Oxford University Press

--------------------------------------------------------------------------------

Review article

Pathophysiology of bradykinesia in Parkinson's disease
.
A. Berardelli1, J. C. Rothwell2, P. D. Thompson3 and M. Hallett4

I have the PDF on my computer if this link isn't accessible to you:

http://brain.oxfordjournals.org/cgi/...ll/124/11/2131

I found it:

"Simultaneous, sequential or repetitive movements

If any additional complexity is added to a simple movement, either by repeating the movement or by combining it with other tasks, bradykinesia becomes more prominent. Clinical tests of bradykinesia often make use of this phenomenon. Repetitive sequential movement involving isolated finger movements, hand opening/closing or wrist pronation/supination become smaller (hypokinesia) and slower with repetition of the movement (`fatigue') (Agostino et al., 1998Go). Schwab and colleagues asked patients to squeeze a sphygmomanometer bulb in one hand and outline a drawing with the other (Schwab et al., 1954Go). They had much more difficulty if they had to do both tasks together than if each one was performed alone. Indeed, in most cases, patients tended to alternate between the tasks rather than perform them at the same time."

Experimental studies have analysed these features of bradykinesia in some detail. In essence, they show that bradykinesia is more than the slowness seen in simple single movements. There are additional problems in combining or sustaining complex movements. Benecke and colleagues examined rapid elbow flexion movements combined with a simultaneous or sequential hand movement performed with either the same or the opposite arm (Benecke et al., 1986Go, 1987Go). In contrast to normal subjects, in whom there was no decrement of performance when two tasks were combined, patients with Parkinson's disease showed (i) a marked slowing of movement over and above that seen in each task alone when both had to be performed together, and (ii) a longer pause between each element of a sequential task. Indeed, these two extra deficits correlated better with clinical measures of bradykinesia than the slowness in each simple movement.

Similar problems in performing simultaneous movements have been described in bilateral reaching (Stelmach and Worringham, 1988Go; Castiello and Bennett, 1997Go) and cranking tasks (Johnson et al., 1998Go). In sequential movements, prolonged pauses between each element have been observed in everyday movements, such as rising from a chair to pick up an object or drinking from a cup (Bennett et al., 1995Go). Elements of fatigue have also been reported in longer-lasting sequences of movements (Berardelli et al., 1986aGo; Agostino et al., 1992Go, 1994Go).


What is the nature of the extra deficits in performance of complex movements?

The problem of combining tasks or switching from one task to another is not confined to movement. It can be observed in cognitive tasks or combined cognitive and motor tasks (Brown and Marsden, 1991Go; Oliveira et al., 1998Go). Such observations are important since they indicate that the extra deficit seen in complex movements is not necessarily a purely motor problem. They raise the possibility that global processing mechanisms, perhaps involving attention, are also a factor. Brown and Marsden suggested that patients either have a limited processing resource that interferes with their ability to run more than one task at the same time, or that they have difficulty in switching this resource between tasks (Brown and Marsden, 1991Go). An alternative is that the global resource is the same in patients, but that tasks are performed less automatically than in normal subjects. In this case, each task would consume more of the processing resource, and lead to difficulties in performing several tasks at once, or in switching between tasks. Effectively, patients may be trying to compensate for lack of basal ganglia input by devoting more resources to each single task they perform. When required to perform more than one task at once, this becomes a limiting factor.