title: Disturbances of grip force behaviour in focal hand dystonia: evidence for a generalised impairment of sensory-motor integration?
abstract: BACKGROUND
  Focal task specific dystonia occurs preferentially during performance of a specific task. There may be an inefficiently high grip force when doing manipulative tasks other than the trigger task, possibly reflecting a generalised impairment of sensory-motor integration.
  
  
  OBJECTIVE
  To examine how well subjects with writer's cramp (n = 4) or musician's cramp (n = 5) adapted their grip force when lifting a new object or catching a weight.
  
  
  METHODS
  Nine patients with focal hand dystonia and 10 controls were studied. Experiments addressed different motor behaviours: (A) lifting and holding an object; (B) adjusting grip force in anticipation of or in reaction to a change in load force by catching a small weight dropped expectedly or unexpectedly into a hand held receptacle.
  
  
  RESULTS
  In (A), patients produced a grip force overshoot during the initial lifts; force overflow was most pronounced in those with writer's cramp. Patients and controls adjusted their grip force to object weight within one or two lifts, though patients settled to a steady force level above normal. In (B), patients with focal hand dystonia and normal controls showed similar predictive grip force adjustments to expected changes in object load, suggesting that this aspect of sensory-motor integration was normal. Patients had a shorter latency of grip force response than controls after an unexpected load increase, reflecting either a greater level of preparatory motor activity or a disinhibited spinal reflex response.
  
  
  CONCLUSIONS
  The overall increased grip force in patients with focal hand dystonia is likely to be a prelearned phenomenon rather than a primary disorder of sensory-motor integration.
authors.affiliation: Sobell Department of Motor Neuroscience and Movements Disorders, Institute of Neurology, University of London, UK. dr.dennis.nowak@gms.de
authors.forename: D A
authors.initials: DA
authors.lastname: Nowak
authors.forename: K
authors.initials: K
authors.lastname: Rosenkranz
authors.forename: H
authors.initials: H
authors.lastname: Topka
authors.forename: J
authors.initials: J
authors.lastname: Rothwell
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D020821:Dystonic Disorders / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006225:Hand / Q000294:innervation*; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D017770:Lifting; D008297:Male; D008875:Middle Aged; D009433:Neural Inhibition / Q000502:physiology; D011596:Psychomotor Disorders / Q000175:diagnosis* / Q000503:physiopathology; D011930:Reaction Time / Q000502:physiology; D012016:Reference Values; D012021:Reflex, Abnormal / Q000502:physiology; D013116:Spinal Cord / Q000503:physiopathology; D018511:Systems Integration; D014892:Weight Perception / Q000502:physiology; D016474:Weight-Bearing / Q000502:physiology