Effects of movement duration on error compensation in periodic bimanual isometric force production

Recent studies using bimanual force production have examined how factors influence redundancy in the nervous system. The present study examined effects of different movement durations on bimanual force control strategies. Ten healthy male participants produced periodic isometric forces such that the sum of two finger forces was a target cycling between 5 and 10 % of maximum voluntary contraction during five movement durations (500, 750, 1,000, 1,250, and 1,500 ms). Correlations between the two finger forces changed from positive to negative with an increase in duration. The polynomial regression analysis indicates that while the correlations between two finger forces were most negative at the target duration of 1,250 ms, they became more positive as the durations deviated from 1,250 ms. Similarly, while force variability was smallest at the target duration of 1,250 ms, it increased as the durations deviated from 1,250 ms. These findings suggested that while the duration of 1,250 ms might be a natural frequency of both fingers, bimanual force strategies changed from force error compensation to force coupling as the durations deviated from 1,250 ms. In addition, while the variance in the sum of two finger forces (the task-relevant variance) decreased with movement duration, the difference between both the finger forces (the task-irrelevant variance) did not change with the duration. Thus, a decrease in the task-relevant variance with movement duration resulted in the negative correlation between the two finger forces and the small force variability.     

Bimanual adaptation: internal representations of bimanual rhythmic movements

From tying your shoes and clipping your tie to the claps at the end of a fine seminar, bimanual coordination plays a major role in our daily activities. An important phenomenon in bimanual coordination is the predisposition toward mirror symmetry in the performance of bimanual rhythmic movements. Although learning and adaptation in bimanual coordination are phenomena that have been observed, they have not been studied in the context of adaptive control and internal representations—approaches that were successfully employed in the arena of reaching movements and adaptation to force perturbations. In this paper we examine the dynamics of the learning mechanisms involved when subjects are trained to perform a bimanual non-harmonic polyrhythm in a bimanual index finger tapping task. Subjects are trained in this task implicitly, using altered visual feedback, while their performance is continuously monitored throughout the experiment. Our experimental results indicate the existence of significant (p<<0.01) learning curves (i.e., error plots with significantly negative slopes) during training and aftereffects with a washout period after the visual feedback ceases to be altered. These results confirm the formation of internal representations in bimanual motor control. We present a simple, physiologically plausible, neural model that combines feedback and adaptation in the control process and which is able to reproduce key phenomena of bimanual coordination and adaptation.     

Perceptual and motor contributions to bimanual coordination

Following earlier work by Mechsner et al. (Nature 414 (2001) 69), the purpose of this experiment was to determine the perceptual and motoric contributions to bimanual coordination. Twenty right-handed, healthy, young adults performed continuous, horizontal, linear movements of both upper limbs at frequencies of 1.5 and 2.0 Hz. The goal was to control the spatial-temporal displacement of two flags by coordinating upper limb movements in two perceptual conditions. In a congruent condition, the movement of the flags matched the movement of the upper limbs. In an incongruent condition, the movement of the flags was opposite to the movement of the upper limbs. Measures of error in coordination provided support primarily for a motor view of bimanual coordination, and failed to replicate the earlier findings of Mechsner et al.     

A guide to performing difficult bimanual coordination tasks: just follow the yellow brick road

Both discrete and continuous bimanual coordination patterns are difficult to effectively perform when the two limbs are required to perform different movements patterns, move at different velocities and/or move different amplitudes unless some form of integrated feedback is provided. The purpose of the present experiment was to determine the degree to which a complex bimanual coordination pattern could be performed when integrated feedback and movement template are provided. The complex bimanual coordination pattern involved reciprocal movements of the two limbs under different difficulty requirements. As defined by Fitts’ index of difficulty (ID), the left arm (ID = 3, A = 16°, W = 4°) task was of lower difficulty than the right arm task (ID = 5, A = 32°, W = 2°). Note that the left and right limb movements are also different in terms of movement time, movement velocity, accuracy requirements and amplitude as well as one movement was continuous and the other intermittent. Participants were provided 2 blocks of 9 trials in the bimanual condition (30 s/trial). Following the bimanual phase, participants performed two unimanual test trials—one with each limb. The results demonstrated that the performance for each limb in the bimanual condition was similar to the performance for the same limb and conditions in the unimanual control conditions. The similarity was indicated by the same movement speed, movement structure, endpoint variability and hit rates for the bimanual and unimanual conditions. The results support our hypothesis that people can overcome the intrinsic difficulties associated with performing complex bimanual coordination patterns when provided appropriate perceptual information feedback that allows them to detect and correct coordination errors.     

High-frequency transcranial magnetic stimulation of the supplementary motor area reduces bimanual coupling during anti-phase but not in-phase movements

Previous electrophysiological and neuroimaging studies have provided evidence that the supplementary motor area (SMA) has an important role in the control of bimanual coordination. The present experiment investigated the effects of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the SMA region on kinematic variables during cyclical bimanual coordination, with a particular focus on the quality of coordination. Subjects performed metronome-paced trials of in-phase and anti-phase bimanual index-finger movements at near-maximal cycling frequency. During movement execution, rTMS (20 Hz, 0.5 s, 120% hand motor threshold) was applied over one of three positions in the sagittal midline 2.0, 4.0 and 6.0 cm anterior to the primary motor leg area. Sham rTMS was included as a control condition. After rTMS, the mean relative phase error between hands increased, but only in the anti-phase trials. The maximum increase in phase error occurred immediately after rather than during the rTMS train. The effect was largest after stimulation 4 or 6 cm anterior to the leg area of the primary motor cortex. We did not observe any changes in the variability of relative phase or in cycle duration or movement amplitude. Findings are discussed in light of recent functional models on the role of the SMA in bimanual movement control.     

Structure of joint variability in bimanual pointing tasks

Changes in the structure of motor variability during practicing a bimanual pointing task were investigated using the framework of the uncontrolled manifold (UCM) hypothesis. The subjects performed fast and accurate planar movements with both arms, one moving the pointer and the other moving the target. The UCM hypothesis predicts that joint kinematic variability will be structured to selectively stabilize important task variables. This prediction was tested with respect to selective stabilization of the trajectory of the endpoint of each arm (unimanual control hypotheses) and with respect to selective stabilization of the timecourse of the vectorial distance between the target and the pointer tip (bimanual control hypothesis). Components of joint position variance not affecting and affecting a mean value of a selected variable were computed at each 10% of normalized movement time. The ratio of these two components ( R(V)) served as a quantitative index of selective stabilization. Both unimanual control hypotheses and the bimanual control hypothesis were supported both prior to and after practice. However, the R(V) values for the bimanual control hypothesis were significantly higher than for either of the unimanual control hypothesis, suggesting that the bimanual synergy was not simply a simultaneous execution of two unimanual synergies. After practice, an improvement in both movement speed and accuracy was accompanied by counterintuitive changes in the structure of kinematic variability. Components of joint position variance affecting and not affecting a mean value of a selected variable decreased, but there was a significantly larger drop in the latter when applied on each of the three selected task variables corresponding to the three control hypotheses. We conclude that the UCM hypothesis allows quantitative assessment of the degree of stabilization of selected performance variables and provides information on changes in the structure of a multijoint synergy that may not be reflected in its overall performance.     

The effects of task demands on bimanual skill acquisition

Bimanual coordination is essential for everyday activities. It is thought that different degrees of demands may affect learning of new bimanual patterns. One demand is at the level of performance and involves breaking the tendency to produce mirror-symmetric movements. A second is at a perceptual level and involves controlling each hand to separate (i.e., split) goals. A third demand involves switching between different task contexts (e.g., a different uni- or bimanual task), instead of continuously practicing one task repeatedly. Here, we studied the effect of these task demands on motor planning (reaction time) and execution (error) while subjects learned a novel bimanual isometric pinch force task. In Experiment 1, subjects continuously practiced in one of the two extremes of the following bimanual conditions: (1) symmetric force demands and a perceptually unified target for each hand or (2) asymmetric force demands and perceptually split targets. Subjects performing in the asymmetric condition showed some interference between hands, but all subjects, regardless of group, could learn the isometric pinch force task similarly. In Experiment 2, subjects practiced these and two other conditions, but in a paradigm where practice was briefly interrupted by the performance of either a unimanual or a different bimanual condition. Reaction times were longer and errors were larger well after the interruption when the main movement to be learned required asymmetric forces. There was no effect when the main movement required symmetric forces. These findings demonstrate two main points. First, people can learn bimanual tasks with very different demands on the same timescale if they are not interrupted. Second, interruption during learning can negatively impact both planning and execution and this depends on the demands of the bimanual task to be learned. This information will be important for training patient populations, who may be more susceptible to increased task demands.     

Coupled bilateral movements and active neuromuscular stimulation: intralimb transfer evidence during bimanual aiming

Motor improvements in chronic stroke recovery accrue from coupled protocols of bilateral movements and active neuromuscular stimulation. This experiment investigated coupled protocols and within-limb transfer between distal and proximal joint combinations. The leading question focused on within-limb transfer of coupled protocols on distal joints to a bimanual aiming task that involved proximal joints. Twenty-six volunteers completed one of three motor recovery protocols according to group assignments: (1) coupled bilateral involved concurrent wrist/finger movements on the unimpaired limb coupled with active stimulation on the impaired limb; (2) unilateral/active stimulation involved neuromuscular electromyogram-triggered stimulation on the impaired wrist/fingers; and (3) no protocol (control group). During the pretest and posttest, subjects performed transverse plane target aiming movements (29 cm) with vision available. The coupled bilateral group showed positive intralimb transfer post-treatment when both arms moved simultaneously. During the posttest, the coupled bilateral group displayed improved movement time, higher peak limb velocity, less variability in peak velocity, and less percentage of total movement time in the deceleration phase than during the pretest. The evidence confirms that within-limb transfer from distal joint training to proximal joint combinations is viable and generalizable in chronic stroke rehabilitation. Moreover, these intralimb transfer findings extend the evidence favoring motor improvements for coupled bilateral protocols during chronic stroke.     

Visual information interacts with neuromuscular factors in the coordination of bimanual isometric force

The role of perceptual-motor processes in the coordination and control of movement is a long standing issue. Nevertheless, there is no coherence on theoretical perspectives with their being frameworks that emphasize perceptual, motor and perceptual-motor processes in coordination and control. The purpose of this study was to examine the interactive effects of visual information and factors of neuromuscular organization (force level, force direction, and homologous muscle pairs) on coordination patterns in bimanual isometric force production. In Experiment 1, the participants were required to abduct two index fingers isometrically and produce simultaneous forces such that their sum matched the constant force target specified at two force levels (10 and 40% of maximum voluntary contraction (MVC)). Visual information of the force outputs was either present or absent between conditions. The results showed that the coordination patterns interact with visual feedback in that the two finger forces exhibit negative correlation with vision and positive correlation without vision, with stronger correlation in each case found at higher force levels. In Experiment 2, the force direction and muscles involved in the task were different between the hands. In comparison with Experiment 1, the negative correlation was stronger with vision at 40% MVC (but equal at 10% MVC), and positive correlation was weaker without vision at 10% MVC (but equal at 40% MVC). The findings provide further evidence that the coordination patterns in bimanual isometric force production are specified by the interaction of task-relevant visual information and force level and, to a lesser degree by force direction and the muscles involved in the task. The capacity to exploit information mediates coordination and control, and the effective utilization of information is dependent on the specific action.     

Age-related differences in the availability of visual feedback during bimanual pinch

Purpose

Previous research has indicated that older adults have significantly lower accuracy in terms of force control than young adults. In addition, accuracy of force control is known to decrease in the absence of visual feedback. However, whether the effect of visual feedback on fine motor control is similar for young adults and older adults is not clear. The purpose of this study, therefore, was to examine the effect of visual feedback on bimanual pinch force control in older adults.

Methods

Thirty-one undergraduate students (age 19.7 ± 0.9 years) and 31 older adults (age 65.1 ± 8.1 years) participated in this study. After measuring finger-pinch maximal voluntary force (MVF), the participants were asked to maintain 10 % MVF as steadily as possible in two different conditions: with visual feedback (visual feedback condition; VF condition) and without visual feedback (no visual feedback condition; NVF condition).

Results

We found that older adults had significantly greater targeting error and force variability than young adults in the VF condition, but not in the NVF condition. In addition, older participants exhibited a significantly greater sum of power for the 0–4 and 4–8 Hz frequency bin than young adults (p < 0.05) in the VF condition, although there was no significant difference in the NVF condition.

Conclusions

These results suggest that older adults do not use visual information as effectively as younger adults to reduce force control error.     

Inter-limb interference during bimanual adaptation to dynamic environments

Skillful manipulation of objects often requires the spatio-temporal coordination of both hands and, at the same time, the compensation of environmental forces. In bimanual coordination, movements of the two hands may be coupled because each hand needs to compensate the forces generated by the other hand or by an object operated by both hands (dynamic coupling), or because the two hands share the same workspace (spatial coupling). We examined how spatial coupling influences bimanual coordination, by looking at the adaptation of velocity-dependent force fields during a task in which the two hands simultaneously perform center-out reaching movements with the same initial position and the same targets, equally spaced on a circle. Subjects were randomly allocated to two groups, which differed in terms of the force fields they were exposed to: in one group (CW–CW), force fields had equal clockwise orientations in both hands; in the other group (CCW–CW), they had opposite orientations. In both groups, in randomly selected trials (catch trials) of the adaptation phase, the force fields were unexpectedly removed. Adaptation was quantified in terms of the changes of directional error for both hand trajectories. Bimanual coordination was quantified in terms of inter-limb longitudinal and sideways displacements, in force field and in catch trials. Experimental results indicate that both arms could simultaneously adapt to the two force fields. However, in the CCW–CW group, adaptation was incomplete for the movements from the central position to the more distant targets with respect to the body. In addition, in this group the left hand systematically leads in the movements toward targets on the left of the starting position, whereas the right hand leads in the movements to targets on the right. We show that these effects are due to a gradual sideways shift of the hands, so that during movements the left hand tends to consistently remain at the left of the right hand. These findings can be interpreted in terms of a neural mechanism of bimanual coordination/interaction, triggered by the force field adaptation process but largely independent from it, which opposes movements that may lead to the crossing of the hands. In conclusion, our results reveal a concurrent interplay of two task-dependent modules of motor-cognitive processing: an adaptive control module and a ‘protective’ module that opposes potentially ‘dangerous’ (or cognitively costly) bimanual interactions.     

Impossible is nothing: 5:3 and 4:3 multi-frequency bimanual coordination

The present findings demonstrate that when participants are provided a Lissajous display with cursor indicating the position of the limbs and a template illustrating the desired movement pattern they can rapidly (10 min) and effectively (continuous relative phase errors and variability ~10°) tune in a difficult 5:3 bimanual coordination pattern and without additional practice re-tune their responding to an equally difficult 4:3 coordination pattern. The findings indicate the extreme difficulty associated with producing complex polyrhythms in previous experiments has been due to split attention when Lissajous feedback has been provided and inability of the participant to detect and correct coordination errors when only provided vision of the limbs. Effective transfer to the 4:3 polyrhythm without previous practice suggests that the perception–action system’s capabilities are extensive. The present findings when viewed in the context of recent experiments using similar protocols suggest that much, but not all, of the difficulty associated with producing a variety of bimanual coordination tasks should be viewed in terms of perceptual constraints imposed by the testing environment.     

The role of auditory and visual models in the production of bimanual tapping patterns

An experiment was designed to determine the effectiveness of auditory and visual models in the learning of a 2:3 bimanual tapping pattern. Participants were randomly assigned to an auditory model, visual model, auditory + visual model, or a control (visual metronome) group. The task for all groups was to tap a left side force transducer with the left hand and a right side force transducer with the right hand in attempt to produce the desired 2:3 bimanual coordination pattern. The auditory model consisted of a series of tones representing the goal pattern played prior to each practice trial. The visual model consisted of a visual display representing the goal tapping pattern. Visual pacing metronomes were provided to the control group. The right and left side metronomes flashed during the trial in a pattern representing the goal tapping pattern. Subjects in all groups performed 14 practice trials consisting of 15 s each devoted to tapping the goal pattern (total practice time = 3.5 min). A retention test without the aid of the models or metronomes was administered following the practice trials. The results for the model groups indicated extremely effective performance of the bimanual coordination patterns for the auditory, visual, and auditory + visual model conditions with not only the relative, but also the absolute characteristics of the models exhibited during retention testing. Retention performance for the visual metronome condition was less accurate and more variable than the three model conditions. In addition, the auditory + visual model condition resulted in retention performance that was more stable than the auditory model condition.     

Visual information gain and task asymmetry interact in bimanual force coordination and control

This study examined the question of whether and how the influence of visual information on force coordination patterns is dependent on the settings of a task asymmetry constraint. In a bimanual isometric force experiment, the task asymmetry was manipulated via imposing different coefficients on the index finger forces such that the weighted sum of the finger forces matched the target force. The environmental constraint was quantified by the visual performance error and was manipulated through the change of visual gain (number of pixels on the screen representing the unit of force). The constraint arising from the individual was quantified by the bilateral coupling effect (i.e., symmetric force production) between hands. The results revealed improved performance in terms of lower variability and performance error and more complex total force structure with higher visual gain. The influence of visual gain on the force coordination pattern, however, was found to be dependent on the task coefficients imposed on the finger forces. Namely, the force sharing between hands became more symmetric with high visual gain only when the right finger force had the higher coefficient, and an error-compensatory strategy was evident with high gain only when symmetric coefficients were imposed on the two fingers. The findings support the proposition that the motor coordination and control patterns are organized by the interactive influence of different categories of constraints where the functional influence of the information provided is dependent on the motor output.     

Simultaneous bimanual dynamics are learned without interference

Dynamic learning in humans has been extensively studied using externally applied force fields to perturb movements of the arm. These studies have focused on unimanual learning in which a force field is applied to only one arm. Here we examine dynamic learning during bimanual movements. Specifically we examine learning of a force field in one arm when the other arm makes movements in a null field or in a force field. For both the dominant and non-dominant arms, the learning (change in performance over the exposure period) was the same regardless of whether the other arm moved in a force field, equivalent either in intrinsic or extrinsic coordinates, or moved in a null field. Moreover there were no significant differences in learning in these bimanual tasks compared to unimanual learning, when one arm experienced a force field and the other arm was at rest. Although the learning was the same, there was an overall increase in error for the non-dominant arm for all bimanual conditions compared to the unimanual condition. This increase in error was the result of bimanual movement alone and was present even in the initial training phase before any forces were introduced. We conclude that, during bimanual movements, the application of a force field to one arm neither interferes with nor facilitates simultaneous learning of a force field applied to the other arm.     

Fingertip force control during bimanual object lifting in hemiplegic cerebral palsy

In the present study we examined unimanual and bimanual fingertip force control during grasping in children with hemiplegic cerebral palsy (CP). Participants lifted, transported and released an object with one hand or both hands together in order to examine the effect on fingertip force control for each hand separately and to determine whether any benefit exists for the affected hand when it performed the task concurrently with the less-affected hand. Seven children with hemiplegic CP performed the task while their movement and fingertip force control were measured. In the bimanual conditions, the weight of the instrumented objects was equal or unequal. The durations of the all temporal phases for the less-affected hand were prolonged during bimanual control compared to unimanual control. We observed close synchrony of both hands when the task was performed with both hands, despite large differences in duration between both hands when they performed separately. There was a marginal benefit for two of the five force related variables for the affected hand (grip force at onset of load force, and peak grip force) when it transported the object simultaneously with the less-affected hand. Collectively, these results corroborate earlier findings of reaching studies that showed slowing down of the less-affected hand when it moved together with the affected hand. A new finding that extends these studies is that bimanual tasks may have the potential to facilitate force control of the affected hand. The implications of these findings for recent rehabilitative therapies in children with CP that make use of bimanual training are discussed.     

Primary motor cortex excitability is modulated with bimanual training

Bimanual visuomotor movement has been shown to enhance cortical motor activity in both hemispheres, especially when movements require simultaneous activation of homologous muscle groups (in-phase movement). It is currently unclear if these adaptations are specific to motor preparatory areas or if they also involve changes in primary motor cortex (M1). The present study investigated the representation of wrist muscles within motor cortex before and following bimanual movement training that was in-phase, anti-phase with or without motor preparation. Motor evoked potentials (MEPs) for the extensor carpi radialis muscle (ECR) cortical territory were acquired and analyzed before and following bimanual movement. The cortical representation was quantified and compared in terms of spatial extent and MEP amplitude, in two different experiments involving distinct movement training types. In Experiment 1, participants performed bimanual wrist flexion/extension movements to targets which involved in-phase movements, either following a 2s preparation period (In-phase preparation), or without the preparation period (In-phase no preparation). In Experiment 2, training involved antagonist muscle groups activated simultaneously (Anti-phase) with the addition of the 2s preparation period. In-phase bimanual movement enhanced the spatial representation of ECR in M1, and did not show a difference in MEP amplitude of the cortical area. It may be that simultaneous activation of homologous M1 representations in both hemispheres, in combination with activity from premotor areas, leads to a greater increase in plasticity in terms of increased M1 spatial extent of trained muscles.     

Resource-demanding versus cost-effective bimanual interaction in the brain

When two hands require different information in bimanual asymmetric movements, interference can occur via callosal connections and ipsilateral corticospinal pathways. This interference could potentially work as a cost-effective measure in symmetric movements, allowing the same information to be commonly available to both hands at once. Using functional magnetic resonance imaging, we investigated supra-additive and sub-additive neural interactions in bimanual movements during the initiation and continuation phases of movement. We compared activity during bimanual asymmetric and symmetric movements with the sum of activity during unimanual right and left finger-tapping. Supra-additive continuation-related activation was found in the right dorsal premotor cortex and left cerebellum (lobule V) during asymmetric movements. In addition, for unimanual movements, the right dorsal premotor cortex and left cerebellum (lobule V) showed significant activation only for left-hand (non-dominant) movements, but not for right-hand movements. These results suggest that resource-demanding interactions in bimanual asymmetric movements are involved in a non-dominant hand motor network that functions to keep non-dominant hand movements stable. We found sub-additive continuation-related activation in the supplementary motor area (SMA), bilateral cerebellum (lobule VI) in symmetric movements, and the SMA in asymmetric movements. This suggests that no extra demands were placed on these areas in bimanual movements despite the conventional notion that they play crucial roles in bimanual coordination. Sub-additive initiation-related activation in the left anterior putamen suggests that symmetric movements place lower demands on motor programming. These findings indicate that, depending on coordination patterns, the neural substrates of bimanual movements either exhibit greater effort to keep non-dominant hand movements stable, or save neural cost by sharing information commonly to both hands.     

Age-related changes in the bimanual advantage and in brain oscillatory activity during tapping movements suggest a decline in processing sensory reafference

Deficits in the processing of sensory reafferences have been suggested as accounting for age-related decline in motor coordination. Whether sensory reafferences are accurately processed can be assessed based on the bimanual advantage in tapping: because of tapping with an additional hand increases kinesthetic reafferences, bimanual tapping is characterized by a reduced inter-tap interval variability than unimanual tapping. A suppression of the bimanual advantage would thus indicate a deficit in sensory reafference. We tested whether elderly indeed show a reduced bimanual advantage by measuring unimanual (UM) and bimanual (BM) self-paced tapping performance in groups of young (n = 29) and old (n = 27) healthy adults. Electroencephalogram was recorded to assess the underlying patterns of oscillatory activity, a neurophysiological mechanism advanced to support the integration of sensory reafferences. Behaviorally, there was a significant interaction between the factors tapping condition and age group at the level of the inter-tap interval variability, driven by a lower variability in BM than UM tapping in the young, but not in the elderly group. This result indicates that in self-paced tapping, the bimanual advantage is absent in elderly. Electrophysiological results revealed an interaction between tapping condition and age group on low beta band (14–20 Hz) activity. Beta activity varied depending on the tapping condition in the elderly but not in the young group. Source estimations localized this effect within left superior parietal and left occipital areas. We interpret our results in terms of engagement of different mechanisms in the elderly depending on the tapping mode: a ‘kinesthetic’ mechanism for UM and a ‘visual imagery’ mechanism for BM tapping movement.     

Force coordination during bimanual task performance in Parkinson’s disease

We investigated within- and between-hand grip-load force coordination in medically managed Parkinson’s disease (PD) patients during bimanual tasks involving realistic actions. Increased grip force production and evidence of bradykinesia were expected in PD patients. Force coordination indices were also expected to be reduced in PD, due to impaired anticipatory force control. Increased grip force, bradykinesia, and abnormal load force production were exhibited in PD patients as compared to healthy controls. Indices of between-hand load force coordination, but not between-hand grip force coordination, were reduced in PD patients. Discrepancies in the strength of within-hand force coordination with respect to hand action were also noted in PD patients. Increased grip force production, in conjunction with abnormal load force production, may result in reduced fine motor control in PD patients during daily activities. Integrating quantitative analyses of realistic motor function in clinic may assist clinicians in evaluating the effectiveness of medical intervention in PD patients.