Effet de la maladie de Parkinson et de la médication dopaminergique sur les mécanismes de traitement et d'intégration sensorielle et l'adaptation visuomotrice

The integrity of our sensorimotor system is essential for adequate interactions with the environment. In Parkinson’s disease (PD), the efficiency of the daily interactions between the body and the environment is often reduced and interfere with quality of life. PD is a neurodegenerative disease resulting primarily from a dopaminergic neuronal loss in the basal ganglia (BG). This progressive loss of neurons alters the normal functioning of the BG-cortical circuitry. Dopaminergic medication is well known to remediate the major clinical motor symptoms of PD.  This thesis investigates the role of the BG in the processing and integration of visual and proprioceptive sensory information and in visuomotor adaptation. This thesis also explores the influence of dopaminergic medication on these sensorimotor functions.  We performed three behavioral studies using three-dimensional reaching movements as an experimental model. In each study, we compared the performance of healthy controls and individuals suffering from PD, while in the non-medicated condition and when on their regular daily antiparkinsonian medication. These three studies were performed using a movement analysis system and a virtual reality station.   In the first study, we evaluated whether the BG are primarily involved in sensorimotor integration or in the processing of proprioceptive sensory information. We tested the ability of PD patients to perform accurate reaching movements in four conditions in which the sensory signals defining target and hand positions (vision and/or proprioception) varied. On average, PD patients made larger spatial errors than healthy controls when proprioception was the only source of sensory information available. Furthermore, these movement inaccuracies were significantly larger than those of healthy controls only when PD patients where tested in the medicated condition.  The second study presented in this thesis demonstrated that the greater movement inaccuracies of PD patients in the proprioceptive conditions resulted mainly from impaired use of proprioceptive information for on-line movement guidance.   In the third study, we evaluated whether the BG are primarily involved in explicit or implicit visoumotor adaptation mechanisms. Visuomotor adaptation skills of non-medicated and medicated patients were assessed in two reaching tasks in which the size of spatial errors made during adaptation was manipulated by varying the temporal evolution of a three-dimensional visuomotor perturbation across trials. In the explicit task, the visuomotor perturbation was applied suddenly resulting in large consciously detected initial spatial errors, whereas in the implicit task, the visuomotor perturbation was gradually introduced in small undetectable steps such that subjects never experienced large movement errors. Results indicate that both non- medicated and medicated PD patients showed markedly impaired visuomotor adaptation only in the explicit task.   Together, the different experimental data presented in this thesis indicate that dopaminergic medication does not improve proprioceptive processing and visuomotor adaptation skills of PD patients. These observations suggest that dysfunction of dopaminergic circuits within the BG is not solely responsible for the reported sensorimotor deficits.

Keyphrases: Parkinson, Proprioception, Planification motrice, Basal ganglia, Dopaminergic medication, Reaching, Sensorimotor integration, On-line movement control, Motor planning, Visuomotor adaptation