Normalizing EMG to Background Muscle Activation Masks Medication-Induced Reductions in Reflex Amplitudes in Parkinsonian Rigidity.

OBJECTIVES Exaggerated reflex responses to passive stretch and shortening contribute to parkinsonian rigidity. Studies have reported medication-induced reductions in rigidity in the absence of attenuated reflex magnitudes. The purpose of this study was to determine if normalization procedures mask medication-induced reductions in reflex responses in Parkinson's disease. METHODS Twelve participants with PD performed passive wrist flexion and extension movements after a 12-hour withdrawal from dopaminergic medication and 60 minutes after medication was administered. EMG was recorded from wrist flexors and extensors. Raw EMG signals were conditioned and normalized to mean background EMG amplitudes collected 100 ms prior to the onset of passive movement by division and by subtraction. RESULTS Raw EMG amplitudes were significantly reduced. No medication-related reductions were observed during passive flexion or extension when EMG amplitudes were normalized by division. When EMG amplitudes were normalized by subtraction, significant reductions were observed following administration of dopaminergic medication during flexion and extension. Dopaminergic medication was associated with significant reductions in rigidity work scores and significant increases in moment-angle slope plots. CONCLUSIONS These findings demonstrate that EMG normalization techniques may hinder data interpretation in studies of altered reflex responses in individuals with Parkinson's disease following the administration of dopaminergic medication.