Does dystonia always include co-contraction? A study of unconstrained reaching in children with primary and secondary dystonia

Dystonia is a movement disorder in which involuntary or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both. Excessive co-contraction and abnormalities in the time course of reciprocal inhibition between antagonist groups of muscles are considered to be cardinal features of some types of dystonia and reduced speed of movement is often attributed to involuntary activation of antagonist muscles about a joint. In the present study we describe muscle activity during unconstrained multi-joint reaching movements. Children diagnosed with arm dystonia due to cerebral palsy (CP) or primary dystonia (n = 7, 4–16 years, 4 with CP, 3 primary) and similar age healthy subjects pointed alternately to two targets as fast as possible. The children with dystonia showed decreased speed, greater variability, and pauses at targets compared with controls. Decreased speed was mostly due to difficulty in reversing reaching direction, and increased variability was associated with large fluctuations in the duration of the pauses at targets, rather than with variations in the flexion/extension velocity profiles. Surface electromyographic (EMG) activities were examined to assess if the abnormalities observed in the children with dystonia could be explained in terms of increased levels of co-contraction. Unexpectedly, we found that the children with dystonia showed lower levels of co-contraction than the controls during movement, and the pauses at targets were associated with reduced levels of activation rather than with excessive activity in antagonist groups of muscles. Therefore reduced speed of movement during unconstrained reaching may not be due to involuntary activation of the antagonist muscle, and co-contraction of opposing muscles about a joint is not an obligatory feature of multi-joint movement in children with dystonia.