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Tian Y, Saradhi S, Bello E, Johnson MD, D’Eleuterio G, Popovic MR, Lankarany M. Model-based closed-loop control of thalamic deep brain stimulation. FRONTIERS IN NETWORK PHYSIOLOGY 2024; 4:1356653. [PMID: 38650608 PMCID: PMC11033853 DOI: 10.3389/fnetp.2024.1356653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/18/2024] [Indexed: 04/25/2024]
Abstract
Introduction: Closed-loop control of deep brain stimulation (DBS) is beneficial for effective and automatic treatment of various neurological disorders like Parkinson's disease (PD) and essential tremor (ET). Manual (open-loop) DBS programming solely based on clinical observations relies on neurologists' expertise and patients' experience. Continuous stimulation in open-loop DBS may decrease battery life and cause side effects. On the contrary, a closed-loop DBS system uses a feedback biomarker/signal to track worsening (or improving) of patients' symptoms and offers several advantages compared to the open-loop DBS system. Existing closed-loop DBS control systems do not incorporate physiological mechanisms underlying DBS or symptoms, e.g., how DBS modulates dynamics of synaptic plasticity. Methods: In this work, we propose a computational framework for development of a model-based DBS controller where a neural model can describe the relationship between DBS and neural activity and a polynomial-based approximation can estimate the relationship between neural and behavioral activities. A controller is used in our model in a quasi-real-time manner to find DBS patterns that significantly reduce the worsening of symptoms. By using the proposed computational framework, these DBS patterns can be tested clinically by predicting the effect of DBS before delivering it to the patient. We applied this framework to the problem of finding optimal DBS frequencies for essential tremor given electromyography (EMG) recordings solely. Building on our recent network model of ventral intermediate nuclei (Vim), the main surgical target of the tremor, in response to DBS, we developed neural model simulation in which physiological mechanisms underlying Vim-DBS are linked to symptomatic changes in EMG signals. By using a proportional-integral-derivative (PID) controller, we showed that a closed-loop system can track EMG signals and adjust the stimulation frequency of Vim-DBS so that the power of EMG reaches a desired control target. Results and discussion: We demonstrated that the model-based DBS frequency aligns well with that used in clinical studies. Our model-based closed-loop system is adaptable to different control targets and can potentially be used for different diseases and personalized systems.
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Affiliation(s)
- Yupeng Tian
- Krembil Brain Institute—University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Srikar Saradhi
- Krembil Brain Institute—University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Edward Bello
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Matthew D. Johnson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | | | - Milos R. Popovic
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Center for Advancing Neurotechnological Innovation to Application, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Milad Lankarany
- Krembil Brain Institute—University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Center for Advancing Neurotechnological Innovation to Application, University Health Network and University of Toronto, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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Heß T, Oehlwein C, Milani TL. Anticipatory Postural Adjustments and Compensatory Postural Responses to Multidirectional Perturbations-Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease. Brain Sci 2023; 13:brainsci13030454. [PMID: 36979264 PMCID: PMC10046463 DOI: 10.3390/brainsci13030454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Postural instability is one of the most restricting motor symptoms for patients with Parkinson's disease (PD). While medication therapy only shows minor effects, it is still unclear whether medication in conjunction with deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves postural stability. Hence, the aim of this study was to investigate whether PD patients treated with medication in conjunction with STN-DBS have superior postural control compared to patients treated with medication alone. METHODS Three study groups were tested: PD patients on medication (PD-MED), PD patients on medication and on STN-DBS (PD-MED-DBS), and healthy elderly subjects (HS) as a reference. Postural performance, including anticipatory postural adjustments (APA) prior to perturbation onset and compensatory postural responses (CPR) following multidirectional horizontal perturbations, was analyzed using force plate and electromyography data. RESULTS Regardless of the treatment condition, both patient groups showed inadequate APA and CPR with early and pronounced antagonistic muscle co-contractions compared to healthy elderly subjects. Comparing the treatment conditions, study group PD-MED-DBS only showed minor advantages over group PD-MED. In particular, group PD-MED-DBS showed faster postural reflexes and tended to have more physiological co-contraction ratios. CONCLUSION medication in conjunction with STN-DBS may have positive effects on the timing and amplitude of postural control.
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Affiliation(s)
- Tobias Heß
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson Disease and Deep Brain Stimulation, 07551 Gera, Germany
| | - Thomas L Milani
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
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Deb R, An S, Bhat G, Shill H, Ogras UY. A Systematic Survey of Research Trends in Technology Usage for Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2022; 22:5491. [PMID: 35897995 PMCID: PMC9371095 DOI: 10.3390/s22155491] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/17/2022] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
Parkinson's disease (PD) is a neurological disorder with complicated and disabling motor and non-motor symptoms. The complexity of PD pathology is amplified due to its dependency on patient diaries and the neurologist's subjective assessment of clinical scales. A significant amount of recent research has explored new cost-effective and subjective assessment methods pertaining to PD symptoms to address this challenge. This article analyzes the application areas and use of mobile and wearable technology in PD research using the PRISMA methodology. Based on the published papers, we identify four significant fields of research: diagnosis, prognosis and monitoring, predicting response to treatment, and rehabilitation. Between January 2008 and December 2021, 31,718 articles were published in four databases: PubMed Central, Science Direct, IEEE Xplore, and MDPI. After removing unrelated articles, duplicate entries, non-English publications, and other articles that did not fulfill the selection criteria, we manually investigated 1559 articles in this review. Most of the articles (45%) were published during a recent four-year stretch (2018-2021), and 19% of the articles were published in 2021 alone. This trend reflects the research community's growing interest in assessing PD with wearable devices, particularly in the last four years of the period under study. We conclude that there is a substantial and steady growth in the use of mobile technology in the PD contexts. We share our automated script and the detailed results with the public, making the review reproducible for future publications.
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Affiliation(s)
| | - Sizhe An
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Ganapati Bhat
- School of Electrical Engineering & Computer Science, Washington State University, Pullman, WA 99164, USA;
| | - Holly Shill
- Lonnie and Muhammad Ali Movement Disorder Center, Phoenix, AZ 85013, USA;
| | - Umit Y. Ogras
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, WI 53705, USA;
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Changes in elbow flexion EMG morphology during adjustment of deep brain stimulator in advanced Parkinson’s disease. PLoS One 2022; 17:e0266936. [PMID: 35421176 PMCID: PMC9009623 DOI: 10.1371/journal.pone.0266936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 03/30/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Deep brain stimulation (DBS) is an effective treatment for motor symptoms of advanced Parkinson’s disease (PD). Currently, DBS programming outcome is based on a clinical assessment. In an optimal situation, an objectively measurable feature would assist the operator to select the appropriate settings for DBS. Surface electromyographic (EMG) measurements have been used to characterise the motor symptoms of PD with good results; with proper methodology, these measurements could be used as an aid to program DBS. Methods Muscle activation measurements were performed for 13 patients who had advanced PD and were treated with DBS. The DBS pulse voltage, frequency, and width were changed during the measurements. The measured EMG signals were analysed with parameters that characterise the EMG signal morphology, and the results were compared to the clinical outcome of the adjustment. Results The EMG signal correlation dimension, recurrence rate, and kurtosis changed significantly when the DBS settings were changed. DBS adjustment affected the signal recurrence rate the most. Relative to the optimal settings, increased recurrence rates (median ± IQR) 1.1 ± 0.5 (−0.3 V), 1.3 ± 1.1 (+0.3 V), 1.7 ± 0.4 (−30 Hz), 1.7 ± 0.8 (+30 Hz), 2.0 ± 1.7 (+30 μs), and 1.5 ± 1.1 (DBS off) were observed. With optimal stimulation settings, the patients’ Unified Parkinson’s Disease Rating Scale motor part (UPDRS-III) score decreased by 35% on average compared to turning the device off. However, the changes in UPRDS-III arm tremor and rigidity scores did not differ significantly in any settings compared to the optimal stimulation settings. Conclusion Adjustment of DBS treatment alters the muscle activation patterns in PD patients. The changes in the muscle activation patterns can be observed with EMG, and the parameters calculated from the signals differ between optimal and non-optimal settings of DBS. This provides a possibility for using the EMG-based measurement to aid the clinicians to adjust the DBS.
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Romanato M, Piatkowska W, Spolaor F, To DK, Volpe D, Sawacha Z. Different perspectives in understanding muscle functions in Parkinson’s disease through surface electromyography: exploring multiple activation patterns. J Electromyogr Kinesiol 2022; 64:102658. [DOI: 10.1016/j.jelekin.2022.102658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 03/29/2022] [Accepted: 04/08/2022] [Indexed: 11/25/2022] Open
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Dong Y, Li B, Hu J, Widmalm SE, Zhang T, Lin M, Buvarp A, Zhou D. Kurtosis, a new variable with possible diagnostic value in analysis of jaw muscle surface EMG. J Oral Rehabil 2021; 49:170-176. [PMID: 34902174 DOI: 10.1111/joor.13294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/30/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a need for methods to compare differences of voltage levels and distribution anomalies in the study of skeletal muscle function. Calculating the kurtosis values has been found to be of value. AIM The aim was to record and analyse voltage and kurtosis levels of SEMG recorded bilaterally in the masseter and anterior temporalis areas during rest and clenching and to compare the kurtosis levels between controls and patients with TMJ disc dysfunction. MATERIAL AND METHODS Twenty-three healthy subjects and 21 patients with TMJ disc dysfunction were taken part in this study. Recordings were made with the BioPAK EMG System. Gain was adjusted to record the data within the range of ±2000 µV. SEMG was recorded in four facial areas, the right masseter, left masseter, right anterior temporalis, and left anterior temporalis areas. Kurtosis levels of SEMG, at clenching with maximal force, and mandibular rest, were compared between the control and patient groups. RESULTS The kurtosis levels of clenches were significantly higher in patients in all four areas with sensitivity, 38.1% to 61.9%, and specificity, 82.6% to 100.0%. No differences were found in kurtosis levels during mandibular rest. CONCLUSION The results support that kurtosis values of SEMG recorded during clenching have a potential diagnostic interest.
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Affiliation(s)
- Yan Dong
- College of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Boxiu Li
- College of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jianlai Hu
- College of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Sven E Widmalm
- School of Dentistry, Department of BMS/Div, University of Michigan, Michigan, USA
| | - Tongsheng Zhang
- Neurosurgery Department, University of New Mexico, Las Cruces, USA
| | - Min Lin
- College of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | | | - Dong Zhou
- Key Laboratory of E&M, Zhejiang University of Technology, Hangzhou, China
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Kleinholdermann U, Wullstein M, Pedrosa D. Prediction of motor Unified Parkinson's Disease Rating Scale scores in patients with Parkinson's disease using surface electromyography. Clin Neurophysiol 2021; 132:1708-1713. [PMID: 33958263 DOI: 10.1016/j.clinph.2021.01.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 12/22/2020] [Accepted: 01/14/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Parkinson's disease (PD) is a chronic neurodegenerative disorder with increasing prevalence in the elderly. Especially patients with advanced PD often require complex medication regimens due to fluctuations, that is abrupt transitions from ON to OFF or vice versa. Current gold standard to quantify PD-patients' motor symptoms is the assessment of the Unified Parkinson's Disease Rating Scale (UPDRS), which, however, is cumbersome and may depend upon investigators. This work aimed at developing a mobile, objective and unobtrusive measurement of motor symptoms in PD. METHODS Data from 45 PD-patients was recorded using surface electromyography (sEMG) electrodes attached to a wristband. The motor paradigm consisted of a tapping task performed with and without dopaminergic medication. Our aim was to predict UPDRS scores from the sEMG characteristics with distinct regression models and machine learning techniques. RESULTS A random forest regression model outnumbered other regression models resulting in a correlation of 0.739 between true and predicted UPDRS values. CONCLUSIONS PD-patients' motor affection can be extrapolated from sEMG data during a simple tapping task. In the future, such records could help determine the need for medication changes in telemedicine applications. SIGNIFICANCE Our findings support the utility of wearables to detect Parkinson's symptoms and could help in developing tailored therapies in the future.
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Affiliation(s)
- Urs Kleinholdermann
- Klinik für Neurologie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstr., 35041 Marburg, Germany
| | - Max Wullstein
- Klinik für Neurologie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstr., 35041 Marburg, Germany
| | - David Pedrosa
- Klinik für Neurologie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstr., 35041 Marburg, Germany.
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Rissanen SM, Koivu M, Hartikainen P, Pekkonen E. Ambulatory surface electromyography with accelerometry for evaluating daily motor fluctuations in Parkinson's disease. Clin Neurophysiol 2020; 132:469-479. [PMID: 33450567 DOI: 10.1016/j.clinph.2020.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate motor fluctuations in patients with advanced Parkinson's disease (PD) using a small-sized wearable device for surface electromyography (EMG) with accelerometry (ACC) for 24 hours. METHODS Seven PD patients with medication were measured once, and nine patients with directional deep brain stimulation (dDBS) twice: before and after the dDBS reprogramming. EMG and ACC parameters were compared with clinical rating scores and patients' home diaries. RESULTS The combination of EMG and ACC parameters (first principal component PC1) correlated significantly with patient's condition as quantified by the motor score of Unified Parkinson's Disease Rating Scale and it changed significantly with dDBS reprogramming in line with decreased PD symptoms. Monitoring data detected in comparison with the home diaries: 91 % concordance with tremor, 76 % with rigidity, and 74 % with dyskinesia. In the DBS group, the wake-up time with abnormal neuromuscular function was reduced with reprogramming in all except one patient based on measurements. CONCLUSIONS A wearable device measuring simultaneously both muscle activity and motion can provide continuous and dynamic information about patient's condition and motor fluctuations at home. SIGNIFICANCE The present method may help to modify pharmacologic management and DBS treatment in advanced PD.
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Affiliation(s)
- Saara M Rissanen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - Maija Koivu
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland
| | - Päivi Hartikainen
- Neurology Outpatient Clinic, Kuopio University Hospital, Kuopio, Finland
| | - Eero Pekkonen
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland
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Wang KL, Burns M, Xu D, Hu W, Fan SY, Han CL, Wang Q, Michitomo S, Xia XT, Zhang JG, Wang F, Meng FG. Electromyography Biomarkers for Quantifying the Intraoperative Efficacy of Deep Brain Stimulation in Parkinson's Patients With Resting Tremor. Front Neurol 2020; 11:142. [PMID: 32161571 PMCID: PMC7054231 DOI: 10.3389/fneur.2020.00142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/07/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction: Deep brain stimulation (DBS) is an effective therapy for resting tremor in Parkinson's disease (PD). However, quick and objective biomarkers for quantifying the efficacy of DBS intraoperatively are lacking. Therefore, we aimed to study how DBS modulates the intraoperative neuromuscular pattern of resting tremor in PD patients and to find predictive surface electromyography (sEMG) biomarkers for quantifying the intraoperative efficacy of DBS. Methods: Intraoperative sEMG of 39 PD patients with resting tremor was measured with the DBS on and off, respectively, during the intraoperative DBS testing stage. Twelve signal features (time and frequency domains) were extracted from the intraoperative sEMG data. These sEMG features were associated with the clinical outcome to evaluate the efficacy of intraoperative DBS. Also, an sEMG-based prediction model was established to predict the clinical improvement rate (IR) of resting tremor with DBS therapy. Results: A typical resting tremor with a peak frequency of 4.93 ± 0.98 Hz (mean ± SD) was measured. Compared to the baseline, DBS modulated significant neuromuscular pattern changes in most features except for the peak frequency, by decreasing the motor unit firing rate, amplitude, or power and by changing the regularity pattern. Three sEMG features were detected with significant associations with the clinical improvement rate (IR) of the tremor scale: peak frequency power (R = 0.37, p = 0.03), weighted root mean square (R = 0.42, p = 0.01), and modified mean amplitude power (R = 0.48, p = 0.003). These were adopted to train a Gaussian process regression model with a leave-one-out cross-validation procedure. The prediction values from the trained sEMG prediction model (1,000 permutations, p = 0.003) showed a good correlation (r = 0.47, p = 0.0043) with the true IR of the tremor scale. Conclusion: DBS acutely modulated the intraoperative resting tremor, mainly by suppressing the amplitude and motor unit firing rate and by changing the regularity pattern, but not by modifying the frequency pattern. Three features showed strong robustness and could be used as quick intraoperative biomarkers to quantify and predict the efficacy of DBS in PD patients with resting tremor.
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Affiliation(s)
- Kai-Liang Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurology, Fixel Center for Neurological Diseases, Program in Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Mathew Burns
- Department of Neurology, Fixel Center for Neurological Diseases, Program in Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - Dan Xu
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Wei Hu
- Department of Neurology, Fixel Center for Neurological Diseases, Program in Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - Shi-Ying Fan
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Chun-Lei Han
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Qiao Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Shimabukuro Michitomo
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Xiao-Tong Xia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian-Guo Zhang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Wang
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Fan-Gang Meng
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Hyppönen J, Hakala A, Annala K, Zhang H, Peltola J, Mervaala E, Kälviäinen R. Automatic assessment of the myoclonus severity from videos recorded according to standardized Unified Myoclonus Rating Scale protocol and using human pose and body movement analysis. Seizure 2020; 76:72-78. [PMID: 32035366 DOI: 10.1016/j.seizure.2020.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/23/2019] [Accepted: 01/20/2020] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Myoclonus in progressive myoclonus epilepsy type 1 (EPM1) patients shows marked variability, which presents a substantial challenge in devising treatment and conducting clinical trials. Consequently, fast and objective myoclonus quantification methods are needed. METHODS Ten video-recorded unified myoclonus rating scale (UMRS) myoclonus with action tests were performed on EPM1 patients who were selected for the development and testing of the automatic myoclonus quantification method. Human pose and body movement analyses of the videos were used to identify body keypoints and further analyze movement smoothness and speed. The automatic myoclonus rating scale (ARMS) was developed. It included the jerk count during movement score and the log dimensionless jerk (LDLJ) score to evaluate changes in the smoothness of movement. RESULTS The scores obtained with the automatic analyses showed moderate to strong significant correlation with the UMRS myoclonus with action scores. The jerk count of the primary keypoints and the LDLJ scores were effective in the evaluation of the myoclonic jerks during hand movements. They also correlated moderately to strongly with the total UMRS test panel scores (r2 = 0,77, P = 0,009 for the jerk count score and r2 = 0,88, P = 0,001 for the LDLJ score). The automatic analyses was weaker in quantification of the neck, trunk, and leg myoclonus. CONCLUSION Automatic quantification of myoclonic jerks using human pose and body movement analysis of patients' videos is feasible and was found to be quite consistent with the accepted clinical gold standard quantification method. Based on the results of this study, the automatic analytical method should be further developed and validated to improve myoclonus severity follow-up for EPM1 patients.
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Affiliation(s)
- Jelena Hyppönen
- Kuopio Epilepsy Center, Department of Clinical Neurophysiology, Kuopio University Hospital, Member of ERN EpiCARE, Kuopio, Finland.
| | - Anna Hakala
- Neuro Event Labs Oy (2712284-1), Tampere, Finland
| | - Kaapo Annala
- Neuro Event Labs Oy (2712284-1), Tampere, Finland
| | | | - Jukka Peltola
- Department of Neurology, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Esa Mervaala
- Kuopio Epilepsy Center, Department of Clinical Neurophysiology, Kuopio University Hospital, Member of ERN EpiCARE, Kuopio, Finland; Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Reetta Kälviäinen
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Kuopio Epilepsy Center, Neurocenter, Kuopio University Hospital, Member of ERN EpiCARE, Kuopio, Finland
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Yang CY, Chen RS, Huang YZ. Analysis and Discrimination of Surface Electromyographic Features for Parkinson's Disease during Elbow Flexion Movements. J Mot Behav 2019; 52:625-633. [PMID: 31538541 DOI: 10.1080/00222895.2019.1666081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disorder. Early intervention/treatment relies on early diagnosis of PD. There is increasing interest in methods based on electromyography measurements of PD patients because of its noninvasiveness. Thus, this study was to investigate electromyographic (EMG) characteristics of the upper limb between PD patients and healthy control subjects using EMG, and to distinguish PD patients from healthy control subjects according to the EMG information using a support vector machine (SVM) classifier. Sixteen right-handed PD patients and 25 right-handed healthy subjects participated in experiments involving elbow flexion movement. The frequency power, duration, skewness, recurrence rate, and correlation dimension of EMG signals and success rate for the right hand and the skewness of EMG signals for the left hand were found to be significantly different between the two groups. This information was subsequently used to distinguish PD patients from healthy control subjects using the SVM classifier to obtain a mean accuracy of 87.02%. Although the results may not be immediately available to use in clinical applications, the safety, simplicity and speed of the system still merits further consideration. Enhancing performance accuracy and examining PD patients in different stages of disease are anticipated in future investigations.
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Affiliation(s)
- Chia-Yen Yang
- Department of Biomedical Engineering, Ming-Chuan University, Taoyuan, Taiwan
| | - Rou-Shayn Chen
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan1
| | - Ying-Zu Huang
- Neuroscience Research Center and Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan
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Ricci M, Di Lazzaro G, Pisani A, Mercuri NB, Giannini F, Saggio G. Assessment of Motor Impairments in Early Untreated Parkinson's Disease Patients: The Wearable Electronics Impact. IEEE J Biomed Health Inform 2019; 24:120-130. [PMID: 30843855 DOI: 10.1109/jbhi.2019.2903627] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The complex nature of Parkinson's disease (PD) makes difficult to rate its severity, mainly based on the visual inspection of motor impairments. Wearable sensors have been demonstrated to help overcoming such a difficulty, by providing objective measures of motor abnormalities. However, up to now, those sensors have been used on advanced PD patients with evident motor impairment. As a novelty, here we report the impact of wearable sensors in the evaluation of motor abnormalities in newly diagnosed, untreated, namely de novo, patients. METHODS A network of wearable sensors was used to measure motor capabilities, in 30 de novo PD patients and 30 healthy subjects, while performing five motor tasks. Measurement data were used to determine motor features useful to highlight impairments and were compared with the corresponding clinical scores. Three classifiers were used to differentiate PD from healthy subjects. RESULTS Motor features gathered from wearable sensors showed a high degree of significance in discriminating the early untreated de novo PD patients from the healthy subjects, with 95% accuracy. The rates of severity obtained from the measured features are partially in agreement with the clinical scores, with some highlighted, though justified, exceptions. CONCLUSION Our findings support the feasibility of adopting wearable sensors in the detection of motor anomalies in early, untreated, PD patients. SIGNIFICANCE This work demonstrates that subtle motor impairments, occurring in de novo patients, can be evidenced by means of wearable sensors, providing clinicians with instrumental tools as suitable supports for early diagnosis, and subsequent management.
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Conway ZJ, Silburn PA, Thevathasan W, Maley KO, Naughton GA, Cole MH. Alternate Subthalamic Nucleus Deep Brain Stimulation Parameters to Manage Motor Symptoms of Parkinson's Disease: Systematic Review and Meta-analysis. Mov Disord Clin Pract 2018; 6:17-26. [PMID: 30746411 DOI: 10.1002/mdc3.12681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 11/06/2022] Open
Abstract
Background The use of alternate frequencies, amplitudes, and pulse widths to manage motor symptoms in Parkinson's disease (PD) patients with subthalamic nucleus deep brain stimulation (STN-DBS) is of clinical interest, but currently lacks systematic evidence. Objective/Hypothesis Systematically review whether alternate STN-DBS settings influence the therapy's efficacy for managing PD motor symptoms. Methods Systematic searches identified studies that; involved bilateral STN-DBS PD patients; manipulated ≥ 1 STN-DBS parameter (e.g., amplitude); assessed ≥ 1 motor symptom (e.g., tremor); and contrasted the experimental and chronic stimulation settings. A Mantel-Haenszel random-effects meta-analysis compared the UPDRS-III sub-scores at low (60-Hz) and high frequencies ( ≥ 130 Hz). Inter-study heterogeneity was assessed with the Cohen's χ2 and I2 index, while the standard GRADE evidence assessment examined strength of evidence. Results Of the 21 included studies, 17 investigated the effect of alternate stimulation frequencies, five examined alternate stimulation amplitudes, and two studied changes in pulse width. Given the available data, meta-analyses were only possible for alternate stimulation frequencies. Analysis of the heterogeneity amongst the included studies indicated significant variability between studies and, on the basis of the GRADE framework, the pooled evidence from the meta-analysis studies was of very low quality due to the significant risks of bias. Conclusions The meta-analysis reported a very low quality of evidence for the efficacy of low-frequency STN-DBS for managing PD motor symptoms. Furthermore, it highlighted that lower amplitudes lead to the re-emergence of motor symptoms and further research is needed to understand the potential benefits of alternate STN-DBS parameters for PD patients.
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Affiliation(s)
- Zachary J Conway
- School of Behavioural and Health Sciences Australian Catholic University Brisbane Queensland Australia
| | - Peter A Silburn
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute The University of Queensland Brisbane Queensland Australia.,Neurosciences Queensland Brisbane Queensland Australia
| | - Wesley Thevathasan
- The Bionics Institute East Melbourne Victoria Australia.,Department of Neurology Royal Melbourne and Austin Hospitals Melbourne Victoria Australia.,Department of Medicine University of Melbourne Parkville Victoria Australia
| | | | - Geraldine A Naughton
- School of Behavioural and Health Sciences Australian Catholic University Melbourne Victoria Australia
| | - Michael H Cole
- School of Behavioural and Health Sciences Australian Catholic University Brisbane Queensland Australia
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Ruonala V, Pekkonen E, Airaksinen O, Kankaanpää M, Karjalainen PA, Rissanen SM. Levodopa-Induced Changes in Electromyographic Patterns in Patients with Advanced Parkinson's Disease. Front Neurol 2018; 9:35. [PMID: 29459845 PMCID: PMC5807331 DOI: 10.3389/fneur.2018.00035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 01/15/2018] [Indexed: 11/13/2022] Open
Abstract
Levodopa medication is the most efficient treatment for motor symptoms of Parkinson's disease (PD). Levodopa significantly alleviates rigidity, rest tremor, and bradykinesia in PD. The severity of motor symptoms can be graded with UPDRS-III scale. Levodopa challenge test is routinely used to assess patients' eligibility to deep-brain stimulation (DBS) in PD. Feasible and objective measurements to assess motor symptoms of PD during levodopa challenge test would be helpful in unifying the treatment. Twelve patients with advanced PD who were candidates for DBS treatment were recruited to the study. Measurements were done in four phases before and after levodopa challenge test. Rest tremor and rigidity were evaluated using UPDRS-III score. Electromyographic (EMG) signals from biceps brachii and kinematic signals from forearm were recorded with wireless measurement setup. The patients performed two different tasks: arm isometric tension and arm passive flexion-extension. The electromyographic and the kinematic signals were analyzed with parametric, principal component, and spectrum-based approaches. The principal component approach for isometric tension EMG signals showed significant decline in characteristics related to PD during levodopa challenge test. The spectral approach on passive flexion-extension EMG signals showed a significant decrease on involuntary muscle activity during the levodopa challenge test. Both effects were stronger during the levodopa challenge test compared to that of patients' personal medication. There were no significant changes in the parametric approach for EMG and kinematic signals during the measurement. The results show that a wireless and wearable measurement and analysis can be used to study the effect of levodopa medication in advanced Parkinson's disease.
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Affiliation(s)
- Verneri Ruonala
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Eero Pekkonen
- Department of Clinical Neurosciences, Neurology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Olavi Airaksinen
- Department of Physical Medicine and Rehabilitaton, Kuopio University Hospital, Kuopio, Finland
| | - Markku Kankaanpää
- Department of Physical Medicine and Rehabilitaton, Tampere University Hospital, Tampere, Finland
| | - Pasi A Karjalainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Saara M Rissanen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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15
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Rovini E, Maremmani C, Cavallo F. How Wearable Sensors Can Support Parkinson's Disease Diagnosis and Treatment: A Systematic Review. Front Neurosci 2017; 11:555. [PMID: 29056899 PMCID: PMC5635326 DOI: 10.3389/fnins.2017.00555] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/21/2017] [Indexed: 01/15/2023] Open
Abstract
Background: Parkinson's disease (PD) is a common and disabling pathology that is characterized by both motor and non-motor symptoms and affects millions of people worldwide. The disease significantly affects quality of life of those affected. Many works in literature discuss the effects of the disease. The most promising trends involve sensor devices, which are low cost, low power, unobtrusive, and accurate in the measurements, for monitoring and managing the pathology. OBJECTIVES This review focuses on wearable devices for PD applications and identifies five main fields: early diagnosis, tremor, body motion analysis, motor fluctuations (ON-OFF phases), and home and long-term monitoring. The concept is to obtain an overview of the pathology at each stage of development, from the beginning of the disease to consider early symptoms, during disease progression with analysis of the most common disorders, and including management of the most complicated situations (i.e., motor fluctuations and long-term remote monitoring). DATA SOURCES The research was conducted within three databases: IEEE Xplore®, Science Direct®, and PubMed Central®, between January 2006 and December 2016. STUDY ELIGIBILITY CRITERIA Since 1,429 articles were found, accurate definition of the exclusion criteria and selection strategy allowed identification of the most relevant papers. RESULTS Finally, 136 papers were fully evaluated and included in this review, allowing a wide overview of wearable devices for the management of Parkinson's disease.
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Affiliation(s)
- Erika Rovini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Carlo Maremmani
- U.O. Neurologia, Ospedale delle Apuane (AUSL Toscana Nord Ovest), Massa, Italy
| | - Filippo Cavallo
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
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16
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Spasojević S, Ilić TV, Stojković I, Potkonjak V, Rodić A, Santos-Victor J. Quantitative Assessment of the Arm/Hand Movements in Parkinson's Disease Using a Wireless Armband Device. Front Neurol 2017; 8:388. [PMID: 28848489 PMCID: PMC5554498 DOI: 10.3389/fneur.2017.00388] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 07/21/2017] [Indexed: 11/16/2022] Open
Abstract
We present an approach for quantitative assessment of the arm/hand movements in patients with Parkinson’s disease (PD), from sensor data acquired with a wearable, wireless armband device (Myo sensor). We propose new Movement Performance Indicators that can be adopted by practitioners for the quantitative evaluation of motor performance and support their clinical evaluations. In addition, specific Movement Performance Indicators can indicate the presence of the bradykinesia symptom. The study includes seventeen PD patients and sixteen age-matched controls. A set of representative arm/hand movements is defined under the supervision of movement disorder specialist. In order to assist the evaluations, and for progress monitoring purposes, as well as for assessing the amount of bradykinesia in PD, a total set of 84 Movement Performance Indicators are computed from the sensor readings. Subsequently, we investigate whether wireless armband device, with the use of the proposed Movement Performance Indicators can be utilized: (1) for objective and precise quantitative evaluation of the arm/hand movements of Parkinson’s patients, (2) for assessment of the bradykinesia motor symptom, and (3) as an adequate low-cost alternative for the sensor glove. We conducted extensive analysis of proposed Movement Performance Indicators and results are indicating following clinically relevant characteristics: (i) adequate reliability as measured by ICC; (ii) high accuracy in discrimination between the patients and controls, and between the disease stages (support to disease diagnosis and progress monitoring, respectively); (iii) substantial difference in comparison between the left-hand and the right-hand movements across controls and patients, as well as between disease stage groups; (iv) statistically significant correlation with clinical scales (tapping test and UPDRS-III Motor Score); and (v) quantitative evaluation of bradykinesia symptom. Results suggest that the proposed approach has a potential to be adopted by physicians, to afford them with quantitative, objective and precise methods and data during clinical evaluations and support the assessment of bradykinesia.
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Affiliation(s)
- Sofija Spasojević
- School of Electrical Engineering, University of Belgrade, Belgrade, Serbia.,Mihailo Pupin Institute, University of Belgrade, Belgrade, Serbia.,Institute for Systems and Robotics, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Tihomir V Ilić
- Department of Neurology, Medical Faculty of Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Ivan Stojković
- School of Electrical Engineering, University of Belgrade, Belgrade, Serbia.,Computer and Information Sciences Department, College of Science and Technology, Temple University, Philadelphia, PA, United States
| | - Veljko Potkonjak
- School of Electrical Engineering, University of Belgrade, Belgrade, Serbia
| | - Aleksandar Rodić
- Mihailo Pupin Institute, University of Belgrade, Belgrade, Serbia
| | - José Santos-Victor
- Institute for Systems and Robotics, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
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Asakawa T, Fang H, Sugiyama K, Nozaki T, Kobayashi S, Hong Z, Suzuki K, Mori N, Yang Y, Hua F, Ding G, Wen G, Namba H, Xia Y. Human behavioral assessments in current research of Parkinson's disease. Neurosci Biobehav Rev 2016; 68:741-772. [PMID: 27375277 DOI: 10.1016/j.neubiorev.2016.06.036] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/23/2016] [Accepted: 06/24/2016] [Indexed: 12/22/2022]
Abstract
Parkinson's disease (PD) is traditionally classified as a movement disorder because patients mainly complain about motor symptoms. Recently, non-motor symptoms of PD have been recognized by clinicians and scientists as early signs of PD, and they are detrimental factors in the quality of life in advanced PD patients. It is crucial to comprehensively understand the essence of behavioral assessments, from the simplest measurement of certain symptoms to complex neuropsychological tasks. We have recently reviewed behavioral assessments in PD research with animal models (Asakawa et al., 2016). As a companion volume, this article will systematically review the behavioral assessments of motor and non-motor PD symptoms of human patients in current research. The major aims of this article are: (1) promoting a comparative understanding of various behavioral assessments in terms of the principle and measuring indexes; (2) addressing the major strengths and weaknesses of these behavioral assessments for a better selection of tasks/tests in order to avoid biased conclusions due to inappropriate assessments; and (3) presenting new concepts regarding the development of wearable devices and mobile internet in future assessments. In conclusion we emphasize the importance of improving the assessments for non-motor symptoms because of their complex and unique mechanisms in human PD brains.
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Affiliation(s)
- Tetsuya Asakawa
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan; Department of Psychiatry, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan.
| | - Huan Fang
- Department of Pharmacy, Jinshan Hospital of Fudan University, Shanghai, China
| | - Kenji Sugiyama
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Takao Nozaki
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Susumu Kobayashi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Zhen Hong
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
| | - Katsuaki Suzuki
- Department of Psychiatry, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Norio Mori
- Department of Psychiatry, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Yilin Yang
- The First People's Hospital of Changzhou, Soochow University School of Medicine, Changzhou, China
| | - Fei Hua
- The First People's Hospital of Changzhou, Soochow University School of Medicine, Changzhou, China
| | - Guanghong Ding
- Shanghai Key laboratory of Acupuncture Mechanism and Acupoint Function, Fudan University, Shanghai, China
| | - Guoqiang Wen
- Department of Neurology, Hainan General Hospital, Haikou, Hainan, China
| | - Hiroki Namba
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu-city, Shizuoka, Japan
| | - Ying Xia
- Department of Neurosurgery, The University of Texas McGovern Medical School, Houston, TX 77030, USA.
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