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Sringean J, Udomsirithamrong O, Bhidayasiri R. Too little or too much nocturnal movements in Parkinson's disease: A practical guide to managing the unseen. Clin Park Relat Disord 2024; 10:100258. [PMID: 38845753 PMCID: PMC11153921 DOI: 10.1016/j.prdoa.2024.100258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/13/2024] [Accepted: 05/21/2024] [Indexed: 06/09/2024] Open
Abstract
Nocturnal and sleep-related motor disorders in people with Parkinson's disease (PD) have a wide spectrum of manifestations and present a complex clinical picture. Problems can arise due to impaired movement ability (hypokinesias), e.g. nocturnal hypokinesia or early-morning akinesia, or to excessive movement (hyperkinesias), e.g. end-of-the-day dyskinesia, parasomnias, periodic limb movement during sleep and restless legs syndrome. These disorders can have a significant negative impact on the sleep, daytime functional ability, and overall quality of life of individuals with PD and their carers. The debilitating motor issues are often accompanied by a combination of non-motor symptoms, including pain and cramping, which add to the overall burden. Importantly, nocturnal motor disorders encompass a broader timeline than just the period of sleep, often starting in the evening, as well as occurring throughout the night and on awakening, and are not just limited to problems of insomnia or sleep fragmentation. Diagnosis can be challenging as, in many cases, the 'gold standard' assessment method is video polysomnography, which may not be available in all settings. Various validated questionnaires are available to support evaluation, and alternative approaches, using wearable sensors and digital technology, are now being developed to facilitate early diagnosis and monitoring. This review sets out the parameters of what can be considered normal nocturnal movement and describes the clinical manifestations, usual clinical or objective assessment methods, and evidence for optimal management strategies for the common nocturnal motor disorders that neurologists will encounter in people with PD in their clinical practice.
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Affiliation(s)
- Jirada Sringean
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Ornanong Udomsirithamrong
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok 10330, Thailand
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Bhidayasiri R, Sringean J, Phumphid S, Anan C, Thanawattano C, Deoisres S, Panyakaew P, Phokaewvarangkul O, Maytharakcheep S, Buranasrikul V, Prasertpan T, Khontong R, Jagota P, Chaisongkram A, Jankate W, Meesri J, Chantadunga A, Rattanajun P, Sutaphan P, Jitpugdee W, Chokpatcharavate M, Avihingsanon Y, Sittipunt C, Sittitrai W, Boonrach G, Phonsrithong A, Suvanprakorn P, Vichitcholchai J, Bunnag T. The rise of Parkinson's disease is a global challenge, but efforts to tackle this must begin at a national level: a protocol for national digital screening and "eat, move, sleep" lifestyle interventions to prevent or slow the rise of non-communicable diseases in Thailand. Front Neurol 2024; 15:1386608. [PMID: 38803644 PMCID: PMC11129688 DOI: 10.3389/fneur.2024.1386608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/19/2024] [Indexed: 05/29/2024] Open
Abstract
The rising prevalence of Parkinson's disease (PD) globally presents a significant public health challenge for national healthcare systems, particularly in low-to-middle income countries, such as Thailand, which may have insufficient resources to meet these escalating healthcare needs. There are also many undiagnosed cases of early-stage PD, a period when therapeutic interventions would have the most value and least cost. The traditional "passive" approach, whereby clinicians wait for patients with symptomatic PD to seek treatment, is inadequate. Proactive, early identification of PD will allow timely therapeutic interventions, and digital health technologies can be scaled up in the identification and early diagnosis of cases. The Parkinson's disease risk survey (TCTR20231025005) aims to evaluate a digital population screening platform to identify undiagnosed PD cases in the Thai population. Recognizing the long prodromal phase of PD, the target demographic for screening is people aged ≥ 40 years, approximately 20 years before the usual emergence of motor symptoms. Thailand has a highly rated healthcare system with an established universal healthcare program for citizens, making it ideal for deploying a national screening program using digital technology. Designed by a multidisciplinary group of PD experts, the digital platform comprises a 20-item questionnaire about PD symptoms along with objective tests of eight digital markers: voice vowel, voice sentences, resting and postural tremor, alternate finger tapping, a "pinch-to-size" test, gait and balance, with performance recorded using a mobile application and smartphone's sensors. Machine learning tools use the collected data to identify subjects at risk of developing, or with early signs of, PD. This article describes the selection and validation of questionnaire items and digital markers, with results showing the chosen parameters and data analysis methods to be robust, reliable, and reproducible. This digital platform could serve as a model for similar screening strategies for other non-communicable diseases in Thailand.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - Jirada Sringean
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Saisamorn Phumphid
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Chanawat Anan
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | | | - Suwijak Deoisres
- National Electronics and Computer Technology Centre, Pathum Thani, Thailand
| | - Pattamon Panyakaew
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Onanong Phokaewvarangkul
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Suppata Maytharakcheep
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Vijittra Buranasrikul
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Tittaya Prasertpan
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Sawanpracharak Hospital, Nakhon Sawan, Thailand
| | | | - Priya Jagota
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Araya Chaisongkram
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Worawit Jankate
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Jeeranun Meesri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Araya Chantadunga
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Piyaporn Rattanajun
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Phantakarn Sutaphan
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Weerachai Jitpugdee
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Marisa Chokpatcharavate
- Chulalongkorn Parkinson's Disease Support Group, Department of Medicine, Faculty of Medicine, Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yingyos Avihingsanon
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Thai Red Cross Society, Bangkok, Thailand
| | - Chanchai Sittipunt
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Thai Red Cross Society, Bangkok, Thailand
| | | | | | | | | | | | - Tej Bunnag
- Thai Red Cross Society, Bangkok, Thailand
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Bhidayasiri R. Old problems, new solutions: harnessing technology and innovation in Parkinson's disease-evidence and experiences from Thailand. J Neural Transm (Vienna) 2024:10.1007/s00702-023-02727-1. [PMID: 38189972 DOI: 10.1007/s00702-023-02727-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/09/2023] [Indexed: 01/09/2024]
Abstract
The prevalence of Parkinson's disease (PD) is increasing rapidly worldwide, but there are notable inequalities in its distribution and in the availability of healthcare resources across different world regions. Low- and middle-income countries (LMICs), including Thailand, bear the highest burden of PD so there is an urgent need to develop effective solutions that can overcome the many regional challenges associated with delivering high-quality, and equitable care to a diverse population with limited resources. This article describes the evolution of healthcare delivery for PD in Thailand, as a case example of a LMIC. The discussions reflect the author's presentation at the Yoshikuni Mizuno Lectureship Award given during the 8th Asian and Oceanian Parkinson's Disease and Movement Disorders Congress in March 2023 for which he was the 2023 recipient. The specific challenges faced in Thailand are reviewed along with new solutions that have been implemented to improve the knowledge and skills of healthcare professionals nationally, the delivery of care, and the outcomes for PD patients. Technology and innovation have played an important role in this process with many new tools and devices being implemented in clinical practice. Without any realistic prospect of a curative therapy in the near future that could halt the current PD pandemic, it will be necessary to focus on preventative lifestyle strategies that can help reduce the risk of developing PD such as good nutrition (EAT), exercise (MOVE), good sleep hygiene (SLEEP), and minimizing environmental risks (PROTECT), which should be initiated and continued (REPEAT) as early as possible.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Bangkok, 10330, Thailand.
- The Academy of Science, The Royal Society of Thailand, Bangkok, 10330, Thailand.
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Taniguchi S, Yamamoto A, D'cruz N. Assessing impaired bed mobility in patients with Parkinson's disease: a scoping review. Physiotherapy 2023; 124:29-39. [PMID: 38870620 DOI: 10.1016/j.physio.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 05/25/2023] [Accepted: 10/19/2023] [Indexed: 06/15/2024]
Abstract
BACKGROUND Although most patients with Parkinson's disease (PD) experience difficulties in bed mobility, evidence on the suitability of the methods for assessing impaired bed mobility in PD are lacking. OBJECTIVES To identify objective methods for assessing impaired bed mobility in PD and to discuss their clinimetric properties and feasibility for use in clinical practice. DATA SOURCES PubMed, Web of Science, and Cochrane Library were searched between 1995 and 2022. SELECTION CRITERIA Studies were included if they described an objective assessment method for assessing impaired bed mobility in PD. DATA EXTRACTION AND DATA SYNTHESIS Characteristics of the identified measurement methods such as clinimetric properties and feasibility were extracted by two authors. The methodological quality of studies was evaluated using the Appraisal of studies tool. RESULTS Twenty-three studies were included and categorised into three assessment methods: sensor-based assessments (48%), rating scales (39%), and timed-tests (13%). The risk of bias was low for all but one study, which was medium. LIMITATIONS Despite applying wide selection criteria, a relatively small number of studies were identified in our results. CONCLUSION Rating scales may be the most preferred for assessing impaired bed mobility in PD in clinical practice, until clinimetric validity are adequately demonstrated in the other assessment methods. CONTRIBUTION OF PAPER.
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Affiliation(s)
- Seira Taniguchi
- Department of Neurology, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, Osaka, Japan.
| | - Ariko Yamamoto
- Department of Rehabilitation, Tekijyu Rehabilitation Hospital, Hanayamacho 2-11-32, Kobe, Hyogo, Japan
| | - Nicholas D'cruz
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group, KU Leuven, Tervuursevest 101, PO Box1501, Leuven, Belgium
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Cochen De Cock V, Dodet P, Leu‐Semenescu S, Aerts C, Abril B, Castelnovo G, Landragin N, Drapier S, Olivet H, Corbillé A, Leclair‐Visonneau L, Anheim M, Vidailhet M, Arnulf I, Doulazmi M, Roze E. Night-Time Apomorphine Infusion: Who Are the Best Candidates? Mov Disord Clin Pract 2023; 10:1192-1197. [PMID: 37635769 PMCID: PMC10450238 DOI: 10.1002/mdc3.13799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 08/29/2023] Open
Abstract
Background We recently demonstrated in a randomized controlled trial (APOMORPHEE, NCT02940912) that night-time only subcutaneous apomorphine infusion improves sleep disturbances and insomnia in patients with advanced Parkinson's disease and moderate to severe insomnia. Objectives To identify the best candidates for receiving night-time only subcutaneous apomorphine infusion in routine care. Methods In this post-hoc analysis of APOMORPHEE, we compared the characteristics of patients according to whether they chose to continue night-time only subcutaneous apomorphine infusion at the end of the study period or not. Results Half of the patients (22/42) chose to continue the treatment. Off duration (day or night), painful Off dystonia, and insomnia severity at baseline were associated with night-time only apomorphine continuation. Multivariate analysis retained only Off duration as an independent predictor of continuation. Conclusions The best candidates for night-time only apomorphine are patients with severe and prolonged Off periods (day or night) and severe insomnia.
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Affiliation(s)
- Valérie Cochen De Cock
- Sleep and Neurology DepartmentBeau Soleil ClinicMontpellierFrance
- EuroMov Digital Health in MotionUniv Montpellier, IMT Mines AlèsMontpellierFrance
| | - Pauline Dodet
- Sleep Disorders UnitPitié‐Salpêtrière University HospitalParisFrance
| | | | - Cécile Aerts
- Sleep and Neurology DepartmentBeau Soleil ClinicMontpellierFrance
- EuroMov Digital Health in MotionUniv Montpellier, IMT Mines AlèsMontpellierFrance
| | - Beatriz Abril
- Sleep DepartmentUniversity Hospital of NîmesNîmesFrance
| | | | | | - Sophie Drapier
- Department of NeurologyPontchaillou INSERM CIC1414RennesFrance
| | - Hélène Olivet
- Sleep DepartmentPolyclinique Rennes Saint‐LaurentRennesFrance
| | | | - Laurène Leclair‐Visonneau
- Clinical Neurophysiology DepartmentUniversity Hospital of Nantes, INSERM U1235, Nantes UniversityNantesFrance
| | - Mathieu Anheim
- Department of NeurologyUniversity Hospital of StrasbourgStrasbourgFrance
- Genetic Institute and Molecular and Cellular Biology (IGBMC), INSERM‐U964/CNRS‐UMR7104/ Strasbourg UniversityIllkirchFrance
| | - Marie Vidailhet
- AP‐HP, Salpetriere Hospital, DMU Neuroscience 6ParisFrance
- Sorbonne University, Paris Brain Institute, Inserm, CNRSParisFrance
| | - Isabelle Arnulf
- Sleep Disorders UnitPitié‐Salpêtrière University HospitalParisFrance
- Sorbonne University, Paris Brain Institute, Inserm, CNRSParisFrance
| | - Mohamed Doulazmi
- Adaptation Biologique et Vieillissement (UMR8256), Institut de Biologie Paris Seine, Sorbonne University, CNRSParisFrance
| | - Emmanuel Roze
- AP‐HP, Salpetriere Hospital, DMU Neuroscience 6ParisFrance
- Sorbonne University, Paris Brain Institute, Inserm, CNRSParisFrance
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Taniguchi S, Yamamoto A. Measurement instruments to assess basic functional mobility in Parkinson's Disease: A systematic review of clinimetric properties and feasibility for use in clinical practice. JAPANESE JOURNAL OF COMPREHENSIVE REHABILITATION SCIENCE 2023; 14:16-25. [PMID: 37859792 PMCID: PMC10585016 DOI: 10.11336/jjcrs.14.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 10/21/2023]
Abstract
Taniguchi S, Yamamoto A. Measurement instruments to assess basic functional mobility in Parkinson's Disease: A systematic review of clinimetric properties and feasibility for use in clinical practice. Jpn J Compr Rehabil Sci 2023; 14: 16-25. Objective To systematically review the evaluation of clinimetric properties and feasibility of the "Modified Parkinson Activity Scale (M-PAS)" and the "Lindop Parkinson's Disease Mobility Assessment (LPA)," which are Parkinson's Disease (PD)-specific measurement instruments to assess basic functional mobility, and to discuss their considerations for use in clinical practice. Methods A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A risk of bias assessment was also performed. Results Eleven studies were included: five studies used M-PAS (45%), five studies used LPA (45%), and one study used M-PAS and LPA (13%). The risk of bias was low for all evaluated studies. Conclusion M-PAS and LPA showed adequate reliability, validity, and responsiveness in detecting intervention changes. M-PAS has more detailed qualitative scoring options, a lack of ceiling effect, and can be used by a non-expert in PD.In contrast, the drawback of M-PAS is that it is time-consuming to apply in everyday clinical practice. On the other hand, LPA with greater simplicity may lead to lower burdens for both patients and raters in situations with strict time limitations. Further research is required to identify new resources.
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Affiliation(s)
- Seira Taniguchi
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ariko Yamamoto
- Division of ward management, Tekiju Rehabilitation Hospital, Kobe, Hyogo, Japan
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Sringean J, Thanawattano C, Bhidayasiri R. Technological evaluation of strategies to get out of bed by people with Parkinson's disease: Insights from multisite wearable sensors. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:922218. [PMID: 36090600 PMCID: PMC9453393 DOI: 10.3389/fmedt.2022.922218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Difficulty getting out of bed is a common night-time and early morning manifestation of Parkinson's disease (PD), rated by 40% of the patients as their most concerning motor symptoms. However, current assessment methods are based on clinical interviews, video analysis, and clinical scales as objective outcome measures are not yet available. Objective To study the technical feasibility of multisite wearable sensors in the assessment of the supine-to-stand (STS) task as a determinant of the ability to get out of bed in patients with PD and age-matched control subjects, and develop relevant objective outcome measures. Methods The STS task was assessed in 32 patients with PD (mean Hoehn and Yahr; HY = 2.5) in the early morning before their first dopaminergic medication, and in 14 control subjects, using multisite wearable sensors (NIGHT-Recorder®; trunk, both wrists, and both ankles) in a sleep laboratory. Objective getting out of bed parameters included duration, onset, velocity and acceleration of truncal rotation, and angle deviation (a°) from the z-axis when subjects rose from the bed at different angles from the x-axis (10°, 15°, 30°, 45°, and 60°) as measures of truncal lateral flexion. Movement patterns were identified from the first body part or parts that moved. Correlation analysis was performed between these objective outcomes and standard clinical rating scales. Results Compared to control subjects, the duration of STS was significantly longer in patients with PD (p = 0.012), which is associated with a significantly slower velocity of truncal rotation (p = 0.003). Moderate and significant correlations were observed between the mean STS duration and age, and the Nocturnal Hypokinesia Questionnaire. The velocity of truncal rotation negatively and significantly correlated with HY staging. Any arm and leg moved together as the first movement significantly correlated with UPDRS-Axial and item #28. Several other correlations were also observed. Conclusion Our study was able to demonstrate the technical feasibility of using multisite wearable sensors to quantitatively assess early objective outcome measures of the ability of patients with PD to get out of bed, which significantly correlated with axial severity scores, suggesting that axial impairment could be a contributing factor in difficulty getting out of bed. Future studies are needed to refine these outcome measures for use in therapeutic trials related to nocturia or early morning akinesia in PD.
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Affiliation(s)
- Jirada Sringean
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Chusak Thanawattano
- National Science and Technology Development Agency (NSTDA), Pathumthani, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. Device-related pressure ulcers: SECURE prevention. Second edition. J Wound Care 2022; 31:S1-S72. [PMID: 35616340 DOI: 10.12968/jowc.2022.31.sup3a.s1] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator, Wounds Research Laboratory, Catholic University of Portugal, Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Lisbon, Portugal
| | - Guido Ciprandi
- Chief Wound Care, Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing (joint appointment), Intensive Care Services, Royal Brisbane and Women's Hospital, School of Nursing, Queensland University of Technology, Brisbane, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, US
| | - Karen Ousey
- Professor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Nicola Waters
- Senior Research Associate, Health, The Conference Board of Canada; Adjunct Professor, School of Nursing, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Peter Worsley
- Associate Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UK
| | - Joyce Black
- Professor, College of Nursing, University of Nebraska Medical Center. Nebraska, US
| | - Michelle Barakat-Johnson
- Clinical Lead and Skin Integrity Lead, HAC Pressure Injury Coordinator, Sydney Local Health District; Adj Associate Professor, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor, Skin Integrity Research Group (SKINT), Ghent University, Belgium; Professor and Vice-Head, School for Research and Internationalisation, Örebro University, Sweden
| | | | | | - Nils A Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, Grenoble Alpes University, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner, Paediatric Skin and Wound Management, Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children's Hospital, Zurich, Switzerland
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REM sleep without atonia and nocturnal body position in prediagnostic Parkinson's disease. Sleep Med 2021; 84:308-316. [PMID: 34217921 DOI: 10.1016/j.sleep.2021.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/20/2021] [Accepted: 06/09/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sleep disturbances are features of Parkinson's disease (PD), that can already occur before PD diagnosis. The most investigated prodromal PD sleep disorder is REM sleep behavior disorder (RBD). The relation between other polysomnographic (PSG) alterations and the prediagnostic stages of PD, however, is less clear. METHODS We performed a retrospective case-control study to characterize polysomnographic alterations in PD and prediagnostic PD. We included 63 PD subjects (33 subjects that underwent a video-PSG before PD diagnosis [13 with and 20 without RBD] and 30 subjects that underwent a PSG after PD diagnosis) and 30 controls. PSGs were analyzed for sleep stages, different RSWA variables, body position, arousals, periodic limb movements, and REM density. RESULTS Higher subscores of all RSWA variables were observed in subjects with PD and prediagnostic PD (with and without RBD). Total RSWA, tonic RSWA and chin RSWA severity were significant predictors for all PD and prediagnostic PD groups. Our study also shows a higher percentage of nocturnal supine body position in all PD and prediagnostic PD groups. Supine body position percentage is the highest in the PD group and has a positive correlation with time since diagnosis. CONCLUSIONS These findings suggest that increased total, tonic and chin RSWA as well as nocturnal supine body position are already present in prediagnostic PD, independently of RBD status. Prospective longitudinal studies are necessary to confirm the additional value of these PSG abnormalities as prodromal PD biomarkers.
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Albán-Cadena AC, Villalba-Meneses F, Pila-Varela KO, Moreno-Calvo A, Villalba-Meneses CP, Almeida-Galárraga DA. Wearable sensors in the diagnosis and study of Parkinson's disease symptoms: a systematic review. J Med Eng Technol 2021; 45:532-545. [PMID: 34060967 DOI: 10.1080/03091902.2021.1922528] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Nowadays, there are several diseases which affect different systems of the body, producing changes in the correct functioning of the organism and the people lifestyles. One of them is Parkinson's disease (PD), which is defined as a neurodegenerative disorder provoked by the destruction of dopaminergic neurons in the brain, resulting in a set of motor and non-motor symptoms. As this disease affects principally to ancient people, several researchers have studied different treatments and therapies for stopping neurodegeneration and diminishing symptoms, to improve the quality patients' lives. The most common therapies created for PD are based on pharmacological treatment for controlling the degeneration advance and the physical ones which do not reveal the progress of patients. For this reason, this review paper opens the possibility for using wearable motion capture systems as an option for the control and study of PD. Therefore, it aims to (1) study the different wearable systems used for capture the movements of PD patients and (2) determine which of them bring better results for monitoring and assess PD people. For the analysis, it uses papers based on experiments that prove the functioning of several motion systems in different aspects as monitoring, treatment and diagnose of the disease. As a result, it works with 30 papers which describe the factors mentioned before. Additionally, the paper uses journals and literature review about the pathology, its characteristics and the function of wearable sensors for the correct understanding of the topic.
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Affiliation(s)
- Andrea C Albán-Cadena
- School of Biological Sciences & Engineering, Universidad Yachay Tech, Urcuquí, Ecuador
| | - Fernando Villalba-Meneses
- School of Biological Sciences & Engineering, Universidad Yachay Tech, Urcuquí, Ecuador.,University of Zaragoza, Zaragoza, Spain
| | - Kevin O Pila-Varela
- School of Biological Sciences & Engineering, Universidad Yachay Tech, Urcuquí, Ecuador
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11
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Choi JH, Lee JY, Shin C, Yoo D, Im JH, Woo KA, Kim HJ, Ahn TB, Kim JM, Jeon B. Investigation of Nocturnal Hypokinesia and Health-Related Quality of Life in Parkinsonian Patients with the Korean Version of the Nocturnal Hypokinesia Questionnaire. J Mov Disord 2021; 14:221-225. [PMID: 34030433 PMCID: PMC8490186 DOI: 10.14802/jmd.20172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/30/2021] [Indexed: 11/24/2022] Open
Abstract
Objective
To assess nocturnal hypokinesia using the Korean version of the Nocturnal Hypokinesia Questionnaire (NHQ-K) in Parkinson’s disease (PD) patients across disease stages. Methods
We developed the NHQ-K and performed questionnaire-based interviews with 108 PD patients from three referral hospitals. Clinical associations of nocturnal hypokinesia and its impact on health-related quality of life (HRQoL) were also analyzed. Results
The NHQ-K showed acceptable internal consistency (0.83) and interrater reliability (0.95). Nocturnal hypokinesia significantly affected HRQoL in PD patients at both the early and advanced stages (adjusted p < 0.001). Increased severity of nocturnal hypokinesia was associated with dyskinesias, off-period disability, apathy, and anxious mood in PD patients (adjusted p < 0.01) after controlling for disease severity and medication dose. Conclusion
The NHQ-K is useful for screening nocturnal hypokinesia in PD patients. Given the high impact of nocturnal hypokinesia on HRQoL, comprehensive management of nocturnal disability is needed for PD patients.
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Affiliation(s)
- Ji-Hyun Choi
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jee-Young Lee
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Chaewon Shin
- Department of Neurology, Chungnam National University Sejong Hospital, Sejong; Chungnam National University College of Medicine, Daejeon, Korea
| | - Dallah Yoo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jin Hee Im
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Ah Woo
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Joon Kim
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Beom Ahn
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jong-Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Beomseok Jeon
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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12
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Shedding Light on Nocturnal Movements in Parkinson's Disease: Evidence from Wearable Technologies. SENSORS 2020; 20:s20185171. [PMID: 32927816 PMCID: PMC7571235 DOI: 10.3390/s20185171] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 12/13/2022]
Abstract
In Parkinson’s disease (PD), abnormal movements consisting of hypokinetic and hyperkinetic manifestations commonly lead to nocturnal distress and sleep impairment, which significantly impact quality of life. In PD patients, these nocturnal disturbances can reflect disease-related complications (e.g., nocturnal akinesia), primary sleep disorders (e.g., rapid eye movement behaviour disorder), or both, thus requiring different therapeutic approaches. Wearable technologies based on actigraphy and innovative sensors have been proposed as feasible solutions to identify and monitor the various types of abnormal nocturnal movements in PD. This narrative review addresses the topic of abnormal nocturnal movements in PD and discusses how wearable technologies could help identify and assess these disturbances. We first examine the pathophysiology of abnormal nocturnal movements and the main clinical and instrumental tools for the evaluation of these disturbances in PD. We then report and discuss findings from previous studies assessing nocturnal movements in PD using actigraphy and innovative wearable sensors. Finally, we discuss clinical and technical prospects supporting the use of wearable technologies for the evaluation of nocturnal movements.
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13
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Monje MHG, Foffani G, Obeso J, Sánchez-Ferro Á. New Sensor and Wearable Technologies to Aid in the Diagnosis and Treatment Monitoring of Parkinson's Disease. Annu Rev Biomed Eng 2020; 21:111-143. [PMID: 31167102 DOI: 10.1146/annurev-bioeng-062117-121036] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Parkinson's disease (PD) is a degenerative disorder of the brain characterized by the impairment of the nigrostriatal system. This impairment leads to specific motor manifestations (i.e., bradykinesia, tremor, and rigidity) that are assessed through clinical examination, scales, and patient-reported outcomes. New sensor-based and wearable technologies are progressively revolutionizing PD care by objectively measuring these manifestations and improving PD diagnosis and treatment monitoring. However, their use is still limited in clinical practice, perhaps because of the absence of external validation and standards for their continuous use at home. In the near future, these systems will progressively complement traditional tools and revolutionize the way we diagnose and monitor patients with PD.
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Affiliation(s)
- Mariana H G Monje
- HM CINAC, Hospital Universitario HM Puerta del Sur, Universidad CEU-San Pablo, 28938 Móstoles, Madrid, Spain; , , , .,Department of Anatomy, Histology and Neuroscience, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
| | - Guglielmo Foffani
- HM CINAC, Hospital Universitario HM Puerta del Sur, Universidad CEU-San Pablo, 28938 Móstoles, Madrid, Spain; , , , .,Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, 45071 Toledo, Spain
| | - José Obeso
- HM CINAC, Hospital Universitario HM Puerta del Sur, Universidad CEU-San Pablo, 28938 Móstoles, Madrid, Spain; , , , .,Centro de Investigación Biomédica en Red, Enfermedades Neurodegenerativas, 28031 Madrid, Spain
| | - Álvaro Sánchez-Ferro
- HM CINAC, Hospital Universitario HM Puerta del Sur, Universidad CEU-San Pablo, 28938 Móstoles, Madrid, Spain; , , , .,Centro de Investigación Biomédica en Red, Enfermedades Neurodegenerativas, 28031 Madrid, Spain.,Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
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14
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Mastering nocturnal jigsaws in Parkinson's disease: a dusk-to-dawn review of night-time symptoms. J Neural Transm (Vienna) 2020; 127:763-777. [PMID: 32172472 DOI: 10.1007/s00702-020-02170-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/05/2020] [Indexed: 12/11/2022]
Abstract
Finding out about night-time symptoms from Parkinson's disease (PD) patients can be a challenge as many patients and their carers cannot recall many symptoms that occur during the night, resulting in an under-recognition or a large variability of responses from clinical interviews and scales. Moreover, technology-based assessments for most night-time symptoms are still not universally available for use in a patient's home environment. Therefore, most physicians rely on their clinical acumen to capture these night-time symptoms based on pieces of patients' history, bedpartner's reports, clinical features, associated symptoms or conditions. To capture more night-time symptoms, the authors identified common nocturnal symptoms based on how they manifest from dusk to dawn with selected features relevant to PD. While some symptoms occur in healthy individuals, in PD patients, they may impact differently. The authors intend this narrative review to provide a practical guide on how these common night-time symptoms manifest and highlight pertinent issues by focusing on prevalence, clinical symptomatology, and specific relationships to PD. It is also important to recognise that PD-specific sleep disturbances increase with advancing disease with additional contributions from ageing, comorbidities, and medication side effects. However, the relative contribution of each factor to individual symptom may be different in individual patient, necessitating clinical expertise for individual interpretation. While there are debatable issues in certain areas, they underlie the complexity of night-time symptoms. Understanding night-time symptoms in PD is like re-arranging jigsaw pieces of clinical information to create, but never complete, a picture for physicians to instigate appropriate management.
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15
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Mirelman A, Hillel I, Rochester L, Del Din S, Bloem BR, Avanzino L, Nieuwboer A, Maidan I, Herman T, Thaler A, Gurevich T, Kestenbaum M, Orr‐Urtreger A, Brys M, Cedarbaum JM, Giladi N, Hausdorff JM. Tossing and Turning in Bed: Nocturnal Movements in Parkinson's Disease. Mov Disord 2020; 35:959-968. [DOI: 10.1002/mds.28006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/27/2020] [Accepted: 02/02/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and MobilityNeurological Institute, Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University Tel Aviv Israel
| | - Inbar Hillel
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and MobilityNeurological Institute, Tel Aviv Sourasky Medical Center Tel Aviv Israel
| | - Lynn Rochester
- Newcastle upon Tyne Hospitals National Health System Foundation TrustUK Institute of Neuroscience, Newcastle University Newcastle upon Tyne UK
| | - Silvia Del Din
- Newcastle upon Tyne Hospitals National Health System Foundation TrustUK Institute of Neuroscience, Newcastle University Newcastle upon Tyne UK
| | - Bastiaan R. Bloem
- Radboud University Medical Center, Donders Institute for BrainCognition and Behavior, Department of Neurology Nijmegen The Netherlands
| | - Laura Avanzino
- Department of NeurosciencesUniversity of Genoa Genoa Italy
- Department of Experimental MedicineUniversity of Genoa Genoa Italy
| | - Alice Nieuwboer
- Department of Rehabilitation SciencesKatholieke Universiteit Leuven Leuven Belgium
| | - Inbal Maidan
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and MobilityNeurological Institute, Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University Tel Aviv Israel
| | - Talia Herman
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and MobilityNeurological Institute, Tel Aviv Sourasky Medical Center Tel Aviv Israel
| | - Avner Thaler
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and MobilityNeurological Institute, Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University Tel Aviv Israel
| | - Tanya Gurevich
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and MobilityNeurological Institute, Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University Tel Aviv Israel
| | | | - Avi Orr‐Urtreger
- Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University Tel Aviv Israel
- Genetic Institute, Tel Aviv Medical Center Tel Aviv Israel
| | | | | | - Nir Giladi
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and MobilityNeurological Institute, Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University Tel Aviv Israel
| | - Jeffrey M. Hausdorff
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and MobilityNeurological Institute, Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University Tel Aviv Israel
- Department of Physical Therapy, Tel Aviv University Tel Aviv Israel
- Rush Alzheimer's Disease Center, Rush University Medical Center Chicago Illinois USA
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16
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Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. Device-related pressure ulcers: SECURE prevention. J Wound Care 2020; 29:S1-S52. [DOI: 10.12968/jowc.2020.29.sup2a.s1] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, the Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator Wounds Research Laboratory, Universidade Católica Portuguesa, Institute of Health Sciences, Center for Interdisciplinary Research in Health, Portugal
| | - Guido Ciprandi
- Chief Wound Care Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu’ Children’s Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing, Joint appointment, Intensive Care Services, Royal Brisbane and Women’s Hospital and School of Nursing, Queensland University of Technology, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, US
| | - Karen Ousey
- Professor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Japan
| | - Nicola Waters
- Associate Professor, School of Nursing, thompson Rivers University, Kamloops, British Columbia, Canada
| | - Peter Worsley
- Assistant Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UK
| | - Joyce Black
- Professor at College of Nursing, University of Nebraska Medical Center. Nebraska, US
| | - Michelle Barakat-Johnson
- Skin Integrity Lead, Sydney Local Health District; Clinical Senior Lecturer, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor of Skin Integrity and Clinical Nursing, Ghent University, Ghent, Belgium
| | | | | | - Nils A. Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, University Grenoble Alps, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner in Paediatric Skin and Wound Management and Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children’s Hospital Zurich, Switzerland
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17
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Morgan C, Rolinski M, McNaney R, Jones B, Rochester L, Maetzler W, Craddock I, Whone AL. Systematic Review Looking at the Use of Technology to Measure Free-Living Symptom and Activity Outcomes in Parkinson's Disease in the Home or a Home-like Environment. JOURNAL OF PARKINSON'S DISEASE 2020; 10:429-454. [PMID: 32250314 PMCID: PMC7242826 DOI: 10.3233/jpd-191781] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/31/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The emergence of new technologies measuring outcomes in Parkinson's disease (PD) to complement the existing clinical rating scales has introduced the possibility of measurement occurring in patients' own homes whilst they freely live and carry out normal day-to-day activities. OBJECTIVE This systematic review seeks to provide an overview of what technology is being used to test which outcomes in PD from free-living participant activity in the setting of the home environment. Additionally, this review seeks to form an impression of the nature of validation and clinimetric testing carried out on the technological device(s) being used. METHODS Five databases (Medline, Embase, PsycInfo, Cochrane and Web of Science) were systematically searched for papers dating from 2000. Study eligibility criteria included: adults with a PD diagnosis; the use of technology; the setting of a home or home-like environment; outcomes measuring any motor and non-motor aspect relevant to PD, as well as activities of daily living; unrestricted/unscripted activities undertaken by participants. RESULTS 65 studies were selected for data extraction. There were wide varieties of participant sample sizes (<10 up to hundreds) and study durations (<2 weeks up to a year). The metrics evaluated by technology, largely using inertial measurement units in wearable devices, included gait, tremor, physical activity, bradykinesia, dyskinesia and motor fluctuations, posture, falls, typing, sleep and activities of daily living. CONCLUSIONS Home-based free-living testing in PD is being conducted by multiple groups with diverse approaches, focussing mainly on motor symptoms and sleep.
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Affiliation(s)
- Catherine Morgan
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- School of Computer Science, Electrical and Electronic Engineering, and Engineering Mathematics, Faculty of Engineering, University of Bristol, Bristol, UK
- Movement Disorders Group, Bristol Brain Centre, Southmead Hospital, North Bristol National Health Service Trust, Bristol, UK
| | - Michal Rolinski
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Movement Disorders Group, Bristol Brain Centre, Southmead Hospital, North Bristol National Health Service Trust, Bristol, UK
| | - Roisin McNaney
- School of Computer Science, Electrical and Electronic Engineering, and Engineering Mathematics, Faculty of Engineering, University of Bristol, Bristol, UK
| | - Bennet Jones
- Library and Knowledge Service, Learning and Research, Southmead Hospital, North Bristol National Health Service Trust, Bristol, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
- Newcastle Upon Tyne Hospitals National Health Service Foundation Trust, Newcastle Upon Tyne, UK
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
| | - Ian Craddock
- School of Computer Science, Electrical and Electronic Engineering, and Engineering Mathematics, Faculty of Engineering, University of Bristol, Bristol, UK
| | - Alan L. Whone
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Movement Disorders Group, Bristol Brain Centre, Southmead Hospital, North Bristol National Health Service Trust, Bristol, UK
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18
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Teshuva I, Hillel I, Gazit E, Giladi N, Mirelman A, Hausdorff JM. Using wearables to assess bradykinesia and rigidity in patients with Parkinson's disease: a focused, narrative review of the literature. J Neural Transm (Vienna) 2019; 126:699-710. [PMID: 31115669 DOI: 10.1007/s00702-019-02017-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
The potential of using wearable technologies for the objective assessment of motor symptoms in Parkinson's disease (PD) has gained prominence recently. Nonetheless, compared to tremor and gait impairment, less emphasis has been placed on the quantification of bradykinesia and rigidity. This review aimed to consolidate the existing research on objective measurement of bradykinesia and rigidity in PD through the use of wearables, focusing on the continuous monitoring of these two symptoms in free-living environments. A search of PubMed was conducted through a combination of keyword and MeSH searches. We also searched the IEEE, Google Scholar, Embase, and Scopus databases to ensure thorough results and to minimize the chances of missing relevant studies. Papers published after the year 2000 with sample sizes greater than five were included. Studies were assessed for quality and information was extracted regarding the devices used and their location on the body, the setting and duration of the study, the "gold standard" used as a reference for validation, the metrics used, and the results of each paper. Thirty-one and eight studies met the search criteria and evaluated bradykinesia and rigidity, respectively. Several studies reported strong associations between wearable-based measures and the gold-standard references for bradykinesia, and, to a lesser extent, rigidity. Only a few, pilot studies investigated the measurement of bradykinesia and rigidity in the home and free-living settings. While the current results are promising for the future of wearables, additional work is needed on their validation and adaptation in ecological, free-living settings. Doing so has the potential to improve the assessment and treatment of motor fluctuations and symptoms of PD more generally through real-time objective monitoring of bradykinesia and rigidity.
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Affiliation(s)
- Itay Teshuva
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Inbar Hillel
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eran Gazit
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nir Giladi
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology and Neurosurgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mirelman
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology and Neurosurgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. .,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel. .,Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv, Israel. .,Rush Alzheimer's Disease Center, Chicago, USA. .,Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA.
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19
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Evaluation of nocturnal hypokinesia in Parkinson’s disease using a novel patient/proxy questionnaire and correlations with objective monitoring. Parkinsonism Relat Disord 2019; 61:219-223. [DOI: 10.1016/j.parkreldis.2018.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 11/20/2022]
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20
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Getting a good night sleep? The importance of recognizing and treating nocturnal hypokinesia in Parkinson's disease. Parkinsonism Relat Disord 2018; 50:10-18. [PMID: 29336905 DOI: 10.1016/j.parkreldis.2018.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/28/2017] [Accepted: 01/04/2018] [Indexed: 02/02/2023]
Abstract
When Parkinson's disease (PD) patients are asked about the quality of their sleep, their answers are dominated by difficulties associated with impaired mobility in bed, medically referred to as nocturnal hypokinesia. Nocturnal hypokinesia is symptomatic from the mid-stage of the disease, affecting up to 70% of PD patients, and contributes to poor sleep quality, and increased carer burden. Here we explore four areas of nocturnal hypokinesia that are relevant to clinical practice, namely: manifestations and definition; clinical assessment and objective monitoring; etiologies and contributing factors; and evidence-based therapeutic approaches. In addition, we provide an operational definition of what constitutes nocturnal hypokinesia and outline different methods of assessment, ranging from clinical interviews and rating scales to objective night-time monitoring with inertial sensors. Optimal management of nocturnal hypokinesia in PD begins with recognizing its manifestation by inquiring about cardinal symptoms and contributing factors from, not only patients, but also carers, followed by formal assessment, and the application of individualized evidence-based treatment. Night-time dopaminergic treatment is the primary therapy; however, careful clinical judgment is required to balance the benefits with the potential adverse events related to nocturnal dopaminergic stimulation. Future studies are needed to explore the practicality of home-based objective assessment of nocturnal hypokinesia, new therapeutic options not limited to dopaminergic medications, and non-pharmacologic approaches, including training on compensatory strategies and bedroom adaptations.
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21
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Historical perspective: The pros and cons of conventional outcome measures in Parkinson's disease. Parkinsonism Relat Disord 2018; 46 Suppl 1:S47-S52. [DOI: 10.1016/j.parkreldis.2017.07.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 07/29/2017] [Indexed: 11/18/2022]
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22
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Fernández-Pajarín G, Sesar Á, Ares B, Castro A. Evaluating the Efficacy of Nocturnal Continuous Subcutaneous Apomorphine Infusion in Sleep Disorders in Advanced Parkinson's Disease: The APO-NIGHT Study. JOURNAL OF PARKINSONS DISEASE 2017; 6:787-792. [PMID: 27662329 DOI: 10.3233/jpd-160886] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There are not many data about the beneficial effect of nocturnal continuous subcutaneous apomorphine infusion (NCSAI) over sleep disturbances in advanced Parkinson's disease (PD). OBJECTIVE Evaluate the effect of the NCSAI in sleeping problems and insomnia due to nocturnal hypokinesia inadvanced PD. METHODS We assessed 17 advanced PD patients with several sleep disturbances measured by SCOPA-SLEEP and PDSS scales. All the patients were on apomorphine infusion during daytime. This therapy was extended to nighttime. We evaluated the patients before the onset and after six weeks with NCSAI. RESULTS NCSAI allowed highly significant improvements in SCOPA-SLEEP and PDSS scales (p<0.0001), and daytime somnolence. NCSAI was well tolerated with no major adverse effects were noticed. CONCLUSION This study shows and confirms the efficacy of NCSAI on the sleep disturbances related to advanced PD. We provide an easy protocol to start this therapy.
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Bhidayasiri R, Sringean J, Thanawattano C. Impaired bed mobility: quantitative torque analysis with axial inertial sensors. Neurodegener Dis Manag 2017; 7:235-243. [DOI: 10.2217/nmt-2017-0016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Difficulty in turning in bed is rated as the most troublesome night-time symptom among Parkinson’s disease (PD) patients. Aim: To develop a practical objective method for home assessment of a patient’s ability to turn in bed. Methods: Nocturnal parameters and torque of self-turning in bed from 17 PD couples were assessed and compared using a wearable axial sensor for two nights in their homes. Results: The torque of axial rotation which indicates the ability of PD patients to turn in bed was significantly less than their spouses (p < 0.001). Significant correlations were observed between the torque of turning in bed and total unified Parkinson’s Disease Rating Scale score (r = 0.71; p = 0.001), and total Nocturnal Akinesia Dystonia and Cramp score (r = 0.634; p = 0.006). Conclusion: Our study confirms a decreased ability in turning in PD.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson’s Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University & King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
- Department of Neurology, Juntendo University, Tokyo, Japan
| | - Jirada Sringean
- Chulalongkorn Center of Excellence for Parkinson’s Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University & King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Chusak Thanawattano
- Chulalongkorn Center of Excellence for Parkinson’s Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University & King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
- Biomedical Signal Processing Laboratory, National Electronics & Computer Technology Center (NECTEC), Pathumthani, Thailand
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Artusi CA, Mishra M, Latimer P, Vizcarra JA, Lopiano L, Maetzler W, Merola A, Espay AJ. Integration of technology-based outcome measures in clinical trials of Parkinson and other neurodegenerative diseases. Parkinsonism Relat Disord 2017; 46 Suppl 1:S53-S56. [PMID: 28760593 DOI: 10.1016/j.parkreldis.2017.07.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/21/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We sought to review the landscape of past, present, and future use of technology-based outcome measures (TOMs) in clinical trials of neurodegenerative disorders. METHODS We systematically reviewed PubMed and ClinicalTrials.gov for published and ongoing clinical trials in neurodegenerative disorders employing TOMs. In addition, medical directors of selected pharmaceutical companies were surveyed on their companies' ongoing efforts and future plans to integrate TOMs in clinical trials as primary, secondary, or exploratory endpoints. RESULTS We identified 164 published clinical trials indexed in PubMed that used TOMs as outcome measures in Parkinson disease (n = 132) or other neurodegenerative disorders (n = 32). The ClinicalTrials.gov search yielded 42 clinical trials using TOMs, representing 2.7% of ongoing trials. Sensor-based technology accounted for over 75% of TOMs applied. Gait and physical activity were the most common targeted domains. Within the next 5 years, 83% of surveyed pharmaceutical companies engaged in neurodegenerative disorders plan to deploy TOMs in clinical trials. CONCLUSION Although promising, TOMs are underutilized in clinical trials of neurodegenerative disorders. Validating relevant endpoints, standardizing measures and procedures, establishing a single platform for integration of data and algorithms from different devices, and facilitating regulatory approvals should advance TOMs integration into clinical trials.
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Affiliation(s)
- Carlo Alberto Artusi
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA; Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10125, Torino, Italy
| | - Murli Mishra
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Patricia Latimer
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Joaquin A Vizcarra
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10125, Torino, Italy
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Aristide Merola
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
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Bhidayasiri R, Martinez-Martin P. Clinical Assessments in Parkinson's Disease: Scales and Monitoring. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 132:129-182. [PMID: 28554406 DOI: 10.1016/bs.irn.2017.01.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Measurement of disease state is essential in both clinical practice and research in order to assess the severity and progression of a patient's disease status, effect of treatment, and alterations in other relevant factors. Parkinson's disease (PD) is a complex disorder expressed through many motor and nonmotor manifestations, which cause disabilities that can vary both gradually over time or come on suddenly. In addition, there is a wide interpatient variability making the appraisal of the many facets of this disease difficult. Two kinds of measure are used for the evaluation of PD. The first is subjective, inferential, based on rater-based interview and examination or patient self-assessment, and consist of rating scales and questionnaires. These evaluations provide estimations of conceptual, nonobservable factors (e.g., symptoms), usually scored on an ordinal scale. The second type of measure is objective, factual, based on technology-based devices capturing physical characteristics of the pathological phenomena (e.g., sensors to measure the frequency and amplitude of tremor). These instrumental evaluations furnish appraisals with real numbers on an interval scale for which a unit exists. In both categories of measures, a broad variety of tools exist. This chapter aims to present an up-to-date summary of the most relevant characteristics of the most widely used scales, questionnaires, and technological resources currently applied to the assessment of PD. The review concludes that, in our opinion: (1) no assessment methods can substitute the clinical judgment and (2) subjective and objective measures in PD complement each other, each method having strengths and weaknesses.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Juntendo University, Tokyo, Japan.
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
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Sringean J, Anan C, Thanawattano C, Bhidayasiri R. Time for a strategy in night-time dopaminergic therapy? An objective sensor-based analysis of nocturnal hypokinesia and sleeping positions in Parkinson's disease. J Neurol Sci 2017; 373:244-248. [DOI: 10.1016/j.jns.2016.12.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 12/19/2016] [Accepted: 12/22/2016] [Indexed: 11/15/2022]
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Bhidayasiri R, Sringean J, Anan C, Boonpang K, Thanawattano C, Ray Chaudhuri K. Quantitative demonstration of the efficacy of night-time apomorphine infusion to treat nocturnal hypokinesia in Parkinson's disease using wearable sensors. Parkinsonism Relat Disord 2016; 33 Suppl 1:S36-S41. [PMID: 27939326 DOI: 10.1016/j.parkreldis.2016.11.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/22/2016] [Accepted: 11/25/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nocturnal hypokinesia/akinesia is one of the common night-time symptoms in patients with Parkinson's disease (PD), negatively affecting quality of life of patients and caregivers. The recognition of this problem and treatment options are limited in clinical practice. OBJECTIVES To evaluate the efficacy of nocturnal apomorphine infusion, using a wearable sensor, in patients who are already on daytime continuous subcutaneous apomorphine infusion and still suffer from nocturnal hypokinesia. METHODS Nocturnal parameters in 10 PD patients before and during nocturnal infusion were assessed over two nights at their homes, using a wearable sensor (trunk). Nocturnal parameters included number, velocity, acceleration, degree, and duration of rolling over, and number of times they got out of bed. Correlations with validated clinical rating scales were performed. RESULTS Following nocturnal apomorphine infusion (34.8 ± 6.5 mg per night), there were significant improvements in the number of turns in bed (p = 0.027), turning velocity (p = 0.046), and the degree of turning (p = 0.028) in PD patients. Significant improvements of Modified Parkinson's Disease Sleep Scale (p = 0.005), the axial score of Unified Parkinson's Disease Rating Scale (p = 0.013), and Nocturnal Akinesia Dystonia and Cramp Scale (p = 0.014) were also observed. CONCLUSION Our study was able to demonstrate quantitatively the efficacy of nocturnal apomorphine infusion in PD patients with nocturnal hypokinesia and demonstrated the feasibility of using wearable sensors to yield objective and quantifiable outcomes in a clinical trial setting. More studies are needed to determine the long-term efficacy of this treatment in a large prospective cohort of PD patients.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand; Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan.
| | - Jirada Sringean
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Chanawat Anan
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Kamolwan Boonpang
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Chusak Thanawattano
- Biomedical Signal Processing Laboratory, National Electronics and Computer Technology Center (NECTEC), Pathumthani, Thailand
| | - K Ray Chaudhuri
- The Maurice Wohl Clinical Neuroscience Institute, King's College London and National Parkinson Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
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