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Bridges B, Taylor J, Weber JT. Evaluation of the Parkinson's Remote Interactive Monitoring System in a Clinical Setting: Usability Study. JMIR Hum Factors 2024; 11:e54145. [PMID: 38787603 PMCID: PMC11161713 DOI: 10.2196/54145] [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: 10/31/2023] [Revised: 03/15/2024] [Accepted: 04/14/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The fastest-growing neurological disorder is Parkinson disease (PD), a progressive neurodegenerative disease that affects 10 million people worldwide. PD is typically treated with levodopa, an oral pill taken to increase dopamine levels, and other dopaminergic agonists. As the disease advances, the efficacy of the drug diminishes, necessitating adjustments in treatment dosage according to the patient's symptoms and disease progression. Therefore, remote monitoring systems that can provide more detailed and accurate information on a patient's condition regularly are a valuable tool for clinicians and patients to manage their medication. The Parkinson's Remote Interactive Monitoring System (PRIMS), developed by PragmaClin Research Inc, was designed on the premise that it will be an easy-to-use digital system that can accurately capture motor and nonmotor symptoms of PD remotely. OBJECTIVE We performed a usability evaluation in a simulated clinical environment to assess the ease of use of the PRIMS and determine whether the product offers suitable functionality for users in a clinical setting. METHODS Participants were recruited from a user sign-up web-based database owned by PragmaClin Research Inc. A total of 11 participants were included in the study based on the following criteria: (1) being diagnosed with PD and (2) not being diagnosed with dementia or any other comorbidities that would make it difficult to complete the PRIMS assessment safely and independently. Patient users completed a questionnaire that is based on the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale. Interviews and field notes were analyzed for underlying themes and topics. RESULTS In total, 11 people with PD participated in the study (female individuals: n=5, 45%; male individuals: n=6, 55%; age: mean 66.7, SD 7.77 years). Thematic analysis of the observer's notes revealed 6 central usability issues associated with the PRIMS. These were the following: (1) the automated voice prompts are confusing, (2) the small camera is problematic, (3) the motor test exhibits excessive sensitivity to the participant's orientation and position in relation to the cameras, (4) the system poses mobility challenges, (5) navigating the system is difficult, and (6) the motor test exhibits inconsistencies and technical issues. Thematic analysis of qualitative interview responses revealed four central themes associated with participants' perspectives and opinions on the PRIMS, which were (1) admiration of purpose, (2) excessive system sensitivity, (3) video instructions preferred, and (4) written instructions disliked. The average system usability score was calculated to be 69.2 (SD 4.92), which failed to meet the acceptable system usability score of 70. CONCLUSIONS Although multiple areas of improvement were identified, most of the participants showed an affinity for the overarching objective of the PRIMS. This feedback is being used to upgrade the current PRIMS so that it aligns more with patients' needs.
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Affiliation(s)
- Bronwyn Bridges
- School of Pharmacy, Memorial University, St. John's, NL, Canada
| | - Jake Taylor
- School of Exercise Science, Physical & Health Education, University of Victoria, Victoria, BC, Canada
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Moreau C, Rouaud T, Grabli D, Benatru I, Remy P, Marques AR, Drapier S, Mariani LL, Roze E, Devos D, Dupont G, Bereau M, Fabbri M. Overview on wearable sensors for the management of Parkinson's disease. NPJ Parkinsons Dis 2023; 9:153. [PMID: 37919332 PMCID: PMC10622581 DOI: 10.1038/s41531-023-00585-y] [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: 05/25/2023] [Accepted: 10/02/2023] [Indexed: 11/04/2023] Open
Abstract
Parkinson's disease (PD) is affecting about 1.2 million patients in Europe with a prevalence that is expected to have an exponential increment, in the next decades. This epidemiological evolution will be challenged by the low number of neurologists able to deliver expert care for PD. As PD is better recognized, there is an increasing demand from patients for rigorous control of their symptoms and for therapeutic education. In addition, the highly variable nature of symtoms between patients and the fluctuations within the same patient requires innovative tools to help doctors and patients monitor the disease in their usual living environment and adapt treatment in a more relevant way. Nowadays, there are various body-worn sensors (BWS) proposed to monitor parkinsonian clinical features, such as motor fluctuations, dyskinesia, tremor, bradykinesia, freezing of gait (FoG) or gait disturbances. BWS have been used as add-on tool for patients' management or research purpose. Here, we propose a practical anthology, summarizing the characteristics of the most used BWS for PD patients in Europe, focusing on their role as tools to improve treatment management. Consideration regarding the use of technology to monitor non-motor features is also included. BWS obviously offer new opportunities for improving management strategy in PD but their precise scope of use in daily routine care should be clarified.
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Affiliation(s)
- Caroline Moreau
- Department of Neurology, Parkinson's disease expert Center, Lille University, INSERM UMRS_1172, University Hospital Center, Lille, France
- The French Ns-Park Network, Paris, France
| | - Tiphaine Rouaud
- The French Ns-Park Network, Paris, France
- CHU Nantes, Centre Expert Parkinson, Department of Neurology, Nantes, F-44093, France
| | - David Grabli
- The French Ns-Park Network, Paris, France
- Assistance Publique Hôpitaux de Paris, Department of Neurology, CIC Neurosciences, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Sorbonne University, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Isabelle Benatru
- The French Ns-Park Network, Paris, France
- Department of Neurology, University Hospital of Poitiers, Poitiers, France
- INSERM, CHU de Poitiers, University of Poitiers, Centre d'Investigation Clinique CIC1402, Poitiers, France
| | - Philippe Remy
- The French Ns-Park Network, Paris, France
- Centre Expert Parkinson, NS-Park/FCRIN Network, CHU Henri Mondor, AP-HP, Equipe NPI, IMRB, INSERM et Faculté de Santé UPE-C, Créteil, FranceService de neurologie, hôpital Henri-Mondor, AP-HP, Créteil, France
| | - Ana-Raquel Marques
- The French Ns-Park Network, Paris, France
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurology department, Clermont-Ferrand, France
| | - Sophie Drapier
- The French Ns-Park Network, Paris, France
- Pontchaillou University Hospital, Department of Neurology, CIC INSERM 1414, Rennes, France
| | - Louise-Laure Mariani
- The French Ns-Park Network, Paris, France
- Assistance Publique Hôpitaux de Paris, Department of Neurology, CIC Neurosciences, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Sorbonne University, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Emmanuel Roze
- The French Ns-Park Network, Paris, France
- Assistance Publique Hôpitaux de Paris, Department of Neurology, CIC Neurosciences, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Sorbonne University, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - David Devos
- The French Ns-Park Network, Paris, France
- Parkinson's Disease Centre of Excellence, Department of Medical Pharmacology, Univ. Lille, INSERM; CHU Lille, U1172 - Degenerative & Vascular Cognitive Disorders, LICEND, NS-Park Network, F-59000, Lille, France
| | - Gwendoline Dupont
- The French Ns-Park Network, Paris, France
- Centre hospitalier universitaire François Mitterrand, Département de Neurologie, Université de Bourgogne, Dijon, France
| | - Matthieu Bereau
- The French Ns-Park Network, Paris, France
- Service de neurologie, université de Franche-Comté, CHRU de Besançon, 25030, Besançon, France
| | - Margherita Fabbri
- The French Ns-Park Network, Paris, France.
- Department of Neurosciences, Clinical Investigation Center CIC 1436, Parkinson Toulouse Expert Centre, NS-Park/FCRIN Network and NeuroToul COEN Center, Toulouse University Hospital, INSERM, University of Toulouse 3, Toulouse, France.
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Moes HR, Henriksen T, Sławek J, Phokaewvarangkul O, Buskens E, van Laar T. Tools and criteria to select patients with advanced Parkinson's disease for device-aided therapies: a narrative review. J Neural Transm (Vienna) 2023; 130:1359-1377. [PMID: 37500937 PMCID: PMC10645650 DOI: 10.1007/s00702-023-02656-z] [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: 02/28/2023] [Accepted: 05/16/2023] [Indexed: 07/29/2023]
Abstract
This article provides an overview of the various screening and selection tools which have been developed over the past 25 years to identify patients with Parkinson's disease (PD) possibly eligible for device-aided therapies (DATs). For the available screening tools, we describe the target therapies (subtypes of DAT), development methods, validation data, and their use in clinical practice. In addition, the historical background and potential utility of these screening tools are discussed. The challenges in developing and validating these tools are also addressed, taking into account the differences in population, the local health care organization, and resource availability.
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Affiliation(s)
- Harmen R Moes
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9713 GZ, Groningen, The Netherlands
| | - Tove Henriksen
- Department of Neurology, Movement Disorder Clinic, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jarosław Sławek
- Department of Neurology, St Adalbert Hospital Copernicus, Gdansk, Poland
- Department of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Onanong Phokaewvarangkul
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Erik Buskens
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9713 GZ, Groningen, The Netherlands.
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Guerra A, D'Onofrio V, Ferreri F, Bologna M, Antonini A. Objective measurement versus clinician-based assessment for Parkinson's disease. Expert Rev Neurother 2023; 23:689-702. [PMID: 37366316 DOI: 10.1080/14737175.2023.2229954] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/18/2023] [Accepted: 06/22/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Although clinician-based assessment through standardized clinical rating scales is currently the gold standard for quantifying motor impairment in Parkinson's disease (PD), it is not without limitations, including intra- and inter-rater variability and a degree of approximation. There is increasing evidence supporting the use of objective motion analyses to complement clinician-based assessment. Objective measurement tools hold significant potential for improving the accuracy of clinical and research-based evaluations of patients. AREAS COVERED The authors provide several examples from the literature demonstrating how different motion measurement tools, including optoelectronics, contactless and wearable systems allow for both the objective quantification and monitoring of key motor symptoms (such as bradykinesia, rigidity, tremor, and gait disturbances), and the identification of motor fluctuations in PD patients. Furthermore, they discuss how, from a clinician's perspective, objective measurements can help in various stages of PD management. EXPERT OPINION In our opinion, sufficient evidence supports the assertion that objective monitoring systems enable accurate evaluation of motor symptoms and complications in PD. A range of devices can be utilized not only to support diagnosis but also to monitor motor symptom during the disease progression and can become relevant in the therapeutic decision-making process.
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Affiliation(s)
- Andrea Guerra
- Parkinson and Movement Disorder Unit, Study Center on Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | | | - Florinda Ferreri
- Unit of Neurology, Unit of Clinical Neurophysiology, Study Center of Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
- Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Angelo Antonini
- Parkinson and Movement Disorder Unit, Study Center on Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
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Oyama G, Burq M, Hatano T, Marks WJ, Kapur R, Fernandez J, Fujikawa K, Furusawa Y, Nakatome K, Rainaldi E, Chen C, Ho KC, Ogawa T, Kamo H, Oji Y, Takeshige-Amano H, Taniguchi D, Nakamura R, Sasaki F, Ueno S, Shiina K, Hattori A, Nishikawa N, Ishiguro M, Saiki S, Hayashi A, Motohashi M, Hattori N. Analytical and clinical validity of wearable, multi-sensor technology for assessment of motor function in patients with Parkinson's disease in Japan. Sci Rep 2023; 13:3600. [PMID: 36918552 PMCID: PMC10015076 DOI: 10.1038/s41598-023-29382-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/03/2023] [Indexed: 03/16/2023] Open
Abstract
Continuous, objective monitoring of motor signs and symptoms may help improve tracking of disease progression and treatment response in Parkinson's disease (PD). This study assessed the analytical and clinical validity of multi-sensor smartwatch measurements in hospitalized and home-based settings (96 patients with PD; mean wear time 19 h/day) using a twice-daily virtual motor examination (VME) at times representing medication OFF/ON states. Digital measurement performance was better during inpatient clinical assessments for composite V-scores than single-sensor-derived features for bradykinesia (Spearman |r|= 0.63, reliability = 0.72), tremor (|r|= 0.41, reliability = 0.65), and overall motor features (|r|= 0.70, reliability = 0.67). Composite levodopa effect sizes during hospitalization were 0.51-1.44 for clinical assessments and 0.56-1.37 for VMEs. Reliability of digital measurements during home-based VMEs was 0.62-0.80 for scores derived from weekly averages and 0.24-0.66 for daily measurements. These results show that unsupervised digital measurements of motor features with wrist-worn sensors are sensitive to medication state and are reliable in naturalistic settings.Trial Registration: Japan Pharmaceutical Information Center Clinical Trials Information (JAPIC-CTI): JapicCTI-194825; Registered June 25, 2019.
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Affiliation(s)
- Genko Oyama
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.
| | - Maximilien Burq
- Verily Life Sciences, 269 East Grand Avenue, South San Francisco, CA, USA
| | - Taku Hatano
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - William J Marks
- Verily Life Sciences, 269 East Grand Avenue, South San Francisco, CA, USA
| | - Ritu Kapur
- Verily Life Sciences, 269 East Grand Avenue, South San Francisco, CA, USA
| | - Jovelle Fernandez
- Takeda Pharmaceutical Company Limited, 2 Chome-1-1 Nihonbashihoncho, Chuo-Ku, Tokyo, 103-0023, Japan
| | - Keita Fujikawa
- Takeda Pharmaceutical Company Limited, 2 Chome-1-1 Nihonbashihoncho, Chuo-Ku, Tokyo, 103-0023, Japan
| | - Yoshihiko Furusawa
- Takeda Pharmaceutical Company Limited, 2 Chome-1-1 Nihonbashihoncho, Chuo-Ku, Tokyo, 103-0023, Japan
| | - Keisuke Nakatome
- Takeda Pharmaceutical Company Limited, 2 Chome-1-1 Nihonbashihoncho, Chuo-Ku, Tokyo, 103-0023, Japan
| | - Erin Rainaldi
- Verily Life Sciences, 269 East Grand Avenue, South San Francisco, CA, USA
| | - Chen Chen
- Verily Life Sciences, 269 East Grand Avenue, South San Francisco, CA, USA
| | - King Chung Ho
- Verily Life Sciences, 269 East Grand Avenue, South San Francisco, CA, USA
| | - Takashi Ogawa
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Hikaru Kamo
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Yutaka Oji
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Haruka Takeshige-Amano
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Daisuke Taniguchi
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Ryota Nakamura
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Fuyuko Sasaki
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Shinichi Ueno
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Kenta Shiina
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Anri Hattori
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Noriko Nishikawa
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Mayu Ishiguro
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Shinji Saiki
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Ayako Hayashi
- Takeda Pharmaceutical Company Limited, 2 Chome-1-1 Nihonbashihoncho, Chuo-Ku, Tokyo, 103-0023, Japan
| | - Masatoshi Motohashi
- Takeda Pharmaceutical Company Limited, 2 Chome-1-1 Nihonbashihoncho, Chuo-Ku, Tokyo, 103-0023, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
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Moes HR, Ten Kate JM, Portman AT, van Harten B, van Kesteren ME, Mondria T, Lunter G, Buskens E, van Laar T. Timely referral for device-aided therapy in Parkinson's disease. Development of a screening tool. Parkinsonism Relat Disord 2023; 109:105359. [PMID: 36958065 DOI: 10.1016/j.parkreldis.2023.105359] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/08/2023] [Accepted: 03/05/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Timely referral of Parkinson's disease (PD) patients to specialized centers for treatment with device-aided therapies (DAT) is suboptimal. OBJECTIVE To develop a screening tool for timely referral for DAT in PD and to compare the tool with the published 5-2-1 criteria. METHODS A cross-sectional, observational study was performed in 8 hospitals in the catchment area of a specialized movement disorder center in the Northern part of the Netherlands. The target population comprised PD patients not yet on DAT visiting the outpatient clinic of participating hospitals. The primary outcome was apparent eligibility for referral for DAT based on consensus by a panel of 5 experts in the field of DAT. Multivariable logistic regression modelling was used to develop a screening tool for eligibility for referral for DAT. Potential predictors were patient and disease characteristics as observed by attending neurologists. RESULTS In total, 259 consecutive PD patients were included, of whom 17 were deemed eligible for referral for DAT (point prevalence: 6.6%). Presence of response fluctuations and troublesome dyskinesias were the strongest independent predictors of being considered eligible. Both variables were included in the final model, as well as levodopa equivalent daily dose. Decision curve analysis revealed the new model outperforms the 5-2-1 criteria. A simple chart was constructed to provide guidance for referral. Discrimination of this simplified scoring system proved excellent (AUC after bootstrapping: 0.97). CONCLUSIONS Awaiting external validation, the developed screening tool already appears promising for timely referral and subsequent treatment with DAT in patients with PD.
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Affiliation(s)
- Harmen R Moes
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands.
| | - Jolien M Ten Kate
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands
| | - Axel T Portman
- Treant Zorggroep, Department of Neurology, Stadskanaal, the Netherlands
| | - Barbera van Harten
- Medical Center Leeuwarden, Department of Neurology, Leeuwarden, the Netherlands
| | | | - Tjeerd Mondria
- Antonius Hospital, Department of Neurology, Sneek, the Netherlands
| | - Gerton Lunter
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Erik Buskens
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Teus van Laar
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands
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Calvano A, Timmermann L, Loehrer PA, Oehrn CR, Weber I. Binaural acoustic stimulation in patients with Parkinson's disease. Front Neurol 2023; 14:1167006. [PMID: 37213909 PMCID: PMC10196363 DOI: 10.3389/fneur.2023.1167006] [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: 02/15/2023] [Accepted: 04/13/2023] [Indexed: 05/23/2023] Open
Abstract
Acoustic stimulation can improve motor symptoms in Parkinson's disease (PD) and might therefore represent a potential non-invasive treatment option. Scalp electroencephalography studies in healthy subjects indicate that specifically binaural beat stimulation (BBS) in the gamma frequency range is associated with synchronized cortical oscillations at 40 Hertz (Hz). Several studies suggest that oscillations in the gamma-frequency range (>30 Hz) serve a prokinetic function in PD. In this double-blind, randomized study, 25 PD patients were recruited. The study was conducted with (ON) and without dopaminergic medication (OFF). Each drug condition consisted of two phases (no stimulation and acoustic stimulation). The acoustic stimulation phase was divided into two blocks including BBS and conventional acoustic stimulation (CAS) as a control condition. For BBS, a modulated frequency of 35 Hz was used (left: 320 Hz; right: 355 Hz) and for CAS 340 Hz on both sides. We assessed effects on motor performance using Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and two validated commercially available portable devices (Kinesia ONE™ and Kinesia 360™) measuring motor symptoms such as dyskinesia, bradykinesia, and tremor. Repeated measures ANOVA revealed that BBS improved resting tremor on the side of the more affected limb in the OFF condition, as measured by wearables (F(2,48) = 3.61, p = 0.035). However, BBS did not exert a general positive effect on motor symptoms as assessed via MDS-UPDRS (F(2,48) = 1.00, p = 0.327). For CAS, we did not observe an improvement in specific symptoms but rather an overall beneficial effect on motor performance (MDS-UPDRS total score OFF medication: F(2,48) = 4.17, p = 0.021; wearable scores: F(2,48) = 2.46, p = 0.097). In this study, we found an improvement of resting tremor when applying BBS in the gamma frequency band OFF medication. Moreover, the positive effects of CAS underline the general positive potential for improvement of motor function by acoustically supported therapeutic approaches. However, more studies are needed to fully characterize the clinical relevance of BBS and to further optimize its ameliorating effects.
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Affiliation(s)
- Alexander Calvano
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- *Correspondence: Alexander Calvano,
| | - Lars Timmermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg, Marburg, Germany
| | - Philipp Alexander Loehrer
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg, Marburg, Germany
| | - Carina Renate Oehrn
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg, Marburg, Germany
| | - Immo Weber
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
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Telemedicine in the Management of Parkinson's Disease: Achievements, Challenges, and Future Perspectives. Brain Sci 2022; 12:brainsci12121735. [PMID: 36552194 PMCID: PMC9775481 DOI: 10.3390/brainsci12121735] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/08/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND As the global population grows, there is an increasing demand for neurologic consultation that prompts new ways to reach more patients. Telemedicine can provide an accessible, cost-effective, and high-quality healthcare services. OBJECTIVES In this article, we highlight recent developments, achievements, and challenges regarding outcomes, clinical care, tele-education, teletreatment, teleresearch, and cybersecurity for telemedicine applied to Parkinson´s disease (PD) and other neurological conditions. RESULTS A growing body of evidence supports the feasibility and effectiveness of telemedicine tools for PD and other movement disorders. Outcome variables regarding satisfaction and efficacy in clinical care and specific issues about education, research, and treatment are reviewed. Additionally, a specific legal framework for teleconsultation has been developed in some centers worldwide. Yet, the implementation of telemedicine is conditioned by the limitations inherent to remote neurological examination, the variable computer usage literacy among patients, and the availability of a reliable internet connection. At present, telemedicine can be considered an additional tool in the clinical management of PD patients. CONCLUSIONS There is an increasing use of remote clinical practice regarding the management of PD and other neurological conditions. Telemedicine is a new and promising tool aimed at special settings and subpopulations.
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Xu Z, Shen B, Tang Y, Wu J, Wang J. Deep Clinical Phenotyping of Parkinson's Disease: Towards a New Era of Research and Clinical Care. PHENOMICS (CHAM, SWITZERLAND) 2022; 2:349-361. [PMID: 36939759 PMCID: PMC9590510 DOI: 10.1007/s43657-022-00051-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/12/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
Despite recent advances in technology, clinical phenotyping of Parkinson's disease (PD) has remained relatively limited as current assessments are mainly based on empirical observation and subjective categorical judgment at the clinic. A lack of comprehensive, objective, and quantifiable clinical phenotyping data has hindered our capacity to diagnose, assess patients' conditions, discover pathogenesis, identify preclinical stages and clinical subtypes, and evaluate new therapies. Therefore, deep clinical phenotyping of PD patients is a necessary step towards understanding PD pathology and improving clinical care. In this review, we present a growing community consensus and perspective on how to clinically phenotype this disease, that is, to phenotype the entire course of disease progression by integrating capacity, performance, and perception approaches with state-of-the-art technology. We also explore the most studied aspects of PD deep clinical phenotypes, namely, bradykinesia, tremor, dyskinesia and motor fluctuation, gait impairment, speech impairment, and non-motor phenotypes.
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Affiliation(s)
- Zhiheng Xu
- Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Bo Shen
- Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Yilin Tang
- Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Jianjun Wu
- Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, 200040 China
| | - Jian Wang
- Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, 200040 China
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10
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Ricci M, Lazzaro GD, Errico V, Pisani A, Giannini F, Saggio G. The impact of wearable electronics in assessing the effectiveness of levodopa treatment in Parkinsons disease. IEEE J Biomed Health Inform 2022; 26:2920-2928. [PMID: 35316198 DOI: 10.1109/jbhi.2022.3160103] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE In order to evaluate Parkinson disease patients response to therapeutic interventions, sources of information are mainly patient reports and clinicians assessment of motor functions. However, these sources can suffer from patients subjectivity and from inter/intra raters score variability. Our work aimed at determining the impact of wearable electronics and data analysis in objectifying the effectiveness of levodopa treatment. METHODS Seven motor tasks performed by thirty-six patients were measured by wearable electronics and related data were analyzed. This was at the time of therapy initiation (T0), and repeated after six (T1) and 12 months (T2). Wearable electronics consisted of inertial measurement units each equipped with 3-axis accelerometer and 3-axis gyroscope, while data analysis of ANOVA and Pearson correlation algorithms, in addition to a support vector machine (SVM) classification. RESULTS According to our findings, levodopa-based therapy alters the patients conditions in general, ameliorating something (e.g. bradykinesia), leaving unchanged others (e.g. tremor), but with poor correlation to the levodopa dose. CONCLUSION A technology-based approach can objectively assess levodopa-based therapy effectiveness. SIGNIFICANCE Novel devices can improve the accuracy of the assessment of motor function, by integrating the clinical evaluation and patient reports.
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11
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Predictive Value of Ambulatory Objective Movement Measurement for Outcomes of Levodopa/Carbidopa Intestinal Gel Infusion. J Pers Med 2022; 12:jpm12010027. [PMID: 35055343 PMCID: PMC8781512 DOI: 10.3390/jpm12010027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/19/2021] [Accepted: 12/28/2021] [Indexed: 12/12/2022] Open
Abstract
Patients with Parkinson's disease that may benefit from device-assisted therapy can be identified with guidelines like Navigate PD. The decision to offer advanced treatment and the choice of treatment modality are, however, not straightforward, and some patients respond less favorably to a chosen therapy. Measurements with the Parkinson Kinetigraph (PKG) can detect motor fluctuations and could therefore predict patients that respond better or worse to intestinal levodopa/carbidopa gel infusion (LCIG). In a retrospective analysis of 45 patients that had been selected to start LCIG between 2014 and 2020, the effects of baseline PKG and clinical characteristic on the outcome were determined with ordinal regression. Although all patients had been found to have handicapping medication-related symptom fluctuations, patients without clear objective off fluctuations in the baseline PKG had low odds ratio for success. Lower odds for success were also found with increasing age, whereas gender, medication intensity and baseline PKG summary scores (median bradykinesia and dyskinesia scores, fluctuation dyskinesia score and percent time with tremor) had no significant effect. Absence of easily identified off-periods in the PKG has a negative prognostic value for the effect of LCIG and could prompt noninvasive infusion evaluation before surgery.
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12
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Ancona S, Faraci FD, Khatab E, Fiorillo L, Gnarra O, Nef T, Bassetti CLA, Bargiotas P. Wearables in the home-based assessment of abnormal movements in Parkinson's disease: a systematic review of the literature. J Neurol 2022; 269:100-110. [PMID: 33409603 DOI: 10.1007/s00415-020-10350-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/19/2020] [Accepted: 12/04/2020] [Indexed: 12/01/2022]
Abstract
At present, the standard practices for home-based assessments of abnormal movements in Parkinson's disease (PD) are based either on subjective tools or on objective measures that often fail to capture day-to-day fluctuations and long-term information in real-life conditions in a way that patient's compliance and privacy are secured. The employment of wearable technologies in PD represents a great paradigm shift in healthcare remote diagnostics and therapeutics monitoring. However, their applicability in everyday clinical practice seems to be still limited. We carried out a systematic search across the Medline Database. In total, 246 publications, published until 1 June 2020, were identified. Among them, 26 reports met the inclusion criteria and were included in the present review. We focused more on clinically relevant aspects of wearables' application including feasibility and efficacy of the assessment, the number, type and body position of the wearable devices, type of PD motor symptom, environment and duration of assessments and validation methodology. The aim of this review is to provide a systematic overview of the current knowledge and state-of-the-art of the home-based assessment of motor symptoms and fluctuations in PD patients using wearable technology, highlighting current problems and laying foundations for future works.
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Affiliation(s)
- Stefania Ancona
- Department of Neurology, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland
| | - Francesca D Faraci
- Institute for Information Systems and Networking, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Elina Khatab
- Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Luigi Fiorillo
- Institute for Information Systems and Networking, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland.,Institute of Informatics, University of Bern, Bern, Switzerland
| | - Oriella Gnarra
- Department of Neurology, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland.,Sensory-Motor System Lab, IRIS, ETH Zurich, Zurich, Switzerland.,Neurotec, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland.,ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation, University of Bern, Bern, Switzerland
| | - Tobias Nef
- Department of Neurology, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland.,Neurotec, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland.,ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation, University of Bern, Bern, Switzerland
| | - Claudio L A Bassetti
- Department of Neurology, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland.,Neurotec, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Panagiotis Bargiotas
- Department of Neurology, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland. .,Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus.
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13
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Hadley AJ, Riley DE, Heldman DA. Real-World Evidence for a Smartwatch-Based Parkinson's Motor Assessment App for Patients Undergoing Therapy Changes. Digit Biomark 2021; 5:206-215. [PMID: 34703975 DOI: 10.1159/000518571] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/19/2021] [Indexed: 01/18/2023] Open
Abstract
Introduction Parkinson's disease (PD) is poorly quantified by patients outside the clinic, and paper diaries have problems with subjective descriptions and bias. Wearable sensor platforms; however, can accurately quantify symptoms such as tremor, dyskinesia, and bradykinesia. Commercially available smartwatches are equipped with accelerometers and gyroscopes that can measure motion for objective evaluation. We sought to evaluate the clinical utility of a prescription smartwatch-based monitoring system for PD utilizing periodic task-based motor assessment. Methods Sixteen patients with PD used a smartphone- and smartwatch-based monitoring system to objectively assess motor symptoms for 1 week prior to instituting a doctor recommended change in therapy and for 4 weeks after the change. After 5 weeks the participants returned to the clinic to discuss their results with their doctor, who made therapy recommendations based on the reports and his clinical judgment. Symptom scores were synchronized with the medication diary and the temporal effects of therapy on weekly and hourly timescales were calculated. Results Thirteen participants successfully completed the study and averaged 4.9 assessments per day for 3 days per week during the study. The doctor instructed 8 participants to continue their new regimens and 5 to revert to their previous regimens. The smartwatch-based assessments successfully captured intraday fluctuations and short- and long-term responses to therapies, including detecting significant improvements (p < 0.05) in at least one symptom in 7 participants. Conclusions The smartwatch-based app successfully captured temporal trends in symptom scores following application of new therapy on hourly, daily, and weekly timescales. These results suggest that validated smartwatch-based PD monitoring can provide clinically relevant information and may reduce the need for traditional office visits for therapy adjustment.
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14
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Khodakarami H, Shokouhi N, Horne M. A method for measuring time spent in bradykinesia and dyskinesia in people with Parkinson's disease using an ambulatory monitor. J Neuroeng Rehabil 2021; 18:116. [PMID: 34271971 PMCID: PMC8283900 DOI: 10.1186/s12984-021-00905-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/25/2021] [Indexed: 01/07/2023] Open
Abstract
Background Fluctuations in motor function in Parkinson’s Disease (PD) are frequent and cause significant disability. Frequently device assisted therapies are required to treat them. Currently, fluctuations are self-reported through diaries and history yet frequently people with PD do not accurately identify and report fluctuations. As the management of fluctuations and the outcomes of many clinical trials depend on accurately measuring fluctuations a means of objectively measuring time spent with bradykinesia or dyskinesia would be important. The aim of this study was to present a system that uses wearable sensors to measure the percentage of time that bradykinesia or dyskinesia scores are above a target as a means for assessing levels of treatment and fluctuations in PD. Methods Data in a database of 228 people with Parkinson’s Disease and 157 control subjects, who had worn the Parkinson’s Kinetigraph ((PKG, Global Kinetics Corporation™, Australia) and scores from the Unified Parkinson’s Disease Rating Scale (UPDRS) and other clinic scales were used. The PKG’s provided score for bradykinesia and dyskinesia every two minutes and these were compared to a previously established target range representing a UPDRS III score of 35. The proportion of these scores above target over the 6 days that the PKG was worn were used to derive the percent time in bradykinesia (PTB) and percent time in dyskinesia (PTD). As well, a previously describe algorithm for estimating the amplitude of the levodopa response was used to determine whether a subject was a fluctuator or non-fluctuator. Results Using this approach, a normal range of PTB and PTD based on Control subject was developed. The level of PTB and PTD experienced by people with PD was compared with their levels of fluctuation. There was a correlation (Pearson’s ρ = 0.4) between UPDRS II scores and PTB: the correlation between Parkinson Disease Questionnaire scores and UPDRS Total scores and PTB and slightly lower. PTB and PTD fell in response to treatment for bradykinesia or dyskinesia (respectively) with greater sensitivity than clinical scales. Conclusions This approach provides an objective assessment of the severity of fluctuations in Parkinson’s Disease that could be used in in clinical trials and routine care. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00905-4.
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Affiliation(s)
- Hamid Khodakarami
- Global Kinetics Pty Ltd, 31 Queen St., Melbourne, Victoria, Australia
| | - Navid Shokouhi
- Global Kinetics Pty Ltd, 31 Queen St., Melbourne, Victoria, Australia
| | - Malcolm Horne
- Florey Institute of Neuroscience and Mental Health, Victoria, Australia. .,The Department of Medicine, The University of Melbourne, St Vincent's Hospital, Fitzroy, VIC, 3010, Australia. .,Department of Neurology, St Vincent's Hospital, Fitzroy, VIC, Australia.
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15
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Digital Technology in Movement Disorders: Updates, Applications, and Challenges. Curr Neurol Neurosci Rep 2021; 21:16. [PMID: 33660110 PMCID: PMC7928701 DOI: 10.1007/s11910-021-01101-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 12/14/2022]
Abstract
Purpose of Review Digital technology affords the opportunity to provide objective, frequent, and sensitive assessment of disease outside of the clinic environment. This article reviews recent literature on the application of digital technology in movement disorders, with a focus on Parkinson’s disease (PD) and Huntington’s disease. Recent Findings Recent research has demonstrated the ability for digital technology to discriminate between individuals with and without PD, identify those at high risk for PD, quantify specific motor features, predict clinical events in PD, inform clinical management, and generate novel insights. Summary Digital technology has enormous potential to transform clinical research and care in movement disorders. However, more work is needed to better validate existing digital measures, including in new populations, and to develop new more holistic digital measures that move beyond motor features.
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16
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Telehealth in Neurodegenerative Diseases: Opportunities and Challenges for Patients and Physicians. Brain Sci 2021; 11:brainsci11020237. [PMID: 33668641 PMCID: PMC7917616 DOI: 10.3390/brainsci11020237] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 02/06/2023] Open
Abstract
Telehealth, by definition, is distributing health-related services while using electronic technologies. This narrative Review describes the technological health services (telemedicine and telemonitoring) for delivering care in neurodegenerative diseases, Alzheimer's disease, Parkinson's Disease, and amyotrophic lateral Sclerosis, among others. This paper aims to illustrate this approach's primary experience and application, highlighting the strengths and weaknesses, with the goal of understanding which could be the most useful application for each one, in order to facilitate telehealth improvement and use in standard clinical practice. We also described the potential role of the COVID-19 pandemic to speed up this service's use, avoiding a sudden interruption of medical care.
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17
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Luis-Martínez R, Monje MHG, Antonini A, Sánchez-Ferro Á, Mestre TA. Technology-Enabled Care: Integrating Multidisciplinary Care in Parkinson's Disease Through Digital Technology. Front Neurol 2020; 11:575975. [PMID: 33250846 PMCID: PMC7673441 DOI: 10.3389/fneur.2020.575975] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/24/2020] [Indexed: 11/13/2022] Open
Abstract
Parkinson's disease (PD) management requires the involvement of movement disorders experts, other medical specialists, and allied health professionals. Traditionally, multispecialty care has been implemented in the form of a multidisciplinary center, with an inconsistent clinical benefit and health economic impact. With the current capabilities of digital technologies, multispecialty care can be reshaped to reach a broader community of people with PD in their home and community. Digital technologies have the potential to connect patients with the care team beyond the traditional sparse clinical visit, fostering care continuity and accessibility. For example, video conferencing systems can enable the remote delivery of multispecialty care. With big data analyses, wearable and non-wearable technologies using artificial intelligence can enable the remote assessment of patients' conditions in their natural home environment, promoting a more comprehensive clinical evaluation and empowering patients to monitor their disease. These advances have been defined as technology-enabled care (TEC). We present examples of TEC under development and describe the potential challenges to achieve a full integration of technology to address complex care needs in PD.
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Affiliation(s)
- Raquel Luis-Martínez
- Department of Neurosciences, University of Basque Country (UPV/EHU), Leioa, Spain
- Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Mariana H G Monje
- HM CINAC, Hospital Universitario HM Puerta del Sur, Universidad CEU-San Pablo, Madrid, Spain
| | - Angelo Antonini
- Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Álvaro Sánchez-Ferro
- HM CINAC, Hospital Universitario HM Puerta del Sur, Universidad CEU-San Pablo, Madrid, Spain
| | - Tiago A Mestre
- Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, Parkinson's Disease and Movement Disorders Center, The University of Ottawa Brain Research Institute, Ottawa, ON, Canada
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18
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Channa A, Popescu N, Ciobanu V. Wearable Solutions for Patients with Parkinson's Disease and Neurocognitive Disorder: A Systematic Review. SENSORS 2020; 20:s20092713. [PMID: 32397516 PMCID: PMC7249148 DOI: 10.3390/s20092713] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 01/01/2023]
Abstract
Prevalence of neurocognitive diseases in adult patients demands the use of wearable devices to transform the future of mental health. Recent development in wearable technology proclaimed its use in diagnosis, rehabilitation, assessment, and monitoring. This systematic review presents the state of the art of wearables used by Parkinson’s disease (PD) patients or the patients who are going through a neurocognitive disorder. This article is based on PRISMA guidelines, and the literature is searched between January 2009 to January 2020 analyzing four databases: PubMed, IEEE Xplorer, Elsevier, and ISI Web of Science. For further validity of articles, a new PEDro-inspired technique is implemented. In PEDro, five statistical indicators were set to classify relevant articles and later the citations were also considered to make strong assessment of relevant articles. This led to 46 articles that met inclusion criteria. Based on them, this systematic review examines different types of wearable devices, essential in improving early diagnose and monitoring, emphasizing their role in improving the quality of life, differentiating the various fitness and gait wearable-based exercises and their impact on the regression of disease and on the motor diagnosis tests and finally addressing the available wearable insoles and their role in rehabilitation. The research findings proved that sensor based wearable devices, and specially instrumented insoles, help not only in monitoring and diagnosis but also in tracking numerous exercises and their positive impact towards the improvement of quality of life among different Parkinson and neurocognitive patients.
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19
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Kleinholdermann U, Melsbach J, Pedrosa DJ. [Remote assessment of idiopathic Parkinson's disease : Developments in diagnostics, monitoring and treatment]. DER NERVENARZT 2019; 90:1232-1238. [PMID: 31654235 DOI: 10.1007/s00115-019-00818-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The idiopathic Parkinson's disease (iPD) is a progressive neurodegenerative disorder primarily resulting in impaired movement execution. In the course of the disease symptom fluctuation is common and makes adequate treatment difficult. In this overview the current approaches using modern and especially mobile technologies for diagnosis, monitoring and treatment of iPD are presented. Currently, there are no medical aids ready for point of care application; however, the development of these technologies has great potential for improving care for patients suffering from iPD.
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Affiliation(s)
- U Kleinholdermann
- Klinik für Psychiatrie und Psychotherapie, Philipps-Universität Marburg, Rudolf-Bultmann-Str. 8, 35039, Marburg, Deutschland.
| | - J Melsbach
- Seminar für Wirtschaftsinformatik und Informationsmanagement, Universität zu Köln, Köln, Deutschland
| | - D J Pedrosa
- Klinik für Neurologie, Philipps-Universität Marburg, Marburg, Deutschland
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20
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Hasan H, Burrows M, Athauda DS, Hellman B, James B, Warner T, Foltynie T, Giovannoni G, Lees AJ, Noyce AJ. The BRadykinesia Akinesia INcoordination (BRAIN) Tap Test: Capturing the Sequence Effect. Mov Disord Clin Pract 2019; 6:462-469. [PMID: 31392247 PMCID: PMC6660282 DOI: 10.1002/mdc3.12798] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/05/2019] [Accepted: 05/18/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The BRadykinesia Akinesia INcoordination (BRAIN) tap test is an online keyboard tapping task that has been previously validated to assess upper limb motor function in Parkinson's disease (PD). OBJECTIVES To develop a new parameter that detects a sequence effect and to reliably distinguish between PD patients on and off medication. In addition, we sought to validate a mobile version of the test for use on smartphones and tablet devices. METHODS The BRAIN test scores in 61 patients with PD and 93 healthy controls were compared. A range of established parameters captured number and accuracy of alternate taps. The new velocity score recorded the intertap speed. Decrement in the velocity score was used as a marker for the sequence effect. In the validation phase, 19 PD patients and 19 controls were tested using different hardware including mobile devices. RESULTS Quantified slopes from the velocity score demonstrated bradykinesia (sequence effect) in PD patients (slope cut-off -0.002) with 58% sensitivity and 81% specificity (discovery phase of the study) and 65% sensitivity and 88% specificity (validation phase). All BRAIN test parameters differentiated between on and off medication states in PD. Differentiation between PD patients and controls was possible on all hardware versions of the test. CONCLUSION The BRAIN tap test is a simple, user-friendly, and free-to-use tool for the assessment of upper limb motor dysfunction in PD, which now includes a measure of bradykinesia.
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Affiliation(s)
- Hasan Hasan
- Institute of NeurologyQueen SquareUniversity College London, LondonUK
| | - Maggie Burrows
- Department of Clinical and Movement NeurosciencesInstitute of NeurologyQueen Square, University College London, LondonUK
- Reta Lila Weston Institute of Neurological StudiesInstitute of Neurology, University College LondonLondonUK
| | - Dilan S. Athauda
- Department of Clinical and Movement NeurosciencesInstitute of NeurologyQueen Square, University College London, LondonUK
- National Hospital for Neurology and NeurosurgeryLondonUK
| | | | | | - Thomas Warner
- Department of Clinical and Movement NeurosciencesInstitute of NeurologyQueen Square, University College London, LondonUK
- Reta Lila Weston Institute of Neurological StudiesInstitute of Neurology, University College LondonLondonUK
| | - Thomas Foltynie
- Department of Clinical and Movement NeurosciencesInstitute of NeurologyQueen Square, University College London, LondonUK
- National Hospital for Neurology and NeurosurgeryLondonUK
| | - Gavin Giovannoni
- Blizard InstituteQueen Mary University London, Barts and the London School of Medicine and DentistryLondonUK
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Andrew J. Lees
- Department of Clinical and Movement NeurosciencesInstitute of NeurologyQueen Square, University College London, LondonUK
- Reta Lila Weston Institute of Neurological StudiesInstitute of Neurology, University College LondonLondonUK
| | - Alastair J. Noyce
- Department of Clinical and Movement NeurosciencesInstitute of NeurologyQueen Square, University College London, LondonUK
- Reta Lila Weston Institute of Neurological StudiesInstitute of Neurology, University College LondonLondonUK
- Blizard InstituteQueen Mary University London, Barts and the London School of Medicine and DentistryLondonUK
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21
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Heldman DA, Urrea-Mendoza E, Lovera LC, Schmerler DA, Garcia X, Mohammad ME, McFarlane MCU, Giuffrida JP, Espay AJ, Fernandez HH. App-Based Bradykinesia Tasks for Clinic and Home Assessment in Parkinson's Disease: Reliability and Responsiveness. JOURNAL OF PARKINSONS DISEASE 2018; 7:741-747. [PMID: 28922169 DOI: 10.3233/jpd-171159] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Clinical rating of bradykinesia in Parkinson disease (PD) is challenging as it must combine several movement features into a single score. Additionally, in-clinic assessment cannot capture fluctuations throughout the day. OBJECTIVE To evaluate the reliability and responsiveness of a motion sensor-based tablet app for objective bradykinesia assessment in clinic and at home as compared to clinical ratings. METHODS Thirty-two PD patients treated with subthalamic deep brain stimulation (DBS) were outfitted with a motion sensor on the index finger of the more affected hand to perform two repetitions of finger-tapping, hand opening-closing, and arm pronation-supination tasks with DBS on and 10, 20, and 30 minutes after turning DBS off. Tasks were videotaped for blinded clinician rating using the Modified Bradykinesia Rating Scale (MBRS). Participants were then sent home with an app-based system to perform two repetitions of the same tasks six times per day spaced two hours apart, three days per week, for two weeks. Intraclass correlation (ICC) and minimal detectable change (MDC) were calculated. RESULTS As the effects of DBS wore off, motion sensors detected worsening of amplitude sooner than did clinician-rated MBRS for all three tasks. ICCs were significantly higher and MDCs were significantly lower for motion sensors in the clinic and at home than for clinician ratings (p < 0.01). CONCLUSIONS The tablet-based app demonstrated higher reliability and responsiveness in capturing bradykinesia-related tasks in the clinic and at home than did clinician ratings. This tool may enhance the assessment of novel therapies.
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Affiliation(s)
| | - Enrique Urrea-Mendoza
- Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA.,Division of Neurology, Greenville Health System, University of South Carolina School of Medicine-Greenville, Greenville, SC, USA
| | - Lilia C Lovera
- Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - David A Schmerler
- Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Xiomara Garcia
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Mohammad E Mohammad
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurology, Cairo University, Egypt
| | | | | | - Alberto J Espay
- Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Hubert H Fernandez
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
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22
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Abstract
PURPOSE OF REVIEW Advances in technology have expanded telemedicine opportunities covering medical practice, research, and education. This is of particular importance in movement disorders (MDs), where the combination of disease progression, mobility limitations, and the sparse distribution of MD specialists increase the difficulty to access. In this review, we discuss the prospects, challenges, and strategies for telemedicine in MDs. RECENT FINDINGS Telemedicine for MDs has been mainly evaluated in Parkinson's disease (PD) and compared to in-office care is cost-effective with similar clinical care, despite the barriers to engagement. However, particular groups including pediatric patients, rare MDs, and the use of telemedicine in underserved areas need further research. Interdisciplinary telemedicine and tele-education for MDs are feasible, provide similar care, and reduce travel costs and travel time compared to in-person visits. These benefits have been mainly demonstrated for PD but serve as a model for further validation in other movement disorders.
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23
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FitzGerald JJ, Lu Z, Jareonsettasin P, Antoniades CA. Quantifying Motor Impairment in Movement Disorders. Front Neurosci 2018; 12:202. [PMID: 29695949 PMCID: PMC5904266 DOI: 10.3389/fnins.2018.00202] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 03/14/2018] [Indexed: 02/05/2023] Open
Abstract
Until recently the assessment of many movement disorders has relied on clinical rating scales that despite careful design are inherently subjective and non-linear. This makes accurate and truly observer-independent quantification difficult and limits the use of sensitive parametric statistical methods. At last, devices capable of measuring neurological problems quantitatively are becoming readily available. Examples include the use of oculometers to measure eye movements and accelerometers to measure tremor. Many applications are being developed for use on smartphones. The benefits include not just more accurate disease quantification, but also consistency of data for longitudinal studies, accurate stratification of patients for entry into trials, and the possibility of automated data capture for remote follow-up. In this mini review, we will look at movement disorders with a particular focus on Parkinson's disease, describe some of the limitations of existing clinical evaluation tools, and illustrate the ways in which objective metrics have already been successful.
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Affiliation(s)
- James J FitzGerald
- NeuroMetrology Lab, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Zhongjiao Lu
- NeuroMetrology Lab, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Department of Neurology, West China Hospital of Medicine, Sichuan University, Chengdu, China
| | - Prem Jareonsettasin
- NeuroMetrology Lab, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Exeter College, University of Oxford, Oxford, United Kingdom
| | - Chrystalina A Antoniades
- NeuroMetrology Lab, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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Hasan H, Athauda DS, Foltynie T, Noyce AJ. Technologies Assessing Limb Bradykinesia in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2017; 7:65-77. [PMID: 28222539 PMCID: PMC5302048 DOI: 10.3233/jpd-160878] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: The MDS-UPDRS (Movement Disorders Society – Unified Parkinson’s Disease Rating Scale) is the most widely used scale for rating impairment in PD. Subscores measuring bradykinesia have low reliability that can be subject to rater variability. Novel technological tools can be used to overcome such issues. Objective: To systematically explore and describe the available technologies for measuring limb bradykinesia in PD that were published between 2006 and 2016. Methods: A systematic literature search using PubMed (MEDLINE), IEEE Xplore, Web of Science, Scopus and Engineering Village (Compendex and Inspec) databases was performed to identify relevant technologies published until 18 October 2016. Results: 47 technologies assessing bradykinesia in PD were identified, 17 of which offered home and clinic-based assessment whilst 30 provided clinic-based assessment only. Of the eligible studies, 7 were validated in a PD patient population only, whilst 40 were tested in both PD and healthy control groups. 19 of the 47 technologies assessed bradykinesia only, whereas 28 assessed other parkinsonian features as well. 33 technologies have been described in additional PD-related studies, whereas 14 are not known to have been tested beyond the pilot phase. Conclusion: Technology based tools offer advantages including objective motor assessment and home monitoring of symptoms, and can be used to assess response to intervention in clinical trials or routine care. This review provides an up-to-date repository and synthesis of the current literature regarding technology used for assessing limb bradykinesia in PD. The review also discusses the current trends with regards to technology and discusses future directions in development.
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Affiliation(s)
- Hasan Hasan
- UCL Institute of Neurology, Queen Square, London, UK
| | - Dilan S Athauda
- UCL Institute of Neurology, Queen Square, London, UK.,Sobell Department of Motor Neuroscience and Movement Disorders, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Thomas Foltynie
- UCL Institute of Neurology, Queen Square, London, UK.,Sobell Department of Motor Neuroscience and Movement Disorders, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Alastair J Noyce
- UCL Institute of Neurology, Queen Square, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, UK.,Reta Lila Weston Institute of Neurological studies, UCL Institute of Neurology, London, UK
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25
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Schneider RB, Biglan KM. The promise of telemedicine for chronic neurological disorders: the example of Parkinson's disease. Lancet Neurol 2017; 16:541-551. [DOI: 10.1016/s1474-4422(17)30167-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 04/02/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
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