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Salaorni F, Bonardi G, Schena F, Tinazzi M, Gandolfi M. Wearable devices for gait and posture monitoring via telemedicine in people with movement disorders and multiple sclerosis: a systematic review. Expert Rev Med Devices 2024; 21:121-140. [PMID: 38124300 DOI: 10.1080/17434440.2023.2298342] [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: 03/15/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Wearable devices and telemedicine are increasingly used to track health-related parameters across patient populations. Since gait and postural control deficits contribute to mobility deficits in persons with movement disorders and multiple sclerosis, we thought it interesting to evaluate devices in telemedicine for gait and posture monitoring in such patients. METHODS For this systematic review, we searched the electronic databases MEDLINE (PubMed), SCOPUS, Cochrane Library, and SPORTDiscus. Of the 452 records retrieved, 12 met the inclusion/exclusion criteria. Data about (1) study characteristics and clinical aspects, (2) technical, and (3) telemonitoring and teleconsulting were retrieved, The studies were quality assessed. RESULTS All studies involved patients with Parkinson's disease; most used triaxial accelerometers for general assessment (n = 4), assessment of motor fluctuation (n = 3), falls (n = 2), and turning (n = 3). Sensor placement and count varied widely across studies. Nine used lab-validated algorithms for data analysis. Only one discussed synchronous patient feedback and asynchronous teleconsultation. CONCLUSIONS Wearable devices enable real-world patient monitoring and suggest biomarkers for symptoms and behaviors related to underlying gait disorders. thus enriching clinical assessment and personalized treatment plans. As digital healthcare evolves, further research is needed to enhance device accuracy, assess user acceptability, and integrate these tools into telemedicine infrastructure. PROSPERO REGISTRATION CRD42022355460.
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Affiliation(s)
- Francesca Salaorni
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giulia Bonardi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Verona, Italy
- Neurorehabilitation Unit - Azienda Ospedaliera Universitaria Integrata, Verona
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Dotov D, Cochen de Cock V, Driss V, Bardy B, Dalla Bella S. Coordination Rigidity in the Gait, Posture, and Speech of Persons with Parkinson's Disease. J Mot Behav 2023; 55:394-409. [PMID: 37257844 DOI: 10.1080/00222895.2023.2217100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/04/2023] [Accepted: 05/18/2023] [Indexed: 06/02/2023]
Abstract
Parkinson's disease (PD) is associated with reduced coordination abilities. These can result either in random or rigid patterns of movement. The latter, described here as coordination rigidity (CR), have been studied less often. We explored whether CR was present in gait, quiet stance, and speech-tasks involving coordination among multiple joints and muscles. Kinematic and voice recordings were used to compute measures describing the dynamics of systems with multiple degrees of freedom and nonlinear interactions. After clinical evaluation, patients with moderate stage PD were compared against matched healthy participants. In the PD group, gait dynamics was associated with decreased dynamic divergence-lower instability-in the vertical axis. Postural fluctuations were associated with increased regularity in the anterior-posterior axis, and voice dynamics with increased predictability, all consistent with CR. The clinical relevance of CR was confirmed by showing that some of those features contribute to disease classification with supervised machine learning (82/81/85% accuracy/sensitivity/specificity).
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Affiliation(s)
- Dobromir Dotov
- Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Canada
| | - Valérie Cochen de Cock
- Clinique Beau Soleil and CHU, Hôpital St Eloi, Montpellier, France
- EuroMov Digital Health in Motion, Université de Montpellier, Montpellier, France
| | - Valérie Driss
- Clinical Investigation Centre (CIC) 1411, University Hospital of Montpellier & Inserm, Montpellier, France
| | - Benoît Bardy
- EuroMov Digital Health in Motion, Université de Montpellier, Montpellier, France
- Institut Universitaire de France (IUF), Paris, France
| | - Simone Dalla Bella
- EuroMov Digital Health in Motion, Université de Montpellier, Montpellier, France
- International Laboratory for Brain, Music, and Sound Research (BRAMS) and Department of Psychology, University of Montreal, Montreal, Canada
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3
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Laar A, Silva de Lima AL, Maas BR, Bloem BR, de Vries NM. Successful implementation of technology in the management of Parkinson's disease: Barriers and facilitators. Clin Park Relat Disord 2023; 8:100188. [PMID: 36864905 PMCID: PMC9972397 DOI: 10.1016/j.prdoa.2023.100188] [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: 11/23/2022] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Background Parkinson's disease (PD) is a progressive neurodegenerative disease with a fast increasing prevalence. Several pharmacological and non-pharmacological interventions are available to alleviate symptoms. Technology can be used to improve the efficiency, accessibility and feasibility of these treatments. Although many technologies are available, only few are actually implemented in daily clinical practice. Aim Here, we study the barriers and facilitators, as experienced by patients, caregivers and/or healthcare providers, to successful implement technology for PD management. Methods We performed a systematic literature search in the PubMed and Embase databases until June 2022. Two independent raters screened the titles, abstracts and full texts on: 1) people with PD; 2) using technology for disease management; 3) qualitative research methods providing patients', caregivers and/or healthcare providers' perspective, and; 4) full text available in English or Dutch. Case studies, reviews and conference abstracts were excluded. Results We found 5420 unique articles of which 34 were included in this study. Five categories were made: cueing (n = 3), exergaming (n = 3), remote monitoring using wearable sensors (n = 10), telerehabilitation (n = 8) and remote consultation (n = 10). The main barriers reported across categories were unfamiliarity with technology, high costs, technical issues and (motor) symptoms hampering the use of some technologies. Facilitators included good usability, experiencing beneficial effects and feeling safe whilst using the technology. Conclusion Although only few articles presented a qualitative evaluation of technologies, we found some important barriers and facilitators that may help to bridge the gap between the fast developing technological world and actual implementation in day-to-day living with PD.
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Affiliation(s)
- Arjonne Laar
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Reinier Postlaan 4, 6525 GC Nijmegen, the Netherlands,Center of Expertise for Parkinson & Movement Disorders, Nijmegen, Reinier Postlaan 4, 6525 GC Nijmegen, the Netherlands
| | - Ana Ligia Silva de Lima
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Reinier Postlaan 4, 6525 GC Nijmegen, the Netherlands,Center of Expertise for Parkinson & Movement Disorders, Nijmegen, Reinier Postlaan 4, 6525 GC Nijmegen, the Netherlands
| | - Bart R. Maas
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Reinier Postlaan 4, 6525 GC Nijmegen, the Netherlands,Center of Expertise for Parkinson & Movement Disorders, Nijmegen, Reinier Postlaan 4, 6525 GC Nijmegen, the Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Reinier Postlaan 4, 6525 GC Nijmegen, the Netherlands,Center of Expertise for Parkinson & Movement Disorders, Nijmegen, Reinier Postlaan 4, 6525 GC Nijmegen, the Netherlands
| | - Nienke M. de Vries
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Reinier Postlaan 4, 6525 GC Nijmegen, the Netherlands,Center of Expertise for Parkinson & Movement Disorders, Nijmegen, Reinier Postlaan 4, 6525 GC Nijmegen, the Netherlands,Corresponding author.
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Utilizing Data from Wearable Technologies in the Era of Telemedicine to Assess Patient Function and Outcomes in Neurosurgery: Systematic Review and Time-Trend Analysis of the Literature. World Neurosurg 2022; 166:90-119. [PMID: 35843580 DOI: 10.1016/j.wneu.2022.07.036] [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: 05/24/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic has driven the increased use of telemedicine and the adoption of wearable technology in neurosurgery. We reviewed studies exploring the use of wearables on neurosurgical patients and analyzed wearables' scientific production trends. METHODS The review encompassed PubMed, EMBASE, Web of Science, and Cochrane Library. Bibliometric analysis was performed using citation data of the included studies through Elsevier's Scopus database. Linear regression was utilized to understand scientific production trends. All analyses were performed on R 4.1.2. RESULTS We identified 979 studies. After screening, 49 studies were included. Most studies evaluated wearable technology use for patients with spinal pathology (n = 31). The studies were published over a 24-year period (1998-2021). Forty-seven studies involved wearable device use relevant to telemedicine. Bibliometric analysis revealed a compounded annual growth rate of 7.3%, adjusted for inflation, in annual scientific production from 1998 to 2021 (coefficient=1.3; 95% Confidence Interval = [0.7, 1.9], P < 0.01). Scientific production steadily increased in 2014 (n = 1) and peaked from 2019 (n = 8) to 2021 (n = 13) in correlation with the COVID-19 pandemic. Publications spanned 34 journals, averaged 24.4 citations per article, 3.0 citations per year per article, and 8.3 authors per article. CONCLUSION Wearables can provide clinicians with objective measurements to determine patient function and quality of life. The rise in articles related to wearables in neurosurgery demonstrates the increased adoption of wearable devices during the COVID-19 pandemic. Wearable devices appear to be a key component in this era of telemedicine and their positive utility and practicality are increasingly being realized in neurosurgery.
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Sahandi Far M, Stolz M, Fischer JM, Eickhoff SB, Dukart J. JTrack: A Digital Biomarker Platform for Remote Monitoring of Daily-Life Behaviour in Health and Disease. Front Public Health 2021; 9:763621. [PMID: 34869177 PMCID: PMC8639579 DOI: 10.3389/fpubh.2021.763621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Health-related data being collected by smartphones offer a promising complementary approach to in-clinic assessments. Despite recent contributions, the trade-off between privacy, optimization, stability and research-grade data quality is not well met by existing platforms. Here we introduce the JTrack platform as a secure, reliable and extendable open-source solution for remote monitoring in daily-life and digital-phenotyping. JTrack is an open-source (released under open-source Apache 2.0 licenses) platform for remote assessment of digital biomarkers (DB) in neurological, psychiatric and other indications. JTrack is developed and maintained to comply with security, privacy and the General Data Protection Regulation (GDPR) requirements. A wide range of anonymized measurements from motion-sensors, social and physical activities and geolocation information can be collected in either active or passive modes by using JTrack Android-based smartphone application. JTrack also provides an online study management dashboard to monitor data collection across studies. To facilitate scaling, reproducibility, data management and sharing we integrated DataLad as a data management infrastructure. Smartphone-based Digital Biomarker data may provide valuable insight into daily-life behaviour in health and disease. As illustrated using sample data, JTrack provides as an easy and reliable open-source solution for collection of such information.
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Affiliation(s)
- Mehran Sahandi Far
- Research Centre Jülich, Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Jülich, Germany.,Medical Faculty, Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Michael Stolz
- Research Centre Jülich, Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Jülich, Germany
| | - Jona M Fischer
- Research Centre Jülich, Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Jülich, Germany
| | - Simon B Eickhoff
- Research Centre Jülich, Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Jülich, Germany.,Medical Faculty, Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Juergen Dukart
- Research Centre Jülich, Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Jülich, Germany.,Medical Faculty, Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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González-Alonso J, Oviedo-Pastor D, Aguado HJ, Díaz-Pernas FJ, González-Ortega D, Martínez-Zarzuela M. Custom IMU-Based Wearable System for Robust 2.4 GHz Wireless Human Body Parts Orientation Tracking and 3D Movement Visualization on an Avatar. SENSORS 2021; 21:s21196642. [PMID: 34640961 PMCID: PMC8512038 DOI: 10.3390/s21196642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 02/06/2023]
Abstract
Recent studies confirm the applicability of Inertial Measurement Unit (IMU)-based systems for human motion analysis. Notwithstanding, high-end IMU-based commercial solutions are yet too expensive and complex to democratize their use among a wide range of potential users. Less featured entry-level commercial solutions are being introduced in the market, trying to fill this gap, but still present some limitations that need to be overcome. At the same time, there is a growing number of scientific papers using not commercial, but custom do-it-yourself IMU-based systems in medical and sports applications. Even though these solutions can help to popularize the use of this technology, they have more limited features and the description on how to design and build them from scratch is yet too scarce in the literature. The aim of this work is two-fold: (1) Proving the feasibility of building an affordable custom solution aimed at simultaneous multiple body parts orientation tracking; while providing a detailed bottom-up description of the required hardware, tools, and mathematical operations to estimate and represent 3D movement in real-time. (2) Showing how the introduction of a custom 2.4 GHz communication protocol including a channel hopping strategy can address some of the current communication limitations of entry-level commercial solutions. The proposed system can be used for wireless real-time human body parts orientation tracking with up to 10 custom sensors, at least at 50 Hz. In addition, it provides a more reliable motion data acquisition in Bluetooth and Wi-Fi crowded environments, where the use of entry-level commercial solutions might be unfeasible. This system can be used as a groundwork for developing affordable human motion analysis solutions that do not require an accurate kinematic analysis.
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Affiliation(s)
- Javier González-Alonso
- Grupo de Telemática e Imagen, Universidad de Valladolid, 47011 Valladolid, Spain; (D.O.-P.); (F.J.D.-P.); (D.G.-O.)
- Correspondence: (J.G.-A.); (M.M.-Z.)
| | - David Oviedo-Pastor
- Grupo de Telemática e Imagen, Universidad de Valladolid, 47011 Valladolid, Spain; (D.O.-P.); (F.J.D.-P.); (D.G.-O.)
| | - Héctor J. Aguado
- Unidad de Traumatología, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain;
| | - Francisco J. Díaz-Pernas
- Grupo de Telemática e Imagen, Universidad de Valladolid, 47011 Valladolid, Spain; (D.O.-P.); (F.J.D.-P.); (D.G.-O.)
| | - David González-Ortega
- Grupo de Telemática e Imagen, Universidad de Valladolid, 47011 Valladolid, Spain; (D.O.-P.); (F.J.D.-P.); (D.G.-O.)
| | - Mario Martínez-Zarzuela
- Grupo de Telemática e Imagen, Universidad de Valladolid, 47011 Valladolid, Spain; (D.O.-P.); (F.J.D.-P.); (D.G.-O.)
- Correspondence: (J.G.-A.); (M.M.-Z.)
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Keogh A, Argent R, Anderson A, Caulfield B, Johnston W. Assessing the usability of wearable devices to measure gait and physical activity in chronic conditions: a systematic review. J Neuroeng Rehabil 2021; 18:138. [PMID: 34526053 PMCID: PMC8444467 DOI: 10.1186/s12984-021-00931-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/01/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The World Health Organisation's global strategy for digital health emphasises the importance of patient involvement. Understanding the usability and acceptability of wearable devices is a core component of this. However, usability assessments to date have focused predominantly on healthy adults. There is a need to understand the patient perspective of wearable devices in participants with chronic health conditions. METHODS A systematic review was conducted to identify any study design that included a usability assessment of wearable devices to measure mobility, through gait and physical activity, within five cohorts with chronic conditions (Parkinson's disease [PD], multiple sclerosis [MS], congestive heart failure, [CHF], chronic obstructive pulmonary disorder [COPD], and proximal femoral fracture [PFF]). RESULTS Thirty-seven studies were identified. Substantial heterogeneity in the quality of reporting, the methods used to assess usability, the devices used, and the aims of the studies precluded any meaningful comparisons. Questionnaires were used in the majority of studies (70.3%; n = 26) with a reliance on intervention specific measures (n = 16; 61.5%). For those who used interviews (n = 17; 45.9%), no topic guides were provided, while methods of analysis were not reported in over a third of studies (n = 6; 35.3%). CONCLUSION Usability of wearable devices is a poorly measured and reported variable in chronic health conditions. Although the heterogeneity in how these devices are implemented implies acceptance, the patient voice should not be assumed. In the absence of being able to make specific usability conclusions, the results of this review instead recommends that future research needs to: (1) Conduct usability assessments as standard, irrespective of the cohort under investigation or the type of study undertaken. (2) Adhere to basic reporting standards (e.g. COREQ) including the basic details of the study. Full copies of any questionnaires and interview guides should be supplied through supplemental files. (3) Utilise mixed methods research to gather a more comprehensive understanding of usability than either qualitative or quantitative research alone will provide. (4) Use previously validated questionnaires alongside any intervention specific measures.
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Affiliation(s)
- Alison Keogh
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland. .,Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland.
| | - Rob Argent
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | | | - Brian Caulfield
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - William Johnston
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
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He X, Wang R, Wang T. The role of immune cells in the course of Parkinson's disease. IBRAIN 2021; 7:146-151. [PMID: 37786903 PMCID: PMC10529156 DOI: 10.1002/j.2769-2795.2021.tb00077.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/13/2021] [Accepted: 06/16/2021] [Indexed: 02/05/2023]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disease in the central nervous system. The pathological manifestations mainly consist of α-synuclein accumulation, degeneration and death of dopaminergic neurons, and insufficient dopamine secretion. There are many pathophysiological mechanisms leading to these pathological changes. The role of autoimmunity in Parkinson's disease is one of the academic hotspots in recent years. Many types of immune cells actively participate in the pathogenesis of Parkinson's disease, such as dendritic cells, microglia, T lymphocytes, B lymphocytes and natural killer (NK) cells, which lead to abnormal immune response in Parkinson's disease patients. Therefore, this paper focuses on reviewing the research progress of immune cells in Parkinson's disease.
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Affiliation(s)
- Xiu‐Ying He
- Institute of Neurological DiseaseDepartment of AnesthesiologyTranslational Neuroscience Center, West China Hospital, Sichuan UniversityChengduSichuanChina
| | - Ru‐Rong Wang
- Institute of Neurological DiseaseDepartment of AnesthesiologyTranslational Neuroscience Center, West China Hospital, Sichuan UniversityChengduSichuanChina
| | - Ting‐Hua Wang
- Institute of Neurological DiseaseDepartment of AnesthesiologyTranslational Neuroscience Center, West China Hospital, Sichuan UniversityChengduSichuanChina
- Institute of NeuroscienceLaboratory Zoology DepartmentKunming Medical UniversityKunmingYunnanChina
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Agurto C, Heisig S, Abrami A, Ho BK, Caggiano V. Parkinson's disease medication state and severity assessment based on coordination during walking. PLoS One 2021; 16:e0244842. [PMID: 33596202 PMCID: PMC7888646 DOI: 10.1371/journal.pone.0244842] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 12/18/2020] [Indexed: 12/31/2022] Open
Abstract
Walking is a complex motor function requiring coordination of all body parts. Parkinson's disease (PD) motor signs such as rigidity, bradykinesia, and impaired balance affect movements including walking. Here, we propose a computational method to objectively assess the effects of Parkinson's disease pathology on coordination between trunk, shoulder and limbs during the gait cycle to assess medication state and disease severity. Movements during a scripted walking task were extracted from wearable devices placed at six different body locations in participants with PD and healthy participants. Three-axis accelerometer data from each device was synchronized at the beginning of either left or right steps. Canonical templates of movements were then extracted from each body location. Movements projected on those templates created a reduced dimensionality space, where complex movements are represented as discrete values. These projections enabled us to relate the body coordination in people with PD to disease severity. Our results show that the velocity profile of the right wrist and right foot during right steps correlated with the participant's total score on the gold standard Unified Parkinson's Disease Rating Scale (UPRDS) with an r2 up to 0.46. Left-right symmetry of feet, trunk and wrists also correlated with the total UPDRS score with an r2 up to 0.3. In addition, we demonstrate that binary dopamine replacement therapy medication states (self-reported 'ON' or 'OFF') can be discriminated in PD participants. In conclusion, we showed that during walking, the movement of body parts individually and in coordination with one another changes in predictable ways that vary with disease severity and medication state.
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Affiliation(s)
- Carla Agurto
- IBM Research - Healthcare and Life Sciences, Yorktown Heights, Yorktown, New York, United States of America
| | - Stephen Heisig
- IBM Research - Healthcare and Life Sciences, Yorktown Heights, Yorktown, New York, United States of America
| | - Avner Abrami
- IBM Research - Healthcare and Life Sciences, Yorktown Heights, Yorktown, New York, United States of America
| | - Bryan K. Ho
- Department of Neurology, Boston, Massachusetts, United States of America
| | - Vittorio Caggiano
- IBM Research - Healthcare and Life Sciences, Yorktown Heights, Yorktown, New York, United States of America
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Sica M, Tedesco S, Crowe C, Kenny L, Moore K, Timmons S, Barton J, O’Flynn B, Komaris DS. Continuous home monitoring of Parkinson's disease using inertial sensors: A systematic review. PLoS One 2021; 16:e0246528. [PMID: 33539481 PMCID: PMC7861548 DOI: 10.1371/journal.pone.0246528] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/20/2021] [Indexed: 02/01/2023] Open
Abstract
Parkinson’s disease (PD) is a progressive neurological disorder of the central nervous system that deteriorates motor functions, while it is also accompanied by a large diversity of non-motor symptoms such as cognitive impairment and mood changes, hallucinations, and sleep disturbance. Parkinsonism is evaluated during clinical examinations and appropriate medical treatments are directed towards alleviating symptoms. Tri-axial accelerometers, gyroscopes, and magnetometers could be adopted to support clinicians in the decision-making process by objectively quantifying the patient’s condition. In this context, at-home data collections aim to capture motor function during daily living and unobstructedly assess the patients’ status and the disease’s symptoms for prolonged time periods. This review aims to collate existing literature on PD monitoring using inertial sensors while it focuses on papers with at least one free-living data capture unsupervised either directly or via videotapes. Twenty-four papers were selected at the end of the process: fourteen investigated gait impairments, eight of which focused on walking, three on turning, two on falls, and one on physical activity; ten articles on the other hand examined symptoms, including bradykinesia, tremor, dyskinesia, and motor state fluctuations in the on/off phenomenon. In summary, inertial sensors are capable of gathering data over a long period of time and have the potential to facilitate the monitoring of people with Parkinson’s, providing relevant information about their motor status. Concerning gait impairments, kinematic parameters (such as duration of gait cycle, step length, and velocity) were typically used to discern PD from healthy subjects, whereas for symptoms’ assessment, researchers were capable of achieving accuracies of over 90% in a free-living environment. Further investigations should be focused on the development of ad-hoc hardware and software capable of providing real-time feedback to clinicians and patients. In addition, features such as the wearability of the system and user comfort, set-up process, and instructions for use, need to be strongly considered in the development of wearable sensors for PD monitoring.
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Affiliation(s)
- Marco Sica
- Tyndall National Institute, University College Cork, Cork, Ireland
- * E-mail:
| | | | - Colum Crowe
- Tyndall National Institute, University College Cork, Cork, Ireland
| | - Lorna Kenny
- Centre for Gerontology and Rehabilitation, University College Cork, Cork, Ireland
| | - Kevin Moore
- Centre for Gerontology and Rehabilitation, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, University College Cork, Cork, Ireland
| | - John Barton
- Tyndall National Institute, University College Cork, Cork, Ireland
| | - Brendan O’Flynn
- Tyndall National Institute, University College Cork, Cork, Ireland
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Powers R, Etezadi-Amoli M, Arnold EM, Kianian S, Mance I, Gibiansky M, Trietsch D, Alvarado AS, Kretlow JD, Herrington TM, Brillman S, Huang N, Lin PT, Pham HA, Ullal AV. Smartwatch inertial sensors continuously monitor real-world motor fluctuations in Parkinson's disease. Sci Transl Med 2021; 13:13/579/eabd7865. [PMID: 33536284 DOI: 10.1126/scitranslmed.abd7865] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/11/2021] [Indexed: 12/19/2022]
Abstract
Longitudinal, remote monitoring of motor symptoms in Parkinson's disease (PD) could enable more precise treatment decisions. We developed the Motor fluctuations Monitor for Parkinson's Disease (MM4PD), an ambulatory monitoring system that used smartwatch inertial sensors to continuously track fluctuations in resting tremor and dyskinesia. We designed and validated MM4PD in 343 participants with PD, including a longitudinal study of up to 6 months in a 225-subject cohort. MM4PD measurements correlated to clinical evaluations of tremor severity (ρ = 0.80) and mapped to expert ratings of dyskinesia presence (P < 0.001) during in-clinic tasks. MM4PD captured symptom changes in response to treatment that matched the clinician's expectations in 94% of evaluated subjects. In the remaining 6% of cases, symptom data from MM4PD identified opportunities to make improvements in pharmacologic strategy. These results demonstrate the promise of MM4PD as a tool to support patient-clinician communication, medication titration, and clinical trial design.
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Affiliation(s)
| | | | | | - Sara Kianian
- Apple Inc., Cupertino, CA 95014, USA.,Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | | | | | | | | | | | - Todd M Herrington
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.,Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Salima Brillman
- Parkinson's Disease and Movement Center of Silicon Valley, Menlo Park, CA 94025, USA
| | - Nengchun Huang
- Silicon Valley Parkinson's Center, Los Gatos, CA 95032, USA
| | - Peter T Lin
- Silicon Valley Parkinson's Center, Los Gatos, CA 95032, USA
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12
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Santos García D, López Ariztegui N, Cubo E, Vinagre Aragón A, García-Ramos R, Borrué C, Fernández-Pajarín G, Caballol N, Cabo I, Barrios-López JM, Hernández Vara J, Ávila Rivera MA, Gasca-Salas C, Escalante S, Manrique de Lara P, Pérez Noguera R, Álvarez Sauco M, Sierra M, Monje MHG, Sánchez Ferro A, Novo Ponte S, Alonso-Frech F, Macías-García D, Legarda I, Rojo A, Álvarez Fernández I, Buongiorno MT, Pastor P, García Ruíz P. Clinical utility of a personalized and long-term monitoring device for Parkinson's disease in a real clinical practice setting: An expert opinion survey on STAT-ON™. Neurologia 2020; 38:S0213-4853(20)30339-X. [PMID: 33358530 DOI: 10.1016/j.nrl.2020.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND STAT-ON™ is an objective tool that registers ON-OFF fluctuations making possible to know the state of the patient at every moment of the day in normal life. Our aim was to analyze the opinion of different Parkinson's disease experts about the STAT-ON™ tool after using the device in a real clinical practice setting (RCPS). METHODS STAT-ON™ was provided by the Company Sense4Care to Spanish neurologists for using it in a RCPS. Each neurologist had the device for at least three months and could use it in PD patients at his/her own discretion. In February 2020, a survey with 30 questions was sent to all participants. RESULTS Two thirds of neurologists (53.8% females; mean age 44.9±9 years old) worked in a Movement Disorders Unit, the average experience in PD was 16±6.9 years, and 40.7% of them had previously used other devices. A total of 119 evaluations were performed in 114 patients (range 2-9 by neurologist; mean 4.5±2.3). STAT-ON™ was considered "quite" to "very useful" by 74% of the neurologists with an overall opinion of 6.9±1.7 (0, worst; 10, best). STAT-ON™ was considered better than diaries by 70.3% of neurologists and a useful tool for the identification of patients with advanced PD by 81.5%. Proper identification of freezing of gait episodes and falls were frequent limitations reported. CONCLUSION STAT-ON™ could be a useful device for using in PD patients in clinical practice.
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Affiliation(s)
- D Santos García
- CHUAC, Complejo Hospitalario Universitario de A Coruña, Spain.
| | | | - E Cubo
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | | | | | - C Borrué
- Hospital Infanta Sofía, Madrid, Spain
| | | | - N Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | - I Cabo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | | | - M A Ávila Rivera
- Consorci Sanitari Integral, Hospital General de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - S Escalante
- Hospital de Tortosa Verge de la Cinta (HTVC), Tortosa, Tarragona, Spain
| | | | | | | | - M Sierra
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - M H G Monje
- CINAC, Hospital Puerta del Sur, Madrid, Spain
| | | | | | | | | | - I Legarda
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - A Rojo
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | - M T Buongiorno
- Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
| | - P Pastor
- Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain
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13
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A Multi-Sensor Wearable System for the Quantitative Assessment of Parkinson's Disease. SENSORS 2020; 20:s20216146. [PMID: 33137953 PMCID: PMC7662222 DOI: 10.3390/s20216146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022]
Abstract
The quantitative characterization of movement disorders and their related neurophysiological signals is important for the management of Parkinson’s disease (PD). The aim of this study is to develop a novel wearable system enabling the simultaneous measurement of both motion and other neurophysiological signals in PD patients. We designed a wearable system that consists of five motion sensors and three electrophysiology sensors to measure the motion signals of the body, electroencephalogram, electrocardiogram, and electromyography, respectively. The data captured by the sensors are transferred wirelessly in real time, and the outcomes are analyzed and uploaded to the cloud-based server automatically. We completed pilot studies to (1) test its validity by comparing outcomes to the commercialized systems, and (2) evaluate the deep brain stimulation (DBS) treatment effects in seven PD patients. Our results showed: (1) the motion and neurophysiological signals measured by this wearable system were strongly correlated with those measured by the commercialized systems (r > 0.94, p < 0.001); and (2) by completing the clinical supination and pronation frequency test, the frequency of motion as measured by this system increased when DBS was turned on. The results demonstrated that this multi-sensor wearable system can be utilized to quantitatively characterize and monitor motion and neurophysiological PD.
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14
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Gaidica M, Dantzer B. Quantifying the Autonomic Response to Stressors-One Way to Expand the Definition of "Stress" in Animals. Integr Comp Biol 2020; 60:113-125. [PMID: 32186720 DOI: 10.1093/icb/icaa009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Quantifying how whole organisms respond to challenges in the external and internal environment ("stressors") is difficult. To date, physiological ecologists have mostly used measures of glucocorticoids (GCs) to assess the impact of stressors on animals. This is of course too simplistic as Hans Seyle himself characterized the response of organisms to "noxious stimuli" using multiple physiological responses. Possible solutions include increasing the number of biomarkers to more accurately characterize the "stress state" of animal or just measuring different biomarkers to more accurately characterize the degree of acute or chronic stressors an animal is experiencing. We focus on the latter and discuss how heart rate (HR) and heart rate variability (HRV) may be better predictors of the degree of activation of the sympathetic-adrenal-medullary system and complement or even replace measures of GCs as indicators of animal health, welfare, fitness, or their level of exposure to stressors. The miniaturization of biological sensor technology ("bio-sensors" or "bio-loggers") presents an opportunity to reassess measures of stress state and develop new approaches. We describe some modern approaches to gathering these HR and HRV data in free-living animals with the aim that heart dynamics will be more integrated with measures of GCs as bio-markers of stress state and predictors of fitness in free-living animals.
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Affiliation(s)
- Matt Gaidica
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Ben Dantzer
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA.,Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI, USA
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15
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Aharonson V, Seedat N, Israeli-Korn S, Hassin-Baer S, Postema M, Yahalom G. Automated Stage Discrimination of Parkinson’s Disease. BIO INTEGRATION 2020. [DOI: 10.15212/bioi-2020-0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract Background: Treatment plans for Parkinson’s disease (PD) are based on a disease stage scale, which is generally determined using a manual, observational procedure. Automated, sensor-based discrimination saves labor and costs in clinical settings and
may offer augmented stage determination accuracy. Previous automated devices were either cumbersome or costly and were not suitable for individuals who cannot walk without support.Methods: Since 2017, a device has been available that successfully detects PD and operates for people
who cannot walk without support. In the present study, the suitability of this device for automated discrimination of PD stages was tested. The device consists of a walking frame fitted with sensors to simultaneously support walking and monitor patient gait. Sixty-five PD patients in Hoehn
and Yahr (HY) stages 1 to 4 and 24 healthy controls were subjected to supported Timed Up and Go (TUG) tests, while using the walking frame. The walking trajectory, velocity, acceleration and force were recorded by the device throughout the tests. These physical parameters were converted into
symptomatic spatiotemporal quantities that are conventionally used in PD gait assessment.Results: An analysis of variance (ANOVA) test extended by a confidence interval (CI) analysis indicated statistically significant separability between HY stages for the following spatiotemporal
quantities: TUG time (p < 0.001), straight line walking time (p < 0.001), turning time (p < 0.001), and step count (p < 0.001). A negative correlation was obtained for mean step velocity (p < 0.001) and mean step length (p < 0.001). Moreover, correlations were established
between these, as well as additional spatiotemporal quantities, and disease duration, L-dihydroxyphenylalanine-(L-DOPA) dose, motor fluctuation, dyskinesia and the mobile part of the Unified Parkinson Disease Rating Scale (UPDRS).Conclusions: We have proven that stage discrimination
of PD can be automated, even to patients who cannot support themselves. A similar method might be successfully applied to other gait disorders.
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Affiliation(s)
- Vered Aharonson
- School of Electrical and Information Engineering, University of the Witwatersrand, Johannesburg, South Africa
| | - Nabeel Seedat
- School of Electrical and Information Engineering, University of the Witwatersrand, Johannesburg, South Africa
| | - Simon Israeli-Korn
- The Movement Disorders Institute, Department of Neurology and Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Sharon Hassin-Baer
- The Movement Disorders Institute, Department of Neurology and Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Michiel Postema
- School of Electrical and Information Engineering, University of the Witwatersrand, Johannesburg, South Africa
| | - Gilad Yahalom
- The Movement Disorders Institute, Department of Neurology and Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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16
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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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17
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Asakawa T, Sugiyama K, Nozaki T, Sameshima T, Kobayashi S, Wang L, Hong Z, Chen S, Li C, Namba H. Can the Latest Computerized Technologies Revolutionize Conventional Assessment Tools and Therapies for a Neurological Disease? The Example of Parkinson's Disease. Neurol Med Chir (Tokyo) 2019; 59:69-78. [PMID: 30760657 PMCID: PMC6434424 DOI: 10.2176/nmc.ra.2018-0045] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Dramatic breakthroughs in the treatment and assessment of neurological diseases are lacking. We believe that conventional methods have several limitations. Computerized technologies, including virtual reality, augmented reality, and robot assistant systems, are advancing at a rapid pace. In this study, we used Parkinson's disease (PD) as an example to elucidate how the latest computerized technologies can improve the diagnosis and treatment of neurological diseases. Dopaminergic medication and deep brain stimulation remain the most effective interventions for treating PD. Subjective scales, such as the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr stage, are still the most widely used assessments. Wearable sensors, virtual reality, augmented reality, and robot assistant systems are increasingly being used for evaluation of patients with PD. The use of such computerized technologies can result in safe, objective, real-time behavioral assessments. Our experiences and understanding of PD have led us to believe that such technologies can provide real-time assessment, which will revolutionize the traditional assessment and treatment of PD. New technologies are desired that can revolutionize PD treatment and facilitate real-time adjustment of treatment based on motor fluctuations, such as telediagnosis systems and "smart treatment systems." The use of these technologies will substantially improve both the assessment and the treatment of neurological diseases before next-generation treatments, such as stem cell and genetic therapy, and next-generation assessments, can be clinically practiced, although the current level of artificial intelligence cannot replace the role of clinicians.
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Affiliation(s)
- Tetsuya Asakawa
- Department of Neurosurgery, Hamamatsu University School of Medicine.,Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine
| | - Kenji Sugiyama
- Department of Neurosurgery, Hamamatsu University School of Medicine
| | - Takao Nozaki
- Department of Neurosurgery, Hamamatsu University School of Medicine
| | | | - Susumu Kobayashi
- Department of Neurosurgery, Hamamatsu University School of Medicine
| | - Liang Wang
- Department of Neurology, Huashan Hospital of Fudan University
| | - Zhen Hong
- Department of Neurology, Huashan Hospital of Fudan University
| | - Shujiao Chen
- Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine
| | - Candong Li
- Research Base of Traditional Chinese Medicine Syndrome, Fujian University of Traditional Chinese Medicine
| | - Hiroki Namba
- Department of Neurosurgery, Hamamatsu University School of Medicine
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18
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Son H, Park WS, Kim H. Mobility monitoring using smart technologies for Parkinson’s disease in free-living environment. Collegian 2018. [DOI: 10.1016/j.colegn.2017.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Rovini E, Maremmani C, Cavallo F. Automated Systems Based on Wearable Sensors for the Management of Parkinson's Disease at Home: A Systematic Review. Telemed J E Health 2018; 25:167-183. [PMID: 29969384 DOI: 10.1089/tmj.2018.0035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Parkinson's disease is a common neurodegenerative pathology that significantly influences quality of life (QoL) of people affected. The increasing interest and development in telemedicine services and internet of things technologies aim to implement automated smart systems for remote assistance of patients. The wide variability of Parkinson's disease in the clinical expression, as well as in the symptom progression, seems to address the patients' care toward a personalized therapy. OBJECTIVES This review addresses automated systems based on wearable/portable devices for the remote treatment and management of Parkinson's disease. The idea is to obtain an overview of the telehealth and automated systems currently developed to address the impairments due to the pathology to allow clinicians to improve the quality of care for Parkinson's disease with benefits for patients in QoL. DATA SOURCES The research was conducted within three databases: IEEE Xplore®, Web of Science®, and PubMed Central®, between January 2008 and September 2017. STUDY ELIGIBILITY CRITERIA Accurate exclusion criteria and selection strategy were applied to screen the 173 articles found. RESULTS Ultimately, 55 articles were fully evaluated and included in this review. Divided into three categories, they were automated systems actually tested at home, implemented mobile applications for Parkinson's disease assessment, or described a telehealth system architecture. CONCLUSION This review would provide an exhaustive overview of wearable systems for the remote management and automated assessment of Parkinson's disease, taking into account the reliability and acceptability of the implemented technologies.
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Affiliation(s)
- Erika Rovini
- 1 The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera (PI), Italy
| | - Carlo Maremmani
- 2 U.O. Neurologia, Ospedale delle Apuane (AUSL Toscana Nord Ovest), Massa (MS), Italy
| | - Filippo Cavallo
- 1 The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera (PI), Italy
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20
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Bayés À, Samá A, Prats A, Pérez-López C, Crespo-Maraver M, Moreno JM, Alcaine S, Rodriguez-Molinero A, Mestre B, Quispe P, de Barros AC, Castro R, Costa A, Annicchiarico R, Browne P, Counihan T, Lewy H, Vainstein G, Quinlan LR, Sweeney D, ÓLaighin G, Rovira J, Rodrigue Z-Martin D, Cabestany J. A "HOLTER" for Parkinson's disease: Validation of the ability to detect on-off states using the REMPARK system. Gait Posture 2018; 59:1-6. [PMID: 28963889 DOI: 10.1016/j.gaitpost.2017.09.031] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 09/20/2017] [Accepted: 09/23/2017] [Indexed: 02/02/2023]
Abstract
UNLABELLED The treatment of Parkinson's disease (PD) with levodopa is very effective. However, over time, motor complications (MCs) appear, restricting the patient from leading a normal life. One of the most disabling MCs is ON-OFF fluctuations. Gathering accurate information about the clinical status of the patient is essential for planning treatment and assessing its effect. Systems such as the REMPARK system, capable of accurately and reliably monitoring ON-OFF fluctuations, are of great interest. OBJECTIVE To analyze the ability of the REMPARK System to detect ON-OFF fluctuations. METHODS Forty-one patients with moderate to severe idiopathic PD were recruited according to the UK Parkinson's Disease Society Brain Bank criteria. Patients with motor fluctuations, freezing of gait and/or dyskinesia and who were able to walk unassisted in the OFF phase, were included in the study. Patients wore the REMPARK System for 3days and completed a diary of their motor state once every hour. RESULTS The record obtained by the REMPARK System, compared with patient-completed diaries, demonstrated 97% sensitivity in detecting OFF states and 88% specificity (i.e., accuracy in detecting ON states). CONCLUSION The REMPARK System detects an accurate evaluation of ON-OFF fluctuations in PD; this technology paves the way for an optimisation of the symptomatic control of PD motor symptoms as well as an accurate assessment of medication efficacy.
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Affiliation(s)
- Àngels Bayés
- Centro Médico Teknon-Grupo Quiron Salud, Parkinson Unit, Barcelona, Catalunya, Spain.
| | - Albert Samá
- Universitat Politècnica de Catalunya, Automatic Control Department, Vilanova I la Geltrú, Catalunya, Spain
| | - Anna Prats
- National University of Ireland, Galway, Ireland; Faculty of Medicine, Neurology, Galway, Ireland
| | - Carlos Pérez-López
- Universitat Politècnica de Catalunya, Automatic Control Department, Vilanova I la Geltrú, Catalunya, Spain
| | - Maricruz Crespo-Maraver
- Centro Médico Teknon-Grupo Quiron Salud, Parkinson Unit, Barcelona, Catalunya, Spain; Fundació Althaia, Divisió de Salud Mental, Manresa, Catalunya, Spain
| | - Juan Manuel Moreno
- Universitat Politècnica de Catalunya, Automatic Control Department, Vilanova I la Geltrú, Catalunya, Spain
| | - Sheila Alcaine
- Centro Médico Teknon-Grupo Quiron Salud, Parkinson Unit, Barcelona, Catalunya, Spain
| | - Alejandro Rodriguez-Molinero
- Consorci Sanitari del Garraf, Clinical Research Unit, Vilanova I la Geltrú, Catalunya, Spain; National University of Ireland, Galway, Ireland; School of Engineering and Informatics, Galway, Ireland
| | - Berta Mestre
- Centro Médico Teknon-Grupo Quiron Salud, Parkinson Unit, Barcelona, Catalunya, Spain
| | - Paola Quispe
- Centro Médico Teknon-Grupo Quiron Salud, Parkinson Unit, Barcelona, Catalunya, Spain
| | - Ana Correia de Barros
- Associaçao Fraunhofer Portugal Research, Fraunhofer Portugal AICOS (FhP-AICOS), Porto, Portugal
| | - Rui Castro
- Associaçao Fraunhofer Portugal Research, Fraunhofer Portugal AICOS (FhP-AICOS), Porto, Portugal
| | | | - Roberta Annicchiarico
- Foundazione Santa Lucia, Technology-Assisted Neuro-Rehabilitation Laboratory, Rome, Italy
| | - Patrick Browne
- University Hospital Galway, Neurology Department, Galway, Ireland
| | - Tim Counihan
- National University of Ireland, Galway, Ireland; Faculty of Medicine, Neurology, Galway, Ireland
| | - Hadas Lewy
- Maccabi Heathcare Services, International center for R&D, Tel-Aviv, Israel
| | - Gabriel Vainstein
- Maccabi Heathcare Services, International center for R&D, Tel-Aviv, Israel
| | - Leo R Quinlan
- National University of Ireland, Galway, Ireland; Electrical & Electronic Engineering, Galway, Ireland
| | - Dean Sweeney
- National University of Ireland, Galway, Ireland; Physiology, School of Medicine, Galway, Ireland
| | - Gearóid ÓLaighin
- National University of Ireland, Galway, Ireland; Electrical & Electronic Engineering, Galway, Ireland
| | | | - Daniel Rodrigue Z-Martin
- Universitat Politècnica de Catalunya, Automatic Control Department, Vilanova I la Geltrú, Catalunya, Spain
| | - Joan Cabestany
- Universitat Politècnica de Catalunya, Automatic Control Department, Vilanova I la Geltrú, Catalunya, Spain
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Cancela J, Villanueva Mascato S, Gatsios D, Rigas G, Marcante A, Gentile G, Biundo R, Giglio M, Chondrogiorgi M, Vilzmann R, Konitsiotis S, Antonini A, Arredondo MT, Fotiadis DI. Monitoring of motor and non-motor symptoms of Parkinson's disease through a mHealth platform. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:663-666. [PMID: 28268415 DOI: 10.1109/embc.2016.7590789] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Parkinson's disease (PD) is a complex, chronic disease that many patients live with for many years. In this work we propose a mHealth approach based on a set of unobtrusive, simple-in-use, off-the-self, co-operative, mobile devices that will be used for motor and non-motor symptoms monitoring and evaluation, as well as for the detection of fluctuations along with their duration through a waking day. Ideally, a multidisciplinary and integrated care approach involving several professionals working together (neurologists, physiotherapists, psychologists and nutritionists) could provide a holistic management of the disease increasing the patient's independence and Quality of Life (QoL). To address these needs we describe also an ecosystem for the management of both motor and non-motor symptoms on PD facilitating the collaboration of health professionals and empowering the patients to self-manage their condition. This would allow not only a better monitoring of PD patients but also a better understanding of the disease progression.
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22
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Quantitative Analysis of Motor Status in Parkinson's Disease Using Wearable Devices: From Methodological Considerations to Problems in Clinical Applications. PARKINSONS DISEASE 2017; 2017:6139716. [PMID: 28607801 PMCID: PMC5451764 DOI: 10.1155/2017/6139716] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/23/2017] [Accepted: 04/27/2017] [Indexed: 11/17/2022]
Abstract
Long-term and objective monitoring is necessary for full assessment of the condition of patients with Parkinson's disease (PD). Recent advances in biotechnology have seen the development of various types of wearable (body-worn) sensor systems. By using accelerometers and gyroscopes, these devices can quantify motor abnormalities, including decreased activity and gait disturbances, as well as nonmotor signs, such as sleep disturbances and autonomic dysfunctions in PD. This review discusses methodological problems inherent in wearable devices. Until now, analysis of the mean values of motion-induced signals on a particular day has been widely applied in the clinical management of PD patients. On the other hand, the reliability of these devices to detect various events, such as freezing of gait and dyskinesia, has been less than satisfactory. Quantification of disease-specific changes rather than nonspecific changes is necessary.
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23
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Arroyo-Gallego T, Ledesma-Carbayo MJ, Sanchez-Ferro A, Butterworth I, Mendoza CS, Matarazzo M, Montero P, Lopez-Blanco R, Puertas-Martin V, Trincado R, Giancardo L. Detection of Motor Impairment in Parkinson's Disease Via Mobile Touchscreen Typing. IEEE Trans Biomed Eng 2017; 64:1994-2002. [PMID: 28237917 DOI: 10.1109/tbme.2017.2664802] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mobile technology is opening a wide range of opportunities for transforming the standard of care for chronic disorders. Using smartphones as tools for longitudinally tracking symptoms could enable personalization of drug regimens and improve patient monitoring. Parkinson's disease (PD) is an ideal candidate for these tools. At present, evaluation of PD signs requires trained experts to quantify motor impairment in the clinic, limiting the frequency and quality of the information available for understanding the status and progression of the disease. Mobile technology can help clinical decision making by completing the information of motor status between hospital visits. This paper presents an algorithm to detect PD by analyzing the typing activity on smartphones independently of the content of the typed text. We propose a set of touchscreen typing features based on a covariance, skewness, and kurtosis analysis of the timing information of the data to capture PD motor signs. We tested these features, both independently and in a multivariate framework, in a population of 21 PD and 23 control subjects, achieving a sensitivity/specificity of 0.81/0.81 for the best performing feature and 0.73/0.84 for the best multivariate method. The results of the alternating finger-tapping, an established motor test, measured in our cohort are 0.75/0.78. This paper contributes to the development of a home-based, high-compliance, and high-frequency PD motor test by analysis of routine typing on touchscreens.
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Affiliation(s)
- Teresa Arroyo-Gallego
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Alvaro Sanchez-Ferro
- Madrid-MIT M+Visión Consortium, Research Laboratory of ElectronicsMassachusetts Institute of Technology
| | - Ian Butterworth
- Madrid-MIT M+Visión Consortium, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Carlos S Mendoza
- Asana Weartech, Spain and also with Madrid-MIT M+Visión Consortium, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Michele Matarazzo
- HM Hospitales-Centro Integral en Neurociencias HM CINAC, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Paloma Montero
- Movement Disorders Unit, Hospital Clinico San Carlos, Madrid, Spain
| | | | | | - Rocio Trincado
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Luca Giancardo
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Açıcı K, Erdaş ÇB, Aşuroğlu T, Toprak MK, Erdem H, Oğul H. A Random Forest Method to Detect Parkinson’s Disease via Gait Analysis. ENGINEERING APPLICATIONS OF NEURAL NETWORKS 2017. [DOI: 10.1007/978-3-319-65172-9_51] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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25
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Automatic Identification of Systolic Time Intervals in Seismocardiogram. Sci Rep 2016; 6:37524. [PMID: 27874050 PMCID: PMC5118745 DOI: 10.1038/srep37524] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 10/31/2016] [Indexed: 11/09/2022] Open
Abstract
Continuous and non-invasive monitoring of hemodynamic parameters through unobtrusive wearable sensors can potentially aid in early detection of cardiac abnormalities, and provides a viable solution for long-term follow-up of patients with chronic cardiovascular diseases without disrupting the daily life activities. Electrocardiogram (ECG) and siesmocardiogram (SCG) signals can be readily acquired from light-weight electrodes and accelerometers respectively, which can be employed to derive systolic time intervals (STI). For this purpose, automated and accurate annotation of the relevant peaks in these signals is required, which is challenging due to the inter-subject morphological variability and noise prone nature of SCG signal. In this paper, an approach is proposed to automatically annotate the desired peaks in SCG signal that are related to STI by utilizing the information of peak detected in the sliding template to narrow-down the search for the desired peak in actual SCG signal. Experimental validation of this approach performed in conventional/controlled supine and realistic/challenging seated conditions, containing over 5600 heart beat cycles shows good performance and robustness of the proposed approach in noisy conditions. Automated measurement of STI in wearable configuration can provide a quantified cardiac health index for long-term monitoring of patients, elderly people at risk and health-enthusiasts.
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Abstract
Real-time personal health monitoring is gaining new ground with advances in wireless communications. Wireless body area networks (WBANs) provide a means for low-powered sensors, affixed either on the human body or in vivo, to communicate with each other and with external telecommunication networks. The healthcare benefits of WBANs include continuous monitoring of patient vitals, measuring postacute rehabilitation time, and improving quality of medical care provided in medical emergencies. This study sought to examine emerging trends in WBAN adoption in healthcare. To that end, a systematic literature survey was undertaken against the PubMed database. The search criteria focused on peer-reviewed articles that contained the keywords "wireless body area network" and "healthcare" or "wireless body area network" and "health care." A comprehensive review of these articles was performed to identify adoption dimensions, including underlying technology framework, healthcare subdomain, and applicable lessons-learned. This article benefits healthcare technology professionals by identifying gaps in implementation of current technology and highlighting opportunities for improving products and services.
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Del Din S, Godfrey A, Mazzà C, Lord S, Rochester L. Free-living monitoring of Parkinson's disease: Lessons from the field. Mov Disord 2016; 31:1293-313. [PMID: 27452964 DOI: 10.1002/mds.26718] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 12/21/2022] Open
Affiliation(s)
- Silvia Del Din
- Institute of Neuroscience; Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University; Newcastle upon Tyne UK
| | - Alan Godfrey
- Institute of Neuroscience; Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University; Newcastle upon Tyne UK
| | - Claudia Mazzà
- Department of Mechanical Engineering; The University of Sheffield; Sheffield UK
- INSIGNEO Institute for In Silico Medicine; The University of Sheffield; Sheffield UK
| | - Sue Lord
- Institute of Neuroscience; Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University; Newcastle upon Tyne UK
| | - Lynn Rochester
- Institute of Neuroscience; Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University; Newcastle upon Tyne UK
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Piro NE, Piro LK, Kassubek J, Blechschmidt-Trapp RA. Analysis and Visualization of 3D Motion Data for UPDRS Rating of Patients with Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2016; 16:E930. [PMID: 27338400 PMCID: PMC4934355 DOI: 10.3390/s16060930] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/04/2016] [Accepted: 06/16/2016] [Indexed: 11/22/2022]
Abstract
Remote monitoring of Parkinson's Disease (PD) patients with inertia sensors is a relevant method for a better assessment of symptoms. We present a new approach for symptom quantification based on motion data: the automatic Unified Parkinson Disease Rating Scale (UPDRS) classification in combination with an animated 3D avatar giving the neurologist the impression of having the patient live in front of him. In this study we compared the UPDRS ratings of the pronation-supination task derived from: (a) an examination based on video recordings as a clinical reference; (b) an automatically classified UPDRS; and (c) a UPDRS rating from the assessment of the animated 3D avatar. Data were recorded using Magnetic, Angular Rate, Gravity (MARG) sensors with 15 subjects performing a pronation-supination movement of the hand. After preprocessing, the data were classified with a J48 classifier and animated as a 3D avatar. Video recording of the movements, as well as the 3D avatar, were examined by movement disorder specialists and rated by UPDRS. The mean agreement between the ratings based on video and (b) the automatically classified UPDRS is 0.48 and with (c) the 3D avatar it is 0.47. The 3D avatar is similarly suitable for assessing the UPDRS as video recordings for the examined task and will be further developed by the research team.
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Affiliation(s)
- Neltje E Piro
- Institute of Medical Engineering and Mechatronics, Ulm University of Applied Sciences, Albert-Einstein-Allee 55, Ulm D-89081, Germany.
| | - Lennart K Piro
- Faculty of Physics, Ludwig-Maximilians-Universität München, Geschwister-Scholl-Platz 1, Munich D-80539, Germany.
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, Ulm D-89081, Germany.
| | - Ronald A Blechschmidt-Trapp
- Institute of Medical Engineering and Mechatronics, Ulm University of Applied Sciences, Albert-Einstein-Allee 55, Ulm D-89081, Germany.
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Ghamari M, Janko B, Sherratt RS, Harwin W, Piechockic R, Soltanpur C. A Survey on Wireless Body Area Networks for eHealthcare Systems in Residential Environments. SENSORS (BASEL, SWITZERLAND) 2016; 16:E831. [PMID: 27338377 PMCID: PMC4934257 DOI: 10.3390/s16060831] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/23/2016] [Accepted: 06/02/2016] [Indexed: 01/28/2023]
Abstract
Current progress in wearable and implanted health monitoring technologies has strong potential to alter the future of healthcare services by enabling ubiquitous monitoring of patients. A typical health monitoring system consists of a network of wearable or implanted sensors that constantly monitor physiological parameters. Collected data are relayed using existing wireless communication protocols to a base station for additional processing. This article provides researchers with information to compare the existing low-power communication technologies that can potentially support the rapid development and deployment of WBAN systems, and mainly focuses on remote monitoring of elderly or chronically ill patients in residential environments.
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Affiliation(s)
- Mohammad Ghamari
- Department of Electrical and Computer Engineering, University of Texas at El Paso, El Paso, TX 79968, USA.
| | - Balazs Janko
- Department to Biomedical Engineering, University of Reading, Reading RG6 6AY, UK.
| | - R Simon Sherratt
- Department to Biomedical Engineering, University of Reading, Reading RG6 6AY, UK.
| | - William Harwin
- Department to Biomedical Engineering, University of Reading, Reading RG6 6AY, UK.
| | - Robert Piechockic
- School of Electrical and Electronic Engineering, Bristol University, Bristol BS8 1UB, UK.
| | - Cinna Soltanpur
- Department of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019, USA.
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Block VAJ, Pitsch E, Tahir P, Cree BAC, Allen DD, Gelfand JM. Remote Physical Activity Monitoring in Neurological Disease: A Systematic Review. PLoS One 2016; 11:e0154335. [PMID: 27124611 PMCID: PMC4849800 DOI: 10.1371/journal.pone.0154335] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/11/2016] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To perform a systematic review of studies using remote physical activity monitoring in neurological diseases, highlighting advances and determining gaps. METHODS Studies were systematically identified in PubMed/MEDLINE, CINAHL and SCOPUS from January 2004 to December 2014 that monitored physical activity for ≥24 hours in adults with neurological diseases. Studies that measured only involuntary motor activity (tremor, seizures), energy expenditure or sleep were excluded. Feasibility, findings, and protocols were examined. RESULTS 137 studies met inclusion criteria in multiple sclerosis (MS) (61 studies); stroke (41); Parkinson's Disease (PD) (20); dementia (11); traumatic brain injury (2) and ataxia (1). Physical activity levels measured by remote monitoring are consistently low in people with MS, stroke and dementia, and patterns of physical activity are altered in PD. In MS, decreased ambulatory activity assessed via remote monitoring is associated with greater disability and lower quality of life. In stroke, remote measures of upper limb function and ambulation are associated with functional recovery following rehabilitation and goal-directed interventions. In PD, remote monitoring may help to predict falls. In dementia, remote physical activity measures correlate with disease severity and can detect wandering. CONCLUSIONS These studies show that remote physical activity monitoring is feasible in neurological diseases, including in people with moderate to severe neurological disability. Remote monitoring can be a psychometrically sound and responsive way to assess physical activity in neurological disease. Further research is needed to ensure these tools provide meaningful information in the context of specific neurological disorders and patterns of neurological disability.
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Affiliation(s)
- Valerie A. J. Block
- Graduate Program in Physical Therapy, University of California San Francisco/ San Francisco State University, San Francisco, California, United States of America
| | - Erica Pitsch
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, California, United States of America
| | - Peggy Tahir
- University of California San Francisco Library, San Francisco, California, United States of America
| | - Bruce A. C. Cree
- Multiple Sclerosis and Neuroinflammation Center, Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
| | - Diane D. Allen
- Graduate Program in Physical Therapy, University of California San Francisco/ San Francisco State University, San Francisco, California, United States of America
| | - Jeffrey M. Gelfand
- Multiple Sclerosis and Neuroinflammation Center, Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
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31
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Cancela J, Arredondo MT, Hurtado O. Proposal of a Kinect(TM)-based system for gait assessment and rehabilitation in Parkinson's disease. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:4519-22. [PMID: 25570996 DOI: 10.1109/embc.2014.6944628] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
It has been proved that audio and visual cueing can improve the motor performance of Parkinson's disease patients. Specially, gait can benefit from repetitive sessions of exercises using cues. Nevertheless, these effects are not permanent and fade away with time, in that sense, home game systems can be an excellent platform for patients to perform daily exercises, as well as to coach and guide them in a smarter way. Within this work a method to track the walking movement is proposed based on the signals coming from the Kinect sensor of Microsoft. At the same time, different setups have been tested in order to study the feasibility of using this sensor to build a game platform for gait rehabilitation for Parkinson's disease patients.
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Cancela J, Fico G, Arredondo Waldmeyer MT. Using the Analytic Hierarchy Process (AHP) to understand the most important factors to design and evaluate a telehealth system for Parkinson's disease. BMC Med Inform Decis Mak 2015; 15 Suppl 3:S7. [PMID: 26391847 PMCID: PMC4705498 DOI: 10.1186/1472-6947-15-s3-s7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The assessment of a new health technology is a multidisciplinary and multidimensional process, which requires a complex analysis and the convergence of different stakeholders into a common decision. This task is even more delicate when the assessment is carried out in early stage of development processes, when the maturity of the technology prevents conducting a large scale trials to evaluate the cost effectiveness through classic health economics methods. This lack of information may limit the future development and deployment in the clinical practice. This work aims to 1) identify the most relevant user needs of a new medical technology for managing and monitoring Parkinson's Disease (PD) patients and to 2) use these user needs for a preliminary assessment of a specific system called PERFORM, as a case study. METHODS Analytic Hierarchy Process (AHP) was used to design a hierarchy of 17 needs, grouped into 5 categories. A total of 16 experts, 6 of them with a clinical background and the remaining 10 with a technical background, were asked to rank these needs and categories. RESULTS On/Off fluctuations detection, Increase wearability acceptance, and Increase self-management support have been identified as the most relevant user needs. No significant differences were found between the clinician and technical groups. These results have been used to evaluate the PERFORM system and to identify future areas of improvement. CONCLUSIONS First of all, the AHP contributed to the elaboration of a unified hierarchy, integrating the needs of a variety of stakeholders, promoting the discussion and the agreement into a common framework of evaluation. Moreover, the AHP effectively supported the user need elicitation as well as the assignment of different weights and priorities to each need and, consequently, it helped to define a framework for the assessment of telehealth systems for PD management and monitoring. This framework can be used to support the decision-making process for the adoption of new technologies in PD.
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Affiliation(s)
- Jorge Cancela
- Life Supporting Technologies, Universidad Politecnica de Madrid, ETSI Telecomunicación, Ciudad Universitaria, Madrid, Spain
| | - Giuseppe Fico
- Life Supporting Technologies, Universidad Politecnica de Madrid, ETSI Telecomunicación, Ciudad Universitaria, Madrid, Spain
| | - Maria T Arredondo Waldmeyer
- Life Supporting Technologies, Universidad Politecnica de Madrid, ETSI Telecomunicación, Ciudad Universitaria, Madrid, Spain
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Maetzler W, Rochester L. Body-worn sensors-the brave new world of clinical measurement? Mov Disord 2015; 30:1203-5. [PMID: 26173577 DOI: 10.1002/mds.26317] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 06/03/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Walter Maetzler
- Department of Neurodegeneration; Hertie Institute for Clinical Brain Research (HIH); University of Tuebingen; Tuebingen Germany
- German Center for Neurodegenerative Diseases (DZNE); Tuebingen Germany
| | - Lynn Rochester
- Institute of Neuroscience; Newcastle University; Newcastle upon Tyne United Kingdom
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Sijobert B, Benoussaad M, Denys J, Pissard-Gibollet R, Geny C, Coste CA. Implementation and Validation of a Stride Length Estimation Algorithm, Using a Single Basic Inertial Sensor on Healthy Subjects and Patients Suffering from Parkinson’s Disease. Health (London) 2015. [DOI: 10.4236/health.2015.76084] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cancela J, Pastorino M, Tzallas AT, Tsipouras MG, Rigas G, Arredondo MT, Fotiadis DI. Wearability assessment of a wearable system for Parkinson's disease remote monitoring based on a body area network of sensors. SENSORS (BASEL, SWITZERLAND) 2014; 14:17235-55. [PMID: 25230307 PMCID: PMC4208222 DOI: 10.3390/s140917235] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 09/03/2014] [Accepted: 09/03/2014] [Indexed: 11/16/2022]
Abstract
Wearable technologies for health monitoring have become a reality in the last few years. So far, most research studies have focused on assessments of the technical performance of these systems, as well as the validation of the clinical outcomes. Nevertheless, the success in the acceptance of these solutions depends not only on the technical and clinical effectiveness, but on the final user acceptance. In this work the compliance of a telehealth system for the remote monitoring of Parkinson's disease (PD) patients is presented with testing in 32 PD patients. This system, called PERFORM, is based on a Body Area Network (BAN) of sensors which has already been validated both from the technical and clinical point for view. Diverse methodologies (REBA, Borg and CRS scales in combination with a body map) are employed to study the comfort, biomechanical and physiological effects of the system. The test results allow us to conclude that the acceptance of this system is satisfactory with all the levels of effect on each component scoring in the lowest ranges. This study also provided useful insights and guidelines to lead to redesign of the system to improve patient compliance.
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Affiliation(s)
- Jorge Cancela
- Life Supporting Technologies, Universidad Politécnica de Madrid, Avenida Complutense 30, Madrid 28040, Spain.
| | - Matteo Pastorino
- Life Supporting Technologies, Universidad Politécnica de Madrid, Avenida Complutense 30, Madrid 28040, Spain.
| | - Alexandros T Tzallas
- Unit of Medical Technology and Intelligent Information Systems, Dept. of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece.
| | - Markos G Tsipouras
- Unit of Medical Technology and Intelligent Information Systems, Dept. of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece.
| | - Giorgios Rigas
- Unit of Medical Technology and Intelligent Information Systems, Dept. of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece.
| | - Maria T Arredondo
- Life Supporting Technologies, Universidad Politécnica de Madrid, Avenida Complutense 30, Madrid 28040, Spain.
| | - Dimitrios I Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Dept. of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece.
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Cancela J, Moreno EM, Arredondo MT, Bonato P. Designing auditory cues for Parkinson's disease gait rehabilitation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2014; 2014:5852-5855. [PMID: 25571327 DOI: 10.1109/embc.2014.6944959] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Recent works have proved that Parkinson's disease (PD) patients can be largely benefit by performing rehabilitation exercises based on audio cueing and music therapy. Specially, gait can benefit from repetitive sessions of exercises using auditory cues. Nevertheless, all the experiments are based on the use of a metronome as auditory stimuli. Within this work, Human-Computer Interaction methodologies have been used to design new cues that could benefit the long-term engagement of PD patients in these repetitive routines. The study has been also extended to commercial music and musical pieces by analyzing features and characteristics that could benefit the engagement of PD patients to rehabilitation tasks.
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