Tailoring Wearable Technology And Telehealth In Treating Parkinsons Disease
Study determines timely and accurate tremor data can improve virtual appointments
Wearable health technologies are vastly popular with people wanting to improve their physical and mental health. Everything from exercise, sleep patterns, calories consumed and heart rhythms can be tracked by a wearable device.
Dr. Daryl Wile
But timely and accurate data is also especially valuable for doctors treating patients with complicated health conditions using virtual care.
A new study from the UBC faculty of medicines Southern Medical Program , based at UBC Okanagan, has examined the use of wearable health technology and telehealth to treat patients with Parkinsons disease.
Dr. Daryl Wile, a movement disorder specialist and clinical assistant professor in the faculty of medicines division of neurology, routinely uses telehealth to connect with Parkinsons patients across the vast and rugged landscape of BCs Interior.
Even prior to the pandemic, telehealth helped deliver specialized care to patients living in remote and rural settings, says Dr. Wile, also a clinical investigator with the faculty of medicines Centre for Chronic Disease Prevention and Management. But with the complex nature of Parkinsons, we wanted to enhance these appointments to better understand how movements vary throughout a patients entire day.
To add a new layer of health information, Dr. Wile and the research team added wearable technology to the equation.
B Prognosis/monitoring The Severity Of Symptoms
Assessing the patients condition and severity of symptoms depend primarily on the clinicians judgment and the patient feedback from diaries and memory. The clinicians judgment is subjective , while the patients diary and memory are limited by compliance and recall bias , , . Since this approach may not be completely reliable, objective remote monitoring of PD symptoms is needed to assess disease progression, evaluate the severity of the symptoms, and continuously monitor the PD patients in unsupervised environments. To address these issues, recent work on PD prognosis focuses on the following areas:
Home-based or remote monitoring of patients with PD
Evaluating the progression of PD for a diagnosed patient
Evaluating the severity of PD symptoms for a diagnosed patient
Eligibility According To Prisma Flow Diagram
According to the PRISMA methodology, a flow diagram is shown in . A total of 166 studies were initially identified in the search process. After the removal of duplicate studies , the titles and abstracts of 132 articles were screened and 65 irrelevant records were excluded, as they were not related to the evaluated topic , to reviews , or were not peer reviewed . Consequently, 65 studies were removed in this step, leaving a total of 67 of articles, which were submitted to the eligibility process. The criteria for inclusion and exclusion were applied. As a result of this phase, eight articles were excluded for not using ML techniques and three articles did not use sensors however, 46 articles focusing on Parkinson motor symptoms did not examine on/off states. The sum of all these types of article resulted in a total of 57 exclusions, leaving us with a total of 10 studies that met the defined inclusion criteria. Of the included articles, the main characteristics related to sensors utilized, study goal, classifier used, and performance obtained are shown in .
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What Is Wearable Technology In Healthcare
Wearable technology in healthcare, in simple words, refers to the devices and applications that users can wear and help collect health and exercise data to make informed healthcare decisions.
The devices may include Fitbits and smartwatches or other electronically powered devices that can help collect patients health data and implement interventions accordingly.
While the likeability for wearable technologies is already flourishing among the audience, the healthcare app development for wearable devices is expected to grow further, with consumers showing significant interest in sharing wearable data.
Early Diagnosis Wearables And The Effects Of Motor Disorders On Quality Of Life
Preponderance of Parkinsons and overall motor symptoms affects the QoL of PD patients very badly . Gait disorders are classified according to an accepted scheme and their associations to falls. Neuro-psychological measures and QoL have been explored for decades, a fact that proved that gait impairments significantly diminish QoL. The main motor disabilities faced by PD patients are elaborated in and . Gait disorders are the most common among PD patients, reducing the mobility in the daily life activities and becoming worse as disease advances . The difference between normal and Parkinsonism gait can be seen in . Hence, PD leads to major walking problems, causing falls and hence leading to long-term disability and independence loss.
shows Normal person gait and shows PD patient gait.
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Could Wearable Technology Help People With Parkinsons
Pedometers and activity trackers are popular among people who want to lose weight or just stay in shape. Could similar devices help people with Parkinsons disease monitor their symptoms, and receive more personalized medical care? An opinion piece published September 1 in the Journal of the American Medical Association makes the case for the potential of body-fixed sensors to improve the lives of people with PD.
Doctors diagnose PD based on hallmark movement symptoms, including tremor|, rigidity|, slowness and balance difficulties. People with PD also experience an array of nonmotor symptoms and side effects, including sleep disturbances and mood changes. But not everyone with PD develops all these symptoms, and the symptoms progress at different rates for different individuals. Thus, it is important to keep track of these changes in order to get the best treatment. Currently, doctors evaluate them using standard rating scales and tests, while people with PD may also keep a diary of symptoms.
Anat Mirelman, Ph.D., and co-authors at Tel Aviv University in Israel, note in their editorial that while such tools are valuable for understanding long-term changes in PD, more subtle symptoms, or changes that fluctuate on a daily or weekly basis, might be overlooked. Other symptoms might not occur during the appointment for example, a doctor might not directly observe a persons dyskinesia or freezing episodes when walking.
What Does It Mean?
Application : Home And Long
To date, as clinical scales are the gold standard for in-clinical setting assessment of PD, the use of patient-completed symptom diaries is the current gold standard for the home monitoring of the pathology . Recent studies proposed the use of commercial devices such as the Microsoft Kinect sensor as a low-cost solution to assess the movement of Parkinsonian patients, not only in clinical settings, but also at home. Nevertheless, the accuracy of these systems can be considered good in the measurement of spatiotemporal features for gross movements, but it is not acceptable compared to validated motion capture systems, which are the gold standard for fine movement analysis of actions such as hand clasping or finger tapping, which is required in the MDS-UPDRS scale for PD severity evaluation.
Table 9. Papers about home and long-term monitoring.
Recommendations and Trends
The principal aim of the home monitoring is to provide an optimal management of PD. According to literature results, this can be done by observing the development of the pathology through the analysis of data acquired by wearable sensors, which seem to be the best type of devices to adopt. The implementation of a Smart Home, in fact, lowered the users’ acceptance of the technology and resulted in an invasive system that did not provide a sufficiently high accuracy in observations and also measured numerous irrelevant features .
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Man Gets Six Kidney Beans Stuck Down His Urethra
Dr. Daryl Wile, a movement disorder specialist and SMP clinical assistant professor, routinely uses telehealth to connect with Parkinsons patients across the vast and rugged landscape of British Columbias interior.
Even prior to the pandemic, telehealth helped deliver specialized care to patients living in remote and rural settings, says Wile, a clinical investigator with the Centre for Chronic Disease Prevention and Management. But with the complex nature of Parkinsons, we wanted to enhance these appointments to better understand how movements vary throughout a patients entire day.
To add a new layer of health information, Wile and the research team added wearable technology to the equation.
We recruited Parkinsons patients with either tremors or involuntary movements, says Joshua Yoneda, SMP student and co-author of the study. We then divided them into two groupssome using telehealth and device-based health tracking and others attending traditional face-to-face appointments.
The telehealth group wore wearable devices to track their movements, involuntary or not, throughout waking hours. The reported data was then reviewed during telehealth appointments to identify peak times patients experienced Parkinsons symptoms.
With the integration of accurate and reliable data from wearable devices, we were able to tailor a patients medication to better manage their symptoms throughout the day, adds Wile.
Improved Monitoring Of Pd
One system which is FDA cleared and is available on the market for monitoring of PD patients between office visits is known as the Personal KinetigraphTM . A patient wears the watch-like sensor for 6-10 days in anticipation of an office visit. The sensor collects data which is then interpreted through the PKG TM algorithms to measure bradykinesia and dyskinesia throughout the time period that the watch is worn. The PKG TM also has the ability to alert a patient to take a medication dose and allows the patient to record whether the dose was taken. After the data is collected, the patient mails the watch in and the data is downloaded and sent to the patients physician so that the physician has the information for the patient visit. The information can then complement what the patient and care partner say about their medication responses at home. A poster at the International Congress demonstrated that when PKG TM is in use, it often influences and informs the decision to change medications.
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Other Research Around Wearable Devices And Parkinsons
There are dozens of other research efforts, both at academic centers and in industry to continue to develop these technologies and bring additional products to market. One interesting project is known as Blue Sky, a collaborative effort between the pharmaceutical industry and the software industry to collect and analyze large amounts of data from many patients using wearable technologies at home, in a simulated home, and in the lab, along with clinical rating scales and patient diaries. An abstract at the Congress presented their work.
A smart-phone based system developed by the pharmaceutical company Roche, was presented as well, and demonstrated that information gleaned from their algorithm correlated with the traditional scales and testing that are performed at a Movement disorders clinical visit and in clinical trials.
Check out some of this type of work that APDA has funded in the past and is currently funding. Beom-Chan Lee developed a smart-phone based technology to improve balance. Yuanfang Guan is working on an algorithm to use voice information gleaned from a smart phone to predict and follow PD.
If the presentations at the Congress are any indication, the next few years will see a continued explosion of research in this field, with the likely development of new commercial products for the purposes of diagnosing and monitoring PD symptoms.
What Are Some Examples Of Wearable Technology In Healthcare
Several wearable technologies are used to monitor patients health conditions and collect data. However, the first wireless device in close contact with the user to collect health was a wireless ECG, developed in 1980.
Subsequently, now there are several wearable devices commonly used to collect and monitor users health data.
Here are different wearable health technologies and what they monitor
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Can Wearable Technology Act As Treatment
Wearable technologies are being developed that not only monitor PD symptoms but can improve the symptoms as well. In 2017, a Microsoft prototype of a watch was revealed, that uses vibrating motors to dampen tremor. The device was known as Emmas watch, named after Emma Lawton, a British graphic designer with young onset Parkinsons disease, who was the inspiration and first user of the invention, which dramatically improved her writing. This product is still under development and not yet available on the market.
Liftware is a company that makes adaptive vibrating spoons that are designed to stabilize a tremoring hand. These spoons are specifically meant to help tremors that occur with action, which can be a symptom in Parkinsons disease, although is less common than the more classic rest tremor.
Light Therapy And Parkinson’s Disease
and references therein.
I have been using strategic light therapy now for some time to assist in my recovery from Parkinson’s Disease. These light based strategies have benefitted me greatly, as is also the case for very many participants now in more formal clinical and scientific trials. So I have become an avid proponent of the use of light in the treatment of PD!
In particular, it has helped me to markedly decrease my bradykinesia which is normally part and parcel of PD, but much more importantly, has dramatically decreased the associated pain . One important caveat is that it has not directly improved my akinesia: it doesn’t give me back my ability to move my limbs without significant willpower – but it has made it easier to move them with effort, and, again, to do so without so much pain. It has also improved my sleep and mood very considerably.
So when Toine Schoutens of Propeaq, who had read my earlier posts about light therapy for Parkinson’s, contacted me via twitter to highlight the development of wearable technology, I immediately realized that their light therapy glasses represented a possible major benefit for me. So I requested from Toine a pair to trial to see if they had application for Parkinson’s, which he very generously agreed to supply me.
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Tracking The Tremor: Wearable Technologies In Parkinsons
For 10 million people worldwide, 1 million of whom live in America, everyday tasks are extremely complicated because they live with Parkinsons Disease . People with PD experience a wide range of motor symptoms due to loss of nerve cells that produce dopamine, a molecule that is sent between neurons to control limb movements. Loss of dopaminergic neurons causes patients to slowly lose mobility and, in some patients, can also lead to cognitive impairments. Simple tasks like buttoning a shirt become a tedious ordeal and walking abnormalities make falls a constant concern.
While there are definite hallmarks of PD, the development and severity of symptoms varies greatly from patient to patient. This variability means that people can be misdiagnosed and/or placed on treatment regimens that may not be effective. To mitigate these discrepancies, wearable technologies have recently emerged in the world of Parkinsons as a tool for improving care and quality of life for people living with PD.
Demographic And Clinical Characteristics Of The Sample
Recruitment for the first study began in July of 2016 and the last subject for the final PD study completed the last visit in April of 2018. For the first study, we recruited healthy volunteers by drawing from the local community in Andover, MA and Yorktown Heights, NY, respectively . Sixty healthy volunteers with a mean age of 44 years were enrolled, and 33 were female. Compared with PD participants, healthy volunteers were significantly younger , had a higher level of education and were more evenly balanced with regard to gender .
Table 1 Participant characteristics.
These results emphasize the significant probability of symptom severity fluctuating at a rate that cannot be captured by using diary entries every 30min. Importantly, the same consideration applies to live observations of individuals with PD experiencing motor fluctuations. In other words, these results suggest that even live assessments that are carried out at time intervals of 30min are insufficient to capture the dynamics of tremor, dyskinesia, and bradykinesia, as they evolve over the medication cycle. This observation underlines an important potential advantage of using wearable sensors to track fluctuations in motor symptoms since this approach has potential for generating continuous estimates of the severity of tremor, dyskinesia, and bradykinesia, hence overcoming the limitations of more traditional approaches.
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Using Wearable Technology To Advance Parkinson’s Research
The Michael J. Fox Foundation is collaborating with Intel on a Parkinsons research solution using wearable technology, Intel algorithms, Big Data analytics, and the Cloudera distribution of Hadoop.
Parkinsons disease , the second most common neurodegenerative disorder after Alzheimers, is estimated to affect one million people in the United States and perhaps as many as seven million globally. There is currently no cure medications, surgery, and multidisciplinary management can provide relief, but they address only some of the symptoms patients face, and are effective only for a limited time. Many also introduce serious side effects that can be as disabling as the disease itself.
The Michael J. Fox Foundation for Parkinsons Research is working with Intel on tech-enabled solutions to gather relevant data about PD, analyze that data to identify patterns and make generalizations, and use insights gained to accelerate the development of therapeutic breakthroughs, and potentially even a cure for the disease.
When seeking a cure for an incurable disease, we often face a knowledge deficit. So the first step is to gather as much data as we can. That is why MJFF is actively seeking volunteers for many clinical trials. Data science tells us, however, that in order to extract meaningful knowledge from data, we must have relevant data to work with. In other words, we have to sort through a lot of haystacks to find a few needles.
The monitoring devices
Evaluation Of Wearable Sensor Devices In Parkinsons Disease: A Review Of Current Status And Future Prospects
Wenwu ChenXuebing Cao
1Department of Neurology, The First Affiliated Hospital of Henan University, Kaifeng 475001, China
2Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
3GYENNO Technologies Co., Ltd., Shenzhen 518000, China
Parkinsons disease decreases the quality of life of the affected individuals. The incidence of PD is expected to increase given the growing aging population. Motor symptoms associated with PD render the patients unable to self-care and function properly. Given that several drugs have been developed to control motor symptoms, highly sensitive scales for clinical evaluation of drug efficacy are needed. Among such scales, the objective and continuous evaluation of wearable devices is increasingly utilized by clinicians and patients. Several electronic technologies have revolutionized the clinical monitoring of PD development, especially its motor symptoms. Here, we review and discuss the recent advances in the development of wearable devices for bradykinesia, tremor, gait, and myotonia. Our aim is to capture the experiences of patients and clinicians, as well as expand our understanding on the application of wearable technology. In so-doing, we lay the foundation for further research into the use of wearable technology in the management of PD.
2. Wearable Sensors
8. Nonmotor Symptoms
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