A Method for Automatic and Objective Scoring of Bradykinesia Using Orientation Sensors and Classification Algorithms

Correct assessment of bradykinesia is a key element in the diagnosis and monitoring of Parkinson's disease. Its evaluation is based on a careful assessment of symptoms and it is quantified using rating scales, where the Movement Disorders Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) is the gold standard. Regardless of their importance, the bradykinesia-related items show low agreement between different evaluators. In this study, we design an applicable tool that provides an objective quantification of bradykinesia and that evaluates all characteristics described in the MDS-UPDRS. Twenty-five patients with Parkinson's disease performed three of the five bradykinesia-related items of the MDS-UPDRS. Their movements were assessed by four evaluators and were recorded with a nine degrees-of-freedom sensor. Sensor fusion was employed to obtain a 3-D representation of movements. Based on the resulting signals, a set of features related to the characteristics described in the MDS-UPDRS was defined. Feature selection methods were employed to determine the most important features to quantify bradykinesia. The features selected were used to train support vector machine classifiers to obtain an automatic score of the movements of each patient. The best results were obtained when seven features were included in the classifiers. The classification errors for finger tapping, diadochokinesis and toe tapping were 15-16.5%, 9.3-9.8%, and 18.2-20.2% smaller than the average interrater scoring error, respectively. The introduction of objective scoring in the assessment of bradykinesia might eliminate inconsistencies within evaluators and interrater assessment disagreements and might improve the monitoring of movement disorders

Smartphone-based estimation of item 3.8 of the MDS-UPDRS-III for assessing leg agility in people with Parkinson’s disease”

In this paper we investigated the use of smartphone sensors and Artificial Intelligence techniques for the automatic quantification of the MDS-UPDRS-Part III Leg Agility (LA) task, representative of lower limb bradykinesia. Methods: We collected inertial data from 93 PD subjects. Four expert neurologists provided clinical evaluations. We employed a novel Artificial Neural Network approach in order to get a continuous output, going beyond the MDS-UPDRS score discretization. Results: We found a Pearson correlation of 0.92 between algorithm output and average clinical score, compared to an inter-rater agreement index of 0.88. Furthermore, the classification error was less than 0.5 scale point in about 80% cases.Conclusions:Weproposedanobjectiveandreliabletoolfor theautomaticquantificationoftheMDS-UPDRSLegAgilitytask. In perspective, this tool is part of a larger monitoring program to be carried out during activities of daily living, and managed by the patients themselves

Parkinson\u27s Symptoms quantification using wearable sensors

Parkinson’s disease (PD) is a common neurodegenerative disorder affecting more than one million people in the United States and seven million people worldwide. Motor symptoms such as tremor, slowness of movements, rigidity, postural instability, and gait impairment are commonly observed in PD patients. Currently, Parkinsonian symptoms are usually assessed in clinical settings, where a patient has to complete some predefined motor tasks. Then a physician assigns a score based on the United Parkinson’s Disease Rating Scale (UPDRS) after observing the motor task. However, this procedure suffers from inter subject variability. Also, patients tend to show fewer symptoms during clinical visit, which leads to false assumption of the disease severity. The objective of this study is to overcome this limitations by building a system using Inertial Measurement Unit (IMU) that can be used at clinics and in home to collect PD symptoms data and build algorithms that can quantify PD symptoms more effectively. Data was acquired from patients seen at movement disorders Clinic at Sanford Health in Fargo, ND. Subjects wore Physilog IMUs and performed tasks for tremor, bradykinesia and gait according to the protocol approved by Sanford IRB. The data was analyzed using modified algorithm that was initially developed using data from normal subjects emulating PD symptoms. For tremor measurement, the study showed that sensor signals collected from the index finger more accurately predict tremor severity compared to signals from a sensor placed on the wrist. For finger tapping, a task measuring bradykinesia, the algorithm could predict with more than 80% accuracy when a set of features were selected to train the prediction model. Regarding gait, three different analysis were done to find the effective parameters indicative of severity of PD. Gait speed measurement algorithm was first developed using treadmill as a reference. Then, it was shown that the features selected could predict PD gait with 85.5% accuracy

Automated assessment of movement impairment in Huntington's disease

Quantitative assessment of movement impairment in Huntington’s disease (HD) is essential to monitoring of disease progression. This study aimed to develop and validate a novel low cost, objective automated system for the evaluation of upper limb movement impairment in HD in order to eliminate the inconsistency of the assessor and offer a more sensitive, continuous assessment scale. Patients with genetically confirmed HD and healthy controls were recruited to this observational study. Demographic data including age (years), gender and Unified Huntington’s Disease Rating Scale Total Motor Score (UHDRS-TMS) were recorded. For the purposes of this study a modified upper limb motor impairment score (mULMS) was generated from the UHDRS-TMS. All participants completed a brief, standardized clinical assessment of upper limb dexterity whilst wearing a tri-axial accelerometer on each wrist and on the sternum. The captured acceleration data were used to develop an automatic classification system for discriminating between healthy and HD participants and to automatically generate a continuous Movement Impairment Score (MIS) that reflected the degree of the movement impairment. Data from 48 healthy and 44 HD participants was used to validate the developed system, which achieved 98.78% accuracy in discriminating between healthy and HD participants. The Pearson correlation coefficient between the automatic MIS and the clinician rated mULMS was 0.77 with a p-value < 0.01. The approach presented in this study demonstrates the possibility of an automated objective, consistent and sensitive assessment of the HD movement impairment

Home monitoring of motor fluctuations in Parkinson's disease patients

In Parkinson's disease, motor fluctuations (worsening of tremor, bradykinesia, freezing of gait, postural instability) affect up to 70% of patients within 9 years of \textsc {l}-dopa therapy. Nevertheless, the assessment of motor fluctuations is difficult in a medical office, and is commonly based on poorly reliable self-reports. Hence, the use of wearable sensors is desirable. In this preliminary trial, we have investigated bradykinesia and freezing of gait—FOG—symptoms by means of inertial measurement units. To this purpose, we have employed a single smartphone on the patient's waist for FOG experiment (38 patients), and on patient thigh for LA (93 subjects). Given the sound performance achieved in this trial (AUC = 0.97 for FOG and AUC = 0.92 for LA), motor fluctuations may be estimated in domestic environments. To this end, we plan to perform measures and data processing on SensorTile, a tiny IoT module including several sensors, a microcontroller, a BlueTooth low-energy interface and microSD card, implementing an electronic diary of motor fluctuations, posture and dyskinesia during activity of daily living

Supervised classification of bradykinesia for Parkinson’s disease diagnosis from smartphone videos

Slowness of movement, known as bradykinesia, in an important early symptom of Parkinson’s disease. This symptom is currently assessed subjectively by clinical experts. However, expert assessment has been shown to be subject to inter-rater variability. We propose a low-cost, contactless system using smartphone videos to automatically determine the presence of bradykinesia. Using 70 videos recorded in a pilot study, we predict the presence of bradykinesia with an estimated test accuracy of 0.79 and the presence of Parkinson’s disease diagnosis with estimated test accuracy 0.63. Even on a small set of pilot data this accuracy is comparable to that recorded by blinded human experts

Contactless finger tapping detection at C band

The rapid finger tap test is widely used in clinical assessment of dyskinesias in Parkinson’s disease. In clinical practice, doctors rely on their clinical experience and use the Parkinson’s Disease Uniform Rating Scale to make a brief judgment of symptoms. We propose a novel C-band microwave sensing method to evaluate finger tapping quantitatively and qualitatively in a non-contact way based on wireless channel information (WCI). The phase difference between adjacent antennas is used to calibrate the original random phase. Outlier filtering and smoothing filtering are used to process WCI waveforms. Based on the resulting signal, we define and extract a set of features related to the features described in UPDRS. Finally, the features are input into a support vector machine (SVM) to obtain results for patients with different severity. The results show that the proposed system can achieve an average accuracy of 99%. Compared with the amplitude, the average quantization accuracy of the phase difference on finger tapping is improved by 3%. In the future, the proposed system could assist doctors to quantify the movement disorders of patients, and it is very promising to be a candidate for clinical practice

Систем за подршку одлучивању, евалуацију и праћење стања пацијената оболелих од неуродегенеративних болести

Системи за подршку клиничком одлучивању представљају рачунарске алате који применом напредних технологија могу утицати на доношење одлука у вези са пацијентима. У овој дисертацији представљени су истраживање и развој новог система за подршку одлучивању, евалуацију и праћење стања пацијената оболелих од неуродегенеративних болести. Анализа клинички релевантних и свакодневних покрета чини основу овог система. Обрасци ових покрета снимљени су помоћу бежичних, носивих сензора малих димензија и тежине, који не захтевају компликовану поставку и могу се једноставно применити у било ком окружењу. Први део система намењен је (раном) препознавању Паркинсонове болести (ПБ) на основу анализе хода и алгоритама дубоког учења. Резултати су показали да је ПБ пацијенте могуће препознати са високом тачношћу. Други део система посвећен је праћењу симптома ПБ брадикинезије применом резоновања који се базира на знању. Представљена је метода за анализу покрета који се користе за евалуацију брадикинезије. Поред тога, применом различитих метода обраде сигнала развијена је нова метрика за квантификацију важних карактеристика ових покрета. Предикција степена развоја симптома се заснива на новом експертском систему који у потпуности објективизује клиничке евалуационе критеријуме. Валидација је урађена на примеру покрета тапкања прстију, који је снимљен на пацијенатима са типичним и атипичним паркинсонизимом. Показана је висока усаглашеност у поређењу са клиничким подацима. Развијени систем је објективан, аутоматизован, једноставно се користи, садржи интуитиван графички и параметарски приказ резултата и значајно доприноси унапређењу клиничких процедура за евалуацију и праћење стања пацијената са неуродегенеративним болестима.Clinical decision support system represents a computer-aided tool that utilizes advanced technologies for influencing clinical decisions about patients. This dissertation presents research and development of a new decision support system for the assessment of patients with neurodegenerative diseases. The analysis of movements that are part of standard clinical scales or everyday activities represents the basis of the system. These movements are recorded using small and lightweight wearable, wireless sensors, which do not require complicated setup and can be easily applied in any environment. The first part of system is dedicated to the (early) recognition of Parkinson’s disease (PD) based on gait analysis and deep learning algorithms. PD patients could be identified with a high accuracy. The other part of the system is dedicated to the assessment of PD symptoms, more specifically, bradykinesia, utilizing the knowledge-based reasoning. A method for analysis of bradykinesia related movements is defined and presented. Moreover, by applying different signal processing techniques, new metrics have been developed to quantify the essential characteristics of these movements. The prediction of symptom severity was performed using new expert system that completely objectified the clinical evaluation criteria. Validation was performed on the example of the finger-tapping movement of patients with typical and atypical parkinsonism. A high compliance rate was obtained compared to clinical data. The developed system is objective, automated, easy to use, contains an intuitive graphical and parametric presentation of results, and significantly contributes to the improvement of clinical assessment of patients with neurodegenerative diseases

Optimizing Clinical Assessments in Parkinson's Disease Through the Use of Wearable Sensors and Data Driven Modeling

The emergence of motion sensors as a tool that provides objective motor performance data on individuals afflicted with Parkinson's disease offers an opportunity to expand the horizon of clinical care for this neurodegenerative condition. Subjective clinical scales and patient based motor diaries have limited clinometric properties and produce a glimpse rather than continuous real time perspective into motor disability. Furthermore, the expansion of machine learn algorithms is yielding novel classification and probabilistic clinical models that stand to change existing treatment paradigms, refine the application of advance therapeutics, and may facilitate the development and testing of disease modifying agents for this disease. We review the use of inertial sensors and machine learning algorithms in Parkinson's disease

Smartphone-based estimation of item 3.8 of the MDS-UPDRS-III for assessing leg agility in people with Parkinson's disease

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