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

Bradykinesia Detection in Parkinson’s Disease Using Smartwatches’ Inertial Sensors and Deep Learning Methods

Bradykinesia is the defining motor symptom of Parkinson’s disease (PD) and is reflected as a progressive reduction in speed and range of motion. The evaluation of bradykinesia severity is important for assessing disease progression, daily motor fluctuations, and therapy response. However, the clinical evaluation of PD motor signs is affected by subjectivity, leading to intra- and inter-rater variability. Moreover, the clinical assessment is performed a few times a year during pre-scheduled follow-up visits. To overcome these limitations, objective and unobtrusive methods based on wearable motion sensors and machine learning (ML) have been proposed, providing promising results. In this study, the combination of inertial sensors embedded in consumer smartwatches and different ML models is exploited to detect bradykinesia in the upper extremities and evaluate its severity. Six PD subjects and seven age-matched healthy controls were equipped with a consumer smartwatch and asked to perform a set of motor exercises for at least 6 weeks. Different feature sets, data representations, data augmentation methods, and ML models were implemented and combined. Data recorded from smartwatches’ motion sensors, properly augmented and fed to a combination of Convolutional Neural Network and Random Forest model, provided the best results, with an accuracy of 0.86 and an area under the curve (AUC) of 0.94. Results suggest that the combination of consumer smartwatches and ML classification methods represents an unobtrusive solution for the detection of bradykinesia and the evaluation of its severity

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

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

Data from an Observational Study

Introduction Effective management and development of new treatment strategies for response fluctuations in advanced Parkinson’s disease (PD) largely depends on clinical rating instruments such as the PD home diary. The Parkinson’s kinetigraph (PKG) measures movement accelerations and analyzes the spectral power of the low frequencies of the accelerometer data. New algorithms convert each hour of continuous PKG data into one of the three motor categories used in the PD home diary, namely motor Off state and On state with and without dyskinesia. Objective To compare quantitative motor state assessment in fluctuating PD patients using the PKG with motor state ratings from PD home diaries. Methods Observational cohort study on 24 in-patients with documented motor fluctuations who completed diaries by rating motor Off, On without dyskinesia, On with dyskinesia, and asleep for every hour for 5 consecutive days. Simultaneously collected PKG data (recorded between 6 am and 10 pm) were analyzed and calibrated to the patient’s individual thresholds for Off and dyskinetic state by novel algorithms classifying the continuous accelerometer data into these motor states for every hour between 6 am and 10 pm. Results From a total of 2,040 hours, 1,752 hours (87.4%) were available for analyses from calibrated PKG data (7.5% sleeping time and 5.1% unclassified motor state time were excluded from analyses). Distributions of total motor state hours per day measured by PKG showed moderate-to-strong correlation to those assessed by diaries for the different motor states (Pearson’s correlations coefficients: 0.404–0.658), but inter-rating method agreements on the single- hour-level were only low-to-moderate (Cohen’s κ: 0.215–0.324). Conclusion The PKG has been shown to capture motor fluctuations in patients with advanced PD. The limited correlation of hour-to-hour diary and PKG recordings should be addressed in further studies

Objective Assessment of the Finger Tapping Task in Parkinson's Disease and Control Subjects using Azure Kinect and Machine Learning

Parkinson's disease (PD) is characterised by a progressive worsening of motor functionalities. In particular, limited hand dexterity strongly correlates with PD diagnosis and staging. Objective detection of alterations in hand motor skills would allow, for example, prompt identification of the disease, its symptoms and the definition of adequate medical treatments. Among the clinical assessment tasks to diagnose and stage PD from hand impairment, the Finger Tapping (FT) task is a well-established tool. This preliminary study exploits a single RGB-Depth camera (Azure Kinect) and Google MediaPipe Hands to track and assess the Finger Tapping task. The system includes several stages. First, hand movements are tracked from FT video recordings and used to extract a series of clinically-relevant features. Then, the most significant features are selected and used to train and test several Machine Learning (ML) models, to distinguish subjects with PD from healthy controls. To test the proposed system, 35 PD subjects and 60 healthy volunteers were recruited. The best-performing ML model achieved a 94.4% Accuracy and 98.4% Fl score in a Leave-One-Subject-Out validation. Moreover, different clusters with respect to spatial and temporal variability in the FT trials among PD subjects were identified. This result suggests the possibility of exploiting the proposed system to perform an even finer identification of subgroups among the PD population

Is Online Motor Control Really Impaired In Parkinson\u27s Disease?

Patients with Parkinson’s disease (PD) are thought to be selectively impaired in consciously-mediated online automatic motor control, whereas the ability to perform subconscious online adjustments remains intact. This present study evaluates the hypothesis that the previously alleged deficits in online motor control in PD are not due to the consciousness of the correction, but rather are attributable to aspects of the prior experimental designs disproportionately penalizing patients for PD-related bradykinesia. Here, we implemented a modified traditional double-step paradigm to investigate consciously-mediated online motor control in PD, in a manner that would be unconfounded by disease-related bradykinesia. Further, we investigated the effects of dopamine-replacement therapy on performance. We found that PD patients (n=12) and healthy-matched controls (n=12) were equal in performing automatic online corrections whether or not these corrections were consciously perceived, and their performance was unaffected by dopaminergic therapy. These findings inform our understanding of automatic motor control in PD

A partial least-squares regression model to measure Parkinson’s disease motor states using smartphone data

Design choices related to development of data-driven models significantly impact or degrade predictive performance of the models. One of the essential steps during development and evaluation of such models is the choice of feature selection and dimension reduction techniques. That is imperative especially in cases dealing with multimodal data gathered from different sources. In this paper, we will investigate the behavior of Partial Least Squares (PLS) regression for dimension reduction and prediction of motor states of Parkinson’s disease (PD) patients, using upper limb motor data gathered by means of a smartphone. The results in terms of correlations between smartphone-based and clinician-derived scores were compared to a previous study using the same data where principal component analysis (PCA) and support vector machines (SVM) were used. The findings from this study show that PLS is superior in terms of prediction performance of motor states in PD than combining PCA and SVM. This indicates that PLS could be considered as a useful methodology in problems where data-driven analysis is needed