Hands-feet wireless devices: Test-retest reliability and discriminant validity of motor measures in Parkinson's disease telemonitoring

Background Telemonitoring, a branch of telemedicine, involves the use of technological tools to remotely detect clinical data and evaluate patients. Telemonitoring of patients with Parkinson's disease (PD) should be performed using reliable and discriminant motor measures. Furthermore, the method of data collection and transmission, and the type of subjects suitable for telemonitoring must be well defined. Objective To analyze differences in patients with PD and healthy controls (HC) with the wearable inertial device SensHands-SensFeet (SH-SF), adopting a standardized acquisition mode, to verify if motor measures provided by SH-SF have a high discriminating capacity and high intraclass correlation coefficient (ICC). Methods Altogether, 64 patients with mild-to-moderate PD and 50 HC performed 14 standardized motor activities for assessing bradykinesia, postural and resting tremors, and gait parameters. SH-SF inertial devices were used to acquire movements and calculate objective motor measures of movement (total: 75). For each motor task, five or more biomechanical parameters were measured twice. The results were compared between patients with PD and HC. Results Fifty-eight objective motor measures significantly differed between patients with PD and HC; among these, 32 demonstrated relevant discrimination power (Cohen's d > 0.8). The test-retest reliability was excellent in patients with PD (median ICC = 0.85 right limbs, 0.91 left limbs) and HC (median ICC = 0.78 right limbs, 0.82 left limbs). Conclusion In a supervised environment, the SH-SF device provides motor measures with good results in terms of reliability and discriminant ability. The reliability of SH-SF measurements should be evaluated in an unsupervised home setting in future studies

Visualization of motor symptoms related to Parkinson's disease using wearable sensors

Parkinson Disease (PD) is the second most common neurological disease after Alzheimer. There is a need for long term monitoring to determine with higher accuracy the stage of the disease and regulate the levodopa treatment. Current wearable technology can achieve this monitorization of the patient’s daily life. Motor symptoms of the disease are the most evident and thus, the easiest to target and to relate to the stage of the disease. They are also the ones that suppose the highest impediment for the patients to perform their daily living activities. In this study, motor symptoms are assessed via pressure sensitive insole and gyroscopic sensors placed on the wrists. Eight subjects were analyzed, four controls and four with different stages of PD, performing a 20-step walking test. Pressure sensitive insole showed the transfer of force in the foot during the gait cycle. These signals showed the level of pronation and supination of each step. The force applied against the ground was reduced in subjects with PD, and specially seen in the toe-off phase which translate in a reduction in the ankle force. There was no apparent change in the step time in any of the signals. Gyroscopic data evaluation consisted in time domain, frequency domain and spectrogram analysis and comparing the Root Mean Squared (RMS) value and entropy of the signals with the stages of the disease to see any correlations. These procedures were made with the signals measured in the three axes and with the calculated angular velocity vector module. The analysis showed that the tremor could be visualized and the effects of bradykinesia were visible in the signals while walking. RMS and Entropy values didn’t show significance correlation between the stages of PD and their values with the exception of the RMS values of the signals in the Y axis and of the vector module. Tremors appeared in the frequency domain in the form of peaks at 5 Hz that were constant through the test, as shown by the spectrograms. The frequency domain of the vector module had the same peaks as the rest of the signals but at the double of their frequency. Since all the signals correspond to a different person from simple tests, there was no way of assessing the effects of the different stages of the disease in the same individual over time. Wearable technology supposes a good viable solution to the problem of long-term daily monitoring for patients with PD. Suunto Movesense ® gyroscope sensors and Smart insole Forciot ® suppose a good of non-invasive monitoring technology that can provide long term daily data with minimal discomfort while assessing motor dysfunctions that alter the movements of a patient

The Feasibility of a Large-Amplitude Aquatic-Based Exercise Occupational Therapy Program for Individuals with Early Parkinson’s Disease

Purpose: The purpose of this research was to determine if a 4-week aquatic-based, large-amplitude exercise program would increase strength and coordination for occupational performance in areas of activities of daily living (ADLs) and mobility in individuals with Parkinson\u27s disease (PD) stage I-II, functional mobility as measured by Timed Up and Go test, and quality of life as measured by PDQ-39 in relation to occupational engagement.Methodology: Recruitment was through capstone placement site, Hands on Rehab, 7921 Professional Circle, Huntington Beach, CA 92648, in which a signed EAA was on file. Informed Consent was reviewed by the student-clinician as well as the supervising clinician prior to assessments or engagement in the program. One participant met criteria and was recruited for the four-week program that ran from February 2023 - March 2023. Data was analyzed through Paired t-test of survey pre- and post-measures. Outcome: The participant in this study was 68 years old with a Hoehn and Yahr stage of 1.5, indicating mild Parkinson\u27s disease symptoms. The statistical analysis revealed a clinically significant improvement in TUG scores, with a notable decrease of about 32% (from 17.51 seconds to 11.92 seconds). The participant went from a fall risk to no fall risk. Similarly, the PDQ-39 showed an improvement of 34.1% with a p-value of p = 0.058. These findings suggest that the aquatic intervention employed in this study has the potential to positively impact balance, functional mobility, and quality of life in individuals with Parkinson\u27s disease. Conclusion: The project was significant for the occupational therapy (OT) profession as it revealed the beneficial and safe impact of aquatic therapy on the occupational performance of individuals with PD (stages I and Il), indicating the need for further research to improve outcomes within the scope of practice for OT practitioners. Aquatic therapy, similar to OT, follows a holistic approach to assess clients through an occupational lens and aligns with the OT profession\u27s scope of practice. The study\u27s primary objective was to determine the program\u27s feasibility, which was supported through the results. Additionally, the study aimed to examine the views of a participant with PD on this large-amplitude aquatic therapy program\u27s effects on posture, balance, and functional performance, paving the way for meaningful assessments, outcomes, and future studies

GYROSCOPIC STABILIZATION FOR UNIAXIAL HAND TREMORS

The goal of this project was to create a device to reduce the magnitude of hand tremors in individuals with Parkinson’s disease or Essential Tremor. We focused primarily on tremors that caused the hand to rotate about a central oscillator parallel to the forearm. We utilized the physical properties of a spinning gyroscope to act as the stabilization mechanism and dampen the tremor effects experienced by the individual. Our final prototype uses a small electric motor to spin a gyroscope on a swinging cradle. This allows the gyroscope to naturally precess due to an input torque and generate a counter torque along the axis of the hand’s rotation. To monitor the device, we incorporated an RPM sensor in conjunction with an Arduino to receive sensory information about the gyroscope

Inertial sensor based full body 3D kinematics in the differential diagnosis between Parkinson’s Disease and mimics

The differential diagnosis of Parkinson’s Disease (PD) remains challenging with frequent mis and underdiagnosis. DAT-Scan has been a useful technique for assessing the lost integrity of the nigrostriatal pathway in PD and differentiating true parkinsonism from mimics. However, DAT-Scan remains unavailable in most non-specialized clinical centres, making imperative the search for other easy and low-cost solutions. This dissertation aimed to investigate the role of inertial sensors in distinguishing between the denervated and the non-denervated individuals. In this dissertation, we've used Inertial Sensor Based 3D Full Body Kinematics (FBK) and tested if this technique was able to distinguish between patients with changes in the DAT-Scan from those without. This was divided into two parts, being that firstly, a group of individuals was referred by the attending physician for DAT-Scan (123I-FP-CIT SPECT) to be able to compare FBK in those with and without evidence of dopaminergic depletion. Second, it was tested whether FBK could be used as a metric for the severity of dopaminergic depletion. Twenty-one patients participated in this study, being recruited from the Nuclear Medicine Unit in the Champalimaud Clinical Centre (CCC), Lisbon. Within these 21 patients, 10 of them had denervation (mean age, 68.4 ± 7.8 years) and the remaining 11 (mean age, 66.6 ± 7.4 years) did not present denervation. The analysis between the worst uptake ratio features and dimensional features, as well as the asymmetry indexes in the striatum revealed significant differences between denervated and non-denervated individuals. On the contrary, the kinematics did not do it. Overall, based on the collected kinematics data, it was identified that there was not any significant correlation between the kinematics and the DAT-Scan. What means that these kinematics variables were not able to explain the DAT-Scan. On the other hand, it was also checked that the kinematics data were strongly correlated to the motor symptoms (MDS-UPDRS III). This way, it was concluded that the classical biomechanics did not distinguish denervated from non-denervated individuals. Therefore, the kinematics could not give the same answer as the DAT-Scan. In spite of these results it would be relevant to keep researching other methods in order to find out the distinction between the denervation and no denervation in a low-cost way

Effect of Baduanjin on physical functioning and balance in adults with mild-to-moderate intellectual disabilities: A comparative study

Background Adults with intellectual disabilities often experience mobility limitations. Baduanjin, a mindfulness-based exercise intervention, can exert positive effects on functional mobility and balance. This study examined the impact of Baduanjin on physical functioning and balance of adults with intellectual disabilities. Method Twenty-nine adults with intellectual disabilities participated in the study. Eighteen received a Baduanjin intervention for 9-months; 11 participants did not receive any intervention (comparison group). Physical functioning and balance were assessed using the short physical performance battery (SPPB) and stabilometry. Results Participants in the Baduanjin group experienced significant changes in the SPPB walking test (p = .042), chair stand test (p = .015), and SPPB summary score (p = .010). No significant changes between groups were observed in any of the variables assessed at the end of the intervention. Conclusions Baduanjin practice may cause significant, albeit small, improvements in physical functioning of adults with intellectual disabilities.The authors would like to acknowledge the staff and participants from Lantegi Batuak for their assistance and willingness to be part of the study. This study was facilitated by an agreement between the regional Government Diputación Foral de Bizkaia/Bizkaiko Foru Aldundia (Departamento de Acción Social/Gizarte Ekintza Saila) and Lantegi Batuak

Effects of Cueing on Sit to Stand Transfers in Parkinson Disease

Problem Statement: Individuals with Parkinson Disease (PD) often experience difficulty transferring from sit to stand (STS). Current evidence suggests cues which promote an external attentional focus improve gait and transfers for individuals with PD. However, this research utilizes cues which are difficult to replicate in clinical or natural environments making the findings difficult to generalize or implement. Purpose: The primary purpose of this study is to determine the effect of 3 different explicit cues on STS for individuals with PD. Additionally we sought to determine if, in this population, a relationship exists between latency of movement initiation and postural sway in early standing, changes in joint angle between conditions and postural sway in early standing, and cue provided during the transfer and postural sway in early standing. Procedures/Methodology: Thirteen individuals in both the experimental and control groups participated in this cross-over design study. Both groups completed trials of self-initiated uncued STS transfers. Those in the experimental group also completed trials of STS transfers in 3 conditions: with an external attentional focus of reaching to targets, with an external attentional focus of concurrent modeling, and with an explicit cue for an internal attentional focus. Data was collected by trained testers and utilized valid and reliable body worn inertial measurement unit sensors. ANOVAs were used to compare performance between conditions and to the performance of the healthy control group. Bonferroni corrections were completed to reduce the likelihood of accepting a false positive. Results: Both cues that elicit an external attentional focus improved motor control during the sit to stand transfer. However, only modeling was able to improve both motor control and postural control. Cueing that promoted an internal attentional focus resulted in decreased motor control and postural control. Additionally, a moderate positive correlation was found between standing taller than typical and postural sway. Clinical Implications: Our results provide evidence for clinicians to better tailor treatment methodologies to the needs of individuals with PD. Optimal cueing can be utilized as compensations that reduce caregiver burden and increase independence of individuals with PD

Personalizing functional Magnetic Resonance Protocols for Studying Neural Substrates of Motor Deficits in Parkinson’s Disease

Parkinson’s disease (PD) is a progressive neurodegenerative movement disorder characterized by a large number of motor and non-motor deficits, which significantly contribute to reduced quality of life. Despite the definition of the broad spectrum of clinical characteristics, mechanisms triggering illness, the nature of its progression and a character of therapeutic effects still remain unknown. The enormous advances in magnetic resonance imaging (MRI) in the last decades have significantly affected the research attempts to uncover the functional and structural abnormalities in PD and have helped to develop and monitor various treatment strategies, of which dopamine replacement strategies, mainly in form of levodopa, has been the gold standard since the late seventies and eighties. Motor, task-related functional MRI (fMRI) has been extensively used to assess the pathological state of the motor circuitry in PD. Several studies employed motor paradigms and fMRI to review the functional brain responses of participants to levodopa treatment. Interestingly, they provided conflicting results. Wide spectrum of symptoms, variability and asymmetry of the disease presentation, several treatment approaches and their divergent outcomes make PD enormously heterogeneous. In this work we hypothesized that not considering the disease heterogeneity might have been an adequate cause for the discrepant results in aforementioned studies. We show that not accounting for the disease variability might indeed compromise the results and invalidate the consequent interpretations. Accordingly, we propose and formalize a statistical approach to account for the intra and inter subject variability. This might help to minimize this bias in future motor fMRI studies revealing the functional brain dysfunction and contribute to the understanding of still unknown pathophysiological mechanisms underlying PD

Diagnosis and Treatment of Parkinson's Disease

Parkinson's disease is diagnosed by history and physical examination and there are no laboratory investigations available to aid the diagnosis of Parkinson's disease. Confirmation of diagnosis of Parkinson's disease thus remains a difficulty. This book brings forth an update of most recent developments made in terms of biomarkers and various imaging techniques with potential use for diagnosing Parkinson's disease. A detailed discussion about the differential diagnosis of Parkinson's disease also follows as Parkinson's disease may be difficult to differentiate from other mimicking conditions at times. As Parkinson's disease affects many systems of human body, a multimodality treatment of this condition is necessary to improve the quality of life of patients. This book provides detailed information on the currently available variety of treatments for Parkinson's disease including pharmacotherapy, physical therapy and surgical treatments of Parkinson's disease. Postoperative care of patients of Parkinson's disease has also been discussed in an organized manner in this text. Clinicians dealing with day to day problems caused by Parkinson's disease as well as other healthcare workers can use beneficial treatment outlines provided in this book