Machine Learning in Tremor Analysis: Critique and Directions

Tremor is the most frequent human movement disorder, and its diagnosis is based on clinical assessment. Yet finding the accurate clinical diagnosis is not always straightforward. Fine-tuning of clinical diagnostic criteria over the past few decades, as well as device-based qualitative analysis, has resulted in incremental improvements to diagnostic accuracy. Accelerometric assessments are commonplace, enabling clinicians to capture high-resolution oscillatory properties of tremor, which recently have been the focus of various machine-learning (ML) studies. In this context, the application of ML models to accelerometric recordings provides the potential for less-biased classification and quantification of tremor disorders. However, if implemented incorrectly, ML can result in spurious or nongeneralizable results and misguided conclusions. This work summarizes and highlights recent developments in ML tools for tremor research, with a focus on supervised ML. We aim to highlight the opportunities and limitations of such approaches and provide future directions while simultaneously guiding the reader through the process of applying ML to analyze tremor data. We identify the need for the movement disorder community to take a more proactive role in the application of these novel analytical technologies, which so far have been predominantly pursued by the engineering and data analysis field. Ultimately, big-data approaches offer the possibility to identify generalizable patterns but warrant meaningful translation into clinical practice. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

Effects of dance therapy on balance, gait and neuro-psychological performances in patients with Parkinson's disease and postural instability

Postural Instability (PI) is a core feature of Parkinson’s Disease (PD) and a major cause of falls and disabilities. Impairment of executive functions has been called as an aggravating factor on motor performances. Dance therapy has been shown effective for improving gait and has been suggested as an alternative rehabilitative method. To evaluate gait performance, spatial-temporal (S-T) gait parameters and cognitive performances in a cohort of patients with PD and PI modifications in balance after a cycle of dance therapy

Development and Assessment of a Movement Disorder Simulator Based on Inertial Data

The detection analysis of neurodegenerative diseases by means of low-cost sensors and suitable classification algorithms is a key part of the widely spreading telemedicine techniques. The choice of suitable sensors and the tuning of analysis algorithms require a large amount of data, which could be derived from a large experimental measurement campaign involving voluntary patients. This process requires a prior approval phase for the processing and the use of sensitive data in order to respect patient privacy and ethical aspects. To obtain clearance from an ethics committee, it is necessary to submit a protocol describing tests and wait for approval, which can take place after a typical period of six months. An alternative consists of structuring, implementing, validating, and adopting a software simulator at most for the initial stage of the research. To this end, the paper proposes the development, validation, and usage of a software simulator able to generate movement disorders-related data, for both healthy and pathological conditions, based on raw inertial measurement data, and give tri-axial acceleration and angular velocity as output. To present a possible operating scenario of the developed software, this work focuses on a specific case study, i.e., the Parkinson’s disease-related tremor, one of the main disorders of the homonym pathology. The full framework is reported, from raw data availability to pathological data generation, along with a common machine learning method implementation to evaluate data suitability to be distinguished and classified. Due to the development of a flexible and easy-to-use simulator, the paper also analyses and discusses the data quality, described with typical measurement features, as a metric to allow accurate classification under a low-performance sensing device. The simulator’s validation results show a correlation coefficient greater than 0.94 for angular velocity and 0.93 regarding acceleration data. Classification performance on Parkinson’s disease tremor was greater than 98% in the best test conditions

A multimodal dataset of real world mobility activities in Parkinson’s disease

Parkinson’s disease (PD) is a neurodegenerative disorder characterised by motor symptoms such as gait dysfunction and postural instability. Technological tools to continuously monitor outcomes could capture the hour-by-hour symptom fluctuations of PD. Development of such tools is hampered by the lack of labelled datasets from home settings. To this end, we propose REMAP (REal-world Mobility Activities in Parkinson’s disease), a human rater-labelled dataset collected in a home-like setting. It includes people with and without PD doing sit-to-stand transitions and turns in gait. These discrete activities are captured from periods of free-living (unobserved, unstructured) and during clinical assessments. The PD participants withheld their dopaminergic medications for a time (causing increased symptoms), so their activities are labelled as being “on” or “off” medications. Accelerometry from wrist-worn wearables and skeleton pose video data is included. We present an open dataset, where the data is coarsened to reduce re-identifiability, and a controlled dataset available on application which contains more refined data. A use-case for the data to estimate sit-to-stand speed and duration is illustrated

Exploring the Usage of Text-Entry as a Digital Endpoint in Parkinson’s Disease

Tese de mestrado, Informática, 2022, Universidade de Lisboa, Faculdade de CiênciasNeurodegenerative diseases are a group of diseases characterised by the loss of neurons and tend to be fatal. The most researched being Parkinson’s disease, some connections have been established between this disease and the use of text-entry towards its diagnosis and monitoring. With such scattered information regarding neurodegenerative diseases and text-entry, a systematic review was carried out to show which diseases have been researched in that direction, being mainly PD but also MCI and MS. The main metrics collected were flight time, hold time and pressure. As previous research did not include clinicians participation towards the design of diagnosing and monitoring tools, this dissertation went a step further and worked together with clinicians to understand their expectations on data and its visualisations. Clinicians believe that text-entry does have potential towards the diagnosis and monitoring of neurodegenerative diseases. Clinicians also provided concepts of interest against recently suggested metrics, such as apraxia, bradykinesia and dyskinesia. Finally, it was possible to understand how clinicians would deem to be the best way to view the data for the patients’ assessments

Deep learning and wearable sensors for the diagnosis and monitoring of Parkinson’s disease: A systematic review

Parkinson’s disease (PD) is a neurodegenerative disorder that produces both motor and non-motor complications, degrading the quality of life of PD patients. Over the past two decades, the use of wearable devices in combination with machine learning algorithms has provided promising methods for more objective and continuous monitoring of PD. Recent advances in artificial intelligence have provided new methods and algorithms for data analysis, such as deep learning (DL). The aim of this article is to provide a comprehensive review of current applications where DL algorithms are employed for the assessment of motor and nonmotor manifestations (NMM) using data collected via wearable sensors. This paper provides the reader with a summary of the current applications of DL and wearable devices for the diagnosis, prognosis, and monitoring of PD, in the hope of improving the adoption, applicability, and impact of both technologies as support tools. Following PRISMA (Systematic Reviews and Meta-Analyses) guidelines, sixty-nine studies were selected and analyzed. For each study, information on sample size, sensor configuration, DL approaches, validation methods, and results according to the specific symptom under study were extracted and summarized. Furthermore, quality assessment was conducted according to the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) method. The majority of studies (74%) were published within the last three years, demonstrating the increasing focus on wearable technology and DL approaches for PD assessment. However, most papers focused on monitoring (59%) and computer-assisted diagnosis (37%), while few papers attempted to predict treatment response. Motor symptoms (86%) were treated much more frequently than NMM (14%). Inertial sensors were the most commonly used technology, followed by force sensors and microphones. Finally, convolutional neural networks (52%) were preferred to other DL approaches, while extracted features (38%) and raw data (37%) were similarly used as input for DL models. The results of this review highlight several challenges related to the use of wearable technology and DL methods in the assessment of PD, despite the advantages this technology could bring in the development and implementation of automated systems for PD assessment

Hand tracking for clinical applications: validation of the Google MediaPipe Hand (GMH) and the depth-enhanced GMH-D frameworks

Accurate 3D tracking of hand and fingers movements poses significant challenges in computer vision. The potential applications span across multiple domains, including human-computer interaction, virtual reality, industry, and medicine. While gesture recognition has achieved remarkable accuracy, quantifying fine movements remains a hurdle, particularly in clinical applications where the assessment of hand dysfunctions and rehabilitation training outcomes necessitate precise measurements. Several novel and lightweight frameworks based on Deep Learning have emerged to address this issue; however, their performance in accurately and reliably measuring fingers movements requires validation against well-established gold standard systems. In this paper, the aim is to validate the handtracking framework implemented by Google MediaPipe Hand (GMH) and an innovative enhanced version, GMH-D, that exploits the depth estimation of an RGB-Depth camera to achieve more accurate tracking of 3D movements. Three dynamic exercises commonly administered by clinicians to assess hand dysfunctions, namely Hand Opening-Closing, Single Finger Tapping and Multiple Finger Tapping are considered. Results demonstrate high temporal and spectral consistency of both frameworks with the gold standard. However, the enhanced GMH-D framework exhibits superior accuracy in spatial measurements compared to the baseline GMH, for both slow and fast movements. Overall, our study contributes to the advancement of hand tracking technology, the establishment of a validation procedure as a good-practice to prove efficacy of deep-learning-based hand-tracking, and proves the effectiveness of GMH-D as a reliable framework for assessing 3D hand movements in clinical applications

Tauopathies with parkinsonism: clinical spectrum, neuropathologic basis, biological markers, and treatment options

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73913/1/j.1468-1331.2008.02513.x.pd