Smart-device based motor function battery, A

2018 Fall.Includes bibliographical references.Growth in the older population will increase the overall impact of age-related neurological disorders. Aging and neurological conditions share features such as impaired motor function and physical dysfunction including reduced muscle strength and power, slowness of movement, increased movement variability and balance dysfunction. Successful performance of daily activities and maintenance of mobility is key to independence and quality of life. Therefore, tracking changes in physical function is critical in gauging quality of life. However truly quantitative measures of physical capacity often require the use of expensive, lab-based equipment. Smart devices contain sensitive tri-axial accelerometers and gyroscopes that measure acceleration and rotation and offer a more cost-effective, portable yet still quantitative means of physical assessment. The purpose is to describe an iPod Touch-instrumented test battery designed to assess features of physical and motor function often shared by normal aging and age-related movement disorders. We have been assessing the correlation between measures taken from expensive lab devices and the iPod Touch smart device for a variety of movements. We developed and tested a multi-item smart device-based battery of motor tasks that addresses motor variability, slowness and postural instability across a range of young, healthy college students. By changing the location of the device we can assess upper and lower limb movement speed and power, hand tremor, or postural control. We have also used previously validated lab devices concurrently with the smart device, which allows us to correlate the results between devices to assess the extent of the association between devices. Outcomes such as peak acceleration and variability of movements can be obtained. Generally, the smart device demonstrated strong correlations with the lab grade sensors for all motor tasks. Furthermore, the smart device was also correlated with the accelerometer across a large range of speed and variability. Strong correlations were seen in ballistic arm and leg tasks, tremor, and postural control assessments. This finding suggests that the smart device can sufficiently assess a broad range of functional capacity. This battery can then be used to study populations exhibiting motor impairment, ranging from older adults, to neurological patients. Using the sensors on the smart device, this testing can be administered remotely and inexpensively by non-experts, providing cost-effective, mobile, user- and patient-friendly physical function testing. More importantly, accessibility of testing is increased while retaining quantitative precision. This should aid in quantifying disease progression and response to pharmacological or exercise/rehabilitative intervention, with the goal of improved function and quality of life in those with impairment

How best to capture the impact of complementary therapies in palliative care: A systematic review to identify and assess the appropriateness and validity of multi-domain tools

BACKGROUND: Complementary therapies are widely used in palliative care settings. Qualitative research found that people with advanced disease report a range of physical and psychological benefits from complementary therapies, however evidence of their effectiveness from clinical trials is inconclusive. This may be because trials are limited by use of inappropriate outcome measures. AIMS: To identify tools which capture the impact of massage, reflexology and aromatherapy in people with advanced disease. We (1) identified multi-domain tools used to evaluate these therapies in populations with any chronic health condition and (2) assessed whether tools were valid and psychometrically robust in populations with advanced disease. DESIGN: A two-stage systematic review was conducted using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines (PROSPERO: CRD42020161199). DATA SOURCES: Six databases were searched (August 2021). Study methodological quality, tool psychometric properties and evidence quality were assessed. A global comparison score was generated. RESULTS: Stage 1: 66 trials using 40 different multi-domain tools were identified. Stage 2: Of these tools, we identified papers for seven tools regarding development or validation in advanced disease populations. The majority of psychometric data were inconsistent or inconclusive. Data were mostly of low quality due to methodological issues. CONCLUSION: Of the tools identified, 'Functional Assessment of Cancer Therapy - General' appears to be the most suitable alternative tool against COMSIN criteria, for trials of massage, reflexology and aromatherapy in palliative care. Further tool validation is required before firm recommendations can be made. Co-development of a core outcome set could ensure relevant domains are assessed

Objective assessment of upper limb motor symptoms in Parkinson's Disease using body-worn sensors

MD ThesisBackground There is a need for an objective method of symptom assessment in Parkinson's disease (PD) to enable better treatment decisions and to aid evaluation of new treatments. Current assessment methods; patient-completed symptom diaries and clinical rating scales, have limitations. Accelerometers (sensors capable of capturing data on human movement) and analysis using artificial neural networks (ANNs) have shown potential as a method of motor symptom evaluation in PD. It is unknown whether symptom monitoring with body-worn sensors is acceptable to PD patients due to a lack of previous research. Methods 34 participants with PD wore bilateral wrist-worn accelerometers for 4 hours in a research facility (phase 1) and then for 7 days in their homes (phase 2) whilst also completing symptom diaries. An ANN designed to predict a patient’s motor status, was developed and trained based on accelerometer data during phase 2. ANN performance was evaluated (leave-one-out approach) against patient-completed symptom diaries during phase 2, and against clinician rating of disease state during phase 1 observations. Participants’ views regarding the sensors were obtained via a Likert-style questionnaire completed after each phase. Differences in responses between phases were assessed for using the Wilcoxon rank-sum test. Results ANN-derived values of the proportion of time in each disease state (phase 2), showed strong, significant correlations with values derived from patient-completed symptom diaries. ANN disease state recognition during phase 1 was sub-optimal. High concordance with sensors was seen. Prolonged wearing of the sensors did not adversely affect participants’ opinions on the wearability of the sensors, when compared to their responses following phase 1 Conclusions Accelerometers and ANNs produced results comparable to those of symptom diaries. Our findings suggest that long-term monitoring with wrist-worn sensors is acceptable to PD patients

The Quick Mild Cognitive Impairment (Qmci) screen: developing a new screening test for mild cognitive impairment and dementia

Introduction: Identifying mild cognitive impairment (MCI) is challenging. Few short instruments have sufficient sensitivity and specificity for use in busy clinical practice. This thesis explores the development, psychometric evaluation and validation of a new short (3–5 min) cognitive screening instrument, designed to screen for MCI and early dementia, called the Quick Mild Cognitive Impairment (Q\u1d62e\u1d624\u1d62a) screen. Specific aims included assessing 1) content validity, 2) concurrent validity against other short screens, 3) construct validity against detailed global and neuropsychological tests and 4) refining the Q\u1d62e\u1d624\u1d62a into a ‘home’-carer administered “Quick Memory Check-QMC”. Methods: A secondary analysis of data from three Canadian databases was conducted to validate the Q\u1d62e\u1d624\u1d62a. The Q\u1d62e\u1d624\u1d62a was then externally validated in different settings (memory clinic, movement disorder clinic, general practice, rehabilitation unit) in Ireland. Translation and external validation in other languages was also begun. Results: The Q\u1d62e\u1d624\u1d62a was more accurate than the ABCS 135, 6CIT, GPCOG, SMMSE and had similar sensitivity but greater specificity than the MoCA in differentiating MCI from normal. Cut-off scores using maximal accuracy and Youden’s Index, adjusted for age and education, were produced. The Q\u1d62e\u1d624\u1d62a correlated with global functional measures (Lawton-Brody ADL scale and CDR) and the Standardised ADAS-cog. The Q\u1d62e\u1d624\u1d62a had excellent inter-rater and test-retest reliability. A shortened Q\u1d62e\u1d624\u1d62a, administered by caregivers (QMC), was acceptable and had comparable accuracy to a battery of short cognitive screens. Discussion: This thesis presents the development and psychometric evaluation of the Q\u1d62e\u1d624\u1d62a screen. It also demonstrates the potential of shortening the instrument to allow caregivers score patients at home in an attempt to reduce performance anxiety. This project also suggests that the Q\u1d62e\u1d624\u1d62a could be substituted for more detailed and longer instruments in a wide variety of settings, as a rapid screening test for cognitive impairment, particularly where the suspicion favours the presence of MC

The comparative neuropsychology of dementia

PhD ThesisOn the basis of neuropathological, neurochemical, genetic, and clinical profile studies on patients, distinct forms of dementia, such as dementia with Lewy bodies (DLB), have been distinguished which were originally thought to be Alzheimer's disease (AD). Dementia with Lewy bodies is probably the second most common form of dementia in the elderly. In this thesis, a well characterised and investigated cohort of DLB and AD patients were compared to non-demented elderly controls in order to establish profiles of cognitive decline in these groups. Initially, comprehensively matched experimental groups were compared using the Cambridge Neuropsychological Test Automated Battery (CANTAB). The DLB group was less impaired than the AD group on a test of visual pattern recognition memory. However, the DLB group performed worse on a number of cognitive tests. Comparison of larger, carefully matched, experimental groups using the Cognitive Drug Research Computerised Assessment Battery (CDR) also revealed differences in the profile of cognitive impairment in DLB and AD. The DLB group showed more marked deficits in attentional abilities than the AD group. In particular, the DLB group were unable to sustain attention. Conversely, the DLB group were less impaired on a test of visual secondary recognition memory than the AD group. Further division of the DLB group into cases with and without persistent visual hallucinations revealed distinct patterns of cognitive impairment in these two groups. Generally, DLB cases with persistent visual hallucinations showed greater attentional and spatial working memory deficits than the DLB cases without persistent visual hallucinations. A final study compared decline in cognitive function over 1 year in DLB, AD and control groups. Similar rates of cognitive decline were identified in a number of cognitive domains in AD and DLB groups. In addition, disproportionate decline in the ability to sustain attention was identified in the DLB group. A comparative model relating known neuropsychological, neurochemical, and neuropathological features of DLB and AD was proposed

Smart Technology for Telerehabilitation: A Smart Device Inertial-sensing Method for Gait Analysis

The aim of this work was to develop and validate an iPod Touch (4th generation) as a potential ambulatory monitoring system for clinical and non-clinical gait analysis. This thesis comprises four interrelated studies, the first overviews the current available literature on wearable accelerometry-based technology (AT) able to assess mobility-related functional activities in subjects with neurological conditions in home and community settings. The second study focuses on the detection of time-accurate and robust gait features from a single inertial measurement unit (IMU) on the lower back, establishing a reference framework in the process. The third study presents a simple step length algorithm for straight-line walking and the fourth and final study addresses the accuracy of an iPod’s inertial-sensing capabilities, more specifically, the validity of an inertial-sensing method (integrated in an iPod) to obtain time-accurate vertical lower trunk displacement measures. The systematic review revealed that present research primarily focuses on the development of accurate methods able to identify and distinguish different functional activities. While these are important aims, much of the conducted work remains in laboratory environments, with relatively little research moving from the “bench to the bedside.” This review only identified a few studies that explored AT’s potential outside of laboratory settings, indicating that clinical and real-world research significantly lags behind its engineering counterpart. In addition, AT methods are largely based on machine-learning algorithms that rely on a feature selection process. However, extracted features depend on the signal output being measured, which is seldom described. It is, therefore, difficult to determine the accuracy of AT methods without characterizing gait signals first. Furthermore, much variability exists among approaches (including the numbers of body-fixed sensors and sensor locations) to obtain useful data to analyze human movement. From an end-user’s perspective, reducing the amount of sensors to one instrument that is attached to a single location on the body would greatly simplify the design and use of the system. With this in mind, the accuracy of formerly identified or gait events from a single IMU attached to the lower trunk was explored. The study’s analysis of the trunk’s vertical and anterior-posterior acceleration pattern (and of their integrands) demonstrates, that a combination of both signals may provide more nuanced information regarding a person’s gait cycle, ultimately permitting more clinically relevant gait features to be extracted. Going one step further, a modified step length algorithm based on a pendulum model of the swing leg was proposed. By incorporating the trunk’s anterior-posterior displacement, more accurate predictions of mean step length can be made in healthy subjects at self-selected walking speeds. Experimental results indicate that the proposed algorithm estimates step length with errors less than 3% (mean error of 0.80 ± 2.01cm). The performance of this algorithm, however, still needs to be verified for those suffering from gait disturbances. Having established a referential framework for the extraction of temporal gait parameters as well as an algorithm for step length estimations from one instrument attached to the lower trunk, the fourth and final study explored the inertial-sensing capabilities of an iPod Touch. With the help of Dr. Ian Sheret and Oxford Brookes’ spin-off company ‘Wildknowledge’, a smart application for the iPod Touch was developed. The study results demonstrate that the proposed inertial-sensing method can reliably derive lower trunk vertical displacement (intraclass correlations ranging from .80 to .96) with similar agreement measurement levels to those gathered by a conventional inertial sensor (small systematic error of 2.2mm and a typical error of 3mm). By incorporating the aforementioned methods, an iPod Touch can potentially serve as a novel ambulatory monitor system capable of assessing gait in clinical and non-clinical environments