Smartphone motor testing to distinguish idiopathic REM sleep behavior disorder, controls, and PD

OBJECTIVE: We sought to identify motor features that would allow the delineation of individuals with sleep study-confirmed idiopathic REM sleep behavior disorder (iRBD) from controls and Parkinson disease (PD) using a customized smartphone application. METHODS: A total of 334 PD, 104 iRBD, and 84 control participants performed 7 tasks to evaluate voice, balance, gait, finger tapping, reaction time, rest tremor, and postural tremor. Smartphone recordings were collected both in clinic and at home under noncontrolled conditions over several days. All participants underwent detailed parallel in-clinic assessments. Using only the smartphone sensor recordings, we sought to (1) discriminate whether the participant had iRBD or PD and (2) identify which of the above 7 motor tasks were most salient in distinguishing groups. RESULTS: Statistically significant differences based on these 7 tasks were observed between the 3 groups. For the 3 pairwise discriminatory comparisons, (1) controls vs iRBD, (2) controls vs PD, and (3) iRBD vs PD, the mean sensitivity and specificity values ranged from 84.6% to 91.9%. Postural tremor, rest tremor, and voice were the most discriminatory tasks overall, whereas the reaction time was least discriminatory. CONCLUSIONS: Prodromal forms of PD include the sleep disorder iRBD, where subtle motor impairment can be detected using clinician-based rating scales (e.g., Unified Parkinson's Disease Rating Scale), which may lack the sensitivity to detect and track granular change. Consumer grade smartphones can be used to accurately separate not only iRBD from controls but also iRBD from PD participants, providing a growing consensus for the utility of digital biomarkers in early and prodromal PD

Radiothérapie guidée par l'image et adaptative. [Image-guided and adaptive radiotherapy.]

International audienceImage-guided radiotherapy (IGRT) aims to take into account anatomical variations occurring during irradiation by visualization of anatomical structures. It may consist of a rigid registration of the tumour by moving the patient, in case of prostatic irradiation for example. IGRT associated with intensity-modulated radiotherapy (IMRT) is strongly recommended when high-dose is delivered in the prostate, where it seems to reduce rectal and bladder toxicity. In case of significant anatomical deformations, as in head and neck tumours (tumour shrinking and decrease in volume of the salivary glands), replanning appears to be necessary, corresponding to the adaptive radiotherapy. This should ideally be "monitored" and possibly triggered based on a calculation of cumulative dose, session after session, compared to the initial planning dose, corresponding to the concept of dose-guided adaptive radiotherapy. The creation of "planning libraries" based on predictable organ positions (as in cervical cancer) is another way of adaptive radiotherapy. All of these strategies still appear very complex and expensive and therefore require stringent validation before being routinely applied

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Data from: Smartphone motor testing to distinguish idiopathic REM sleep behavior disorder, controls, and PD

Objective: We sought to identify motor features that would allow the delineation of individuals with sleep study-confirmed idiopathic rapid eye movement sleep behaviour disorder (iRBD) from controls and Parkinson’s disease (PD) using a customised smartphone application. Methods: 334 PD, 104 iRBD, and 84 control participants performed seven tasks to evaluate voice, balance, gait, finger tapping, reaction time, rest tremor, and postural tremor. Smartphone recordings were collected both in clinic and at home under non-controlled conditions over several days. All participants underwent detailed parallel in-clinic assessments. Using only the smartphone sensor recordings, we sought to: (1) discriminate whether the participant had iRBD or PD and, (2) identify which of the above seven motor tasks were most salient in distinguishing groups. Results: Statistically significant differences based on these seven tasks were observed between the three groups. For the three pairwise discriminatory comparisons: (1) Controls versus iRBD, (2) Controls versus PD, and (3) iRBD versus PD, mean sensitivity and specificity values ranged from 84.6% to 91.9%. Postural tremor, rest tremor, and voice were the most discriminatory tasks overall, while reaction time was least discriminatory. Conclusions: Prodromal forms of PD include the sleep disorder iRBD, where subtle motor impairment can be detected using clinician based rating scales (e.g UPDRS), which may lack the sensitivity to detect and track granular change. Consumer grade smartphones can be used not only to accurately separate iRBD from controls, but also iRBD from PD participants, providing growing consensus for the utility of digital biomarkers in early and prodromal PD

Supplementary Text-NEUROLOGY-2018-902841

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Smartphone motor testing to distinguish idiopathic REM sleep behaviour disorder, controls and PD

Objective: We sought to identify motor features that would allow the delineation of individuals with sleep study-confirmed idiopathic rapid eye movement sleep behaviour disorder (iRBD) from controls and Parkinson’s disease (PD) using a customised smartphone application. Methods: 334 PD, 104 iRBD, and 84 control participants performed seven tasks to evaluate voice, balance, gait, finger tapping, reaction time, rest tremor, and postural tremor. Smartphone recordings were collected both in clinic and at home under non-controlled conditions over several days. All participants underwent detailed parallel in-clinic assessments. Using only the smartphone sensor recordings, we sought to: (1) discriminate whether the participant had iRBD or PD and, (2) identify which of the above seven motor tasks were most salient in distinguishing groups. Results: Statistically significant differences based on these seven tasks were observed between the three groups. For the three pairwise discriminatory comparisons: (1) Controls versus iRBD, (2) Controls versus PD, and (3) iRBD versus PD, mean sensitivity and specificity values ranged from 84.6% to 91.9%. Postural tremor, rest tremor, and voice were the most discriminatory tasks overall, while reaction time was least discriminatory. Conclusions: Prodromal forms of PD include the sleep disorder iRBD, where subtle motor impairment can be detected using clinician based rating scales (e.g UPDRS), which may lack the sensitivity to detect and track granular change. Consumer grade smartphones can be used not only to accurately separate iRBD from controls, but also iRBD from PD participants, providing growing consensus for the utility of digital biomarkers in early and prodromal PD