scholarly journals Smartphone-Based Monitoring of Parkinson Disease: Quasi-Experimental Study to Quantify Hand Tremor Severity and Medication Effectiveness

10.2196/21543 ◽  
2020 ◽  
Vol 8 (11) ◽  
pp. e21543
Author(s):  
Elina Kuosmanen ◽  
Florian Wolling ◽  
Julio Vega ◽  
Valerii Kan ◽  
Yuuki Nishiyama ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Rating Scale ◽  
Inertial Sensors ◽  
Negative Impact ◽  
Wearable Sensors ◽  
Real Life ◽  
Rank Correlation ◽  
Accelerometer Data ◽  
Hand Tremor ◽  
Significant Difference

Background Hand tremor typically has a negative impact on a person’s ability to complete many common daily activities. Previous research has investigated how to quantify hand tremor with smartphones and wearable sensors, mainly under controlled data collection conditions. Solutions for daily real-life settings remain largely underexplored. Objective Our objective was to monitor and assess hand tremor severity in patients with Parkinson disease (PD), and to better understand the effects of PD medications in a naturalistic environment. Methods Using the Welch method, we generated periodograms of accelerometer data and computed signal features to compare patients with varying degrees of PD symptoms. Results We introduced and empirically evaluated the tremor intensity parameter (TIP), an accelerometer-based metric to quantify hand tremor severity in PD using smartphones. There was a statistically significant correlation between the TIP and self-assessed Unified Parkinson Disease Rating Scale (UPDRS) II tremor scores (Kendall rank correlation test: z=30.521, P<.001, τ=0.5367379; n=11). An analysis of the “before” and “after” medication intake conditions identified a significant difference in accelerometer signal characteristics among participants with different levels of rigidity and bradykinesia (Wilcoxon rank sum test, P<.05). Conclusions Our work demonstrates the potential use of smartphone inertial sensors as a systematic symptom severity assessment mechanism to monitor PD symptoms and to assess medication effectiveness remotely. Our smartphone-based monitoring app may also be relevant for other conditions where hand tremor is a prevalent symptom.

scholarly journals Smartphone-Based Monitoring of Parkinson Disease: Quasi-Experimental Study to Quantify Hand Tremor Severity and Medication Effectiveness (Preprint)

2020 ◽  
Author(s):  
Elina Kuosmanen ◽  
Florian Wolling ◽  
Julio Vega ◽  
Valerii Kan ◽  
Yuuki Nishiyama ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Rating Scale ◽  
Inertial Sensors ◽  
Negative Impact ◽  
Wearable Sensors ◽  
Real Life ◽  
Rank Correlation ◽  
Accelerometer Data ◽  
Hand Tremor ◽  
Significant Difference

BACKGROUND Hand tremor typically has a negative impact on a person’s ability to complete many common daily activities. Previous research has investigated how to quantify hand tremor with smartphones and wearable sensors, mainly under controlled data collection conditions. Solutions for daily real-life settings remain largely underexplored. OBJECTIVE Our objective was to monitor and assess hand tremor severity in patients with Parkinson disease (PD), and to better understand the effects of PD medications in a naturalistic environment. METHODS Using the Welch method, we generated periodograms of accelerometer data and computed signal features to compare patients with varying degrees of PD symptoms. RESULTS We introduced and empirically evaluated the tremor intensity parameter (TIP), an accelerometer-based metric to quantify hand tremor severity in PD using smartphones. There was a statistically significant correlation between the TIP and self-assessed Unified Parkinson Disease Rating Scale (UPDRS) II tremor scores (Kendall rank correlation test: z=30.521, <i>P</i>&lt;.001, τ=0.5367379; n=11). An analysis of the “before” and “after” medication intake conditions identified a significant difference in accelerometer signal characteristics among participants with different levels of rigidity and bradykinesia (Wilcoxon rank sum test, <i>P</i>&lt;.05). CONCLUSIONS Our work demonstrates the potential use of smartphone inertial sensors as a systematic symptom severity assessment mechanism to monitor PD symptoms and to assess medication effectiveness remotely. Our smartphone-based monitoring app may also be relevant for other conditions where hand tremor is a prevalent symptom.

scholarly journals Innovation through Wearable Sensors to Collect Real-Life Data among Pediatric Patients with Cardiometabolic Risk Factors

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Kestens Yan ◽  
Barnett Tracie ◽  
Mathieu Marie-Ève ◽  
Henderson Mélanie ◽  
Bigras Jean-Luc ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Heart Rate ◽  
Cardiometabolic Risk ◽  
Wearable Sensors ◽  
Real Life ◽  
Cardiometabolic Risk Factors ◽  
University Hospital ◽  
Activity Levels ◽  
Accelerometer Data

Background. While increasing evidence links environments to health behavior, clinicians lack information about patients’ physical activity levels and lifestyle environments. We present mobile health tools to collect and use spatio-behavioural lifestyle data for personalized physical activity plans in clinical settings.Methods. The Dyn@mo lifestyle intervention was developed at the Sainte-Justine University Hospital Center to promote physical activity and reduce sedentary time among children with cardiometabolic risk factors. Mobility, physical activity, and heart rate were measured in free-living environments during seven days. Algorithms processed data to generate spatio-behavioural indicators that fed a web-based interactive mapping application for personalised counseling. Proof of concept and tools are presented using data collected among the first 37 participants recruited in 2011.Results. Valid accelerometer data was available for 5.6 (SD=1.62) days in average, heart rate data for 6.5 days, and GPS data was available for 6.1 (2.1) days. Spatio-behavioural indicators were shared between patients, parents, and practitioners to support counseling.Conclusion. Use of wearable sensors along with data treatment algorithms and visualisation tools allow to better measure and describe real-life environments, mobility, physical activity, and physiological responses. Increased specificity in lifestyle interventions opens new avenues for remote patient monitoring and intervention.

Clinical profiles and outcomes of deep brain stimulation in G2019S LRRK2 Parkinson disease

2021 ◽  
pp. 1-8
Author(s):  
Katherine Leaver ◽  
Aaron Viser ◽  
Brian H. Kopell ◽  
Roberto A. Ortega ◽  
Joan Miravite ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Clinical Features ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Age Of Onset ◽  
Disease Onset ◽  
Hand Tremor ◽  
Stn Dbs ◽  
Deep Brain

OBJECTIVE The objective of this study was to evaluate clinical features and response to deep brain stimulation (DBS) in G2019S LRRK2-Parkinson disease (LRRK2-PD) and idiopathic PD (IPD). METHODS The authors conducted a clinic-based cohort study of PD patients recruited from the Mount Sinai Beth Israel Genetics database of PD studies. The cohort included 87 participants with LRRK2-PD (13 who underwent DBS) and 14 DBS participants with IPD enrolled between 2009 and 2017. The baseline clinical features, including motor ratings and levodopa-equivalent daily dose (LEDD), were compared among LRRK2-PD patients with and without DBS, between LRRK2-PD with DBS and IPD with DBS, and between LRRK2-PD with subthalamic nucleus (STN) and internal segment of the globus pallidus (GPi) DBS. Longitudinal motor scores (Unified Parkinson’s Disease Rating Scale–part III) and medication usage were also assessed pre- and postoperatively. RESULTS Compared to LRRK2-PD without DBS (n = 74), the LRRK2-PD with DBS cohort (n = 13) had a significantly younger age of onset, longer disease duration, were more likely to have dyskinesia, and were less likely to experience hand tremor at disease onset. LRRK2-PD participants were also more likely to be referred for surgery because of severe dyskinesia (11/13 [85%] vs 6/14 [43%], p = 0.04) and were less likely to be referred for medically refractory tremor (0/13 [0%] vs 6/14 [43%], p = 0.02) than were IPD patients. Among LRRK2-PD patients, both STN-DBS and GPi-DBS targets were effective, although the sample size was small for both groups. There were no revisions or adverse effects reported in the GPi-DBS group, while 2 of the LRRK2-PD participants who underwent STN-DBS required revisions and a third reported depression as a stimulation-related side effect. Medication reduction favored the STN group. CONCLUSIONS The LRRK2-PD cohort referred for DBS had a slightly different profile, including earlier age of onset and dyskinesia. Both the STN and GPi DBS targets were effective in symptom suppression. Patients with G2019S LRRK2 PD were well-suited for DBS therapy and had favorable motor outcomes regardless of the DBS target. LRRK2-DBS patients had longer disease durations and tended to have more dyskinesia. Dyskinesia commonly served as the trigger for DBS surgical candidacy. Medication-refractory tremor was not a common indication for surgery in the LRRK2 cohort.

scholarly journals Botulinum Toxin for the Treatment of Hand Tremor

Toxins ◽  
2018 ◽  
Vol 10 (7) ◽  
pp. 299 ◽  
Author(s):  
Nicki Niemann ◽  
Joseph Jankovic
Keyword(s):  
Marked Improvement ◽  
Rating Scale ◽  
Total Duration ◽  
Peak Effect ◽  
Global Rating ◽  
Rating Score ◽  
Limb Weakness ◽  
Hand Tremor ◽  
Significant Difference

The aim of this study is to review our longitudinal experience with onabotulinumtoxinA (onaBoNT-A) injections for medically refractory hand tremor. We performed a retrospective review of our database of patients treated with onaBoNT-A for hand tremor evaluated between 2010 and 2018 in at least 2 sessions with follow-up. The majority were injected into the forearm flexors (FF), although treatment was individualized. During the specified period, 91 patients (53 essential tremor, 31 dystonic tremor, 6 Parkinson’s disease tremor, and 1 cerebellar outflow tremor) met our inclusion criteria. The mean age (SD) was 64.8 years (12.8), and mean duration of follow-up was 29.6 months (25.1) with mean of 7.7 (6.3) treatment visits. FF were injected in 89 (97.8%) patients, exclusively in 74 (81.3%), and 15 (16.5%) were injected in FF and other muscles. EMG guidance was used in 5 patients (5.5%). On a 0–4 “peak effect” rating scale (0 = no effect, 4 = marked improvement in severity and function), 80.2% and 85.7% of patients reported moderate or marked improvement (score 3 or 4) at their first and last follow-up visit, respectively. There was no statistically significant difference in the outcomes between first and last visit: average “peak effect” rating score (3.2 versus 3.4), “global” rating score (3.0 versus 3.2), latency of response (4.5 versus 3.8 days), and total duration of response (12.7 versus 12.8 weeks), except onaBoNT-A dose (65.0 versus 78.6 U/limb, p = 0.002). Of 1095 limb injections, there were 134 (12.2%) non-disabling and transient (mean 36 days) adverse events (132 limb weakness, 2 pain). OnaBoNT-A injections are safe and effective in the treatment of hand tremor.

scholarly journals Towards ecologically valid biomarkers: real-life gait assessment in cerebellar ataxia

2019 ◽  
Author(s):  
Winfried Ilg ◽  
Jens Seemann ◽  
Martin Giese ◽  
Andreas Traschütz ◽  
Ludger Schöls ◽  
...  
Keyword(s):  
Inertial Sensors ◽  
Wearable Sensors ◽  
Real Life ◽  
Movement Analysis ◽  
High Sensitivity ◽  
Step Length ◽  
Gait Variability ◽  
Effect Sizes ◽  
Ataxic Gait ◽  
Disease Modifying Drugs

AbstractBACKGROUNDWith disease-modifying drugs on the horizon for degenerative ataxias, motor biomarkers are highly warranted. While ataxic gait and its treatment-induced improvements can be captured in laboratory-based assessments, quantitative markers of ataxic gait in real life will help to determine ecologically meaningful improvements.OBJECTIVESTo unravel and validate markers of ataxic gait in real life by using wearable sensors.METHODSWe assessed gait characteristics of 43 patients with degenerative cerebellar disease (SARA:9.4±3.9) compared to 35 controls by 3 body-worn inertial sensors in three conditions: (1) laboratory-based walking; (2) supervised free walking; (3) real-life walking during everyday living (subgroup n=21). Movement analysis focussed on measures of movement smoothness and spatio-temporal step variability.RESULTSA set of gait variability measures was identified which allowed to consistently identify ataxic gait changes in all three conditions. Lateral step deviation and a compound measure of step length categorized patients against controls in real life with a discrimination accuracy of 0.86. Both were highly correlated with clinical ataxia severity (effect size ρ=0.76). These measures allowed detecting group differences even for patients who differed only 1 point in the SARAp&g subscore, with highest effect sizes for real-life walking (d=0.67).CONCLUSIONSWe identified measures of ataxic gait that allowed not only to capture the gait variability inherent in ataxic gait in real life, but also demonstrate high sensitivity to small differences in disease severity - with highest effect sizes in real-life walking. They thus represent promising candidates for quantitative motor markers for natural history and treatment trials in ecologically valid contexts.

Toward Automated, At-Home Assessment of Mobility Among Patients With Parkinson Disease, Using a Body-Worn Accelerometer

2011 ◽  
Vol 25 (9) ◽  
pp. 810-818 ◽  
Author(s):  
Aner Weiss ◽  
Sarvi Sharifi ◽  
Meir Plotnik ◽  
Jeroen P. P. van Vugt ◽  
Nir Giladi ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Validation Study ◽  
Rating Scale ◽  
Medical Center ◽  
Real Life ◽  
Frequency Dispersion ◽  
Dominant Frequency ◽  
Signal Frequency ◽  
Before And After ◽  
At Home

Objective. To develop an automated and objective method to assess mobility in Parkinson disease (PD) patients in daily-life settings and to investigate whether accelerometer-derived measures discriminate between PD and healthy controls as they walk and simulate activities of daily living (ADL). Methods. Healthy older adults (17) and patients with PD (22) wore a triaxial accelerometer on their lower back during short walks (validation study) and during a walk around the medical center to simulate daily activities (ADL simulation). The variability (consistency and rhythmicity) of stepping was assessed. The patients completed the walks before and after taking their anti-Parkinsonian medications. Frequency-based acceleration measures included dominant frequency, amplitude (strength of signal frequency), width (frequency dispersion), and slope (a combination reflecting amplitude and width) of the main frequency of the power spectral density in the 0.5- to 3.0-Hz band. A subset of the Unified Parkinson-Disease Rating Scale provided a clinical measure of gait impairment (UPDRS-Gait5). A PD patient and control wore the sensors for 3 days at home. Results. The width was larger, and the amplitude and slope were smaller in the PD patients compared to the controls in the validation study and ADL simulation ( P < .02). The width decreased, and the amplitude and slope increased when patients took anti-Parkinsonian medications ( P < .007). Significant correlations were observed between acceleration-derived measures and UPDRS-Gait5. The data obtained at home was similar to the clinic data. Conclusions. Frequency-derived measures are valid and sensitive estimates of stride-to-stride variability that can be used to assess the quality and consistency of walking in patients with PD in real-life settings.

scholarly journals The Effect of Loneliness on Social Networking Sites Use and Its Related Behaviors

2015 ◽  
Vol 8 (8) ◽  
pp. 162 ◽  
Author(s):  
Samira Ranaeiy ◽  
Mohammad Reza Taghavi ◽  
Mohammad Ali Goodarzi
Keyword(s):  
Social Behavior ◽  
Social Networking ◽  
Social Networking Sites ◽  
Negative Impact ◽  
Real Life ◽  
Daily Functioning ◽  
Social Aspect ◽  
Significant Difference ◽  
Research Findings ◽  
The Subject

<p><strong>INTRODUCTION: </strong>The current research was conducted to examine the effect of “Loneliness”, on time spent in Social Networking Sites (S.N.S), main reasons for S.N.S use, and its related behaviors.</p><p><strong>MATERIALS &amp; METHODS: </strong>156 students of Shiraz University voluntarily participated in this research. Loneliness was assessed usingthe UCLA Loneliness scale. 25% of highest scoring students reported that they were lonely whereas 25% of the lowest scoring students were considered to be non-lonely. The positive and negative reasons of using S.N.S were assessed based on Reasons for Internet Use Scale, and internet behaviors were assessed based on Scale of Internet Behaviors.</p><p><strong>RESULTS: </strong>There was no difference in time spent in S.N.S as well as the positive and negative reasons of using S.N.S (contrary to literature), but internet behaviors showed a significant difference between “lonely” and “non-lonely” individuals. “Lonely” and “non-lonely” individuals showed a significant difference in “social aspect” of S.N.S behaviors. There was also a significant difference between “Lonely” and “non-Lonely” individuals in “Negative impact” of S.N.S behaviors. Yet, there seemed to be no difference in “competency and convenience aspect” of S.N.S behaviors.</p><p><strong>CONCLUSIONS: </strong>This study suggested that there is no difference between lonely and non-lonely individuals in reasons for using S.N.S and time spent in S.N.S. This finding stands contrary to previous research findings and general literature on the subject In other words, what drives people to S.N.S at the first place shows no significant difference between lonely and non-lonely individuals while after attending S.N.S, social behavior of lonely individuals shows a significant difference which is consistently enhanced online. Lonely people also significantly develop internet-related problems in their daily functioning, including interference with real life socializing.</p>

Real-life gait assessment in degenerative cerebellar ataxia

Neurology ◽  
2020 ◽  
Vol 95 (9) ◽  
pp. e1199-e1210
Author(s):  
Winfried Ilg ◽  
Jens Seemann ◽  
Martin Giese ◽  
Andreas Traschütz ◽  
Ludger Schöls ◽  
...  
Keyword(s):  
Inertial Sensors ◽  
Wearable Sensors ◽  
Real Life ◽  
High Sensitivity ◽  
Gait Variability ◽  
Clinical Severity ◽  
Effect Sizes ◽  
Cerebellar Disease ◽  
Ataxic Gait ◽  
Disease Modifying Drugs

ObjectivesWith disease-modifying drugs on the horizon for degenerative ataxias, ecologically valid motor biomarkers are highly warranted. In this observational study, we aimed to unravel and validate markers of ataxic gait in real life by using wearable sensors.MethodsWe assessed gait characteristics of 43 patients with degenerative cerebellar disease (Scale for the Assessment and Rating of Ataxia [SARA] 9.4 ± 3.9) compared with 35 controls by 3 body-worn inertial sensors in 3 conditions: (1) laboratory-based walking; (2) supervised free walking; (3) real-life walking during everyday living (subgroup n = 21). Movement analysis focused on measures of spatiotemporal step variability and movement smoothness.ResultsA set of gait variability measures was identified that allowed us to consistently identify ataxic gait changes in all 3 conditions. Lateral step deviation and a compound measure of spatial step variability categorized patients vs controls with a discrimination accuracy of 0.86 in real life. Both were highly correlated with clinical ataxia severity (effect size ρ = 0.76). These measures allowed detecting group differences even for patients who differed only 1 point in the clinical SARAposture&gait subscore, with highest effect sizes for real-life walking (d = 0.67).ConclusionsWe identified measures of ataxic gait that allowed us not only to capture the gait variability inherent in ataxic gait in real life, but also to demonstrate high sensitivity to small differences in disease severity, with the highest effect sizes in real-life walking. They thus represent promising candidates for motor markers for natural history and treatment trials in ecologically valid contexts.Classification of evidenceThis study provides Class I evidence that a set of gait variability measures, even if accessed in real life, correlated with the clinical severity of ataxia in patients with degenerative cerebellar disease.

scholarly journals A fixed-dose randomized controlled trial of olanzapine for psychosis in Parkinson disease

F1000Research ◽  
2013 ◽  
Vol 2 ◽  
pp. 150 ◽  
Author(s):  
Michelle J Nichols ◽  
Johanna M Hartlein ◽  
Meredith GA Eicken ◽  
Brad A Racette ◽  
Kevin J Black
Keyword(s):  
Parkinson Disease ◽  
Repeated Measures ◽  
Rating Scale ◽  
Controlled Trial ◽  
Depression Score ◽  
Fixed Dose ◽  
Drug Induced ◽  
Serious Adverse Events ◽  
Double Blind ◽  
Significant Difference

Background: Psychosis is a common and debilitating side effect of long-term dopaminergic treatment of Parkinson disease (PD). While clozapine is an effective treatment, the need for blood monitoring has limited its first-line use. Objective: Since olanzapine shows similar receptor affinity to clozapine, we hypothesized that it might be an effective alternative to clozapine for treatment of drug-induced psychosis (DIP) in PD, and that lower doses than usual might make it tolerable.Methods: In 1998-2003 we conducted a four-week, double-blind, placebo-controlled, parallel group, fixed-dose trial of olanzapine (0, 2.5mg, or 5mg) in 23 PD patients with DIP while allowing for clinically realistic dose adjustments of dopaminomimetic mid-study. The primary outcome measures were Brief Psychiatric Rating Scale (BPRS) ratings scored from videotaped interviews after study termination by an observer blinded to dose assignment and to interview timing, and CGI (Clinical Global Impression). The Unified Parkinson’s Disease Rating Scale motor subscale (UPDRS) was the primary measure of tolerability.Results: Intention-to-treat analysis found no significant differences among treatment groups in study completion or serious adverse events. However, a disproportionate number of olanzapine vs. placebo subjects reported mild side effects (p<0.04), many citing motor worsening. Fourteen patients completed the study (seven on placebo, two on 2.5mg olanzapine, five on 5mg olanzapine). In study completers, analysis by repeated measures ANOVA revealed no significant difference between olanzapine and placebo groups in BPRS psychosis reduction (p=0.536), parkinsonism (p=0.608), or any other measured parameters (CGI, MMSE, Beck Depression Inventory, Hamilton Depression score, PDQ‑39, Schwab-England ADL assessment, and sleep scores).Conclusion: This study adds to other evidence that olanzapine is ineffective in treating medication-induced psychosis in Parkinson disease.

scholarly journals Development and sensory evaluation of gluten free bakery products using quinoa (Chenopodium Quinoa) flour

2017 ◽  
Vol 9 (4) ◽  
pp. 2449-2455 ◽  
Author(s):  
Sukhmandeep Kaur ◽  
Navjot Kaur
Keyword(s):  
Rating Scale ◽  
Negative Impact ◽  
Percent Level ◽  
Chenopodium Quinoa ◽  
Sensory Attributes ◽  
Bakery Products ◽  
Gluten Free ◽  
Overall Acceptability ◽  
Significant Difference ◽  
Quinoa Flour

Quinoa based gluten free bakery products were prepared by supplementing roasted quinoa flour in oats and rice flour at different substitution levels and were organoleptically evaluated using eight point hedonic rating scale for sensory attributes by a semi – trained (including Professors and Assistant Professors not a professionally sensory panel) panel of 10 judges. Substitution of roasted quinoa flour at 5, 10 and 15 percent levels showed significant difference (p≤ 0.05) at 10 percent levels for all the products namely cookies, cakes, muffins, pies and tarts for overall acceptability. The products with 10 percent level of supplementation of roasted quinoa flour (10%) with rice (45%) and oats flour (45%) were found to be highly acceptable and the scores for overall acceptability for cakes (7.54), cookies (7.46), muffins (7.32), pies (7.78) and tarts (7.56) were achieved. The pies with 10 percent level of supplementation of roasted quinoa flour were considered as best product by the judges in terms of all the sensory attributes such as appearance, colour, texture, flavour, taste and overall acceptability. It may be concluded that roasted quinoa flour can be utilized successfully up to 10 percent level to prepare gluten free bakery products with high nutritional value without imposing negative impact on sensory attributes which may prove a boon to celiac patients.

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