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Mobile systems for monitoring Parkinson's disease
Dalarna University, School of Technology and Business Studies, Computer Engineering. School of Science and Technology, Örebro University.ORCID iD: 0000-0002-2372-4226
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A challenge for the clinical management of Parkinson's disease (PD) is the large within- and between-patient variability in symptom profiles as well as the emergence of motor complications which represent a significant source of disability in patients. This thesis deals with the development and evaluation of methods and systems for supporting the management of PD by using repeated measures, consisting of subjective assessments of symptoms and objective assessments of motor function through fine motor tests (spirography and tapping), collected by means of a telemetry touch screen device.

One aim of the thesis was to develop methods for objective quantification and analysis of the severity of motor impairments being represented in spiral drawings and tapping results. This was accomplished by first quantifying the digitized movement data with time series analysis and then using them in data-driven modelling for automating the process of assessment of symptom severity. The objective measures were then analysed with respect to subjective assessments of motor conditions. Another aim was to develop a method for providing comparable information content as clinical rating scales by combining subjective and objective measures into composite scores, using time series analysis and data-driven methods. The scores represent six symptom dimensions and an overall test score for reflecting the global health condition of the patient. In addition, the thesis presents the development of a web-based system for providing a visual representation of symptoms over time allowing clinicians to remotely monitor the symptom profiles of their patients. The quality of the methods was assessed by reporting different metrics of validity, reliability and sensitivity to treatment interventions and natural PD progression over time.

Results from two studies demonstrated that the methods developed for the fine motor tests had good metrics indicating that they are appropriate to quantitatively and objectively assess the severity of motor impairments of PD patients. The fine motor tests captured different symptoms; spiral drawing impairment and tapping accuracy related to dyskinesias (involuntary movements) whereas tapping speed related to bradykinesia (slowness of movements). A longitudinal data analysis indicated that the six symptom dimensions and the overall test score contained important elements of information of the clinical scales and can be used to measure effects of PD treatment interventions and disease progression. A usability evaluation of the web-based system showed that the information presented in the system was comparable to qualitative clinical observations and the system was recognized as a tool that will assist in the management of patients.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2014. , 87 p.
Series
Örebro Studies in Technology, ISSN 1650-8580 ; 57
Keyword [en]
automatic assessments, data visualization, data-driven modelling, home assessments, information technology, mobile computing, objective measures, Parkinson’s disease, quantitative assessments, remote monitoring, spirography, symptom severity, tapping tests, telemedicine, telemetry, time series analysis, web technology.
National Category
Computer Systems
Research subject
Komplexa system - mikrodataanalys, PAULINA - Uppföljning av Parkinsonsymptom från hemmet
Identifiers
URN: urn:nbn:se:du-13797ISBN: 978-91-7668-988-2 (print)OAI: oai:DiVA.org:du-13797DiVA: diva2:695998
Public defence
2014-02-14, Clas Ohlsonsalen, Tenoren, Skomakargatan 1, Borlänge, 13:00 (English)
Opponent
Supervisors
Available from: 2014-02-13 Created: 2014-02-12 Last updated: 2015-06-12Bibliographically approved
List of papers
1. A new computer method for assessing drawing impairment in Parkinson's disease
Open this publication in new window or tab >>A new computer method for assessing drawing impairment in Parkinson's disease
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2010 (English)In: Journal of Neuroscience Methods, ISSN 0165-0270, E-ISSN 1872-678X, Vol. 190, no 1, 143-148 p.Article in journal (Refereed) Published
Abstract [en]

A test battery, consisting of self-assessments and motor tests (tapping and spiral drawing tasks) was used on 9482 test occasions by 62 patients with advanced Parkinson's disease (PD) in a telemedicine setting. On each test occasion, three Archimedes spirals were traced. A new computer method, using wavelet transforms and principal component analysis processed the spiral drawings to generate a spiral score. In a web interface, two PD specialists rated drawing impairment in spiral drawings from three random test occasions per patient, using a modification of the Bain & Findley 10-category scale. A standardised manual rating was defined as the mean of the two raters' assessments. Bland-Altman analysis was used to evaluate agreement between the spiral score and the standardised manual rating. Another selection of spiral drawings was used to estimate the Spearman rank correlations between the raters (r = 0.87), and between the mean rating and the spiral score (r = 0.89). The 95% confidence interval for the method's prediction errors was +/- 1.5 scale units, which was similar to the differences between the human raters. In conclusion, the method could assess PD-related drawing impairments well comparable to trained raters.

National Category
Health Sciences
Research subject
Komplexa system - mikrodataanalys, E-MOTIONS, Beslutsstöd för Parkinsonbehandling
Identifiers
urn:nbn:se:du-10481 (URN)10.1016/j.jneumeth.2010.04.027 (DOI)000279888800019 ()
Available from: 2012-08-03 Created: 2012-08-03 Last updated: 2017-12-07Bibliographically approved
2. Automatic and objective assessment of alternating tapping performance in Parkinson’s disease
Open this publication in new window or tab >>Automatic and objective assessment of alternating tapping performance in Parkinson’s disease
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2013 (English)In: Sensors, ISSN 1424-8220, E-ISSN 1424-8220, Vol. 13, no 12, 16965-16984 p.Article in journal (Refereed) Published
Abstract [en]

This paper presents the development and evaluation of a method for enabling quantitative and automatic scoring of alternating tapping performance of patients with Parkinson’s disease (PD). Ten healthy elderly subjects and 95 patients in different clinical stages of PD have utilized a touch-pad handheld computer to perform alternate tapping tests in their home environments. First, a neurologist used a web-based system to visually assess impairments in four tapping dimensions (‘speed’, ‘accuracy’, ‘fatigue’ and ‘arrhythmia’) and a global tapping severity (GTS). Second, tapping signals were processed with time series analysis and statistical methods to derive 24 quantitative parameters. Third, principal component analysis was used to reduce the dimensions of these parameters and to obtain scores for the four dimensions. Finally, a logistic regression classifier was trained using a 10-fold stratified cross-validation to map the reduced parameters to the corresponding visually assessed GTS scores. Results showed that the computed scores correlated well to visually assessed scores and were significantly different across Unified Parkinson’s Disease Rating Scale scores of upper limb motor performance. In addition, they had good internal consistency, had good ability to discriminate between healthy elderly and patients in different disease stages, had good sensitivity to treatment interventions and could reflect the natural disease progression over time. In conclusion, the automatic method can be useful to objectively assess the tapping performance of PD patients and can be included in telemedicine tools for remote monitoring of tapping.

Keyword
alternating tapping, touch-pad, handheld computer, telemedicine, Parkinson’s disease, remote monitoring, automatic assessment, objective assessment, visual assessment
National Category
Computer Systems
Research subject
Komplexa system - mikrodataanalys, PAULINA - Uppföljning av Parkinsonsymptom från hemmet
Identifiers
urn:nbn:se:du-13473 (URN)10.3390/s131216965 (DOI)000330220600061 ()
Note

Open Access

Available from: 2013-12-09 Created: 2013-12-09 Last updated: 2017-12-06Bibliographically approved
3. Spiral drawing during self-rated dyskinesia is more impaired than during self-rated off
Open this publication in new window or tab >>Spiral drawing during self-rated dyskinesia is more impaired than during self-rated off
2013 (English)In: Parkinsonism & Related Disorders, ISSN 1353-8020, E-ISSN 1873-5126, Vol. 19, no 5, 553-556 p.Article in journal (Refereed) Published
Abstract [en]

Objective. The purpose of this study was to examine repeated measures of fine motor function in relation to self-assessed motor conditions in Parkinson's disease (PD).

Methods. One-hundred PD patients, 65 with advanced PD and 35 patients with different disease stages have utilized a test battery in a telemedicine setting. On each test occasion, they initially self-assessed their motor condition (from ‘very off’ to ‘very dyskinetic’) and then performed a set of fine motor tests (tapping and spiral drawings).

Results. The motor tests scores were found to be the best during self-rated On. Self-rated dyskinesias caused more impaired spiral drawing performance (mean = 9.8% worse, P < 0.001) but at the same time tapping speed was faster (mean = 5.0% increase, P < 0.001), compared to scores in self-rated Off.

Conclusions. The fine motor tests of the test battery capture different symptoms; the spiral impairment primarily relates to dyskinesias whereas the tapping speed captures the Off symptoms.

Place, publisher, year, edition, pages
Elsevier, 2013
Keyword
Spiral drawing;Dyskinesia; Tapping; Bradykinesia; Self-assessment; Telemedicine
National Category
Computer and Information Science
Research subject
Komplexa system - mikrodataanalys, E-MOTIONS, Beslutsstöd för Parkinsonbehandling
Identifiers
urn:nbn:se:du-11827 (URN)10.1016/j.parkreldis.2013.01.011 (DOI)000317455800010 ()23402993 (PubMedID)
Available from: 2013-02-12 Created: 2013-02-12 Last updated: 2017-12-06Bibliographically approved
4. Combined fine-motor tests and self-assessments for remote detection of motor fluctuations
Open this publication in new window or tab >>Combined fine-motor tests and self-assessments for remote detection of motor fluctuations
2013 (English)In: Recent Patents on Biomedial Engineering, ISSN 1874-7647, Vol. 6, no 2, 127-135 p.Article in journal (Refereed) Published
Abstract [en]

A major problem with the clinical management of fluctuating movement disorders, e.g. Parkinson's disease (PD), is the large variability in manifestation of symptoms among patients. In this condition, frequent measurements which account for both patient-reported and objective assessments are needed in order to capture symptom fluctuations, with the purpose to optimize therapy. The main focus of this paper is to present a mobile-based system for enabling remote monitoring of PD patients from their home environment conditions. The system consists of a patient diary section for collecting patient-based self-assessments, a motor test section for collecting fine motor movements through upper limb motor tests, and a scheduler for restricting operation to a multitude of predetermined limited time intervals. The system processes and compiles time series data into different summary scores representing symptom severity. In addition, the paper presents a review of recent inventions which were filed after year 2000 in the field of telemedicine applications. The review includes a summary of systems and methods which enable remote symptom assessments of patients, not necessarily suffering from movement disorders, through repeated measurements and which take into account their subjective and/or objective health indicators. The findings conclude that there are a small number of inventions which collect subjective and objective health measures in telemedicine settings. Consequently, there is a lack of mechanisms that combine these two types of information into scores to provide a more in-depth assessment of the patient's general health, their motor and non-motor symptom fluctuations and treatment effects. The paper also provides a discussion concerning different approaches for analyzing and combining subjective and objective measures, and handling data from longitudinal studies.

Place, publisher, year, edition, pages
Bentham Science, 2013
Keyword
Remote patient monitoring, Parkinson’s disease, subjective, objective, telemedicine
National Category
Computer Systems
Research subject
Komplexa system - mikrodataanalys, PAULINA - Uppföljning av Parkinsonsymptom från hemmet
Identifiers
urn:nbn:se:du-12729 (URN)
Available from: 2013-07-22 Created: 2013-07-22 Last updated: 2015-06-12Bibliographically approved
5. A web application for follow-up of results from a mobile device test battery for Parkinson's disease patients
Open this publication in new window or tab >>A web application for follow-up of results from a mobile device test battery for Parkinson's disease patients
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2011 (English)In: Computer Methods and Programs in Biomedicine, ISSN 0169-2607, E-ISSN 1872-7565, Vol. 104, no 2, 219-226 p.Article in journal (Refereed) Published
Abstract [en]

This paper describes a web-based system for enabling remote monitoring of patients with Parkinson's disease (PD) and supporting clinicians in treating their patients. The system consists of a patient node for subjective and objective data collection based on a handheld computer, a service node for data storage and processing, and a web application for data presentation. Using statistical and machine learning methods, time series of raw data are summarized into scores for conceptual symptom dimensions and an "overall test score" providing a comprehensive profile of patient's health during a test period of about one week. The handheld unit was used quarterly or biannually by 65 patients with advanced PD for up to four years at nine clinics in Sweden. The IBM Computer System Usability Questionnaire was administered to assess nurses' satisfaction with the web application. Results showed that a majority of the nurses were quite satisfied with the usability although a sizeable minority were not. Our findings support that this system can become an efficient tool to easily access relevant symptom information from the home environment of PD patients. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

Keyword
Parkinson's disease, Test battery, Web application, Decision support, Remote patient monitoring, Telemedicine, Principal component analysis
National Category
Medical Engineering
Research subject
Komplexa system - mikrodataanalys, E-MOTIONS, Beslutsstöd för Parkinsonbehandling
Identifiers
urn:nbn:se:du-10412 (URN)10.1016/j.cmpb.2011.07.017 (DOI)000296945100024 ()
Available from: 2012-08-03 Created: 2012-08-03 Last updated: 2017-12-07Bibliographically approved
6. Self-assessments and motor tests via telemetry in a 36-month levodopa-carbidopa intestinal gel infusion trial
Open this publication in new window or tab >>Self-assessments and motor tests via telemetry in a 36-month levodopa-carbidopa intestinal gel infusion trial
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2014 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective: The aim of this study was to investigate if a telemetry test battery can be used to measure effects of Parkinson’s disease (PD) treatment intervention and disease progression.

Methods: Sixty-five patients diagnosed with advanced PD were recruited in an open longitudinal 36-month study; 35 treated with levodopa-carbidopa intestinal gel (LCIG) and 30 were candidates for switching from oral PD treatment to LCIG. They utilized a test battery, consisting of self-assessments of symptoms and fine motor tests (tapping and spiral drawings), four times per day in their homes during week-long test periods. The repeated measurements were summarized into an overall test score (OTS) to represent the global condition of the patient during a test period. Clinical assessments included ratings on Unified PD Rating Scale (UPDRS) and 39-item PD Questionnaire (PDQ-39) scales.

Results: In LCIG-naïve patients, mean OTS compared to baseline was significantly improved from the first test period on LCIG treatment until month 24. In LCIG-non-naïve patients, there were no significant changes in mean OTS, except at month 36 (P<0.01). The OTS correlated adequately with total UPDRS (rho = 0.59) and total PDQ-39 (0.59).

Conclusions: PD symptoms can be remotely monitored over time with this test battery. The trends of the test scores were similar to the trends of clinical rating scores. Correlations between OTS and clinical rating scales were adequate indicating that the test battery contains important elements of the information of the well-established scales.

Keyword
Remote monitoring; Telemedicine; Home assessments; Parkinson’s disease; Levodopa infusion
National Category
Computer Systems
Research subject
Komplexa system - mikrodataanalys, PAULINA - Uppföljning av Parkinsonsymptom från hemmet
Identifiers
urn:nbn:se:du-13795 (URN)
Available from: 2014-02-12 Created: 2014-02-12 Last updated: 2015-11-23Bibliographically approved

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