Unsupervised home monitoring of Parkinson's disease motor symptoms using body-worn accelerometers.

This is not so much the future, as the present... there are now lots of devices that are available for monitoring of PD symptoms. One of the biggest issues is that almost all have been insufficiently validated... there are lots of examples of pilot studies and very few with replication... PD lends itself better than most other diseases to home monitoring... and this area will only grow over the coming years...

Parkinsonism Relat Disord. 2016 Sep 9. pii: S1353-8020(16)30334-0. doi: 10.1016/j.parkreldis.2016.09.009. [Epub ahead of print]

Fisher JM, Hammerla NY, Ploetz T, Andras P, Rochester L, Walker RW.

http://www.prd-journal.com/article/S1353-8020(16)30334-0/abstract

INTRODUCTION:

Current PD assessment methods have inherent limitations. There is need for an objective method to assist clinical decisions and to facilitate evaluation of treatments. Accelerometers, and analysis using artificial neural networks (ANN), have shown potential as a method of motor symptom evaluation. This work describes the development of a novel PD disease state detection system informed by algorithms based on data collected in an unsupervised, home environment. We evaluated whether this approach can reproduce patient-completed symptom diaries and clinical assessment of disease state.

METHODS:

34 participants with PD wore bilateral wrist-worn accelerometers for 4 h in a research facility (phase 1) and for 7 days at home whilst completing symptom diaries (phase 2). An ANN to predict disease state was developed based on home-derived accelerometer data. Using a leave-one-out approach, ANN performance was evaluated against patient-completed symptom diaries and against clinician rating of disease state.

RESULTS:

In the clinical setting, specificity for dyskinesia detection was extremely high (0.99); high specificity was also demonstrated for home-derived data (0.93), but with low sensitivity (0.38). In both settings, sensitivity for on/off detection was sub-optimal. ANN-derived values of the proportions of time in each disease state showed strong, significant correlations with patient-completed symptom diaries.

CONCLUSION:

Accurate, real-time evaluation of symptoms in an unsupervised, home environment, with this sensor system, is not yet achievable. In terms of the amounts of time spent in each disease state, ANN-derived results were comparable to those of symptom diaries, suggesting this method may provide a valuable outcome measure for medication trials.