Abstract
Embedded sensors of the smartphones offer opportunities for granular, patient-autonomous measurements of neurological dysfunctions for disease identification, management, and for drug development. We hypothesized that aggregating data from two simple smartphone tests of fine finger movements with differing contribution of specific neurological domains (i.e., strength & cerebellar functions, vision, and reaction time) will allow establishment of secondary outcomes that reflect domain-specific deficit. This hypothesis was tested by assessing correlations of smartphone-derived outcomes with relevant parts of neurological examination in multiple sclerosis (MS) patients. We developed MS test suite on Android platform, consisting of several simple functional tests. This paper compares cross-sectional and longitudinal performance of Finger tapping and Balloon popping tests by 76 MS patients and 19 healthy volunteers (HV). The primary outcomes of smartphone tests, the average number of taps (per two 10-s intervals) and the average number of pops (per two 26-s intervals) differentiated MS from HV with similar power to traditional, investigator-administered test of fine finger movements, 9-hole peg test (9HPT). Additionally, the secondary outcomes identified patients with predominant cerebellar dysfunction, motor fatigue and poor eye-hand coordination and/or reaction time, as evidenced by significant correlations between these derived outcomes and relevant parts of neurological examination. The intra-individual variance in longitudinal sampling was low. In the time necessary for performing 9HPT, smartphone tests provide much richer and reliable measurements of several distinct neurological functions. These data suggest that combing more creatively-construed smartphone apps may one day recreate the entire neurological examination.
Highlights
Neurological examination measures diverse functions of the central (CNS) and peripheral nervous systems to diagnose neurological diseases and guide treatment decisions
Non-clinician administered measurements of physical disability such as timed 25-foot walk (25FW) and 9-hole peg test (9HPT) or measurements of cognitive functions exemplified by paced auditory serial addition test (PASAT) and symbol digit modalities test (SDMT), are frequently used in clinical trials of neurological diseases such as multiple sclerosis (MS) [1, 2]
Strong correlations between cumulative number of taps and pops with clinician-derived scores of cerebellar and motoric functions of upper extremities indicate that both smartphone app tests are measuring, analogously to 9HPT, predominantly fine motoric skills, which are strongly affected by cerebellar dysfunction
Summary
Neurological examination measures diverse functions of the central (CNS) and peripheral nervous systems to diagnose neurological diseases and guide treatment decisions. Non-clinician administered measurements of physical disability such as timed 25-foot walk (25FW) and 9-hole peg test (9HPT) or measurements of cognitive functions exemplified by paced auditory serial addition test (PASAT) and symbol digit modalities test (SDMT), are frequently used in clinical trials of neurological diseases such as multiple sclerosis (MS) [1, 2]. Combining these “functional scales” with clinicianbased disability scales such as Expanded Disability Status Scale (EDSS)(3) into EDSS-plus [4] or Combinatorial weight-adjusted disability scale (CombiWISE) [5] enhances sensitivity of clinical trial outcomes. These sensitive combinatorial scales are rarely, if ever acquired in clinical practice due to time and expense constrains
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