Abstract
Deep brain stimulation (DBS) surgery is the gold standard therapeutic intervention in Parkinson’s disease (PD) with motor complications, notwithstanding drug therapy. In the intraoperative evaluation of DBS’s efficacy, neurologists impose a passive wrist flexion movement and qualitatively describe the perceived decrease in rigidity under different stimulation parameters and electrode positions. To tackle this subjectivity, we designed a wearable device to quantitatively evaluate the wrist rigidity changes during the neurosurgery procedure, supporting physicians in decision-making when setting the stimulation parameters and reducing surgery time. This system comprises a gyroscope sensor embedded in a textile band for patient’s hand, communicating to a smartphone via Bluetooth and has been evaluated on three datasets, showing an average accuracy of 80%. In this work, we present a system that has seen four iterations since 2015, improving on accuracy, usability and reliability. We aim to review the work done so far, outlining the iHandU system evolution, as well as the main challenges, lessons learned, and future steps to improve it. We also introduce the last version (iHandU 4.0), currently used in DBS surgeries at São João Hospital in Portugal.
Highlights
Parkinson’s Disease (PD) is a neurodegenerative disorder caused by a dopaminergic neural loss in the substantia nigra
The x-angular velocity, on the other hand, varied with the wrist feedback during the system evolution made possible to achieve a more robust, user-friendly and customized system, and new features and improvements that will be made in the iteration named iHandU 5.0, furthered explained
The iHandU is proving its capability to support clinicians showing very good results, as shown before. This system evolution results from a high level of interaction between medicine and engineering area resulting in a persuasive system focused on personalized health with direct impact on healthcare procedures
Summary
Parkinson’s Disease (PD) is a neurodegenerative disorder caused by a dopaminergic neural loss in the substantia nigra. The decrease of dopamine transmission between neurons will lead the motor pathway to remain in an excited state. The cure for PD is still unknown and dopamine replacement therapy with Levodopa (L-dopa) remains the major medical approach to control the PD symptoms. Deep brain stimulation (DBS) surgery has emerged as the second therapy in those patients, leading to the improvement of dyskinesia, as well as of dopamine-responsive motor symptoms [3]. The DBS surgical procedure is based on the implantation of stimulation electrodes at high frequencies (130 Hz) with a pulse length at 60 μs in the basal ganglia structures (subthalamic nucleus (STN) or internal globulus pallidum (GPi)), aiming to promote the functional inhibition of the excited motor control pathways [3]
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