Abstract
A fundamental challenge in the clinical care of Parkinson disease (PD) is the current dependence on subjective evaluations of tremor and bradykinesia. New technologies offer the ability to evaluate motor deficits using purely objective measures. The aim of this study was to develop and evaluate the efficacy of a wireless stylus (Cleveland Clinic Stylus) with an embedded motion sensor to quantitatively assess tremor and bradykinesia in patients with PD with subthalamic nucleus (STN) deep brain stimulation (DBS). Twenty-one subjects were tested in various on and off DBS conditions while holding the Cleveland Clinic Stylus while at rest, maintaining a postural hold, and during a movement task. Kinematic metrics were calculated from the motion sensor data, including 3D angular velocity and 3D acceleration data, and were compared between the on and off conditions. Generalized estimating equations (GEEs) were used to determine the relationship between kinematic metrics and MDS-Unified Parkinson's Disease Rating Scale Motor III (UPDRS-III) subscores. Kinematic metrics from the rest and postural tasks were significantly related to the UPDRS-III subscores of tremor (p < 0.001 for all metrics), and kinematic metrics from the movement task were significantly related to the UPDRS-III subscore of bradykinesia (p < 0.001 for 3/7 metrics). Kinematic metrics (7/9) showed a significant effect of stimulation setting (range: p < 0.03– < 0.0001) across the three tasks, indicating significant improvements from DBS in these measures. The Cleveland Clinic Stylus provided quantitative kinematic measures of tremor and bradykinesia severity and detected significant improvements in these measures from medication and DBS therapy. This low-cost, easy-to-use tool can provide objective measures that will improve clinical care of PD patients by providing a more reliable and objective evaluation of movement symptoms, disease progression, and effects of therapy in and outside the clinical setting.
Highlights
Parkinson’s disease (PD) is a movement disorder characterized primarily by tremor, bradykinesia, and rigidity due to dysfunction of the dopaminergic striatal system in the basal ganglia [1, 2]
A fundamental challenge and gap in the clinical care of patients with PD is the current dependence on subjective evaluations of tremor and bradykinesia [3], which in turn is prone to the placebo effect and poor interrater and intrarater reliability for subsections of the MDS-Unified Parkinson’s Disease Rating Scale Motor III (UPDRS-III) subscores [4,5,6]. e exponential increase in computing power, resulting in the development of smaller and more affordable electronics [7], provides the opportunity to utilize technology to objectively evaluate PD
Leveraging our previous work, we have developed a functional-based motion sensor stylus to quantitatively characterize kinematic changes in PD-related tremor and bradykinesia of upper extremities. e design of the Cleveland Clinic Stylus was developed to create a more ecologically familiar experience for the patient
Summary
Parkinson’s disease (PD) is a movement disorder characterized primarily by tremor, bradykinesia, and rigidity due to dysfunction of the dopaminergic striatal system in the basal ganglia [1, 2]. In addition to providing an unbiased quantitative assessment of motor performance, these kinematic metrics can be used to identify the impact of physical training, pharmacological, and surgical interventions on daily function [8, 9]. These instruments create the potential to untether movement assessments from the clinical setting and allow for physicians to more precisely track disease progression via self-administered, at-home assessments performed repeatedly throughout the days and weeks between clinical visits. To achieve the transformative potential of any device that could be used to digitize motor function in PD, the device must be validated in terms of technical capability and its relationship to accepted clinical measures. erefore, the aim of this project was to determine the relationship between tremor and bradykinesia measures from the Cleveland Clinic Stylus and clinician-rated MDS-UPDRS-III subscores under various deep brain stimulation (DBS) settings that reflect conditions of clinical practice
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