Traditional Ordinal Strategies for Establishing the Severity and Status of Movement Disorders, Such as Parkinson’s Disease and Essential Tremor

Abstract

Ordinal scale strategies are standardly applied to diagnose the severity of neurodegenerative movement disorders, such as Parkinson’s disease and Essential tremor. A clinician is tasked with the challenge of assigning an ordinal parameter based on a series of criteria to quantify a subjectively observed interpretation. Multiple ordinal scale systems exist for evaluating movement disorder symptoms. However, the issue is the uncertainty of translating the findings of one scale to another. The Unified Parkinson’s Disease Rating Scale (UPDRS) and upgraded Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) are commonly utilized for evaluating Parkinson’s disease severity. The Fahn-Tolosa-Marin Tremor Rating Scale is prevalently applied for Essential tremor. There are issues of concern regarding the application of ordinal scale approaches for determining the state of progressive neurodegenerative movement disorders, such as Parkinson’s disease and Essential tremor. The reliability of ordinal scale systems has not been conclusively established, and interpretive disparity is apparent respective of experience. A novel resolution is the introduction of wearable and wireless inertial sensor systems to objectively quantify movement disorder tremor. The inertial signal (accelerometer and/or gyroscope) can readily record the intrinsic characteristics of tremor for both Parkinson’s disease and Essential tremor. Successful testing and evaluation have even demonstrated the efficacy of deep brain stimulation systems for Parkinson’s disease and Essential tremor using a smartphone as a wearable and wireless inertial sensor system. These findings enable the pathways for developing Network Centric Therapy, which is in essence the emergence of the Internet of Things for healthcare regarding the domains of robustly diagnosing severity of neurodegenerative movement disorders, such as Parkinson’s disease and Essential tremor.