A telemedicine instrument for remote evaluation of tremor: design and initial applications in fatigue and patients with Parkinson's Disease

IntroductionA novel system that combines a compact mobile instrument and Internet communications is presented in this paper for remote evaluation of tremors. The system presents a high potential application in Parkinson's disease and connects to the Internet through a TCP/IP protocol. Tremor transduction is carried out by accelerometers, and the data processing, presentation and storage were obtained by a virtual instrument. The system supplies the peak frequency (fp), the amplitude (Afp) and power in this frequency (Pfp), the total power (Ptot), and the power in low (1-4 Hz) and high (4-7 Hz) frequencies (Plf and Phf, respectively).MethodsThe ability of the proposed system to detect abnormal tremors was initially demonstrated by a fatigue study in normal subjects. In close agreement with physiological fundamentals, the presence of fatigue increased fp, Afp, Pfp and Pt (p < 0.05), while the removal of fatigue reduced all the mentioned parameters (p < 0.05). The system was also evaluated in a preliminary in vivo test in parkinsonian patients. Afp, Pfp, Ptot, Plf and Phf were the most accurate parameters in the detection of the adverse effects of this disease (Se = 100%, Sp = 100%), followed by fp (Se = 100%, Sp = 80%). Tests for Internet transmission that realistically simulated clinical conditions revealed adequate acquisition and analysis of tremor signals and also revealed that the user could adequately receive medical recommendations.ConclusionsThe proposed system can be used in a wide spectrum of telemedicine scenarios, enabling the home evaluation of tremor occurrence under specific medical treatments and contributing to reduce the costs of the assistance offered to these patients.

[1]  M. Zweig,et al.  Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. , 1993, Clinical chemistry.

[2]  Max A. Little,et al.  Suitability of Dysphonia Measurements for Telemonitoring of Parkinson's Disease , 2008, IEEE Transactions on Biomedical Engineering.

[3]  Mehmet Engin,et al.  A recording and analysis system for human tremor , 2007 .

[4]  Yuan-Hsiang Lin,et al.  A wireless PDA-based physiological monitoring system for patient transport , 2004, IEEE Transactions on Information Technology in Biomedicine.

[5]  M. F. Golnaraghi,et al.  Tuned vibration absorber for suppression of rest tremor in Parkinson's disease , 2006, Medical and Biological Engineering and Computing.

[6]  J. B. Gao,et al.  Analysis of amplitude and frequency variations of essential and Parkinsonian tremors , 2004, Medical and Biological Engineering and Computing.

[7]  G Chevalier,et al.  A new method for the measurement of tremor at rest. , 1992, Archives internationales de physiologie, de biochimie et de biophysique.

[8]  Paolo Bonato,et al.  Monitoring Motor Fluctuations in Patients With Parkinson's Disease Using Wearable Sensors , 2009, IEEE Transactions on Information Technology in Biomedicine.

[9]  Jens Timmer,et al.  Characteristics of hand tremor time series , 1993, Biological Cybernetics.

[10]  C D Marsden,et al.  Accuracy of self-reported disability in patients with parkinsonism. , 1989, Archives of neurology.

[11]  J. Jankovic.  Parkinson’s disease: clinical features and diagnosis , 2008, Journal of Neurology, Neurosurgery, and Psychiatry.

[12]  Michael J. Ackerman,et al.  Chapter 6: Telemedicine Technology , 2002 .

[13]  C. Dolea,et al.  World Health Organization , 1949, International Organization.

[14]  V. Calabrese,et al.  PROJECTED NUMBER OF PEOPLE WITH PARKINSON DISEASE IN THE MOST POPULOUS NATIONS, 2005 THROUGH 2030 , 2007, Neurology.

[15]  Xianghong Ma,et al.  Tremor amplitude determination for use in clinical applications , 2007 .

[16]  Paolo Bonato,et al.  Advances in wearable technology and its medical applications , 2010, 2010 Annual International Conference of the IEEE Engineering in Medicine and Biology.

[17]  Andrea Tura,et al.  A telemedicine instrument for home monitoring of patients with chronic respiratory diseases. , 2007, Annali dell'Istituto superiore di sanita.

[18]  Yung-Hoh Sheu,et al.  Portable tremor monitor system for real-time full-wave monitoring and analysis , 2003 .

[19]  R. Golpe,et al.  Utility of home oximetry as a screening test for patients with moderate to severe symptoms of obstructive sleep apnea. , 1999, Sleep.

[20]  J A Swets,et al.  Measuring the accuracy of diagnostic systems. , 1988, Science.

[21]  Abul Kashem,et al.  Management of heart failure patients using telemedicine communication systems , 2006, Current cardiology reports.

[22]  Shyamal Patel,et al.  A Web-Based System for Home Monitoring of Patients With Parkinson's Disease Using Wearable Sensors , 2011, IEEE Transactions on Biomedical Engineering.

[23]  O. Lippold,et al.  Long‐lasting increases in the tremor of human hand muscles following brief, strong effort. , 1977, The Journal of physiology.

[24]  A. S. Grove,et al.  Testing objective measures of motor impairment in early Parkinson's disease: Feasibility study of an at‐home testing device , 2009, Movement disorders : official journal of the Movement Disorder Society.

[25]  Jennifer G. Dy,et al.  Home monitoring of patients with Parkinson's disease via wearable technology and a web-based application , 2010, 2010 Annual International Conference of the IEEE Engineering in Medicine and Biology.

[26]  O. Lippold,et al.  The 4‐6 HZ tremor during sustained contraction in normal human subjects. , 1983, The Journal of physiology.

[27]  Mark Guttman,et al.  Current concepts in the diagnosis and management of Parkinson's disease. , 2003, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[28]  Kamiar Aminian,et al.  Quantification of Tremor and Bradykinesia in Parkinson's Disease Using a Novel Ambulatory Monitoring System , 2007, IEEE Transactions on Biomedical Engineering.

[29]  Max A. Little,et al.  Accurate Telemonitoring of Parkinson's Disease Progression by Noninvasive Speech Tests , 2009, IEEE Transactions on Biomedical Engineering.

[30]  R. Bashshur,et al.  Chapter 1: Telemedicine and Health Care , 2002 .

[31]  L. Tarassenko,et al.  A systematic review of telemedicine interventions to support blood glucose self‐monitoring in diabetes , 2005, Diabetic medicine : a journal of the British Diabetic Association.

[32]  Richard M. Wiard,et al.  Robust ballistocardiogram acquisition for home monitoring , 2009, Physiological measurement.

[33]  Len Gray,et al.  The application of telemedicine to geriatric medicine. , 2007, Age and ageing.

[34]  B. V. van Hilten,et al.  Ambulatory Objective Assessment of Tremor in Parkinson's Disease , 2001, Clinical neuropharmacology.

[35]  Petros C. Karakousis,et al.  Reply from the authors [4] , 2007 .

[36]  C. Tanner,et al.  Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030 , 2007, Neurology.

[37]  Chris D. Nugent,et al.  Home-Based Monitoring and Assessment of Parkinson's Disease , 2011, IEEE Transactions on Information Technology in Biomedicine.

[38]  V. Es'kov,et al.  Measuring Biomechanical Parameters of Human Extremity Tremor , 2003 .

[39]  M. Pansera,et al.  A comprehensive motor symptom monitoring and management system: The bradykinesia case , 2010, 2010 Annual International Conference of the IEEE Engineering in Medicine and Biology.