Enhancing remote monitoring and classification of motor state in Parkinson’s disease using Wearable Technology and Machine Learning

Parkinson’s disease (PD) is a neurodegenerative condition where dopaminergic medication, such as levodopa, is typically used to improve motor symptoms, including mobility. Identifying the impact of levodopa on real-world motor state (e.g. ON/OFF/ DYSKINESIA) is important for both clinicians and people with PD. The aim of the present work was to automatically classify medication states using machine learning models. Continuous 7-day data were collected in 26 people with PD using an Inertial Measurement Unit (IMU) placed on the fifth lumbar vertebrae (L5) level. Over the week, each participant was asked to complete a diary by annotating medication states (off-condition and dyskinesias) with a 30-minute resolution. Diary entries were used as reference labels assigned to the processed IMU data. Two different networks were chosen for the classification: the k-Nearest Neighbors algorithm (kNN) to identify ON-OFF-DYSKINESIA classes and Fine Tree (FT) to identify only OFF and ON classes. Preliminary results demonstrate that IMU data paired with machine learning could accurately classify ON-OFF and DYSKINESIA with 84% accuracy and the ON-OFF states were classified with 95% accuracy. These results are encouraging and pave the way to a better understanding of the effect that medication has on motor symptoms in PD during everyday life and may serve as a useful tool for optimizing clinical management of people with PD.

[1]  A. Rodio,et al.  Technological support for people with Parkinson’s disease: a narrative review , 2022, Journal of Gerontology and Geriatrics.

[2]  L. Ferrigno,et al.  Development and Assessment of a Movement Disorder Simulator Based on Inertial Data , 2022, Sensors.

[3]  L. Ferrigno,et al.  Parkinson's disease aided diagnosis: online symptoms detection by a low-cost wearable Inertial Measurement Unit , 2022, 2022 IEEE International Symposium on Medical Measurements and Applications (MeMeA).

[4]  C. Mazzà,et al.  Connecting real-world digital mobility assessment to clinical outcomes for regulatory and clinical endorsement–the Mobilise-D study protocol , 2022, medRxiv.

[5]  K. Demestichas,et al.  Internet of Things Technologies and Machine Learning Methods for Parkinson’s Disease Diagnosis, Monitoring and Management: A Systematic Review , 2022, Sensors.

[6]  B. Eskofier,et al.  Do We Walk Differently at Home? A Context-Aware Gait Analysis System in Continuous Real-World Environments , 2021, 2021 43rd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC).

[7]  J. Hausdorff,et al.  Body-Worn Sensors for Remote Monitoring of Parkinson’s Disease Motor Symptoms: Vision, State of the Art, and Challenges Ahead , 2021, Journal of Parkinson's disease.

[8]  Max A. Little,et al.  Real-Life Gait Performance as a Digital Biomarker for Motor Fluctuations: The Parkinson@Home Validation Study , 2020, Journal of medical Internet research.

[9]  P. M. Pradhan,et al.  A Supervised Machine Learning Approach to Detect the On/Off State in Parkinson’s Disease Using Wearable Based Gait Signals , 2020, Diagnostics.

[10]  Bernd Bischl,et al.  High-Resolution Motor State Detection in Parkinson’s Disease Using Convolutional Neural Networks , 2020, Scientific Reports.

[11]  B. Mollenhauer,et al.  Levodopa Equivalent Dose Conversion Factors: An Updated Proposal Including Opicapone and Safinamide , 2020, Movement disorders clinical practice.

[12]  M. Okun,et al.  Diagnosis and Treatment of Parkinson Disease: A Review. , 2020, JAMA.

[13]  J. Bronstein,et al.  PKG Movement Recording System Use Shows Promise in Routine Clinical Care of Patients With Parkinson's Disease , 2019, Front. Neurol..

[14]  V. Boleková,et al.  Adherence to Pharmacotherapy in Patients With Parkinson's Disease Taking Three and More Daily Doses of Medication , 2019, Front. Neurol..

[15]  Lynn Rochester,et al.  Gait analysis with wearables predicts conversion to Parkinson disease , 2019, Annals of neurology.

[16]  Benedict Michael,et al.  Faculty Opinions recommendation of Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. , 2019, Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature.

[17]  Murtadha D. Hssayeni,et al.  Deep Learning for Medication Assessment of Individuals with Parkinson’s Disease Using Wearable Sensors , 2018, 2018 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[18]  Richard P. Martin,et al.  A Review of Medication Adherence Monitoring Technologies , 2018 .

[19]  B. Galna,et al.  Free-living gait characteristics in ageing and Parkinson’s disease: impact of environment and ambulatory bout length , 2016, Journal of NeuroEngineering and Rehabilitation.

[20]  Alan Godfrey,et al.  Validation of an Accelerometer to Quantify a Comprehensive Battery of Gait Characteristics in Healthy Older Adults and Parkinson's Disease: Toward Clinical and at Home Use , 2016, IEEE Journal of Biomedical and Health Informatics.

[21]  G. Deuschl,et al.  MDS clinical diagnostic criteria for Parkinson's disease , 2015, Movement disorders : official journal of the Movement Disorder Society.

[22]  P. Lewitt,et al.  Levodopa therapy for Parkinson's disease: Pharmacokinetics and pharmacodynamics , 2015, Movement disorders : official journal of the Movement Disorder Society.

[23]  Joan Cabestany,et al.  Dyskinesia and motor state detection in Parkinson's Disease patients with a single movement sensor , 2012, 2012 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[24]  Angelo Antonini,et al.  Levodopa in the treatment of Parkinson’s disease: an old drug still going strong , 2010, Clinical interventions in aging.

[25]  Talia Herman,et al.  Reliability of the new freezing of gait questionnaire: agreement between patients with Parkinson's disease and their carers. , 2009, Gait & posture.

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

[27]  J. Jankovic,et al.  Movement Disorder Society‐sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS‐UPDRS): Scale presentation and clinimetric testing results , 2008, Movement disorders : official journal of the Movement Disorder Society.

[28]  J. Cummings,et al.  The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment , 2005, Journal of the American Geriatrics Society.

[29]  Tianjian Ji,et al.  FREQUENCY AND VELOCITY OF PEOPLE WALKING , 2005 .

[30]  R. Hauser,et al.  Parkinson's disease home diary: Further validation and implications for clinical trials , 2004, Movement disorders : official journal of the Movement Disorder Society.

[31]  Alan M Jette,et al.  Late life function and disability instrument: I. Development and evaluation of the disability component. , 2002, The journals of gerontology. Series A, Biological sciences and medical sciences.

[32]  A. H. Rajput,et al.  Levodopa prolongs life expectancy and is non-toxic to substantia nigra. , 2001, Parkinsonism & related disorders.

[33]  Wolzt,et al.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. , 2003, The Journal of the American College of Dentists.

[34]  L. Fried,et al.  Frailty in older adults: evidence for a phenotype. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[35]  M. Hoehn,et al.  Parkinsonism , 1967, Neurology.

[36]  Alan Godfrey,et al.  Detecting free-living steps and walking bouts: validating an algorithm for macro gait analysis , 2017, Physiological measurement.

[37]  S. Fahn The history of dopamine and levodopa in the treatment of Parkinson's disease , 2008, Movement disorders : official journal of the Movement Disorder Society.