PERFORM: a system for monitoring, assessment and management of patients with Parkinson's disease

Alexandros T Tzallas, Markos G Tsipouras, Georgios Rigas, Dimitrios G Tsalikakis, Evaggelos C Karvounis, Maria Chondrogiorgi, Fotis Psomadellis, Jorge Cancela, Matteo Pastorino, María Teresa Arredondo Waldmeyer, Spiros Konitsiotis, Dimitrios I Fotiadis, Alexandros T Tzallas, Markos G Tsipouras, Georgios Rigas, Dimitrios G Tsalikakis, Evaggelos C Karvounis, Maria Chondrogiorgi, Fotis Psomadellis, Jorge Cancela, Matteo Pastorino, María Teresa Arredondo Waldmeyer, Spiros Konitsiotis, Dimitrios I Fotiadis

Abstract

In this paper, we describe the PERFORM system for the continuous remote monitoring and management of Parkinson's disease (PD) patients. The PERFORM system is an intelligent closed-loop system that seamlessly integrates a wide range of wearable sensors constantly monitoring several motor signals of the PD patients. Data acquired are pre-processed by advanced knowledge processing methods, integrated by fusion algorithms to allow health professionals to remotely monitor the overall status of the patients, adjust medication schedules and personalize treatment. The information collected by the sensors (accelerometers and gyroscopes) is processed by several classifiers. As a result, it is possible to evaluate and quantify the PD motor symptoms related to end of dose deterioration (tremor, bradykinesia, freezing of gait (FoG)) as well as those related to over-dose concentration (Levodopa-induced dyskinesia (LID)). Based on this information, together with information derived from tests performed with a virtual reality glove and information about the medication and food intake, a patient specific profile can be built. In addition, the patient specific profile with his evaluation during the last week and last month, is compared to understand whether his status is stable, improving or worsening. Based on that, the system analyses whether a medication change is needed--always under medical supervision--and in this case, information about the medication change proposal is sent to the patient. The performance of the system has been evaluated in real life conditions, the accuracy and acceptability of the system by the PD patients and healthcare professionals has been tested, and a comparison with the standard routine clinical evaluation done by the PD patients' physician has been carried out. The PERFORM system is used by the PD patients and in a simple and safe non-invasive way for long-term record of their motor status, thus offering to the clinician a precise, long-term and objective view of patient's motor status and drug/food intake. Thus, with the PERFORM system the clinician can remotely receive precise information for the PD patient's status on previous days and define the optimal therapeutical treatment.

Figures

Figure 1.
Figure 1.
The PERFORM system architecture.
Figure 2.
Figure 2.
PERFORM wearable multi-sensor monitor unit (WMSMU) (left): four ALA-6g accelerometers, one AGYRO device (accelerometer/gyroscope) and the Parkinson Daily Data Set Logger (PDSL)-1 device. PERFORM WMSMU placement on the body of a Parkinson's disease (PD) patient (right).
Figure 3.
Figure 3.
PDSL-1 logger (Normal Operating Mode): messages and alerts.
Figure 4.
Figure 4.
The main screen of P-GUI (Local Base Unit) menu is split into the following tasks: (1) Configuration Menu (touch button); (2) Questionnaire Menu (touch button); (3) Tests Menu (touch button); and (4) Schedules Menu (touch button).
Figure 5.
Figure 5.
P-GUI Questionnaire Menu screen: Self-Assessment Questionnaire (left); Medication intake information (middle) and Food intake information (right).
Figure 6.
Figure 6.
Instructions to patient screen (left); Patient's facial expression recording screen (right).
Figure 7.
Figure 7.
Data flow in the Perform system.
Figure 8.
Figure 8.
C-GUI functionalities (a) patient summary report; (b) tests results page; (c) symptoms page; (d) on-off results page.
Figure 8.
Figure 8.
C-GUI functionalities (a) patient summary report; (b) tests results page; (c) symptoms page; (d) on-off results page.
Figure 9.
Figure 9.
Results for Tremor analysis: (from top to bottom) left wrist, right wrist, left leg, right leg.
Figure 10.
Figure 10.
Indicative results for (a) Levodopa-induced dyskinesia (LID); (b) activity; (c) bradykinesia; (d) freezing of gait (FOG) and (e) akinesia (from top to bottom).
Figure 11.
Figure 11.
(a) A PD patient without wearing the PERFORM WMSMU; (b) A PD patient with PERFORM WMSMU. Posture Analysis was based on Rapid Entire Body Assessment (REBA) evaluation [49,51]. All patients were asked to stand up and stay still for a couple of minutes, while an observer completed the scoring cart of REBA evaluation based on the posture of trunk, neck, legs and arms.

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