SAMENVATTING
REHABILITATION TECHNOLOGY
A. NIEUWBOER, W. SAEYS, P. FEYS, B. BONNECHÈRE, A.
TIMMERMANS AND E. SWINNEN
Gitte Van Cleemput
, Gitte Van Cleemput
SAMENVATTING REHABILITATION TECHNOLOGY
TECHNOLOGY-BASED ASSESSMENT AND TRAINING FOR PD
INFO EXAMINATION
- 3-5 MC questions PD / +-30 MC total
- Theory (50%)
o Course material for PD
▪ Slides
▪ Article on VR in PD – see pdf Canning et al 2020
- Group written report + oral presentation (50%)
ASSESSMENT OF GAIT&BALANCE IN PATIENTS WITH PD USING WEARABLE TECHNOLOGY
INTRODUCTION WHY WEARABLE TECHNOLOGY I N PD?
CAPACITY ≠ PERFORMANCE
Capacity
- As tested in the lab supervised
- As tested at home supervised
- = TEST met instructies en supervisie van een therapeut
Performance
- Monitored during actual free living unsupervised
- Fysieke capaciteit die de P gebruikt in de functionele omgeving zonder instructies/supervisie
→ Technology can help us to bring capacity and performance measures closer together
Bij welke test doet de PD patiënt het beste?
- Capaciteit > performance
- Meer aandacht bij capaciteitstest (cognitief)
Andere P met een andere aandoening kunnen het thuis in een vertrouwde omgeving net beter doen omdat ze
dan meer op hun gemak zijn.
INERTIAL MEASUREMENT UNIT
VALIDATION
Early validation → accuracy Mid-stage validation → clinical efficacy
In-lab protocol Free-living
7 IMUs 7 IMUs 5 IMUs 2 IMUs 1 IMU
2 sensors 2 sensors
1
, Gitte Van Cleemput
SAMENVATTING REHABILITATION TECHNOLOGY
IMU’S ARE DIGITAL OUTCOME MEASURES (DMO’S)
Most commonly used wearable sensors for gait & postural instability in PD in research settings
IMU – 3-axial
- Gyroscope: position against gravity
- Magnetometer: detection of environment
o Ook positie van li en re been tov elkaar, adhv magnetisch veld
- Accelerometer: body acceleration
- CuPiD: can connect with Bluetooth connections to a smartphone
Single accelerometer (ACC)
- Activity-monitoring with one single sensor
- Applied at the lower back (dimension) with adhesive tape
- Meet 7 dagen de activiteit
- Gegevens van lange periode met maar 1 IMU
These measures are becoming smaller and cheaper and now can be used wirelessly
and in combination with smartphone or laptop processors.
WHY DMOS PARTICULARLY IMPORTANT FOR PD?
These pictures provide simplified representations of compensatory networks.
We can assume that sensory and cognitive compensatory resources will become more integrated with the
motor system, as an adaptive response in early disease. In moderate disease, compensatory NWs likely become
increasingly entangled. And eventually in later stage PD, brain networks turn out to betrokken bij het
ziekteproces may incur ongewenste adaptatie. What I am describing here is still speculative of course, but the
point I am making is that this left-over resilience will determine how people respond to training.
De-automaticity and loss of motor vigour
- Compensatory networks more active in PD (dependent on sensory or cognitive networks)
- Parkinson is a learning disease with retention and transfer deficits
Effect DMOs
- Spontaneous automatic behaviour and mitigate the ‘white coat’ effects during assessment
- May help stimulate movement and exercise
- May help learning retention and transfer to other settings
2
, Gitte Van Cleemput
SAMENVATTING REHABILITATION TECHNOLOGY
PHYSICAL ACTIVITY IN PD – DMO’S
There are discrepancies and we still know relatively little
- Self-reported physical activity ≠ objectively measured
- Self-reported exercise ≠ actual exercise compliance
o The under-adhering tend to over-report compliance
Due to DMOs we now know that
- Mild to moderate PD are on average 30% ↓ active > healthy control
- 1/6 PD: >7000 steps/day (averages very variable)
- 8,7 (± 2,1) hours/day sedentary state (PD 10 ± 6,7 years)
EVIDENCE IS PAHTOLOGY -SPECIFIC
Scoping review on 855 DMO-validity studies applied to walking
Studies with DMOs PD MS COPD Femoral #
Lab/home 252/20 240/25 63/135 41/5
Total 272 265 198 46
- Gait quality
o PD & MS: meer studies in een lab omdat de kwaliteit hier belangrijk is
- Gait quantity
o COPD: meer thuis omdat ook het functionele belangrijk is en dus de kwantiteit van de gang
gemeten moet worden
Validation pipeline
1. Free-living? Moeilijkste -> vaak ‘ruis’ op de gegevens
2. Responsiveness? We weten niet of de outcomes van DMO responsief zijn
Discriminative validity (N=282)
Number of studies with statistically sign between-group differences/total (%)
3
REHABILITATION TECHNOLOGY
A. NIEUWBOER, W. SAEYS, P. FEYS, B. BONNECHÈRE, A.
TIMMERMANS AND E. SWINNEN
Gitte Van Cleemput
, Gitte Van Cleemput
SAMENVATTING REHABILITATION TECHNOLOGY
TECHNOLOGY-BASED ASSESSMENT AND TRAINING FOR PD
INFO EXAMINATION
- 3-5 MC questions PD / +-30 MC total
- Theory (50%)
o Course material for PD
▪ Slides
▪ Article on VR in PD – see pdf Canning et al 2020
- Group written report + oral presentation (50%)
ASSESSMENT OF GAIT&BALANCE IN PATIENTS WITH PD USING WEARABLE TECHNOLOGY
INTRODUCTION WHY WEARABLE TECHNOLOGY I N PD?
CAPACITY ≠ PERFORMANCE
Capacity
- As tested in the lab supervised
- As tested at home supervised
- = TEST met instructies en supervisie van een therapeut
Performance
- Monitored during actual free living unsupervised
- Fysieke capaciteit die de P gebruikt in de functionele omgeving zonder instructies/supervisie
→ Technology can help us to bring capacity and performance measures closer together
Bij welke test doet de PD patiënt het beste?
- Capaciteit > performance
- Meer aandacht bij capaciteitstest (cognitief)
Andere P met een andere aandoening kunnen het thuis in een vertrouwde omgeving net beter doen omdat ze
dan meer op hun gemak zijn.
INERTIAL MEASUREMENT UNIT
VALIDATION
Early validation → accuracy Mid-stage validation → clinical efficacy
In-lab protocol Free-living
7 IMUs 7 IMUs 5 IMUs 2 IMUs 1 IMU
2 sensors 2 sensors
1
, Gitte Van Cleemput
SAMENVATTING REHABILITATION TECHNOLOGY
IMU’S ARE DIGITAL OUTCOME MEASURES (DMO’S)
Most commonly used wearable sensors for gait & postural instability in PD in research settings
IMU – 3-axial
- Gyroscope: position against gravity
- Magnetometer: detection of environment
o Ook positie van li en re been tov elkaar, adhv magnetisch veld
- Accelerometer: body acceleration
- CuPiD: can connect with Bluetooth connections to a smartphone
Single accelerometer (ACC)
- Activity-monitoring with one single sensor
- Applied at the lower back (dimension) with adhesive tape
- Meet 7 dagen de activiteit
- Gegevens van lange periode met maar 1 IMU
These measures are becoming smaller and cheaper and now can be used wirelessly
and in combination with smartphone or laptop processors.
WHY DMOS PARTICULARLY IMPORTANT FOR PD?
These pictures provide simplified representations of compensatory networks.
We can assume that sensory and cognitive compensatory resources will become more integrated with the
motor system, as an adaptive response in early disease. In moderate disease, compensatory NWs likely become
increasingly entangled. And eventually in later stage PD, brain networks turn out to betrokken bij het
ziekteproces may incur ongewenste adaptatie. What I am describing here is still speculative of course, but the
point I am making is that this left-over resilience will determine how people respond to training.
De-automaticity and loss of motor vigour
- Compensatory networks more active in PD (dependent on sensory or cognitive networks)
- Parkinson is a learning disease with retention and transfer deficits
Effect DMOs
- Spontaneous automatic behaviour and mitigate the ‘white coat’ effects during assessment
- May help stimulate movement and exercise
- May help learning retention and transfer to other settings
2
, Gitte Van Cleemput
SAMENVATTING REHABILITATION TECHNOLOGY
PHYSICAL ACTIVITY IN PD – DMO’S
There are discrepancies and we still know relatively little
- Self-reported physical activity ≠ objectively measured
- Self-reported exercise ≠ actual exercise compliance
o The under-adhering tend to over-report compliance
Due to DMOs we now know that
- Mild to moderate PD are on average 30% ↓ active > healthy control
- 1/6 PD: >7000 steps/day (averages very variable)
- 8,7 (± 2,1) hours/day sedentary state (PD 10 ± 6,7 years)
EVIDENCE IS PAHTOLOGY -SPECIFIC
Scoping review on 855 DMO-validity studies applied to walking
Studies with DMOs PD MS COPD Femoral #
Lab/home 252/20 240/25 63/135 41/5
Total 272 265 198 46
- Gait quality
o PD & MS: meer studies in een lab omdat de kwaliteit hier belangrijk is
- Gait quantity
o COPD: meer thuis omdat ook het functionele belangrijk is en dus de kwantiteit van de gang
gemeten moet worden
Validation pipeline
1. Free-living? Moeilijkste -> vaak ‘ruis’ op de gegevens
2. Responsiveness? We weten niet of de outcomes van DMO responsief zijn
Discriminative validity (N=282)
Number of studies with statistically sign between-group differences/total (%)
3
