Summary rehab technology: assessment & training in PD

Rehab 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 IN PD?

 Waarom wearable technology gebruiken
- Gedetailleerdere info & acurratere info
 Self report ≠ Capacity ≠ Performance
 Ecological validity
 Discriminative ability (aid diagnosis)
 Objective outcome measure to assess physical activity
 Objective outcome measure to assess symptoms
 Objective outcome measure to assess responsiveness to therapy
 Objective outcome meaure to predict conversion (diagnosis/symptom)
 Waarom gebruiken??
- Eliminate human error / bias
- Safe time and money
 Voornamelijk PD maakt gebruik van wearables

 Slechte correlatie tussen hoe gang echt is en gemeten in een lab




 CAPACITY ≠ PERFORMANCE
- Capacity
 Bste van P wanneer gemeten in een lab/ thuis met supervisie
 As tested in the lab supervised
 As tested at home supervised
= TEST met instructies en supervisie van een therapeut
- Performance
 Zonder begeleiding/ supervisie
 Hopen meest natuurlijke gangpatroon & gedrag van P zien
 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




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, Rehab technology: technology based assessment and
training for PD




 Motorcircuit gemodulerd (hoofdzakelijk) door substantia nigra  dopamine
- Indien voldoende dopamine in stritaal circuit = bewegen zonder na te denken
- PD= dopamine neuronen degeneratie
 1st aantasten posterieure deel striatum, nadien ook anterieur deel
- Motorcircuit
 Motor cortex
 Cerebellum
 Striaum
 brainstem
 Verlizen mogelijkheid automatsche bewegingen putamen vnl. verantwoordelijk voor auto.bew
- Gaan andere circuits gebruiken: profontale cortex + parietale cortex
- Extra visuele & sensorische info om beweging te begeleiden
- Veel meer aandacht nodig
- Gaan na testen bij thuiskomen wandelen zonder extra aandacht circuit
 Ciruit vraagt veel energie
 Roblemen terug bovenkomen
 White coat effect
- Dokter kijkt toe wanneer P beweegt/ wandelt
- P is bewuster van beweging
- Geen extra circuits gebruiken
- Geen echte representatie van problemen krijgen
 Bij welke test doet de PD patiënt het beste?
- Capaciteit > performance
- Meer aandacht bij capaciteitstest (cognitief)
 Andere P met andere aandoening kunnen thuis in vertrouwde omgeving net beter doen = meer op gemak.

1. INERTIAL MEASUREMENT UNIT
1.1. VALIDATION
 Wearables op iemand plaatsen & zo echte performance in thuissituatie bekijken
 Hoe meer sensoren= hoe accurater data= hoe ↓ gebruiksvriendelijk
Early validation  accuracy Mid-stage validation  clinical efficacy
 Nog steeds white coat effect

Free-living
 Heel grote EU-
trail
 Cohort validatie
studie


7 IMUs 7 IMUs 5 IMUs 2 IMUs 1 IMU
2 sensors 2 sensors

1.2. IMU’S ARE DIGITAL OUTCOME MEASURES (DMO’S)



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, Rehab technology: technology based assessment and
training for PD
 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
spatiele componenten
- Accelerometer: body acceleration
- APDM- opal system
 5 lichaamssensoren
 Heel P vriendeljk
 Data processing in real time
- 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.

1.3. WHY DMO’S PARTICULARLY IMPORTANT FOR PD?
 DMO= digital measurement outcome




 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
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


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