A “HOLTER” for Parkinson’s disease: Validation of the ability to detect on-off states using the REMPARK system

Abstract

The REMPARK System detects an accurate evaluation of ON-OFF fluctuations in PD; this technology paves the way for an optimisation of the symptomatic control of PD motor symptoms as well as an accurate assessment of medication efficacy.

Systematic Review Looking at the Use of Technology to Measure Free-Living Symptom and Activity Outcomes in Parkinson’s Disease in the Home or a Home-like Environment

“…Motor fluctuations specifically were evaluated as a stand-alone outcome measure by two studies [83,84], and they were evaluated alongside the dyskinesia outcome measure in three papers [81,82,85]. Dyskinesia was measured by technologies in 11 further papers included in this review [37-40, 42, 45, 52, 54-56, 68].…”

“…Wearable devices were used in all studies which evaluated dyskinesia and/or motor fluctuations, with seven using single wearable devices. Sama et al [56], Rodriguez-Molinero et al [82,84] and Perez-Lopez et al [81] used devices located at the waist or on the belt, Johansson et al [42] and Bayes et al [83] used a device at the wrist and Ramsperger et al [45] used an ankle-worn device. Accelerometers were ubiquitously employed; they were used in some studies without other sensing technology and in other papers alongside gyroscopes [45,52,[54][55][56], magnetometers [56] and surface electromyographs [37][38][39][40].…”

“…Accelerometers were ubiquitously employed; they were used in some studies without other sensing technology and in other papers alongside gyroscopes [45,52,[54][55][56], magnetometers [56] and surface electromyographs [37][38][39][40]. Validation of dyskinesia outcome measurements had been documented in eight papers, with various comparators used as ground truth to aid validation, including videotape recordings [39,40,55,56,84], direct clinician evaluation/observation [42,83,84], and participant diaries plus telephone calls from a researcher [82]. The clinimetric properties of the technologies under evaluation, where discovered, are detailed more fully in Table 2.…”

“…With respect to motor outcomes, we found that the devices are being used to measure outcomes such as gait, physical activity levels, bradykinesia or akinesia, dyskinesia and tremor, but there were no papers evaluating rigidity and few which were measuring falls or posture. Additionally, technology was used to measure motor fluctuations in five of the included papers [81][82][83][84][85] with some encouraging results in terms of accuracy (see Table 2). Motor fluctuations are a relevant burden for patients [107] but are arguably inadequately quantified by the gold-standard clinical rating scales frequently used in clinical trials and in clinical practice.…”

“…This review found that 35 studies mentioned validation attempts of their technologies in PD using various methods: videotape analysis was used to validate technologies described by 19 papers [39, 50, 51, 53, 55-61, 67, 72, 73, 77, 84, 85, 94], direct clinician observation in six [41,46,49,58,65,83], participant diaries in seven [31,33,62,82,85,93,94], comparison with the MDS-UPDRS or another clinical rating scale was used in three studies [42,65,80], an instrumented walkway in three [61,63,64], motion analysis in three [53,59,60], comparison to other wearable devices or device filter settings in three [36,44,72], telephone calls from a researcher in one [82], polysomnography in one paper [90] and sleep respiratory home monitoring (assessing snoring, nasal airflow, oxygen saturation, body position, and respiratory and abdominal wall movements) in another [92].…”