Automated gait and balance parameters diagnose and correlate with severity in Parkinson disease

Abstract

Objective To assess the suitability of instrumented gait and balance measures for diagnosis and estimation of disease severity in PD. Methods Each subject performed iTUG (instrumented Timed-Up-and-Go) and iSway (instrumented Sway) using the APDM® Mobility Lab. MDS-UPDRS parts II and III, a postural instability and gait disorder (PIGD) score, the mobility subscale of the PDQ-39, and Hoehn & Yahr stage were measured in the PD cohort. Two sets of gait and balance variables were defined by high correlation with diagnosis or disease severity and were evaluated using multiple linear and logistic regressions, ROC analyses, and t-tests. Results 135 PD subjects and 66 age-matched controls were evaluated in this prospective cohort study. We found that both iTUG and iSway variables differentiated PD subjects from controls (area under the ROC curve was 0.82 and 0.75 respectively) and correlated with all PD severity measures (R2 ranging from 0.18 to 0.61). Objective exam-based scores correlated more strongly with iTUG than iSway. The chosen set of iTUG variables was abnormal in very mild disease. Age and gender influenced gait and balance parameters and were therefore controlled in all analyses. Interpretation Our study identified sets of iTUG and iSway variables which correlate with PD severity measures and differentiate PD subjects from controls. These gait and balance measures could potentially serve as markers of PD progression and are under evaluation for this purpose in the ongoing NIH Parkinson Disease Biomarker Program.

Wearable inertial sensors for human movement analysis

“…It is worthwhile to mention a series of papers showing combined methodological solutions based on networks of body-worn sensors, used to assess standing balance, gait analysis and TUG at the same time [113]. Such approach has been used in clinical settings as a diagnostic tool in subjects with Parkinson disease [114,115] and multiple sclerosis [116], and as a general monitoring tool for balance and gait rehabilitation [117]. Figure 2 shows the raw data obtained with an IMU during the execution of TUG test by a patient with stroke.…”

Investigation of factors impacting mobility and gait in Parkinson disease

“…While age-related changes and disease severity are commonly known to affect mobility and gait in PD (Rodriguez et al, 2015; Dewey et al, 2014), recent evidence suggests that cognitive function may also play a role (Smulders et al, 2013). In contrast to other neurodegenerative conditions which primarily feature cognitive deficits (such as Alzheimer disease), the cognitive profile in PD is more heterogeneous, likely reflecting the more variable underlying neuropathology (Lin & Wu, 2015; Burdick et al, 2014).…”

Potential of APDM mobility lab for the monitoring of the progression of Parkinson’s disease

“…More recently, Dewey et al, [46] used the Mobility Lab system in a large cohort of 135 early-to-moderate subjects with PD. The cohort included both de novo subjects (never treated with Levodopa) as well as subjects in a moderate stage of the disease (tested ON their antiparkinson medication).…”

“…However, the work from Dewey [46] did not take into account the medication status. In fact, our recent findings[6] show how levodopa is a double-edged sword for balance and gait in a cohort of 104 subjects with PD.…”