Capturing nighttime symptoms in Parkinson disease: Technical development and experimental verification of inertial sensors for nocturnal hypokinesia

Abstract

Abstract-Although nocturnal hypokinesia represents one of the most common nocturnal disabilities in Parkinson disease (PD), it is often a neglected problem in daily clinical practice. We have developed a portable ambulatory motion recorder (the NIGHT-Recorder), which consists of 16-bit triaxial integrated microelectromechanical system inertial sensors that are specifically designed to measure movements, register the position of the body with respect to gravity, and provide information on rotations on the longitudinal axis while lying in bed. The signal processing uses the forward derivative method to identify rolling over and getting out of bed as primary indicators. The prototype was tested on six PD pairs to measure their movements for one night. Using predetermined definitions, 134 movements were captured consisting of rolling over 115 times and getting out of bed 19 times. Patients with PD rolled over significantly fewer times than their spouses (p = 0.03), and the position change was significantly smaller in patients with PD (p = 0.03). Patients with PD rolled over at a significantly slower speed (p = 0.03) and acceleration (p = 0.03) than their spouses. In contrast, patients with PD got out of bed significantly more often than their spouses (p = 0.02). It is technically feasible to develop an easy-to-use, portable, and accurate device that can assist physicians in the assessment of nocturnal movements of patients with PD.

Shedding Light on Nocturnal Movements in Parkinson’s Disease: Evidence from Wearable Technologies

“…A small number of authors have used innovative wearable sensors to investigate abnormal nocturnal movements in PD [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 97 ]. A single research group has performed most of these investigations (7 out of 12 studies) [ 26 , 27 , 28 , 29 , 30 , 31 , 34 ]. Overall, these studies have examined a heterogeneous cohort of PD patients, including subjects with early and advanced disease stages.…”

“…Overall, these studies have examined a heterogeneous cohort of PD patients, including subjects with early and advanced disease stages. Only 8 out of 12 studies also enrolled HS [ 25 , 26 , 27 , 29 , 31 , 34 , 35 , 98 ]. Of the studies that did not enrol HS [ 28 , 30 , 32 , 33 ], one investigated changes in nocturnal movements based on disease stage and severity [ 32 ], while another investigated subjective perception of impaired bed mobility [ 33 ].…”

“…Along with the examination of sleep impairment, some previous studies using actigraphy in PD have also provided information about nocturnal limb movements in parkinsonian patients [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. More recently, innovative wearable technologies including wireless sensor networks have also been used to examine nocturnal movements involving axial body rotations in PD patients [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. Compared to clinical evaluation and polysomnography, actigraphy and innovative wearable sensors are now increasingly considered feasible solutions for the long-term recording of a large amount of ecological data due to the low costs and unobtrusiveness of these tools.…”

Evaluation of nocturnal hypokinesia in Parkinson’s disease using a novel patient/proxy questionnaire and correlations with objective monitoring

“…The NADCS has three components, exploring the severity of akinesia, dystonia, and cramp during the night via an ordinal scale [7]. In addition, a random sample of 25 patients-caregivers pairs were also assessed with night-time sensor monitoring (the NIGHT-Recorder, ChulaPD, Thailand) to provide objective correlations [4,8]. Objective nocturnal parameters in this study consisted of the number of times, degree, velocity and acceleration of turning in bed as described in our prior study [4].…”

Overnight Accelerometric Monitoring of Nocturnal Motor Disability: Different Kinetic Properties between Parkinson’s Disease and Hemiplegic Stroke

“…Because of the lack of methods to evaluate motor function during sleep, night time disability has not been fully elucidated or its severity has only been estimated based on the daytime motor impairment as evaluated by disease-specific clinimetric scales 1)2) . Recently, wearable threeaxis accelerometers have become available to analyze kinetic data of overnight movements [3][4][5][6][7][8] . Previously, we reported the clinical utility of overnight monitoring of turnover movements in bed for patients with Parkinson's disease (PD) 3)4) .…”