Using Ecological Whole Body Kinematics to Evaluate Effects of Medication Adjustment in Parkinson Disease

Abstract

Background: Functional motor impairments including mobility are major reasons for clinical intervention and medication adjustment in symptomatic therapy for Parkinson's disease (PD). Outcome measures used to assess the impact of medication are mostly based on patients' memory or diaries which, considering the gaps between visits, are neither objective nor very reliable. Objective: Investigating the feasibility of using movement features extracted from ecological whole-body kinematics recordings to measure the quantitative and qualitative changes in multiple aspects of mobility after medication changes in PD. Methods: Eleven patients with PD (PwPD) performed mobility tasks in their own home, wearing a full body wireless inertial sensing based motion capture system. Three scripted walking tasks (walking, fast walking, and walk turns) were examined at baseline and two weeks after medication changes. Clinical scales, including investigator-rated clinical global impression of improvement (CGI-I), were collected at both visits. Results: Out of 59 recorded body joint variables, five were identified as pertinent. Changes were represented in vector space as a plot of mean versus peak amplitude. Regression analysis was used to predict clinical improvement or worsening based on these vector features. The predictors were able to explain (>98.5% of variance) patients' clinical global impression of improvement, thus correctly predicting 5 cases of improvement and 2 cases of worsening. Conclusions: This study provided a method of extracting clinically meaningful reports from ecological kinematic data showing changes after drug adjustments. The results are presented using a novel concept called change space that may be more understandable for clinical staff.

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“…Today, clinical scales and traditional patient‐reported outcomes continue to be the primary assessment tools or endpoints in PD clinical care and research. However, there is a growing awareness that TOMs may improve the sensitivity, accuracy, reproducibility, and feasibility of objectively capturing the full complexity and diversity of changes in motor and nonmotor behaviors . Examples include the difficulty to reliably evaluate fluctuating events (eg, the variable response to medication), to capture rare incidents (eg, falls or freezing of gait), or to assess behaviors that, by definition, take place over long periods of time outside the clinical examination room (eg, physical activities in everyday life).…”

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