A guide to wearable tech and Parkinson’s disease
For those of you who read my blog last week, you are aware that the main theme of the International Congress of Parkinson’s Disease and Movement Disorders was Technology in the Diagnosis, Monitoring and Management of Movement Disorders. This inspired the topic for my current blog – wearable technology in Parkinson’s disease.
Wearable technology refers to numerous methods by which movement information is captured on a continuous basis using various sensors worn by a patient. The basic technology being used in the research efforts currently underway typically consist of various combinations of accelerometers (electronic devices that measure magnitude and direction of the change in the rate of an object’s speed) and gyrometers (electronic devices that measure the rate and angle of an object’s rotation). The technologies differ mainly in the algorithms used to interpret the data that is collected.
Why use wearable sensors?
The primary reason to have people wear sensors is to capture data, and the reasons for capturing this data are multi-fold:
- To improve diagnosis of PD – Currently, the way PD is diagnosed is mainly through clinical exam. When clinical features are subtle, a clinician may not be able to firmly diagnose PD. Some wearable technology research efforts are focused on developing an algorithm to help make a more clear diagnosis of PD.
- To improve monitoring of PD – Patients tend to see their doctors for relatively brief periods, and currently, doctors adjust medication doses primarily based on patient and care partner anecdotal reports. More information about how a patient is actually doing at home, in the form of reliable information gleaned from a wearable sensor, may allow for more accurate medication adjustments.
- To encourage increased activity or track compliance with an exercise program – this is the rationale behind personal fitness tracking devices which are used by the general population and can be effective in the PD population as well.
- To improve clinical trial data – Currently the way clinical trials determine whether a medication is helpful is by performing rating scales at various points in the trial, such as the United Parkinson’s Disease Rating Scale (UPDRS). This is a very crude way of determining whether the medication was effective since the scale shows imperfect inter-rater reliability (i.e. different examiners can come up with a different UPDRS score for the same patient). In addition, patients tend to perform well for their physician, but may not be doing as well at home. Trials sometimes ask patients to keep diaries at home to gather more information, however, these can also be inaccurate. Supplementing the current rating scales and patient diaries with data gleaned from a wearable sensor could help determine whether a clinical trial medication is helping or not. This effort explains why pharmaceutical companies are very interested in wearables and some are working to develop their own devices.
What types of sensors are available?
There are also multiple methods of collecting the data:
- Data passively captured without a patient having to wear any new sensors – for example, capturing typing data by placing software on a patient’s computer with the patient continuing to interact with the keyboard as he/she normally does. Typing data that is collected can include how long a patient spends touching a key and how long it takes between touching one key and the next.
- Data passively captured by a sensor without the patient having to do any additional tasks – the sensor can be placed on the wrist, ankle or trunk. The sensor can also be in the patient’s cell phone.
- Data actively captured by a sensor – the patient wears the sensor and then performs certain tasks beyond what he/she typically does in his/her daily activities. This could include finger tapping, for example. Sometimes the sensors are too complicated or large for the activities to be performed at home, and the patient needs to come to a neurophysiology lab for the data collection.
Improved monitoring of PD
One system which is FDA cleared and is available on the market for monitoring of PD patients between office visits is known as the Personal KinetigraphTM (PKG TM). A patient wears the watch-like sensor for 6-10 days in anticipation of an office visit. The sensor collects data which is then interpreted through the PKG TM algorithms to measure bradykinesia and dyskinesia throughout the time period that the watch is worn. The PKG TM also has the ability to alert a patient to take a medication dose and allows the patient to record whether the dose was taken. After the data is collected, the patient mails the watch in and the data is downloaded and sent to the patient’s physician so that the physician has the information for the patient visit. The information can then complement what the patient and care partner say about their medication responses at home. A poster at the International Congress demonstrated that when PKG TM is in use, it often influences and informs the decision to change medications.
Other research around wearable devices and Parkinson’s
There are dozens of other research efforts, both at academic centers and in industry to continue to develop these technologies and bring additional products to market. One interesting project is known as Blue Sky, a collaborative effort between the pharmaceutical industry (Pfizer) and the software industry (IBM) to collect and analyze large amounts of data from many patients using wearable technologies at home, in a simulated home, and in the lab, along with clinical rating scales and patient diaries. An abstract at the Congress presented their work.
A smart-phone based system developed by the pharmaceutical company Roche, was presented as well, and demonstrated that information gleaned from their algorithm correlated with the traditional scales and testing that are performed at a Movement disorders clinical visit and in clinical trials.
Check out some of this type of work that APDA has funded in the past and is currently funding. Beom-Chan Lee developed a smart-phone based technology to improve balance. Yuanfang Guan is working on an algorithm to use voice information gleaned from a smart phone to predict and follow PD.
If the presentations at the Congress are any indication, the next few years will see a continued explosion of research in this field, with the likely development of new commercial products for the purposes of diagnosing and monitoring PD symptoms.
Can wearable technology act as treatment?
Wearable technologies are being developed that not only monitor PD symptoms but can improve the symptoms as well. In 2017, a Microsoft prototype of a watch was revealed, that uses vibrating motors to dampen tremor. The device was known as Emma’s watch, named after Emma Lawton, a British graphic designer with young onset Parkinson’s disease, who was the inspiration and first user of the invention, which dramatically improved her writing. This product is still under development and not yet available on the market.
Liftware is a company that makes adaptive vibrating spoons that are designed to stabilize a tremoring hand. These spoons are specifically meant to help tremors that occur with action, which can be a symptom in Parkinson’s disease, although is less common than the more classic rest tremor.
Tips and takeaways:
- Wearable technology is being used to diagnose, monitor and manage PD and has uses in clinical management and in clinical trials.
- PKGTM is a system that is currently FDA cleared and commercially available for monitoring PD patients between office visits. If you’re interested, ask your doctor if he/she is set up to use this system.
- Wearable technology to help symptoms may also be on the horizon.