1. |
- Aghanavesi, Somayeh, 1981-, et al.
(författare)
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A multiple motion sensors index for motor state quantification in Parkinson's disease
- 2020
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Ingår i: Computer Methods and Programs in Biomedicine. - : Elsevier BV. - 0169-2607 .- 1872-7565. ; 189
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To construct a Treatment Response Index from Multiple Sensors (TRIMS) for quantification of motor state in patients with Parkinson's disease (PD) during a single levodopa dose. Another aim was to compare TRIMS to sensor indexes derived from individual motor tasks. Method: Nineteen PD patients performed three motor tests including leg agility, pronation-supination movement of hands, and walking in a clinic while wearing inertial measurement unit sensors on their wrists and ankles. They performed the tests repeatedly before and after taking 150% of their individual oral levodopa-carbidopa equivalent morning dose.Three neurologists blinded to treatment status, viewed patients’ videos and rated their motor symptoms, dyskinesia, overall motor state based on selected items of Unified PD Rating Scale (UPDRS) part III, Dyskinesia scale, and Treatment Response Scale (TRS). To build TRIMS, out of initially 178 extracted features from upper- and lower-limbs data, 39 features were selected by stepwise regression method and were used as input to support vector machines to be mapped to mean reference TRS scores using 10-fold cross-validation method. Test-retest reliability, responsiveness to medication, and correlation to TRS as well as other UPDRS items were evaluated for TRIMS. Results: The correlation of TRIMS with TRS was 0.93. TRIMS had good test-retest reliability (ICC = 0.83). Responsiveness of the TRIMS to medication was good compared to TRS indicating its power in capturing the treatment effects. TRIMS was highly correlated to dyskinesia (R = 0.85), bradykinesia (R = 0.84) and gait (R = 0.79) UPDRS items. Correlation of sensor index from the upper-limb to TRS was 0.89. Conclusion: Using the fusion of upper- and lower-limbs sensor data to construct TRIMS provided accurate PD motor states estimation and responsive to treatment. In addition, quantification of upper-limb sensor data during walking test provided strong results. © 2019
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2. |
- Jusufi, Ilir, 1983-, et al.
(författare)
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Interactive visualization of sensor and self-reported data of patients with Parkinson's disease
- 2019
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Ingår i: MIRAI AGEING Seminar, November 13-14, 2019, Stockh.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Advancements in telemedicine have been helpful for frequent monitoring of patients with Parkinson's disease (PD) from remote locations and assessment of their individual symptoms and treatment-related complications. These data can be useful for helping clinicians and patients to interpret symptom states and individually tailor the treatments by visualizing the physiological information collected by sensor-based systems as well as patient self-reported states. Here we present various visualization and interaction techniques to help physicians explore patient’s daily activities, which could be useful for guiding them during the decision-making process. An interface is designed to visualize symptom and medication information, collected by an Internet of Things-based system comprising of a smartphone, electronic dosing device, wrist sensor and a bed sensor.
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3. |
- Jusufi, Ilir, 1983-, et al.
(författare)
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Interactive visualization tools for improving empowerment and treatment of Parkinson's disease patients
- 2019
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Ingår i: MIRAI AGEING Workshop, June 2-5, 2019, Tokyo.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Advancements in telemedicine have been helpful for frequent monitoring of patients with Parkinson's disease (PD) from remote locations and assessment of their individual symptoms and treatment-related complications. These data can be useful for helping clinicians and patients to interpret symptom states and individually tailor the treatments by visualizing the physiological information collected by sensor-based systems. Here we present various visualization and interaction techniques developed to help patients track their daily activities. We also present our most recent development to aid physicians in exploring this data in more detailed fashion. Both sets of interfaces are designed to visualize symptom and medication information, collected by an Internet of Things (IoT)-based system comprising of a smartphone, electronic dosing device, wrist sensor and a bed sensor.
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4. |
- Jusufi, Ilir, 1983-, et al.
(författare)
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TapVis : A Data Visualization Approach for Assessment of Alternating Tapping Performance in Patients with Parkinson's Disease
- 2018
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Ingår i: EuroVis 2018 - Short Papers. - : Eurographics - European Association for Computer Graphics. - 9783038680604 ; , s. 55-59
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Konferensbidrag (refereegranskat)abstract
- Advancements in telemedicine have been helpful for frequent monitoring of patients with Parkinson's disease (PD) from remote locations and assessment of their individual symptoms and treatment-related complications. These data can be useful for helping clinicians to interpret symptom states and individually tailor the treatments by visualizing the physiological information collected by sensor-based systems. In this paper we present a visualization metaphor that represents symptom information of PD patients during tapping tests performed with a smartphone. The metaphor has been developed and evaluated with a clinician. It enabled the clinician to observe fine motor impairments and identify motor fluctuations regarding several movement aspects of patients that perform the tests from their homes.
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5. |
- Karni, Liran, 1979-, et al.
(författare)
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Toward Improved Treatment and Empowerment of Individuals With Parkinson Disease : Design and Evaluation of an Internet of Things System
- 2022
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Ingår i: JMIR Formative Research. - : JMIR Publications Inc.. - 2561-326X. ; 6:6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Parkinson disease (PD) is a chronic degenerative disorder that causes progressive neurological deterioration with profound effects on the affected individual's quality of life. Therefore, there is an urgent need to improve patient empowerment and clinical decision support in PD care. Home-based disease monitoring is an emerging information technology with the potential to transform the care of patients with chronic illnesses. Its acceptance and role in PD care need to be elucidated both among patients and caregivers.OBJECTIVE: Our main objective was to develop a novel home-based monitoring system (named EMPARK) with patient and clinician interface to improve patient empowerment and clinical care in PD.METHODS: We used elements of design science research and user-centered design for requirement elicitation and subsequent information and communications technology (ICT) development. Functionalities of the interfaces were the subject of user-centric multistep evaluation complemented by semantic analysis of the recorded end-user reactions. The ICT structure of EMPARK was evaluated using the ICT for patient empowerment model.RESULTS: Software and hardware system architecture for the collection and calculation of relevant parameters of disease management via home monitoring were established. Here, we describe the patient interface and the functional characteristics and evaluation of a novel clinician interface. In accordance with our previous findings with regard to the patient interface, our current results indicate an overall high utility and user acceptance of the clinician interface. Special characteristics of EMPARK in key areas of interest emerged from end-user evaluations, with clear potential for future system development and deployment in daily clinical practice. Evaluation through the principles of ICT for patient empowerment model, along with prior findings from patient interface evaluation, suggests that EMPARK has the potential to empower patients with PD.CONCLUSIONS: The EMPARK system is a novel home monitoring system for providing patients with PD and the care team with feedback on longitudinal disease activities. User-centric development and evaluation of the system indicated high user acceptance and usability. The EMPARK infrastructure would empower patients and could be used for future applications in daily care and research.
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6. |
- Memedi, Mevludin, 1983-, et al.
(författare)
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An interface for IoT : feeding back health-related data to Parkinson's disease patients
- 2018
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Ingår i: Journal of Sensor and Actuator Networks. - : MDPI. - 2224-2708. ; 7:1, s. 1-16
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Tidskriftsartikel (refereegranskat)abstract
- This paper presents a user-centered design (UCD) process of an interface for Parkinson’s disease (PD) patients for helping them to better manage their symptoms. The interface is designed to visualize symptom and medication information, collected by an Internet of Things (IoT)-based system, which will consist of a smartphone, electronic dosing device, wrist sensor and a bed sensor. In our work, the focus is on measuring data related to some of the main health-related quality of life aspects such as motor function, sleep, medication compliance, meal intake timing in relation to medication intake, and physical exercise. A mock-up demonstrator for the interface was developed using UCD methodology in collaboration with PD patients. The research work was performed as an iterative design and evaluation process based on interviews and observations with 11 PD patients. Additional usability evaluations were conducted with three information visualization experts. Contributions include a list of requirements for the interface, results evaluating the performance of the patients when using the demonstrator during task-based evaluation sessions as well as opinions of the experts. The list of requirements included ability of the patients to track an ideal day, so they could repeat certain activities in the future as well as determine how the scores are related to each other. The patients found the visualizations as clear and easy to understand and could successfully perform the tasks. The evaluation with experts showed that the visualizations are in line with the current standards and guidelines for the intended group of users. In conclusion, the results from this work indicate that the proposed system can be considered as a tool for assisting patients in better management of the disease by giving them insights on their own aggregated symptom and medication information. However, the actual effects of providing such feedback to patients on their health-related quality of life should be investigated in a clinical trial.
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7. |
- Aghanavesi, Somayeh, 1981-, et al.
(författare)
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A smartphone-based system to quantify dexterity in Parkinson's disease patients
- 2017
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Ingår i: Informatics in Medicine Unlocked. - : Elsevier BV. - 2352-9148. ; 9, s. 11-17
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The aim of this paper is to investigate whether a smartphone-based system can be used to quantify dexterity in Parkinson's disease (PD). More specifically, the aim was to develop data-driven methods to quantify and characterize dexterity in PD. Methods Nineteen advanced PD patients and 22 healthy controls participated in a clinical trial in Uppsala, Sweden. The subjects were asked to perform tapping and spiral drawing tests using a smartphone. Patients performed the tests before, and at pre-specified time points after they received 150% of their usual levodopa morning dose. Patients were video recorded and their motor symptoms were assessed by three movement disorder specialists using three Unified PD Rating Scale (UPDRS) motor items from part III, the dyskinesia scoring and the treatment response scale (TRS). The raw tapping and spiral data were processed and analyzed with time series analysis techniques to extract 37 spatiotemporal features. For each of the five scales, separate machine learning models were built and tested by using principal components of the features as predictors and mean ratings of the three specialists as target variables. Results There were weak to moderate correlations between smartphone-based scores and mean ratings of UPDRS item #23 (0.52; finger tapping), UPDRS #25 (0.47; rapid alternating movements of hands), UPDRS #31 (0.57; body bradykinesia and hypokinesia), sum of the three UPDRS items (0.46), dyskinesia (0.64), and TRS (0.59). When assessing the test-retest reliability of the scores it was found that, in general, the clinical scores had better test-retest reliability than the smartphone-based scores. Only the smartphone-based predicted scores on the TRS and dyskinesia scales had good repeatability with intra-class correlation coefficients of 0.51 and 0.84, respectively. Clinician-based scores had higher effect sizes than smartphone-based scores indicating a better responsiveness in detecting changes in relation to treatment interventions. However, the first principal component of the 37 features was able to capture changes throughout the levodopa cycle and had trends similar to the clinical TRS and dyskinesia scales. Smartphone-based scores differed significantly between patients and healthy controls. Conclusions Quantifying PD motor symptoms via instrumented, dexterity tests employed in a smartphone is feasible and data from such tests can also be used for measuring treatment-related changes in patients. © 2017
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8. |
- Aghanavesi, Somayeh, 1981-, et al.
(författare)
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Feasibility of a multi-sensor data fusion method for assessment of Parkinson’s disease motor symptoms
- 2018
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Title: Feasibility of a multi-sensor data fusion method for assessment of Parkinson’s disease motor symptomsObjective: To assess the feasibility of measuring Parkinson’s disease (PD) motor symptoms with a multi-sensor data fusion method. More specifically, the aim is to assess validity, reliability and sensitivity to treatment of the methods.Background: Data from 19 advanced PD patients (Gender: 14 males and 5 females, mean age: 71.4, mean years with PD: 9.7, mean years with levodopa: 9.5) were collected in a single center, open label, single dose clinical trial in Sweden [1].Methods: The patients performed leg agility and 2-5 meter straight walking tests while wearing motion sensors on their limbs. They performed the tests at baseline, at the time they received the morning dose, and at pre-specified time points until the medication wore off. While performing the tests the patients were video recorded. The videos were observed by three movement disorder specialists who rated the symptoms using a treatment response scale (TRS), ranging from -3 (very off) to 3 (very dyskinetic). The sensor data consisted of lower limb data during leg agility, upper limb data during walking, and lower limb data during walking. Time series analysis was performed on the raw sensor data extracted from 17 patients to derive a set of quantitative measures, which were then used during machine learning to be mapped to mean ratings of the three raters on the TRS scale. Combinations of data were tested during the machine learning procedure.Results: Using data from both tests, the Support Vector Machines (SVM) could predict the motor states of the patients on the TRS scale with a good agreement in relation to the mean ratings of the three raters (correlation coefficient = 0.92, root mean square error = 0.42, p<0.001). Additionally, there was good test-retest reliability of the SVM scores during baseline and second tests with intraclass-correlation coefficient of 0.84. Sensitivity to treatment for SVM was good (Figure 1), indicating its ability to detect changes in motor symptoms. The upper limb data during walking was more informative than lower limb data during walking since SVMs had higher correlation coefficient to mean ratings. Conclusions: The methodology demonstrates good validity, reliability, and sensitivity to treatment. This indicates that it could be useful for individualized optimization of treatments among PD patients, leading to an improvement in health-related quality of life.
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9. |
- Aghanavesi, Somayeh, et al.
(författare)
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Measuring temporal irregularity in spiral drawings of patients with Parkinson’s disease
- 2017
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Ingår i: Abstracts of the 21<sup>st</sup> International Congress of Parkinson's Disease and Movement Disorders. - : John Wiley & Sons. ; , s. s252-s252
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Konferensbidrag (populärvet., debatt m.m.)abstract
- Objective: The aim of this work is to evaluate clinimetric properties of a method for measuring Parkinson’s disease (PD) upper limb temporal irregularities during spiral drawing tasks.Background: Basal ganglia fluctuations of PD patients are associated with motor symptoms and relating them to objective sensor-based measures may facilitate the assessment of temporal irregularities, which could be difficult to be assessed visually. The present study investigated the upper limb temporal irregularity of patients at different stages of PD and medication time points.Methods: Nineteen PD patients and 22 healthy controls performed repeated spiral drawing tasks on a smartphone. Patients performed the tests before a single levodopa dose and at specific time intervals after the dose was given. Three movement disorder specialists rated the videos of patients' performance according to six items of UPDRS-III, dyskinesia (Dys), and Treatment Response Scale (TRS). A temporal irregularity score (TIS) was developed using approximate entropy (ApEn) method. Differences in mean TIS between two groups of patients and healthy subjects, and also across four subject groups: early, intermediate, advanced patients and, healthy subjects were assessed. The relative ability of TIS to detect changes from baseline (no medication) to later time points when patients were on medication was assessed. Correlations between TIS and clinical rating scales were assessed by Pearson correlation coefficients and test-retest reliability of TIS was measured by intra-class correlation coefficients (ICC).Results: The mean TIS was significantly different between healthy subjects and patients (P<0.0001). When assessing the changes in relation to treatment, clinical-based scores (TRS and Dys) had better responsiveness than TIS. However, the TIS was able to capture changes from Off to On, and the wearing off effects. Correlations between TIS and clinical scales were low indicating poor validity. Test-retest reliability correlation coefficient of the mean TIS was good (ICC=0.67).Conclusions: Our study found that TIS was able to differentiate spiral drawings drawn by patients from those drawn by healthy subjects. In addition, TIS could capture changes throughout the levodopa cycle.TIS was weakly correlated to clinical ratings indicating that TIS measures high frequency upper limb temporal irregularities that could be difficult to be detected during clinical observations.
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10. |
- Aghanavesi, Somayeh, 1981-, et al.
(författare)
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Motion sensor-based assessment of Parkinson's disease motor symptoms during leg agility tests : results from levodopa challenge
- 2020
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Ingår i: IEEE journal of biomedical and health informatics. - : IEEE Computer Society. - 2168-2194 .- 2168-2208. ; 24:1, s. 111-118
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Tidskriftsartikel (refereegranskat)abstract
- Parkinson's disease (PD) is a degenerative, progressive disorder of the central nervous system that mainly affects motor control. The aim of this study was to develop data-driven methods and test their clinimetric properties to detect and quantify PD motor states using motion sensor data from leg agility tests. Nineteen PD patients were recruited in a levodopa single dose challenge study. PD patients performed leg agility tasks while wearing motion sensors on their lower extremities. Clinical evaluation of video recordings was performed by three movement disorder specialists who used four items from the motor section of the Unified PD Rating Scale (UPDRS), the treatment response scale (TRS) and a dyskinesia score. Using the sensor data, spatiotemporal features were calculated and relevant features were selected by feature selection. Machine learning methods like support vector machines (SVM), decision trees and linear regression, using 10-fold cross validation were trained to predict motor states of the patients. SVM showed the best convergence validity with correlation coefficients of 0.81 to TRS, 0.83 to UPDRS #31 (body bradykinesia and hypokinesia), 0.78 to SUMUPDRS (the sum of the UPDRS items: #26-leg agility, #27-arising from chair and #29-gait), and 0.67 to dyskinesia. Additionally, the SVM-based scores had similar test-retest reliability in relation to clinical ratings. The SVM-based scores were less responsive to treatment effects than the clinical scores, particularly with regards to dyskinesia. In conclusion, the results from this study indicate that using motion sensors during leg agility tests may lead to valid and reliable objective measures of PD motor symptoms.
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11. |
- Aghanavesi, Somayeh, 1981-, et al.
(författare)
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Objective assessment of Parkinson’s disease motor symptoms during leg agility test using motion sensors
- 2018
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Konferensbidrag (refereegranskat)abstract
- Title: Objective assessment of Parkinson’s disease motor symptoms during leg agility test using motion sensorsObjective: To develop and evaluate machine learning methods for assessment of Parkinson’s disease (PD) motor symptoms using leg agility (LA) data collected with motion sensors during a single dose experiment.Background: Nineteen advanced PD patients (Gender: 14 males and 5 females, mean age: 71.4, mean years with PD: 9.7, mean years with levodopa: 9.5) were recruited in a single center, open label, single dose clinical trial in Sweden [1].Methods: The patients performed up to 15 LA tasks while wearing motions sensors on their foot ankle. They performed tests at pre-defined time points starting from baseline, at the time they received a morning dose (150% of their levodopa equivalent morning dose), and at follow-up time points until the medication wore off. The patients were video recorded while performing the motor tasks. and three movement disorder experts rated the observed motor symptoms using 4 items from the Unified PD Rating Scale (UPDRS) motor section including UPDRS #26 (leg agility), UPDRS #27 (Arising from chair), UPDRS #29 (Gait), UPDRS #31 (Body Bradykinesia and Hypokinesia), and dyskinesia scale. In addition, they rated the overall mobility of the patients using Treatment Response Scale (TRS), ranging from -3 (very off) to 3 (very dyskinetic). Sensors data were processed and their quantitative measures were used to develop machine learning methods, which mapped them to the mean ratings of the three raters. The quality of measurements of the machine learning methods was assessed by convergence validity, test-retest reliability and sensitivity to treatment.Results: Results from the 10-fold cross validation showed good convergent validity of the machine learning methods (Support Vector Machines, SVM) with correlation coefficients of 0.81 for TRS, 0.78 for UPDRS #26, 0.69 for UPDRS #27, 0.78 for UPDRS #29, 0.83 for UPDRS #31, and 0.67 for dyskinesia scale (P<0.001). There were good correlations between scores produced by the methods during the first (baseline) and second tests with coefficients ranging from 0.58 to 0.96, indicating good test-retest reliability. The machine learning methods had lower sensitivity than mean clinical ratings (Figure. 1).Conclusions: The presented methodology was able to assess motor symptoms in PD well, comparable to movement disorder experts. The leg agility test did not reflect treatment related changes.
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12. |
- Aghanavesi, Somayeh, 1981-, et al.
(författare)
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Verification of a Method for Measuring Parkinson's Disease Related Temporal Irregularity in Spiral Drawings
- 2017
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Ingår i: Sensors. - Basel : MDPI AG. - 1424-8220. ; 17:10
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Tidskriftsartikel (refereegranskat)abstract
- -value = 0.02). Test-retest reliability of TIS was good with Intra-class Correlation Coefficient of 0.81. When assessing changes in relation to treatment, TIS contained some information to capture changes from Off to On and wearing off effects. However, the correlations between TIS and clinical scores (UPDRS and Dyskinesia) were weak. TIS was able to differentiate spiral drawings drawn by patients in an advanced stage from those drawn by healthy subjects, and TIS had good test-retest reliability. TIS was somewhat responsive to single-dose levodopa treatment. Since TIS is an upper limb high-frequency-based measure, it cannot be detected during clinical assessment.
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13. |
- Forsman, Anders, et al.
(författare)
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Hur kan man flippa klassrum – några exempel på "blended learning" från olika kurser på campus och distans
- 2015
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Syftet var att beskriva och jämföra hur vi arbetar med blended learning/flipped classroom (FC) i fyra olika kurser (campus och/eller distans) vid Högskolan Dalarna, där målet var att få syn på den egna praktiken, dela erfarenheter och inspirera varandra. Inventering av och diskussioner om hur vi arbetar med blended learning/FC och varför. De tre kurserna Forskningsmetodikkurs i informatik (campus), kurs i informatik om webbsidor (campus) och Datateknikkurs i programmering (distans) ges i princip enligt "klassiskt" FC, dvs. med inspelad föreläsning följt av diskussion vid efterföljande seminarium/motsvarande (med viss variation). I den fjärde kursen, naturvetenskap i lärarutbildningen (campus/distans), blandas inspelade och streamade föreläsningar, och laborationer och seminarier genomförs både på campus och distans (gäller både campus- och distanskurser). Vi arbetar både på liknande sätt men även olika beroende av "ämneskultur", ämnenas olika karaktär och olika kursers karaktär, men vi har ungefär samma mål: att försöka få bättre förberedda och mer aktiva studenter, dvs. försöka att gynna djupinlärning. Men möjligheterna till mer genomgripande förändringar i arbetssätt beror också av hur "öppen" ämneskulturen är för detta. En gemensam slutsats är att det är viktigt att fundera över hur man kan använda tekniken i pedagogikens tjänst för att möjliggöra/iscensätta FC. Vi upplever allihop att FC är en möjlighet att göra något på ett nytt och förhoppningsvis bättre sätt. Vi är också överens om betydelsen av att få igång studenterna och att få dem att samarbeta - kruxet är hur man kan åstadkomma detta. Nya arbetssätt ska inte medföra att studenterna sitter och tittar på när vi arbetar, om än vi gör det på ett annat sätt än vid t.ex. traditionella föreläsningar, för då är vi tillbaka i den "envägskommunikation" man vill komma bort från FC. Vi har också fått upp ögonen för att olika ämnen/kurser har olika förutsättningar/utmaningar vilket lett till att vi använder delvis olika strategier och metoder. En skillnad gentemot litteraturens beskrivningar av FC är att vi alla även använder detta i våra distanskurser, vilket ger ytterligare en dimension vad gäller utmaningar, både pedagogiskt och tekniskt, jämfört med att "flippa" på campus. Det har varit inspirerande och utvecklande att ventilera hur vi resonerar om och genomför våra olika versioner av FC, och samtalen har även medfört att vi haft möjlighet att reflektera över den egna praktiken och att spegla den i de andras praktiker, vilket både inspirerat och gett praktiska tips.
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14. |
- Javed, Farrukh, 1984-, et al.
(författare)
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A comparison of feature selection methods when using motion sensors data : a case study in Parkinson’s disease
- 2018
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Ingår i: 2018 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC). - : IEEE. - 9781538636466 ; , s. 5426-5429
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Konferensbidrag (refereegranskat)abstract
- The objective of this study is to investigate the effects of feature selection methods on the performance of machine learning methods for quantifying motor symptoms of Parkinson’s disease (PD) patients. Different feature selection methods including step-wise regression, Lasso regression and Principal Component Analysis (PCA) were applied on 88 spatiotemporal features that were extracted from motion sensors during hand rotation tests. The selected features were then used in support vector machines (SVM), decision trees (DT), linear regression, and random forests models to calculate a so-called treatment-response index (TRIS). The validity, testretest reliability and sensitivity to treatment were assessed for each combination (feature selection method plus machine learning method). There were improvements in correlation coefficients and root mean squared error (RMSE) for all the machine learning methods, except DTs, when using the selected features from step-wise regression inputs. Using step-wise regression and SVM was found to have better sensitivity to treatment and higher correlation to clinical ratings on the Unified PD Rating Scale as compared to the combination of PCA and SVM. When assessing the ability of the machine learning methods to discriminate between tests performed by PD patients and healthy controls the results were mixed. These results suggest that the choice of feature selection methods is crucial when working with data-driven modelling. Based on our findings the step-wise regression can be considered as the method with the best performance.
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15. |
- Johansson, Dongni, 1988, et al.
(författare)
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Evaluation of a sensor algorithm for motor state rating in Parkinson's disease
- 2019
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Ingår i: Parkinsonism & Related Disorders. - : Elsevier BV. - 1353-8020 .- 1873-5126. ; 64:July, s. 112-117
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: A treatment response objective index (TRIS) was previously developed based on sensor data from pronation-supination tests. This study aimed to examine the performance of TRIS for medication effects in a new population sample with Parkinson's disease (PD) and its usefulness for constructing individual dose-response models. Methods: Twenty-five patients with PD performed a series of tasks throughout a levodopa challenge while wearing sensors. TRIS was used to determine motor changes in pronation-supination tests following a single levodopa dose, and was compared to clinical ratings including the Treatment Response Scale (TRS) and six sub-items of the UPDRS part III. Results: As expected, correlations between TRIS and clinical ratings were lower in the new population than in the initial study. TRIS was still significantly correlated to TRS (r(s) = 0.23, P < 0.001) with a root mean square error (RMSE) of 1.33. For the patients (n = 17) with a good levodopa response and clear motor fluctuations, a stronger correlation was found (r(s) = 0.38, RMSE = 1.29, P < 0.001). The mean TRIS increased significantly when patients went from the practically defined off to their best on state (P = 0.024). Individual dose-response models could be fitted for more participants when TRIS was used for modelling than when TRS ratings were used. Conclusion: The objective sensor index shows promise for constructing individual dose-response models, but further evaluations and retraining of the TRIS algorithm are desirable to improve its performance and to ensure its clinical effectiveness.
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16. |
- Karni, Liran, 1979-, et al.
(författare)
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EMPARK : Internet of Things for Empowerment and Improved Treatment of Patients with Parkinson's Disease
- 2018
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Konferensbidrag (populärvet., debatt m.m.)abstract
- Objective: This study aims to assess the effects of patient-directed feedback from remote symptom, medication, and disease activity monitoring on patient empowerment and treatment in Parkinson’s disease (PD).Background: There is a need to empower patients with PD to be able to understand better and control their disease using prescribed medication and following recommendations on lifestyle. The research project EMPARK will develop an Internet of Things system of sensors, mobile devices to deliver real-time, 24/7 patient symptom information with the primary goal to support PD patients empowerment and better understanding of their disease. The system will be deployed in patient homes to continuously measure movements, time-in-bed and drug delivery from a micro-dose levodopa system. Subjective symptom scoring, time of meals and physical activities will be reported by the patients via a smartphone application. Interfaces for patients and clinicians are being developed based on the user center design methodology to ensure maximal user acceptance. Methods: This is a randomized controlled trial where 30 PD patients from 2 university clinics in Sweden will be randomized to receive (intervention group) or not (control group) continuous feedback from the results of the EMPARK home monitoring for 2 weeks. Disease-specific (UPDRS, PDQ-39), Quality of Life (QoL) (modified EuroQoL EQ-5D) and empowerment questionnaires will be collected prior and after the intervention. The correlation of technology-based objective and patient-reported subjective parameters will be assessed in both groups. Interviews will be conducted with the clinicians and observations will be made about the patient-clinician interaction to assess the potential treatment benefits of the intervention.Results: Preliminary results from workshops with patients and clinicians show potential to improve patient empowerment and disease control among patients. Completion of the trial will show the degree of patient empowerment, individualized treatment, and patientclinician interactions.Conclusions: Raising patients’ awareness about disease activity and home medication is possible among PD patients by providing them with feedback from the results of a home monitoring system. This randomized, controlled trial aims to provide evidence that this approach leads to improved patient empowerment and treatment results.
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17. |
- Karni, Liran, 1979-
(författare)
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Health Information Technology for Empowering Elderly Patients with Chronic Diseases
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patient empowerment (PE) is at the centre of the ongoing paradigm shift toward patient-centred healthcare. Novel health information technology (HIT) interventions frequently aim to improve PE and trigger changes in the healthcare. However, little is known about the actual efficacy of HIT to induce PE. The objective of this thesis is to study how HIT can improve PE. The thesis describes empirical research in C3-Cloud, an EU project developing broad HIT-based solutions for PE in multi-morbidity care; and in EMPARK, a homebased HIT monitoring system for PE in Parkinson disease. Theoretical research covers the systematic evaluation of shortcomings hindering HITs to induce PE, and the development of ICT4PEM, a framework for HIT development targeting PE. Empirical research was based on user-centric design for ICT artefact development and evaluation. Design science research was guiding the ICT4PEM development, including utility demonstration by applying it for the project-wide evaluation of the C3-Cloud and EMPARK regarding their design, interventions, evaluation and expected effects on PE. The thesis demonstrates empirical examples on how HIT contributes to PE by enabling multidisciplinary, patient-centric individual care plan elaboration, patient monitoring, patient-targeted and clinician feedback, and clinical decision support (CDS), including a clinical guideline based intelligent CDS for multi-morbidity. ICT4PEM is the first framework, which provides a patient-centric, HIT-friendly conceptual foundation for PE, and assists HIT development on targeting PE. The ICT4PEM-based evaluation revealed strength and weaknesses of C3-Cloud and EMPARK related to their design, interventions, evaluation and expected long-term effects. It also demonstrated a utility of ICT4PEM for retrospective HIT project evaluation. In summary, the thesis provides strong evidence and reveals shortcomings about HIT efficacy to promote PE. The novel ICT4PEM framework address and resolve these shortcomings with the capacity to guide future HIT developments which aim to empower patients.
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18. |
- Karni, Liran, 1979-, et al.
(författare)
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Information and Communications Technology-Based Interventions Targeting Patient Empowerment : Framework Development
- 2020
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 22:8
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Empowerment of patients is often an explicit goal of various information and communications technology (ICT) (electronic, digital) interventions where the patients themselves use ICT tools via the internet. Although several models of empowerment exist, a comprehensive and pragmatic framework is lacking for the development of such interventions.OBJECTIVE: This study proposes a framework for digital interventions aiming to empower patients that includes a methodology that links objectives, strategies, and evaluation.METHODS: This study is based on a literature review and iterated expert discussions including a focus group to formulate the proposed model. Our model is based on a review of various models of empowerment and models of technology intervention.RESULTS: Our framework includes the core characteristics of the empowerment concept (control, psychological coping, self-efficacy, understanding, legitimacy, and support) as well as a set of empowerment consequences: expressed patient perceptions, behavior, clinical outcomes, and health systems effects. The framework for designing interventions includes strategies to achieve empowerment goals using different ICT services. Finally, the intervention model can be used to define project evaluations where the aim is to demonstrate empowerment. The study also included example indicators and associated measurement instruments.CONCLUSIONS: This framework, which includes definitions, can be useful for the design and evaluation of digital interventions targeting patient empowerment and assist in the development of methods to measure results in this dimension. Further evaluation in the form of interventional studies will be needed to assess the generalizability of the model.
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19. |
- Karni, Liran, 1979-, et al.
(författare)
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Targeting Patient Empowerment via ICT interventions : An ICT-specific Analytical Framework
- 2019
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Ingår i: AMCIS 2019 Proceedings. - Cancun, Mexico : Association for Information Systems.
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Konferensbidrag (refereegranskat)abstract
- Empowerment of patients is today often an explicit goal of various ICT interventions where the patients themselves use ICT tools, often via the internet. This study is proposing a framework model for ICT interventions aiming to empower patients. Our new model includes different aspects of the Empowerment concept, general possible strategies to achieve Empowerment using different ICT services. Finally, the ICT services and the underlying strategic model can be used to define evaluations of such interventions where the aim is to demonstrate Empowerment. Our model is based on a review of various general models of Empowerment and the Behavioral Intervention Technology Model (BIT). The implications of our model are discussed using two case studies projects, the C3-Cloud EU project about empowering patients with 4 chronic diseases and the EMPARK project about Internet-of-Things sensors based real time feedback to Parkinson patients.
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20. |
- Khan, Taha, et al.
(författare)
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A case study in healthcare informatics : a telemedicine framework for automated parkinson’s disease symptom assessment
- 2014
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Ingår i: Smart Health. - Cham : Springer. - 9783319084169 - 9783319084152 ; , s. 197-199
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Konferensbidrag (refereegranskat)abstract
- This paper reports the development and evaluation of a mobile-based telemedicine framework for enabling remote monitoring of Parkinson’s disease (PD) symptoms. The system consists of different measurement devices for remote collection, processing and presentation of symptom data of advanced PD patients. Different numerical analysis techniques were applied on the raw symptom data to extract clinically symptom information which in turn were then used in a machine learning process to be mapped to the standard clinician-based measures. The methods for quantitative and automatic assessment of symptoms were then evaluated for their clinimetric properties such as validity, reliability and sensitivity to change. Results from several studies indicate that the methods had good metrics suggesting that they are appropriate to quantitatively and objectively assess the severity of motor impairments of PD patients.
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21. |
- Kolkowska, Ella, 1972-, et al.
(författare)
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A user-centered ethical assessment of welfare technology for elderly
- 2018
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Ingår i: Lect. Notes Comput. Sci.. - Cham : Springer International Publishing. - 9783319920368 - 9783319920375 ; , s. 59-73
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Konferensbidrag (refereegranskat)abstract
- Welfare technology (WT) is often developed with a technical perspective, and little consideration is taken regarding the involvement of important ethical considerations and different values that come up during the development and implementation of WT. Safety, security and privacy are significant, as well as the usability and overall benefit of the tool, but to date assessments often lack a holistic picture of the WT as seen by the users. This paper suggests a user-centered ethical assessment (UCEA) framework for WT to be able to evaluate ethical consequences as a part of the user-centered aspects. Building on established methodologies from research on ethical considerations, as well as the research domain of human-computer interaction, this assessment framework joins knowledge of ethical consequences with aspects affecting the “digitalization with the individual in the center”, e.g. privacy, safety, well-being, dignity, empowerment and usability. The framework was applied during development of an interface for providing symptom information to Parkinson patients. The results showed that the UCEA framework directs the attention to values emphasized by the patients. Thus, functionality of the system was evaluated in the light of values and expected results of the patients, thereby facilitating follow-up of a user-centered assessment. The framework may be further developed and tested, but in this study it served as a working tool for assessing ethical consequences of WT as a part of user-centered aspects.
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22. |
- Matić, Teodora, et al.
(författare)
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Unsupervised Learning from Motion Sensor Data to Assess the Condition of Patients with Parkinson’s Disease
- 2019
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Ingår i: AIME 2019. - Cham : Springer. - 9783030216429 - 9783030216412 ; , s. 420-424
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Konferensbidrag (refereegranskat)abstract
- Parkinson’s disease (PD) is a chronic neurodegenerative disorder that predominantly affects the patient’s motor system, resulting in muscle rigidity, bradykinesia, tremor, and postural instability. As the disease slowly progresses, the symptoms worsen, and regular monitoring is required to adjust the treatment accordingly. The objective evaluation of the patient’s condition is sometimes rather difficult and automated systems based on various sensors could be helpful to the physicians. The data in this paper come from a clinical study of 19 advanced PD patients with motor fluctuations. The measurements used come from the motion sensors the patients wore during the study. The paper presents an unsupervised learning approach applied on this data with the aim of checking whether sensor data alone can indicate the patient’s motor state. The rationale for the unsupervised approach is that there was significant inter-physician disagreement on the patient’s condition (target value for supervised machine learning). The input to clustering came from sensor data alone. The resulting clusters were matched against the physicians’ estimates showing relatively good agreement.
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23. |
- Memedi, Mevludin, 1983-, et al.
(författare)
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A method for measuring Parkinson's disease related temporal irregularity in spiral drawings
- 2016
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Ingår i: 2016 IEEE International Conference on Biomedical and Health Informatics. - New York : Institute of Electrical and Electronics Engineers (IEEE). - 9781509024551 ; , s. 410-413
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Konferensbidrag (refereegranskat)abstract
- The objective of this paper was to develop and evaluate clinimetric properties of a method for measuring Parkinson's disease (PD)-related temporal irregularities using digital spiral analysis. In total, 108 (98 patients in different stages of PD and 10 healthy elderly subjects) performed repeated spiral drawing tasks in their home environments using a touch screen device. A score was developed for representing the amount of temporal irregularity during spiral drawing tasks, using Approximate Entropy (ApEn) technique. In addition, two previously published spiral scoring methods were adapted and their scores were analyzed. The mean temporal irregularity score differed significantly between healthy elderly subjects and advanced PD patients (P<0.005). The ApEn-based method had a better responsiveness and test-retest reliability when compared to the other two methods. In contrast to the other methods, the mean scores of the ApEn-based method improved significantly during a 3 year clinical study, indicating a possible impact of pathological basal ganglia oscillations in temporal control during spiral drawing tasks. In conclusion, the ApEn-based method could be used for differentiating between patients in different stages of PD and healthy subjects. The responsiveness and test-retest reliability were good for the ApEn-based method indicating that this method is useful for measuring upper limb temporal irregularity at a micro-level.
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24. |
- Memedi, Mevludin, 1983-
(författare)
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A mobile-based system can assess Parkinson's disease symptoms from home environments of patients
- 2014
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Ingår i: Neurologi i Sverige. - : Pharma Industry Publishing. - 2000-8538. ; :3, s. 24-28
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Treatment of Parkinson's disease (PD) patients involves major challenges like the large within- and between-patient variability in symptom profiles and the emergence of motor complications. As PD progresses, the symptoms develop slowly and they represent a significant source of disability in advanced patients. During evaluation of treatments and symptoms, both the physician- and patient-oriented outcomes offer complementary information. In addition, quantitative assessments of symptoms using sensing technologies can potentially complement and enhance both patient and clinician perspectives. At Högskolan Dalarna, the Lecturer Mevludin Memedi has developed a telemetry system that assesses symptoms via analysis of self-assessments and motor tests to objectively measure disease-related outcomes and to improve the management of PD.
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25. |
- Memedi, Mevludin, PhD, 1983-, et al.
(författare)
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A multimodal sensor fusion platform for objective assessment of motor states in Parkinson's disease
- 2019
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Ingår i: IEEE-EMBS INTERNATIONAL CONFERENCE ON BIOMEDICAL AND HEALTH INFORMATICS (BHI 19).
-
Konferensbidrag (refereegranskat)abstract
- This study proposes a platform to objectively assess motor states in Parkinson’s disease (PD) using sensor technology and machine learning. The platform uses sensor information gathered during standardized motor tasks and fuses them in a data-driven manner to produce an index representing motor states of the patients. After investigating clinimetric properties of the platform it was found that the platform had good validity and responsiveness to treatment, which are essential for developing systems to individualize treatments.
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26. |
- Memedi, Mevludin, PhD, 1983-, et al.
(författare)
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A partial least-squares regression model to measure Parkinson’s disease motor states using smartphone data
- 2020
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Ingår i: Proceedings of the 53rd Hawaii International Conference on System Sciences | 2020. - Maui, Hawaii : HCSS. ; , s. 1056-1062
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Konferensbidrag (refereegranskat)abstract
- Design choices related to development of data- driven models significantly impact or degrade predictive performance of the models. One of the essential steps during development and evaluation of such models is the choice of feature selection and dimension reduction techniques. That is imperative especially in cases dealing with multimodal data gathered from different sources. In this paper, we will investigate the behavior of Partial Least Squares (PLS) regression for dimension reduction and prediction of motor states of Parkinson’s disease (PD) patients, using upper limb motor data gathered by means of a smartphone. The results in terms of correlations between smartphone-based and clinician-derived scores were compared to a previous study using the same data where principal component analysis (PCA) and support vector machines (SVM) were used. The findings from this study show that PLS is superior in terms of prediction performance of motor states in PD than combining PCA and SVM. This indicates that PLS could be considered as a useful methodology in problems where data-driven analysis is needed.
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27. |
- Memedi, Mevludin, PhD, 1983-, et al.
(författare)
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A study on pre-adoption of a self-management application by Parkinson’s disease patients
- 2018
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Konferensbidrag (refereegranskat)abstract
- The aim of this paper is to provide an overview of factors influencing the acceptance by Parkinson's disease (PD) patients of a self-management application for an Internet of Things system. Unified Theory of Acceptance and Use of Technology (UTAUT) factors including performance expectancy, effort expectancy, and social influence were tested along with sociodemographic (age and gender) and technology-associated (experience with modern technology) factors to determine their contributions for predicting behavioral intention to use the application. Fifty respondents completed the survey. The results show that the UTAUT-based factors, sociodemographic and technology-associated factors account for 82.9% of the variability in PD patients' behavioralintention to use the application. We found that women were significantly more positive than men (p<0.001) in their intention to use the application. If offered the application in the future, 70% of the respondents would use it. Respondents with lower level of experience with technology had less intention to use the application. Performance expectancy and social influence were the only factors that positively predicted intention to use the application. The results showed high scores related to intention to use the application, suggesting high acceptance of the application by the PD patients. Based on qualitative results, the application was seen by PD patients as a useful tool for providing them a better overview of their health status. Finally, the acceptance of the application can be increased by showing its benefits to the PD patients and by developing social strategies to encourage them to stimulate each other to use the application.
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28. |
- Memedi, Mevludin, 1983-, et al.
(författare)
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A web application for follow-up of results from a mobile device test battery for Parkinson’s disease patients
- 2011
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Ingår i: Computer Methods and Programs in Biomedicine. - Amsterdam : Elsevier BV. - 0169-2607 .- 1872-7565. ; 104:2, s. 219-226
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Tidskriftsartikel (refereegranskat)abstract
- A test battery consisting of self-assessments and motor tests for patients with Parkinson’s disease (PD) was constructed and implemented on a hand computer with touch screen in a telemedicine setting. In this work, a Web-based system was developed to deliver decision support information to treating clinical staff for assessing PD symptoms in their patients. Test results from the hand unit are transferred to a central server and processed into scores for different symptom dimensions and an “overall test score” reflecting the overall condition of the patient during a test period. The IBM Computer System Usability Questionnaire was administered to assess the users’ satisfaction with the system. Results showed that a majority of users who completed the evaluation were quite satisfied with the usability although a sizeable minority were not. Response times were tested by simulating up to 100 users accessing the web application at the same time. The average page completion times were in the range of 0.5 seconds indicating fast response. The system was able to summarize the test-battery data and present them in a useful manner. Its main contribution is a novel way to easily access symptom information from the home environment of patients.
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29. |
- Memedi, Mevludin, 1983-, et al.
(författare)
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A web-based system for visualizing upper limb motor performance of Parkinson's disease patients
- 2013
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To design, develop and set up a web-based system for enabling graphical visualization of upper limb motor performance (ULMP) of Parkinson’s disease (PD) patients to clinicians.Background: Sixty-five patients diagnosed with advanced PD have used a wireless handheld computer, consisting of upper limb motor tests (finger to tapping and spiral drawings), in their home environments over the course of a 3 year clinical study. For the tapping tests, they were asked to perform alternate tapping of two buttons as fast and accurate as possible, first using the right hand and then the left hand. The spiral test included tracing a pre-drawn Archimedes spiral using the dominant hand and the test was repeated three times per test occasion.Methods: The system employs advanced graphics such as animations and time-series plots to visualize the ULMP of PD patients to three trained neurologists. Performance during spiral tests is shown by animating the three spiral drawings, allowing the neurologists to observe real-time accelerations (or hesitations) during the actual drawing. Tapping performance is visualized by displaying graphs like distribution of taps over the two buttons, deviation of taps on horizontal axis, deviation of taps on vertical axis, and tapping reaction time.Results: Different scales are utilized by neurologists to rate the observed impairments. For the spiral drawing performance, neurologists rate firstly the impairment using a 0 (no impairment) – 10 (extremely severe) scale and secondly the probable cause for the said impairment using 3 choices including Tremor, Bradykinesia/Rigidity and Dyskinesia. For the tapping performance, a 0 (normal) – 4 (severe) scale is used for rating Speed, Accuracy, Fatigue, Arrhythmia and Global Tapping Severity. The system is currently in use and results (intra- and inter-neurologist agreements) will be available for the poster presentation.Conclusions: In contrast from current approaches used in clinical settings for the assessment of PD symptoms, this system enables clinicians to animate easily and realistically the ULMP of PD patients who at the same time are at their homes.
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30. |
- Memedi, Mevludin, 1983-, et al.
(författare)
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Automatic Spiral Analysis for Objective Assessment of Motor Symptoms in Parkinson's Disease
- 2015
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Ingår i: Sensors. - : MDPI AG. - 1424-8220. ; 15:9, s. 23727-23744
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Tidskriftsartikel (refereegranskat)abstract
- A challenge for the clinical management of advanced Parkinson's disease (PD) patients is the emergence of fluctuations in motor performance, which represents a significant source of disability during activities of daily living of the patients. There is a lack of objective measurement of treatment effects for in-clinic and at-home use that can provide an overview of the treatment response. The objective of this paper was to develop a method for objective quantification of advanced PD motor symptoms related to off episodes and peak dose dyskinesia, using spiral data gathered by a touch screen telemetry device. More specifically, the aim was to objectively characterize motor symptoms (bradykinesia and dyskinesia), to help in automating the process of visual interpretation of movement anomalies in spirals as rated by movement disorder specialists. Digitized upper limb movement data of 65 advanced PD patients and 10 healthy (HE) subjects were recorded as they performed spiral drawing tasks on a touch screen device in their home environment settings. Several spatiotemporal features were extracted from the time series and used as inputs to machine learning methods. The methods were validated against ratings on animated spirals scored by four movement disorder specialists who visually assessed a set of kinematic features and the motor symptom. The ability of the method to discriminate between PD patients and HE subjects and the test-retest reliability of the computed scores were also evaluated. Computed scores correlated well with mean visual ratings of individual kinematic features. The best performing classifier (Multilayer Perceptron) classified the motor symptom (bradykinesia or dyskinesia) with an accuracy of 84% and area under the receiver operating characteristics curve of 0.86 in relation to visual classifications of the raters. In addition, the method provided high discriminating power when distinguishing between PD patients and HE subjects as well as had good test-retest reliability. This study demonstrated the potential of using digital spiral analysis for objective quantification of PD-specific and/or treatment-induced motor symptoms.
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31. |
- Memedi, Mevludin, 1983-, et al.
(författare)
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Automatic spiral analysis for objective assessment of motor symptoms in Parkinson's disease
- 2015
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To develop a method for objective quantification of PD motor symptoms related to Off episodes and peak dose dyskinesias, using spiral data gathered by using a touch screen telemetry device. The aim was to objectively characterize predominant motor phenotypes (bradykinesia and dyskinesia), to help in automating the process of visual interpretation of movement anomalies in spirals as rated by movement disorder specialists.Background: A retrospective analysis was conducted on recordings from 65 patients with advanced idiopathic PD from nine different clinics in Sweden, recruited from January 2006 until August 2010. In addition to the patient group, 10 healthy elderly subjects were recruited. Upper limb movement data were collected using a touch screen telemetry device from home environments of the subjects. Measurements with the device were performed four times per day during week-long test periods. On each test occasion, the subjects were asked to trace pre-drawn Archimedean spirals, using the dominant hand. The pre-drawn spiral was shown on the screen of the device. The spiral test was repeated three times per test occasion and they were instructed to complete it within 10 seconds. The device had a sampling rate of 10Hz and measured both position and time-stamps (in milliseconds) of the pen tip.Methods: Four independent raters (FB, DH, AJ and DN) used a web interface that animated the spiral drawings and allowed them to observe different kinematic features during the drawing process and to rate task performance. Initially, a number of kinematic features were assessed including ‘impairment’, ‘speed’, ‘irregularity’ and ‘hesitation’ followed by marking the predominant motor phenotype on a 3-category scale: tremor, bradykinesia and/or choreatic dyskinesia. There were only 2 test occasions for which all the four raters either classified them as tremor or could not identify the motor phenotype. Therefore, the two main motor phenotype categories were bradykinesia and dyskinesia. ‘Impairment’ was rated on a scale from 0 (no impairment) to 10 (extremely severe) whereas ‘speed’, ‘irregularity’ and ‘hesitation’ were rated on a scale from 0 (normal) to 4 (extremely severe). The proposed data-driven method consisted of the following steps. Initially, 28 spatiotemporal features were extracted from the time series signals before being presented to a Multilayer Perceptron (MLP) classifier. The features were based on different kinematic quantities of spirals including radius, angle, speed and velocity with the aim of measuring the severity of involuntary symptoms and discriminate between PD-specific (bradykinesia) and/or treatment-induced symptoms (dyskinesia). A Principal Component Analysis was applied on the features to reduce their dimensions where 4 relevant principal components (PCs) were retained and used as inputs to the MLP classifier. Finally, the MLP classifier mapped these components to the corresponding visually assessed motor phenotype scores for automating the process of scoring the bradykinesia and dyskinesia in PD patients whilst they draw spirals using the touch screen device. For motor phenotype (bradykinesia vs. dyskinesia) classification, the stratified 10-fold cross validation technique was employed.Results: There were good agreements between the four raters when rating the individual kinematic features with intra-class correlation coefficient (ICC) of 0.88 for ‘impairment’, 0.74 for ‘speed’, 0.70 for ‘irregularity’, and moderate agreements when rating ‘hesitation’ with an ICC of 0.49. When assessing the two main motor phenotype categories (bradykinesia or dyskinesia) in animated spirals the agreements between the four raters ranged from fair to moderate. There were good correlations between mean ratings of the four raters on individual kinematic features and computed scores. The MLP classifier classified the motor phenotype that is bradykinesia or dyskinesia with an accuracy of 85% in relation to visual classifications of the four movement disorder specialists. The test-retest reliability of the four PCs across the three spiral test trials was good with Cronbach’s Alpha coefficients of 0.80, 0.82, 0.54 and 0.49, respectively. These results indicate that the computed scores are stable and consistent over time. Significant differences were found between the two groups (patients and healthy elderly subjects) in all the PCs, except for the PC3.Conclusions: The proposed method automatically assessed the severity of unwanted symptoms and could reasonably well discriminate between PD-specific and/or treatment-induced motor symptoms, in relation to visual assessments of movement disorder specialists. The objective assessments could provide a time-effect summary score that could be useful for improving decision-making during symptom evaluation of individualized treatment when the goal is to maximize functional On time for patients while minimizing their Off episodes and troublesome dyskinesias.
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32. |
- Memedi, Mevludin, 1983-, et al.
(författare)
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Combined fine-motor tests and self-assessments for remote detection of motor fluctuations
- 2013
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Ingår i: Recent Patents on Biomedical Engineering. - : Bentham Science Publishers. - 1874-7647. ; 6:2, s. 127-135
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Tidskriftsartikel (refereegranskat)abstract
- A major problem with the clinical management of fluctuating movement disorders, e.g. Parkinson’s disease (PD), is the large variability in manifestation of symptoms among patients. In this condition, frequent measurements which account for both patient-reported and objective assessments are needed in order to capture symptom fluctuations, with the purpose to optimize therapy. The main focus of this paper is to present a mobile-based system for enabling remote monitoring of PD patients from their home environment conditions. The system consists of a patient diary section for collecting patient-based self-assessments, a motor test section for collecting fine motor movements through upper limb motor tests, and a scheduler for restricting operation to a multitude of predetermined limited time intervals. The system processes and compiles time series data into different summary scores representing symptom severity. In addition, the paper presents a review of recent inventions which were filed after year 2000 in the field of telemedicine applications. The review includes a summary of systems and methods which enable remote symptom assessments of patients, not necessarily suffering from movement disorders, through repeated measurements and which take into account their subjective and/or objective health indicators. The findings conclude that there are a small number of inventions which collect subjective and objective health measures in telemedicine settings. Consequently, there is a lack of mechanisms that combine these two types of information into scores to provide a more in-depth assessment of the patient’s general health, their motor and non-motor symptom fluctuations and treatment effects. The paper also provides a discussion concerning different approaches for analyzing and combining subjective and objective measures, and handling data from longitudinal studies.
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33. |
- Memedi, Mevludin, 1983-, et al.
(författare)
-
Computerized identification of motor complications in Parkinson's disease
- 2014
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Ingår i: Movement Disorders Supplement. - : Wiley-Blackwell. - 0885-3185. ; , s. S187-S188
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To investigate whether spirography-based objective measures of motor dysfunctions are able to discriminate between Parkinson’s disease (PD) patients with different motor states (Off and Dyskinesia) and healthy elderly (HE) subjects.Background: Sixty-five advanced PD patients and 10 HE subjects performed repeated assessments of spirography, using a touch screen telemetry device. On each test occasion, they were asked to trace a pre-drawn Archimedes spiral using dominant hand and repeating the test three times. The clinical assessment was only performed in the patient group by animating the three spirals in a web interface, allowing a clinician (DN) to observe accelerations and spa-tial changes during the drawing process. A scale ranging from 0 (normal) to 4 (extremely severe) was used for the assessment of kinematic properties of speed, irregularity and hesitation. Finally, the momentary motor state of the patient was marked using two classes: - 1 (Off) and 1 (Dyskinesia). The HE samples were assigned a 0 (On) class and used in subsequent analysis.Methods: After time series analysis, 13 quantitative measures were calculated for representing the severity of symptoms in each individual kinematic property. Principal Component Analysis was then used to reduce their dimensions by retaining the first 4 principal components (PC). To investigate differences in mean PC scores across the three classes a one-way ANOVA test followed by Tukey multiple comparisons was used. An ordinal logistic regression model, using 10-fold cross-validation, was used to map the 4 PC to the corresponding motor state classes.Results: The agreements between computer and clinician ratings were very good with a weighted area under the receiver operating characteristic curve (AUC) coefficient of 0.91 (Table 1). The mean PC scores were different across the three classes, only at different levels (Fig 1). The Spearman’s rank correlations between the first two PC and visually assessed kinematic properties were: speed (PC1, 0.34; PC2, 0.83), irregularity (PC1, 0.17; PC2, 0.17) and hesitation (PC1, 0.27; PC2, 0.77).Conclusions: These findings suggest that spirography-based objective measures are valid measures of spatial- and time-dependent deficits in PD. The differences among the three classes imply that these measures can be used to assess changes in the motor states in response to therapeutic interventions.
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34. |
- Memedi, Mevludin, 1983-, et al.
(författare)
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Construction of levodopa-response index from wearable sensors for quantifying Parkinson's disease motor functions
- 2016
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The goal of this study was to investigate the feasibility of wrist worn motion sensors to objectively measure motor functions in Parkinson’s disease (PD). More specifically, the aim was to construct a sensor-based levodopa-response index (SBLRI) and evaluate its clinimetric properties (convergent validity and internal consistency). Nineteen advanced PD patients and 22 healthy controls were recruited in a single center, open label, single dose clinical trial in Sweden. The subjects performed standardized motor tasks while wearing one sensor on each wrist and one on each ankle. Each sensor unit consisted of three-dimensional accelerometer and gyroscope. The patients were video recorded and the videos were blindly rated by three independent movement disorder specialists. The clinical scores were given using the Treatment Response Scale (TRS) on a scale from -3 = ‘Very Off’ to 0 = ‘On’ to +3 = ‘Very dyskinetic’. The clinical assessments were based on the overall motor function of the patients. A mean TRS was defined as the mean of the three specialists’ assessments per time point. The measurements were repeated over several time points following a single levodopa/carbidopa morning dose (50% over normal to induce dyskinesias). Sensor measurements during rapid alternating movements of hands were processed with time series analysis methods to calculate spatiotemporal parameters designed to measure bradykinesia and dyskinesia. For each hand, 96 spatiotemporal parameters were calculated and their average scores were then used in a principal component analysis to reduce the dimensionality by retaining 6 principal components. These components were then used as predictors to support vector machines and to be mapped to the mean TRS ratings of the three specialists and to calculate the SBLRI. For this analysis, a 10-fold stratified cross-validation was performed. The SBLRI was strongly correlated to mean TRS with a Pearson correlation coefficient of 0.79 (CI: 0.74-0.83, p<0.001). The 95% confidence interval for the mean squared error of SBLRI on patients data was ± 1.62 with a mean value of 0.57 whereas on healthy controls data was ± 1 with a mean value of 0.27. The sensor-based spatiotemporal parameters had good internal consistency with a Cronbach’s Alpha coefficient of 0.87 and significantly differed between patients and healthy controls. The results demonstrated that the SBLRI had good clinimetric properties for measuring motor functions (Off and dyskinesia) in PD patients. The method could also distinguish hand rotation movements exhibited by patients from those exhibited by healthy controls. The SBLRI provides effect-time profiles, which could be useful during therapy individualization of advanced PD patients.
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35. |
- Memedi, Mevludin, 1983-, et al.
(författare)
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Digital spiral analysis for objective assessment of fine motor timing variability in Parkinson's disease
- 2015
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- OBJECTIVES: To develop a method for objective assessment of fine motor timing variability in Parkinson’s disease (PD) patients, using digital spiral data gathered by a touch screen device.BACKGROUND: A retrospective analysis was conducted on data from 105 subjects including65 patients with advanced PD (group A), 15 intermediate patients experiencing motor fluctuations (group I), 15 early stage patients (group S), and 10 healthy elderly subjects (HE) were examined. The subjects were asked to perform repeated upper limb motor tasks by tracing a pre-drawn Archimedes spiral as shown on the screen of the device. The spiral tracing test was performed using an ergonomic pen stylus, using dominant hand. The test was repeated three times per test occasion and the subjects were instructed to complete it within 10 seconds. Digital spiral data including stylus position (x-ycoordinates) and timestamps (milliseconds) were collected and used in subsequent analysis. The total number of observations with the test battery were as follows: Swedish group (n=10079), Italian I group (n=822), Italian S group (n = 811), and HE (n=299).METHODS: The raw spiral data were processed with three data processing methods. To quantify motor timing variability during spiral drawing tasks Approximate Entropy (APEN) method was applied on digitized spiral data. APEN is designed to capture the amount of irregularity or complexity in time series. APEN requires determination of two parameters, namely, the window size and similarity measure. In our work and after experimentation, window size was set to 4 and similarity measure to 0.2 (20% of the standard deviation of the time series). The final score obtained by APEN was normalized by total drawing completion time and used in subsequent analysis. The score generated by this method is hence on denoted APEN. In addition, two more methods were applied on digital spiral data and their scores were used in subsequent analysis. The first method was based on Digital Wavelet Transform and Principal Component Analysis and generated a score representing spiral drawing impairment. The score generated by this method is hence on denoted WAV. The second method was based on standard deviation of frequency filtered drawing velocity. The score generated by this method is hence on denoted SDDV. Linear mixed-effects (LME) models were used to evaluate mean differences of the spiral scores of the three methods across the four subject groups. Test-retest reliability of the three scores was assessed after taking mean of the three possible correlations (Spearman’s rank coefficients) between the three test trials. Internal consistency of the methods was assessed by calculating correlations between their scores.RESULTS: When comparing mean spiral scores between the four subject groups, the APEN scores were different between HE subjects and three patient groups (P=0.626 for S group with 9.9% mean value difference, P=0.089 for I group with 30.2%, and P=0.0019 for A group with 44.1%). However, there were no significant differences in mean scores of the other two methods, except for the WAV between the HE and A groups (P<0.001). WAV and SDDV were highly and significantly correlated to each other with a coefficient of 0.69. However, APEN was not correlated to neither WAV nor SDDV with coefficients of 0.11 and 0.12, respectively. Test-retest reliability coefficients of the three scores were as follows: APEN (0.9), WAV(0.83) and SD-DV (0.55).CONCLUSIONS: The results show that the digital spiral analysis-based objective APEN measure is able to significantly differentiate the healthy subjects from patients at advanced level. In contrast to the other two methods (WAV and SDDV) that are designed to quantify dyskinesias (over-medications), this method can be useful for characterizing Off symptoms in PD. The APEN was not correlated to none of the other two methods indicating that it measures a different construct of upper limb motor function in PD patients than WAV and SDDV. The APEN also had a better test-retest reliability indicating that it is more stable and consistent over time than WAV and SDDV.
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36. |
- Memedi, Mevludin, 1983-, et al.
(författare)
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Finger tapping 'off' performance in Parkinson's disease is detected by digital signal processing
- 2012
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To process tapping test results collected by a test battery device using signal processing methods. To analyze the tapping performance of PD patients in relation to their self-assessed motor conditions.Background: A series of tests in a mobile device test battery, consisting of self-assessments and motor tests, were carried out repeatedly in a telemedicine setting. The test battery has been used by 65 patients with advanced PD in Sweden and 33 Italian patients; including 17 patients experiencing on-off fluctuations and 16 who were clinically stable. On test occasions, patients were asked to self-assess their momentary motor condition, just before starting 20-seconds-long tapping tests. There were three types of tapping tests: alternate tapping (AT), tapping with increasing speed (IS) and random chasing (RC).Methods: Three self-assessed motor states were used in the analysis: OFF (including slightly, moderately and very off), ON (on without dyskinesias) and DYS (slightly, moderately and very dyskinetic). Digital signal processing and multivariate analysis methods based on data from the 65 Swedish patients were employed to process and summarize tapping results into scores for tapping distance and time, where 0 is worst and 1 is best possible scores. The scoring methods were then applied on the Italian data set. Fifty random samples of single test occasions per patient were drawn and then used in subsequent analysis. One-way ANOVA test with Tukey comparisons test was used to test whether the mean tapping scores were different among the self-assessed motor states. Statistical significance was set at p<0.05.Results: In the stable group, the tapping distance scores were not different across the motor states for any test. The tapping time scores during AT were lower in OFF than in ON and DYS. During RC, the time scores were lower in OFF han in ON. In the fluctuating group, the tapping distance scores during AT were lower in OFF than in ON and DYS. The tapping time scores during RC were not different (p50.096) whereas during AT, time scores were higher in ON than in OFF and DYS.Conclusions: Tapping scores in patient-rated OFF states were detected as poor performance by the signal processing method. The AT test shows best performance in separating the motor conditions and tapping time is a more important variable than tapping distance.
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37. |
- Memedi, Mevludin, 1983-, et al.
(författare)
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Methods for detection of handwriting/drawing impairment using inputs from touch screens
- 2011
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Ingår i: Recent Patents on Signal Processing. - Bussum : Bentham Science Publishers. - 1877-6124 .- 2210-6863. ; 1:2, s. 156-162
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Tidskriftsartikel (refereegranskat)abstract
- Fine motor dysfunction in patients with movement disorders, such as Parkinson’s disease, is characterized by slowness of movements, decrease of reaction time and involuntary movements. In this article, recent patents on detecting and assessing the said dysfunction are reviewed; their implementation in telemedicine settings, design considerations and ability to assist in dose and time adjustments are discussed. These patents explain application of signal processing techniques in analysis and interpretation of digitized handwriting/drawing information of individuals based on data gathered using touch screens. The study reveals that measures concerning forces, accelerations and radial displacements are the most relevant measurements to detect fine movement anomalies. These findings demonstrate that digitized analysis of handwriting/drawing movements may be useful in clinical trials evaluating fine motor control. This review further depicts the role of employing event-based data acquisition and signal processing techniques suitable for nonstationary signals, such as Wavelet transform, in systems for patient home-monitoring.
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38. |
- Memedi, Mevludin, 1983-
(författare)
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Mobile systems for monitoring Parkinson's disease
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A challenge for the clinical management of Parkinson's disease (PD) is the large within- and between-patient variability in symptom profiles as well as the emergence of motor complications which represent a significant source of disability in patients. This thesis deals with the development and evaluation of methods and systems for supporting the management of PD by using repeated measures, consisting of subjective assessments of symptoms and objective assessments of motor function through fine motor tests (spirography and tapping), collected by means of a telemetry touch screen device.One aim of the thesis was to develop methods for objective quantification and analysis of the severity of motor impairments being represented in spiral drawings and tapping results. This was accomplished by first quantifying the digitized movement data with time series analysis and then using them in data-driven modelling for automating the process of assessment of symptom severity. The objective measures were then analysed with respect to subjective assessments of motor conditions. Another aim was to develop a method for providing comparable information content as clinical rating scales by combining subjective and objective measures into composite scores, using time series analysis and data driven methods. The scores represent six symptom dimensions and an overall test score for reflecting the global health condition of the patient. In addition, the thesis presents the development of a web-based system for providing a visual representation of symptoms over time allowing clinicians to remotely monitor the symptom profiles of their patients. The quality of the methods was assessed by reporting different metrics of validity, reliability and sensitivity to treatment interventions and natural PD progression over time.Results from two studies demonstrated that the methods developed for the fine motor tests had good metrics indicating that they are appropriate to quantitatively and objectively assess the severity of motor impairments of PD patients. The fine motor tests captured different symptoms; spiral drawing impairment and tapping accuracy related to dyskinesias (involuntary movements) whereas tapping speed related to bradykinesia (slowness of movements). A longitudinal data analysis indicated that the six symptom dimensions and the overall test score contained important elements of information of the clinical scales and can be used to measure effects of PD treatment interventions and disease progression. A usability evaluation of the web-based system showed that the information presented in the system was comparable to qualitative clinical observations and the system was recognized as a tool that will assist in the management of patients.
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39. |
- Memedi, Mevludin, 1983-
(författare)
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Mobile systems for monitoring Parkinson's disease
- 2011
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis presents the development and evaluation of IT-based methods and systems for supporting assessment of symptoms and enabling remote monitoring of Parkinson‟s disease (PD) patients. PD is a common neurological disorder associated with impaired body movements. Its clinical management regarding treatment outcomes and follow-up of patients is complex. In order to reveal the full extent of a patient‟s condition, there is a need for repeated and time-stamped assessments related to both patient‟s perception towards common symptoms and motor function. In this thesis, data from a mobile device test battery, collected during a three year clinical study, was used for the development and evaluation of methods. The data was gathered from a series of tests, consisting of selfassessments and motor tests (tapping and spiral drawing). These tests were carried out repeatedly in a telemedicine setting during week-long test periods. One objective was to develop a computer method that would process tracedspiral drawings and generate a score representing PD-related drawing impairments. The data processing part consisted of using the discrete wavelet transform and principal component analysis. When this computer method was evaluated against human clinical ratings, the results showed that it could perform quantitative assessments of drawing impairment in spirals comparatively well. As a part of this objective, a review of systems and methods for detecting the handwriting and drawing impairment using touch screens was performed. The review showed that measures concerning forces, accelerations, and radial displacements were the most important ones in detecting fine motor movement anomalies. Another objective of this thesis work was to design and evaluate an information system for delivering assessment support information to the treating clinical staff for monitoring PD symptoms in their patients. The system consisted of a patient node for data collection based on the mobile device test battery, a service node for data storage and processing, and a web application for data presentation. A system module was designed for compiling the test battery time series into summary scores on a test period level. The web application allowed adequate graphic feedback of the summary scores to the treating clinical staff. The evaluation results for this integrated system indicate that it can be used as a tool for frequent PD symptom assessments in home environments.
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40. |
- Memedi, Mevludin, 1983-, et al.
(författare)
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Objective quantification of Parkinson's disease upper limb motor timing variability using spirography
- 2015
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Konferensbidrag (refereegranskat)abstract
- Objective quantification of the upper limb motor timing variability of Parkinson’s disease (PD) patients was evaluated using traces of spirals by groups of patients at different disease stages, stable (S), intermediate (I), advanced (A) and a healthy elderly (HE) group. The approximate entropy (APEN) method of quantifying motor timing variability in time series was applied to capture the amount of irregularity during the spiral drawing process. The APEN score was then normalized by total drawing completion time and used in subsequent analysis. In addition, two previously published methods (WAV and SDDV) were applied on the spiral data. Comparing subject groups’ APEN mean scores, they were found to be significantly different from HE group, for group A (P<0.001) indicating this method’s ability in distinguishing patients at advanced disease stage. Comparing the three methods’ ability to track response to advanced treatment, APEN scores were all significantly different between base-line and levodopa-carbidopa intestinal gel (LCIG) treatment, during the 36 month study period as opposed to WAV and SDDV as they were not significantly improving for all periods. APEN scores were weakly correlated to WAV and SDDV, indicating that they measure different aspects of symptom severity.
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41. |
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42. |
- Memedi, Mevludin, 1983-, et al.
(författare)
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Self-reported symptoms and motor tests via telemetry in a 36-month levodopa-carbidopa intestinal gel infusion trial
- 2013
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To determine if a home environment test battery can be used to measure effects of Parkinson’s disease (PD) treatment intervention and disease progression.Background: Sixty-five patients diagnosed with advanced PD were recruited in an open longitudinal 36-month study. On inclusion, 35 of them were treated with continuous intraduodenal administration of a levodopa-carbidopa intestinal gel (LCIG) and 30 patients were candidates for switching from conventional oral PD treatment to LCIG. They utilized a test battery, consisting of self-assessments and fine motor tests (tapping and spiral drawings), in their homes. Assessments were performed four times per day during week-long test periods. For the majority of these test periods, UPDRS and PDQ-39 ratings were performed at the start of the period.Methods: The test battery time series were summarized into scores for representing symptom severities over test periods. Six conceptual dimensions were defined; four subjectively-reported: ‘Walking’, ‘Satisfied’, ‘Dyskinesia’ and ‘Off’, and two objectively-measured: ‘Tapping’ and ‘Spiral’. In addition, an overall test score (OTS) was defined to represent the overall condition of a patient during a test period.Results: In LCIG-naïve patients, mean OTS improved startingf rom the first test period on LCIG treatment and this improvement remained statistically significant until month 24 (figure). In contrast to objectively-measured dimensions, mean scores of subjectively-reported dimensions improved significantly throughout the study. In LCIG-non-na€ıve patients, there were no significant changes in mean OTS, except at month 36 (p < 0.01). The OTS correlated adequately with total UPDRS (rho 5 0.59) and total PDQ-39 (0.59).Conclusions: Using the test battery it is possible to monitor PD symptoms over time. The trends of the test scores were strikingly similar to the trends of the clinical rating scores. Correlations between OTS and the rating scales were adequate indicating that the test battery contains important elements of the information of these well-established scales.
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43. |
- Memedi, Mevludin, PhD, 1983-, et al.
(författare)
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Sensor-based Measurement of Nociceptive Pain : An Exploratory Study with Healthy Subjects
- 2022
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Ingår i: Pervasive Computing Technologies for Healthcare. - Cham : Springer. - 9783030991937 - 9783030991944 ; , s. 88-95
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Konferensbidrag (refereegranskat)abstract
- Valid assessment of pain is essential in daily clinical practice to enhance the quality of care for the patients and to avoid the risk of addiction to strong analgesics. The aim of this paper is to find a method for objective and quantitative evaluation of pain using multiple physiological markers. Data was obtained from healthy volunteers exposed to thermal and ischemic stimuli. Twelve subjects were recruited and their physiological data including skin conductance, heart rate, and skin temperature were collected via a wrist-worn sensor together with their selfreported pain on a visual analogue scale (VAS). Statistically significant differences (p< 0.01) were found between physiological scores obtained with the wearable sensor before and during the thermal test. Test-retest reliability of sensor-based measures was good during the thermal test with intraclass correlation coefficients ranging from 0.22 to 0.89. These results support the idea that a multi-sensor wearable device can objectively measure physiological reactions in the subjects due to experimentally induced pain, which could be used for daily clinical practice and as an endpoint in clinical studies. Nevertheless, the results indicate a need for further investigation of the method in real-life pain settings.
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44. |
- Memedi, Mevludin, 1983-, et al.
(författare)
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Spatial and temporal variability during spirography
- 2015
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To investigate variability of spatial and temporal performance of Parkinson’s disease (PD) patients and healthy elderly subjects during spirography tasks.Background: A total of 105 subjects were recruited, comprising of 65 patients with advanced PD (mean 6 sd age; 65 6 11), 15 patients intermediate stage patients experiencing motor fluctuations (65 6 6), 15 clinically stable patients (65 6 6) and 10 healthy elderly subjects (61 6 7). Thirty of the 65 advanced patients switched from oral to continuous administration of treatment via pump. The subjects used a telemetry touch screen device in their home environment settings. On each test occasion, they were asked to trace pre-drawn Archimedes spirals as accurately and fast as possible.Methods: Spatial and temporal variability were measured by computing four intra-individual measures of drawing displacement and speed, respectively. Combined scores were derived by applying principal component analysis on these measures and retaining the first component. One-way ANOVA test followed by Tukey multiple comparisons test was used to assess differences between the groups.Results: Patients with advanced PD had slower drawing speed and more spatial variability than moderate patients, stable patients and healthy elderly subjects with a mean increase of 76%, 89% and 90% (p<0.001), respectively. The spatial variability of stable patients did not differ from healthy elderly subjects. In contrast, the mean temporal variability did not differ between healthy subjects, stable patients and advanced patients. Moderate patients had higher temporal variability than other groups.Conclusions: The findings suggest that patients with PD can be best discriminated from healthy subjects on measures of spatial variability rather than temporal variability. Spatial variability measures are not useful for diagnosing PD but can be used for measuring the severity of symptoms.
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45. |
- Memedi, Mevludin, 1983-, et al.
(författare)
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Spiral drawing during self-rated dyskinesia is more impaired than during self-rated off
- 2013
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Ingår i: Parkinsonism & Related Disorders. - : Elsevier BV. - 1353-8020 .- 1873-5126. ; 19:5, s. 553-556
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The purpose of this study was to examine repeated measures of fine motor function in relation to self-assessed motor conditions in Parkinson's disease (PD).Methods: One-hundred PD patients, 65 with advanced PD and 35 patients with different disease stages have utilized a test battery in a telemedicine setting. On each test occasion, they initially self-assessed their motor condition (from 'very off' to 'very dyskinetic') and then performed a set of fine motor tests (tapping and spiral drawings).Results: The motor tests scores were found to be the best during self-rated On. Self-rated dyskinesias caused more impaired spiral drawing performance (mean = 9.8% worse, P < 0.001) but at the same time tapping speed was faster (mean = 5.0% increase, P < 0.001), compared to scores in self-rated Off.Conclusions: The fine motor tests of the test battery capture different symptoms; the spiral impairment primarily relates to dyskinesias whereas the tapping speed captures the Off symptoms.
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46. |
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47. |
- Memedi, Mevludin, 1983-, et al.
(författare)
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Visualization of spirography-based objective measures in Parkinson's disease
- 2014
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Ingår i: Movement Disorders Supplement. - : Wiley-Blackwell. - 0885-3185. ; , s. S187-S189
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To investigate whether advanced visualizations of spirography-based objective measures are useful in differentiating motor complications among Parkinson’s disease (PD) patients.Background: Sixty-five patients diagnosed with advanced PD have utilized a telemetry test battery, implemented on a touch screen handheld computer, in a telemedicine setting. On each test occasion, they were asked to perform repeated and time-stamped assessments of spiral drawing performance by tracing a pre-drawn Archimedes spiral. The test battery was also used by 10 healthy elderly (HE) subjects.Methods: A web-based framework was developed to visualize the performance during spirography of both patients and HE subjects to a clinician (DN). The performance was depicted by animating the spiral drawings (Fig 1). In addition, the framework displayed two time series views for representing drawing speed (blue line) and displacement from the ideal trajectory (orange line). The views are coordinated and linked i.e. user interactions in one of the views will be reflected in other views. For instance, when the user points in one of the pixels in spiral view, the circle size of the underlying pixel increases and a vertical line appears in the time series views to depict the corresponding position. Fig 1 shows single randomly selected spirals per each subject group: A) a PD patient in Dyskinesia state, B) a HE subject, and C) a PD patient in Off state.Results: The clinician recognized Dyskinesia symptoms as movements made with high speed, smooth/gradual spatial displacements, and a small amount of hesitation (Fig 1A). Similarly, Off symptoms were associated with low speed, sharp/abrupt spatial displacements, and a large amount of hesitation (Fig 1C). In contrast, the spiral drawn by a HE subject (Fig 1B) was associated with unchanging levels of kinematic features i.e. drawing speed, spatial displacements and hesitation over time.Conclusions: Visualizing spirography-based objective measures enables identification of trends and patterns of motor dysfunctions at the patient’s individual level. Dynamic access of visualized motor tests may be useful during the evaluation of therapy-related complications such as under- and over-medications. This will assist during individualized optimization of therapies, enabling patients to spend more time in the On state with a minimum of Off and dyskinetic states.
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48. |
- Sadikov, Aleksander, et al.
(författare)
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Feasibility of spirography features for objective assessment of motor function in Parkinson's disease
- 2017
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Ingår i: Artificial Intelligence in Medicine. - : Elsevier BV. - 0933-3657 .- 1873-2860. ; 81:SI, s. 54-62
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Parkinson's disease (PD) is currently incurable, however proper treatment can ease the symptoms and significantly improve the quality of life of patients. Since PD is a chronic disease, its efficient monitoring and management is very important. The objective of this paper was to investigate the feasibility of using the features and methodology of a spirography application, originally designed to detect early Parkinson's disease (PD) motoric symptoms, for automatically assessing motor symptoms of advanced PD patients experiencing motor fluctuations. More specifically, the aim was to objectively assess motor symptoms related to bradykinesias (slowness of movements occurring as a result of under-medication) and dyskinesias (involuntary movements occurring as a result of over-medication).Materials and methods: This work combined spirography data and clinical assessments from a longitudinal clinical study in Sweden with the features and pre-processing methodology of a Slovenian spirography application. The study involved 65 advanced PD patients and over 30,000 spiral-drawing measurements over the course of three years. Machine learning methods were used to learn to predict the "cause" (bradykinesia or dyskinesia) of upper limb motor dysfunctions as assessed by a clinician who observed animated spirals in a web interface. The classification model was also tested for comprehensibility. For this purpose a visualisation technique was used to present visual clues to clinicians as to which parts of the spiral drawing (or its animation) are important for the given classification.Results: Using the machine learning methods with feature descriptions and pre-processing from the Slovenian application resulted in 86% classification accuracy and over 0.90 AUC. The clinicians also rated the computer's visual explanations of its classifications as at least meaningful if not necessarily helpful in over 90% of the cases.Conclusions: The relatively high classification accuracy and AUC demonstrates the usefulness of this approach for objective monitoring of PD patients. The positive evaluation of computer's explanations suggests the potential use of this methodology in a decision support setting.
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49. |
- Sadikov, Aleksander, et al.
(författare)
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Feasibility of spirography features for objective assessment of motor symptoms in Parkinson's disease
- 2015
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Ingår i: Artificial Intelligence in Medicine. - Cham : Springer. - 9783319195506 - 9783319195513 ; , s. 267-276
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Konferensbidrag (refereegranskat)abstract
- Parkinsons disease (PD) is currently incurable, however the proper treatment can ease the symptoms and significantly improve the quality of patients life. Since PD is a chronic disease, its efficient monitoring and management is very important. The objective of this paper is to investigate the feasibility of using the features and methodology of a spirography device, originally designed to measure early Parkinsons disease (PD) symptoms, for assessing motor symptoms of advanced PD patients suffering from motor fluctuations. More specifically, the aim is to objectively assess motor symptoms related to bradykinesias (slowness of movements occurring as a result of under-medication) and dyskinesias (involuntary movements occurring as a result of over-medication). The work combines spirography data and clinical assessments from a longitudinal clinical study in Sweden with the features and pre-processing methodology of a Slovenian spirography application. The target outcome was to learn to predict the “cause” of upper limb motor dysfunctions as assessed by a clinician who observed animated spirals in a web interface. Using the machine learning methods with feature descriptions from the Slovenian application resulted in 86% classification accuracy and over 90% AUC, demonstrating the usefulness of this approach for objective monitoring of PD patients.
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50. |
- Senek, Marina, et al.
(författare)
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Levodopa/carbidopa microtablets in Parkinson disease : pharmacokinetics and blinded motor assessment
- 2016
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Ingår i: Twentieth International Congress of Parkinson's Disease and Movement Disorders.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study was to characterize the levodopa and carbidopa plasma concentration in relation to blinded motor function ratings. This is a part of a study where a Multimodal motor Symptoms Quantification (MuSyQ) platform consisting of three different types of sensors were tested while evoking motor fluctuations with levodopa/carbidopa(LD/CD) microtablets in fluctuating Parkinson’s disease (PD) patients. Today, dose titration and chronic treatment largely relies on the patient’s subjective assessment of symptoms and clinicians’ assessment of patient status during a visit at the clinic. This was a single-center, open-label, single dose study in patients experiencing motor fluctuations. Patients were given 150% of their individual levodopa equivalent morning dose. Blood sampling and motor function testing were conducted for up to 6.5 hours at prespecified time points. The patients performed standardized motor activities for clinical rating in accordance with parts of the Unified Parkinson’s disease Rating Scale (UPDRS) and Unified Dyskinesia RatingScale (UDysRS). Each test cycle was video recorded, and the video sequences were presented to three movement disorder specialists in a randomized order for blinded rating of UPDRS items and the treatment response scale (TRS). Concentration versus time profiles and the pharmacokinetics were compared with a study previously conducted in healthy subjects. Nineteen patients, 14 male and 5 female, were included in the study. The individual LD/CD doses ranged between 110/27.5mg to 410/102.5 mg. The concentration time profiles are similar to the LD/CD microtablet profiles reported in healthy subjects. The blinded video ratings managed to capture the most distinctive movements. This is the first pharmacokinetic study where patients received LD/CD microtablets. For patients fluctuating from 'off' to dyskinetic, the relationship between the plasma concentration and motor function was clearer compared to the patients that fluctuated to a lesser extent.
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