Parkinson's Gait: Global Efficacy of DBS and Pharma Therapy Thursday - - PowerPoint PPT Presentation

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Parkinson's Gait: Global Efficacy of DBS and Pharma Therapy Thursday - - PowerPoint PPT Presentation

Dec 28, 2023 284 likes •592 views

Parkinson's Gait: Global Efficacy of DBS and Pharma Therapy Thursday September 19 th , 2013 Starts at 12:00 PM EST Presented by Elizabeth Brokaw, PhD Outline Parkinsons Gait Quantifying Impairment Kinesia Discrete: Tasks

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Parkinson's Gait: Global Efficacy

  • f DBS and Pharma Therapy

Thursday September 19th, 2013 Starts at 12:00 PM EST Presented by Elizabeth Brokaw, PhD

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  • Parkinson’s Gait
  • Quantifying Impairment
  • Kinesia

– Discrete: Tasks – Continuous: Activities of Daily Living

Outline

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‘Paralysis agitans’ By Albert Londe (1858-1917)

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  • Range of Symptoms
  • Global Measure of

Impairment

  • Mobility for Quality of

Life

  • Increase Fall Risk

– 68.3% at least one fall

Parkinson’s Disease

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Van Gehuchten (1861-1914) “Moving Pictures of Parkinson’s Disease” Anne Jeanjean and Genevieve Aubert The Lancet. 378(9805) 2011

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Symptom Treatments

– Levodopa – Deep Brain Stimulation

  • Effects symptoms like tremor quickly
  • Lagging effect on gait of up to three hours

Parkinson’s Disease

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  • Outcome measures

– Subjective and low resolution.

  • The Unified Parkinson’s Disease Rating Scale

(UPDRS)

– Integer scale from 0 - 4. Gait:

Outcome Measures

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Discrete vs Continuous

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  • High Sensitivity
  • Short evaluations
  • Standardized tasks
  • Global Impairment
  • All day
  • Everyday activities
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Quantifying Impairment with the Kinesia Sensors

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  • Sensors on the thighs, back of feet and

sternum. Discrete Evaluation Kinesia Sensor Placement

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Mera, T. O., Filipkowski, D. E., Riley, D. E., Whitney, C. M., Walter, B. L., Gunzler, S. a, & Giuffrida, J. P. (2013). Quantitative analysis of gait and balance response to deep brain stimulation in Parkinson’s

  • disease. Gait & posture, 38(1), 109–14. doi:10.1016/j.gaitpost.2012.10.025
  • 42 individuals with Parkinson’s disease.

– 19 evaluated with DBS on and off.

  • Unified Parkinson’s Disease Rating Scale tasks
  • Scored by three evaluators.

Evaluation Protocol

Published:

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Mera, T. O., Filipkowski, D. E., Riley, D. E., Whitney, C. M., Walter, B. L., Gunzler, S. a, & Giuffrida, J. P. (2013). Quantitative analysis of gait and balance response to deep brain stimulation in Parkinson’s

  • disease. Gait & posture, 38(1), 109–14. doi:10.1016/j.gaitpost.2012.10.025
  • Good correlation (>0.7) for

all but one task

  • Clinically relevant

Clinical Evaluation Results

Published:

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Mera, T. O., Filipkowski, D. E., Riley, D. E., Whitney, C. M., Walter, B. L., Gunzler, S. a, & Giuffrida, J. P. (2013). Quantitative analysis of gait and balance response to deep brain stimulation in Parkinson’s

  • disease. Gait & posture, 38(1), 109–14. doi:10.1016/j.gaitpost.2012.10.025

Clinical Evaluation Results

Published: UPDRS Posture Score of 3

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Mera, T. O., Filipkowski, D. E., Riley, D. E., Whitney, C. M., Walter, B. L., Gunzler, S. a, & Giuffrida, J. P. (2013). Quantitative analysis of gait and balance response to deep brain stimulation in Parkinson’s

  • disease. Gait & posture, 38(1), 109–14. doi:10.1016/j.gaitpost.2012.10.025
  • Kinematic features show increased

impairment with DBS-Off for three of the tasks (p<0.05) Clinical Evaluation Results DBS Effect

Published:

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  • Simplified for Clinic and Home Use

– 5 sensors → 1 sensor

  • Information into clinician relevant form

– Toe angle amplitude → UPDRS equivalent score

Usability

2 4 6 8 10

  • 60
  • 40
  • 20

20 40 60 80 100 120 Time in Seconds Wx in Degrees Per Second Toe Tapping Kinematic Measure

→

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Heldman, D., Filipkowski, D. E., Riley, D. E., Whitney, C. M., Walter, B. L., Gunzler, S. a, Giuffrida, J.P. & Mera, T . Automated motion sensor quantification of gait and lower extremity bradykinesia. International conference of the IEEE EMBS. 2012.

  • A model to predict UPDRS scores from

kinematic measures

  • Good correlation to

clinician score Discrete Clinical Evaluation Results Single Foot Sensor for Home Use

Published:

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Kinesia HomeView

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Applications and Markets

Web Interface Patient Kit (Home Use)

Telemedicine DBS Programming Clinical Trials

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Continuous Evaluation of Impairment

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Continuous Evaluation for Home Use

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  • Activity level and general function
  • Low time burden
  • Single sensor

Gait ADL Classifications Sitting Standing Walking

1 2 3 4 5 6 7

  • 1
  • 0.8
  • 0.6
  • 0.4
  • 0.2

0.2 0.4 Time in Seconds Acceleration Due to Gravity Arise Task 1 2 3 4 5 6

  • 80
  • 60
  • 40
  • 20

20 40 60 80 100 120 Time in Seconds Angular Velocity Gait Task

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Continuous Evaluation for Home Use

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  • Validate with discrete task data
  • Examined gait and arise tasks
  • Single Sensor

Gait ADL Classifications Standing and Moving Standing Still Sitting and Moving Sitting Still

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  • Expected classification
  • Time standing correlated with UPDRS

Freezing of Gait and Gait Scores (r > 0.7). Continuous Evaluation Results Gait

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Sitting 0% Sitting and Moving 1% Standing Not Moving 18% Standing Moving 81% 5 10 15 20 25 30 35 40 45 50 1 2 3 4 Standing Not Moving Time (sec) Average Clinician Freezing of Gait Score

Gait Task

r = 0.77

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  • Expected classification
  • The task time had a good correlation (r > 0.7)

with the UPDRS arise score. Continuous Evaluation Results Arise

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Sitting Not Moving 43% Sitting Moving 19% Standing Not Moving 19% Standing Moving 19% 10 20 30 40 50 60 1 2 3 4 Task Time (sec) Average Clinician Score

Arising From Chair

r = 0.75

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  • UPDRS change in arise (p=0.058).
  • Classification shows changes similar to the

clinical measure Continuous Clinical Evaluation Results DBS Effect

  • 10

10 20 30 40

  • 1

1 2 3 4 Change in Task Time (sec) Change in Average Clinician Score

Changes in Arising From Chair Task with DBS on and off

r = 0.83

  • 10

10 20 30 40

  • 1

1 2 3 4 Change in Sitting Time (sec) Change in Average Clinician Score

Changes in Arising From Chair Task with DBS on and off

r = 0.75

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  • Arise task showed a significant increase in

time spent sitting and moving with DBS-Off (p=0.045) Continuous Evaluation Results DBS Effect

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3 = Standing and Moving 2 = Standing Still 1 Sitting and Moving 0 = Sitting Still

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  • Gait Impairment Negatively Effects Quality of

Life

  • Improve Evaluation

– Quantify – Changes through out the day

  • The Kinesia motion sensors

– Collect and quantify clinically meaningful information about gait.

Conclusions

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On Going Study

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  • Further validate models
  • Evaluate time based effects of DBS-Off (3 hours)
  • David Riley
  • Christina Whitney
  • Benjamin Walter
  • Steven Gunzler
  • Alberto Espay
  • Fredy Revilla
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SLIDE 28

Acknowledgements

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  • Thomas Mera
  • Dustin Heldman
  • Danielle Filipkowski
  • Christopher Pulliam
  • Joseph Giuffrida
  • David Riley
  • Christina Whitney
  • Benjamin Walter
  • Steven Gunzler

Funding from NIH National Institute on Aging 5R43AG033947

  • Alberto Espay
  • Fredy Revilla
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Questions

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For more information contact: Elizabeth Brokaw Ebrokaw@glneurotech.com