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Quantitative Parkinsons Gait Assessment: A high resolution measure - - PowerPoint PPT Presentation

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Quantitative Parkinsons Gait Assessment: A high resolution measure of change in impairment Tuesday July 22 th , 2014 Starts at 12:00 PM EST Presented by Elizabeth Brokaw, PhD Outline Impairment due to Parkinsons Disease Deep

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Quantitative Parkinson’s Gait Assessment: A high resolution measure of change in impairment

Tuesday July 22th, 2014 Starts at 12:00 PM EST Presented by Elizabeth Brokaw, PhD

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  • Impairment due to Parkinson’s Disease
  • Deep Brain Stimulation
  • Evaluations with wearable sensors
  • DBS cessation research
  • Role of Kinesia to improve gait outcomes

Outline

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Parkinson’s Disease Motor Impairments

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  • Wide range of motor symptoms
  • Treatments outcomes often focus on the

upper extremity

  • Mobility is important for quality of life
  • Increased fall risk after PD

– 68.3% fell during one year

Parkinson’s Disease

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  • Gait

– Freezing of gait – Slowed movement – Shortened stride length – Flat foot strike (shuffled steps) – Impaired balance and posture

Parkinson’s Disease

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Deep Brain Stimulation

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  • Became a standard treatment for PD in the

1990’s

  • Effective method for improving symptoms and

reducing medication burden

  • Typically indicated for

– Tremor – Bradykinesia – Rigidity

Deep Brain Stimulation

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  • Researcher have observed STN stimulation

induced improvement in

– Stride length – Walking speed – Freezing of gait

  • Evaluation of settings and location is ongoing

– Frequency effects – Pedunculopontine nucleus (PPN)

Deep Brain Stimulation for Gait Impairment

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Deep Brain Stimulation

– Effects some symptoms quickly – Effect on gait is slow and less predictable

  • Unknown final effect on gait and balance
  • Not optimized to improve gait and balance

Deep Brain Stimulation Response Time

DBS Change 15 30 60 120 180 Gait

Time For Effect on Motor Function After DBS Change (In Minutes)

Tremor and Rigidity Bradykinesia

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Wearable Sensors

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  • Quantitative Evaluation of Movement

– Acceleration – Angular Velocity

Wearable Sensors

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  • Objective measure of impairment
  • High resolution
  • Not confined to in clinic evaluations

Benefits of Wearable Movement Sensors

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The goal is to examine changes in impairment related to changes in to DBS settings

Quantifying Effect of DBS Cessation With the Kinesia Sensors

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  • Quantitative assessment of

– Tremor – Bradykineisia – Dyskinesia – Gait – Freezing of gait

  • For more information

– http://glneurotech.com/publications/

Kinesia

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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 (2012). Automated motion sensor quantification of gait and lower extremity bradykinesia. International conference of the IEEE EMBS. 2012.

Published:

Kinesia Lower Extremity and Gait Evaluation

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  • Sensors placed on the more affected thigh,

back and top of feet. Kinesia Sensor Placement

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  • Individuals with Parkinson’s Disease and DBS

– Started off medication and with DBS on

  • Kinesia Evaluation: Unified Parkinson’s Disease

Rating Scale tasks Protocol

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  • Clinician UPDRS at study start DBS on and 3

hours after DBS off

  • 2 Kinesia evaluations at each time point

Protocol

DBS On DBS Off 15 30 60 120 180

Time After DBS Was Turned Off In Minutes

Times of Kinesia evaluations Times of clinician evaluations

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  • Evaluate changes in impairment over time
  • Evaluate ability to minimize sensor number to

reduce user burden

– Sensors data from both legs – Sensor data from just the subject reported more affected limb

Study Goals

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  • 8 Individuals with Parkinson’s Disease
  • STN DBS implanted
  • DBS surgery average of 1.8 ± 2.3 years prior
  • Average of 14 ± 1.5 hours off medication

Results

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Overall Effect of DBS Cessation

Average Kinesia Score Average Clinician Score Gait DBS on 0.77 ± 0.38 0.5 ± 0.53 DBS off 3 hr 1.00 ± 0.45 0.88 ± 0.99 P value 0.001 * 0.28 Toe Taps DBS on 2.19 ± 0.57 1.63 ± 0.92 DBS off 3 hr 2.58 ± 0.49 2.38 ± 1.06 P value <0.0001* 0.02* Leg Lifts DBS on 1.67 ± 0.76 0.57 ± 0.53 DBS off 3 hr 2.54 ± 0.94 2 ± 0.58 P value <0.0001* 0.003*

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Effect of DBS Cessation Over Time Gait

Both Legs Paired t-tests

  • DBS On to 120 min

(p=0.002)

  • 120 to180 min

(p=0.53)

*

DBS On DBS Off

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More Impaired Leg Paired t-tests

  • DBS On to 120 min

(p=0.04)

  • 120 to 180 min

(p=0.25)

DBS On DBS Off

Effect of DBS Cessation Over Time Gait

*

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Effect of DBS Cessation Over Time Toe Tapping

Both Legs Paired t-tests

  • DBS On to 15 min

(p=0.016)

  • 15 to 180 min

(p=0.1)

*

DBS On DBS Off

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Effect of DBS Cessation Over Time Toe Tapping

More Impaired Leg Paired t-tests

  • DBS On to 15 min

(p=0.02)

  • 15 to 180 min

(p=0.13)

*

DBS On DBS Off

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Effect of DBS Cessation Over Time Leg Lifts

Both Legs Paired t-test

  • DBS On to Off

(p=0.002)

  • Off to 120 min

(p<0.001 )

  • 120 to 180 min

(p=0.4)

* *

DBS On DBS Off

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Effect of DBS Cessation Over Time Leg Lifts

More Impaired Leg Paired t-test

  • DBS On to Off

(p=0.007)

  • Off to 60 min

(p<0.001)

  • 60 to 180 min

(p=0.99)

* *

DBS On DBS Off

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  • Increase in impairment after off 3 hour with

DBS off

– Except clinician gait score

  • Different movements showed very different

time response. Summary of DBS Cessation

DBS On DBS Off 15 30 60 120 180 Gait Leg Lift Toe Tap

Time After DBS Was Turned Off In Minutes

Ultimate Significant Response Initial Significant Response

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Limitations

  • Small sample size (study is ongoing)
  • DBS cessation as a model for change in DBS

settings

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Role of the Kinesia Systems

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Independent home assessments

Kinesia

Tune DBS settings in the clinic

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Kinesia for DBS

  • Integrate remote evaluation and DBS tuning

– This will improve knowledge of DBS effects – Allow for tuning of gait parameters

Kinesia for DBS

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  • DBS changes over time
  • Kinesia system

– High resolution quantitative evaluation – Not limited to use in the clinic – Integration of Kinesia and DBS tuning could improve gait

  • utcomes

Conclusions

DBS On DBS Off 15 30 60 120 180 Gait Leg Lift Toe Tap

Time After DBS Was Turned Off In Minutes

Ultimate Significant Response Initial Significant Response

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Acknowledgements

  • Thomas Mera
  • Dustin Heldman
  • Joseph Giuffrida
  • David Riley
  • Benjamin Walter
  • Steven Gunzler

Funding from NIH National Institute on Aging 2R44AG033947-03A1

  • Alberto Espay
  • Fredy Revilla
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Questions

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