Assessment Tasks and Virtual Exergames for Remote Monitoring of Parkinson’s Disease: An Integrated Approach Based on Azure Kinect

Abstract

Motor impairments are among the most relevant, evident, and disabling symptoms of Parkinson’s disease that adversely affect quality of life, resulting in limited autonomy, independence, and safety. Recent studies have demonstrated the benefits of physiotherapy and rehabilitation programs specifically targeted to the needs of Parkinsonian patients in supporting drug treatments and improving motor control and coordination. However, due to the expected increase in patients in the coming years, traditional rehabilitation pathways in healthcare facilities could become unsustainable. Consequently, new strategies are needed, in which technologies play a key role in enabling more frequent, comprehensive, and out-of-hospital follow-up. The paper proposes a vision-based solution using the new Azure Kinect DK sensor to implement an integrated approach for remote assessment, monitoring, and rehabilitation of Parkinsonian patients, exploiting non-invasive 3D tracking of body movements to objectively and automatically characterize both standard evaluative motor tasks and virtual exergames. An experimental test involving 20 parkinsonian subjects and 15 healthy controls was organized. Preliminary results show the system’s ability to quantify specific and statistically significant (p < 0.05) features of motor performance, easily monitor changes as the disease progresses over time, and at the same time permit the use of exergames in virtual reality both for training and as a support for motor condition assessment (for example, detecting an average reduction in arm swing asymmetry of about 14% after arm training). The main innovation relies precisely on the integration of evaluative and rehabilitative aspects, which could be used as a closed loop to design new protocols for remote management of patients tailored to their actual conditions.

Usability of the REHOME Solution for the Telerehabilitation in Neurological Diseases: Preliminary Results on Motor and Cognitive Platforms

“…This novelty intends to overcome the limitations of many eHealth platforms and services that focus only on specific individual aspects without providing a comprehensive overview of the patient’s condition. Instead, this novelty could be particularly relevant from a clinical perspective, especially in complex and multi-system pathologies such as those considered by the REHOME project; The use of recent, innovative, and promising methodologies in the context of motor and cognitive rehabilitation, such as gamification and exergaming in virtual environments, to favor patient condition assessment and motor–cognitive training in playful, fun, life-situation-inspired, and rewarding environments, with a focus on patients’ engagement, needs, motivations, and aesthetic preferences [ 101 , 102 ]. This novelty intends to foster greater patient involvement and satisfaction, thus enticing the patient to continue with the treatment according to the therapeutic plan.…”

“…The use of recent, innovative, and promising methodologies in the context of motor and cognitive rehabilitation, such as gamification and exergaming in virtual environments, to favor patient condition assessment and motor–cognitive training in playful, fun, life-situation-inspired, and rewarding environments, with a focus on patients’ engagement, needs, motivations, and aesthetic preferences [ 101 , 102 ]. This novelty intends to foster greater patient involvement and satisfaction, thus enticing the patient to continue with the treatment according to the therapeutic plan.…”

“…The second experimental study focused on the MREP platform and, in particular, the assessment of motor condition through traditional and gamified motor tasks [ 73 , 76 , 79 , 102 ]. The study involved 27 subjects with Parkinson’s disease.…”

The Role of Telemedicine in the Treatment of Cognitive and Psychological Disorders in Parkinson’s Disease: An Overview

“…In a randomized controlled trial, Stillerova et al reported that monitoring PD symptoms using videoconferencing may be useful to give an overall idea of symptom severity over time [ 53 ]. In a randomized crossover pilot study of telemedicine, Sekimoto et al demonstrated that the outcomes of telemedicine were comparable to those of face-to-face visits, though the authors revealed some limits, such as evaluations that require in-person contact (such as rigidity and postural stability measures) [ 49 , 55 ]. Motor rehabilitation via telemedicine has also demonstrated its efficacy if conducted at home [ 56 ].…”

“…tDCS’s portability, high acceptability, and user-friendly interface make it an easy application for telemedicine practices. Dobbs et al created a tDCS protocol combined with computerized cognitive rehabilitation for PD patients with improvement in cognitive functions (language, attention, and executive) [ 55 ].…”