Comprehensive telemedicine solution for remote monitoring of Parkinson’s disease patients with orthostatic hypotension during COVID-19 pandemic

Abstract

Objective Orthostatic hypotension (OH) represents a frequent but under-recognized phenomenon in Parkinson’s disease (PD). During COVID-19 pandemic, Information and Communication Technologies (ICT) have become pivotal in the management of chronic diseases like PD, not only to assess motor impairment, but also for vital signs monitoring. This pilot study aimed to propose a real-time remote home-monitoring system and protocol for PD patients with OH. Methods Vital parameters were acquired by wireless devices and transmitted to an ICT platform, providing data and smart notifications to the healthcare provider through an interactive web portal. Eight patients with idiopathic PD and OH underwent 5-day monitoring. Data about OH episodes, therapeutic interventions, impact on daily activities, and patient satisfaction were collected and analyzed. Results The proposed solution allowed the identification of 65 OH episodes and subsequent medical interventions. Thirty-five episodes were asymptomatic, especially in the postprandial and in the afternoon recordings. Systolic-blood-pressure (SBP) and diastolic-blood-pressure (DBP) were significantly lower in symptomatic episodes, while the pressure drops resulted significantly higher in presence of symptoms. High usability and patient satisfaction scores were observed. Conclusion The proposed home-monitoring system and protocol have proved to provide useful information and to allow prompt interventions in the management of PD patients with OH during COVID-19 pandemic.

A Novel Non-Invasive Thermometer for Continuous Core Body Temperature: Comparison with Tympanic Temperature in an Acute Stroke Clinical Setting

“…Indeed, although such technology might have some limitations in providing an assessment of core body temperature during exercise and its precision should be further evaluated [37][38][39], it might be useful for detecting hyperthermic events in the clinical setting, particularly when compared to other non-invasive methods which might not provide continuous temperature readings [40][41][42] or when patients have to be remotely monitored [1,[43][44][45][46]. Our results showed that a novel non-invasive wireless heat flux-based thermometer was able to detect body temperature changes measured by the tympanic thermometer as the presence or absence of hyperthermia (94.1%) and the presence or absence of fever (97.4%) in the post-stroke clinical setting.…”

Challenges in Parkinson’s Disease Care—In Light of the COVID-19 Pandemic

“…13 Research on home-monitoring systems to help evaluate movement disorders remotely is also being actively conducted. 14 In our survey, 93.4% of participants responded that they were in favor of introducing telemedicine for parkinsonian disorders. While telephone consultations and prescriptions were temporarily permitted during the COVID-19 outbreak, additional discussions are needed to establish the scope and methodology of the introduction of telemedicine in Korea.…”

“…A total of 77.5% of respondents said that they offered phone counseling to patients during the pandemic and that this option was “broadly accepted” by patients [ 13 ]. Research on home-monitoring systems to help evaluate movement disorders remotely is also being actively conducted [ 14 ]. In our survey, 93.4% of participants responded that they were in favor of introducing telemedicine for parkinsonian disorders.…”

At-Home Blood Pressure Measurements Provide Better Assessments of Orthostatic Hypotension in Parkinson’s Disease

“…On the other hand, supine hypertension may occur [ 10 ] because the baroreflex and renal mechanisms are not centrally coordinated to respond to fluid from the lower extremities returning to central compartments overnight. There is also marked variability in systolic BP [ 37 , 38 , 39 ], which is frequently elevated in the morning. Capturing these features requires frequent BP measures with morning measurements or measurements when at least one stressor, for example, standing, is present.…”

“…Measurement is often prompted by a history of symptoms consistent with OH. However, history is unreliable, with episodes of OH frequently asymptomatic or unrecognised by the PwP [ 4 , 37 , 40 ], as well as the presence of symptoms not correlating with the presence of OH [ 37 ]. Furthermore, as discussed above, OH can be intermittent and thus missed by a single measurement, which also cannot identify variability or morning supine hypertension.…”