PERFORM: A System for Monitoring, Assessment and Management of Patients with Parkinson’s Disease

Abstract

In this paper, we describe the PERFORM system for the continuous remote monitoring and management of Parkinson's disease (PD) patients. The PERFORM system is an intelligent closed-loop system that seamlessly integrates a wide range of wearable sensors constantly monitoring several motor signals of the PD patients. Data acquired are pre-processed by advanced knowledge processing methods, integrated by fusion algorithms to allow health professionals to remotely monitor the overall status of the patients, adjust medication schedules and personalize treatment. The information collected by the sensors (accelerometers and gyroscopes) is processed by several classifiers. As a result, it is possible to evaluate and quantify the PD motor symptoms related to end of dose deterioration (tremor, bradykinesia, freezing of gait (FoG)) as well as those related to over-dose concentration (Levodopa-induced dyskinesia (LID)). Based on this information, together with information derived from tests performed with a virtual reality glove and information about the medication and food intake, a patient specific profile can be built. In addition, the patient specific profile with his evaluation during the last week and last month, is compared to understand whether his status is stable, improving or worsening. Based on that, the system analyses whether a medication change is needed—always under medical supervision—and in this case, information about the medication change proposal is sent to the patient. The performance of the system has been evaluated in real life conditions, the accuracy and acceptability of the system by the PD patients and healthcare professionals has been tested, and a comparison with the standard routine clinical evaluation done by the PD patients' physician has been carried out. The PERFORM system is used by the PD patients and in a simple and safe non-invasive way for long-term record of their motor status, thus offering to the clinician a precise, long-term and objective view of patient's motor status and drug/food intake. Thus, with the PERFORM system the clinician can remotely receive precise information for the PD patient's status on previous days and define the optimal therapeutical treatment.

Objective and quantitative assessment of motor function in Parkinson’s disease—from the perspective of practical applications

“…An example system is called PERFORM (49), which is an intelligent closed-loop system integrating a wide range of wearable sensors, allowing physicians to remotely monitor the condition changes of the patients, adjust medication schedules, and individualize therapy. In a study regarding gait measurement, researchers were working on combining the data from wrist and sternum sensors with the data from foot sensors (50).…”

Entrenamiento motor en el continuo de la realidad a la virtualidad

“…Tzallas et al (41) diseñaron PERFORM, un sistema de monitoreo de signos motores con sensores inerciales que permite ajustar los horarios de la medicación y personaliza el tratamiento de pacientes con EP registrando la cantidad de síntomas motores como temblor, bradicinesia y congelamiento de la marcha. Este registro se relacionó con la dosis de levodopa y brindó información relevante para orientar la ruta terapéutica.…”

A holistic approach to assess the feasability of telehealth for Parkinson's disease management

“…Telemedicine, being concerned more narrowly with the more clinical aspects of health and well-being (and including services within which clinicians exchange data and information) becomes a sub-domain of telehealth [121]. The domain model for telemedicine/telehealth offered by COCIR 15 is, in some respects, different from that of the TeleSCoPE partners ( Figure 21). For COCIR, the overarching telemedicine domain includes telehealth, ambient assisted living, telecare, telemonitoring and several teledisciplines [121].…”

“…The recorded signals are pre-processed and stored at the patient site. At the point of care (hospital centre), the supervising health professionals are able to remotely monitor their patients, personalize their treatment and medication schedules and generate statistical data, so as to study and evaluate the efficacy of medication, based on the patients' specific personal and medical characteristics [15]. The PERFORM system was aimed at supporting the continuous follow-up of patients using wearable devices and extracting the appropriate information from the collected data to optimize and personalize the treatment for each patient and consequently to delay the progression and/or the appearance of symptoms and to improve quality of patients' lives.…”

“…In addition, they had good internal consistency, had good ability to discriminate between healthy elderly and patients in different disease stages, had good sensitivity to treatment interventions and could reflect the natural disease progression over time [473]. PERFORM system was aimed at increasing the performance of the medication through a better and more objective monitoring of the patients' symptoms, reducing costs by utilizing communications technology, which eliminates the need for transportation, reduces the waiting and/or consultation time can be reduced via telemedicine consultations, transferring health knowledge transfer from the practitioner to the patient, ability to self-care, and medication adherence [14], [15], [288], [434]. PERFORM platform was composed by a set of wearable sensors for the continuous recording of the motion signals and a set of software algorithms for the signal processing.…”