Tablet-Based Application for Objective Measurement of Motor Fluctuations in Parkinson Disease

Abstract

Background: The motor subscale of the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS-III) has limited applicability for the assessment of motor fluctuations in the home setting. Methods: To assess whether a self-administered, tablet-based application can reliably quantify differences in motor performance using two-target finger tapping and forearm pronation-supination tasks in the ON (maximal dopaminergic medication efficacy) and OFF (reemergence of parkinsonian deficits) medication states, we recruited 11 Parkinson disease (PD) patients (age, 60.6 ± 9.0 years; disease duration, 12.8 ± 4.1 years) and 11 healthy age-matched controls (age, 62.5 ± 10.5 years). The total number of taps, tap interval, tap duration, and tap accuracy were algorithmically calculated by the application, using the more affected side in patients and the dominant hand in healthy controls. Results: Compared to the OFF state, PD patients showed a higher number of taps (84.2 ± 20.3 vs. 54.9 ± 26.9 taps; p = 0.0036) and a shorter tap interval (375.3 ± 97.2 vs. 708.2 ± 412.8 ms; p = 0.0146) but poorer tap accuracy (2,008.4 ± 995.7 vs. 1,111.8 ± 901.3 pixels; p = 0.0055) for the two-target task in the ON state, unaffected by the magnitude of coexistent dyskinesia. Overall, test-retest reliability was high (r >0.75) and the discriminatory ability between OFF and ON states was good (0.60 ≤ AUC ≤ 0.82). The correlations between tapping data and MDS-UPDRS-III scores were only moderate (–0.55 to 0.55). Conclusions: A self-administered, tablet-based application can reliably distinguish between OFF and ON states in fluctuating PD patients and may be sensitive to additional motor phenomena, such as accuracy, not captured by the MDS-UPDRS-III.

The BRadykinesia Akinesia INcoordination (BRAIN) Tap Test: Capturing the Sequence Effect

“…The BRAIN tap test parameters correlated only approximately with MDS‐UPDRS part III scores. This could be because BRAIN tap test parameters such as KS (proxy measure for total taps), AT (dwell time), and DS (proxy measure for accuracy) capture aspects of bradykinesia not tested with MDS‐UPDRS subscores (finger tapping, hand movements, pronation/supination), which focus on rhythm, slowing, and decrement in amplitude . IS provided the best differentiation between PD patients and controls.…”

Application of Machine Learning in a Parkinson's Disease Digital Biomarker Dataset Using Neural Network Construction (NNC) Methodology Discriminates Patient Motor Status

“…Data from a study (10) with the iMotor application were collected from 36 participants (19 with PD and 17 healthy controls) for the following tasks: (1) Two-target finger tapping test, (2) Pronation-supination test, and (3) Reaction time test: Details on the execution of these tests are provided in Figure 1 and described in details in previous papers on iMotor (Mitsi et al, 2017;Wissel et al, 2017).…”

“…The method was evaluated on three different datasets collected using the iMotor digital platform using methodologies previously described (Mitsi et al, 2017;Wissel et al, 2017). In summary:…”

“…We demonstrated that by using a variety of upper limb functional tests iMotor differentiated PD subjects from healthy volunteers (HV) (Mitsi et al, 2017;Wissel et al, 2017). The objective of this paper is to provide preliminary evidence that artificial intelligence systems may allow one to discriminate PD patients from HV further and determine different features of the disease within a cohort of PD subjects.…”

The BRadykinesia Akinesia INcoordination (BRAIN) tap test: capturing the sequence effect

“…Adaptation of the test to better capture a distal sequence effect may be beneficial in a future iteration.BRAIN tap test parameters correlated only approximately with MDS-UPDRS part IIIscores. This could be because BRAIN tap test parameters such as KS (proxy measure for total taps), AT (dwell time) and DS (proxy measure for accuracy) capture aspects of bradykinesia not tested with MDS-UPDRS sub-scores (finger tapping, hand movements, pronation/supination) which focus on rhythm, slowing and decrement in amplitude[2,23]. IS provided the best differentiation between PD patients and controls.…”