TUG Test Instrumentation for Parkinson’s disease patients using Inertial Sensors and Dynamic Time Warping

Abstract

The Timed Up and Go (TUG) test is a clinical tool widely used to evaluate balance and mobility, e.g. in Parkinson's disease (PD). This test includes a sequence of functional activities, namely: sit-to-stand, 3-meters walk, 180° turning, walk back, and turn-to-sit. The work introduces a new method to instrument the TUG test using a wearable inertial sensor unit (DynaPort Hybrid, McRoberts B.V., NL) attached on the lower back of the person. It builds on Dynamic Time Warping (DTW) for detection and duration assessment of associated state transitions. An automatic assessment to substitute a manual evaluation with visual observation and a stopwatch is aimed at to gain objective information about the patients. The algorithm was tested on data of 10 healthy individuals and 20 patients with Parkinson's disease (10 patients for early and late disease phases respectively). The algorithm successfully extracted the time information of the sit-to-stand, turn and turn-to-sit transitions.

Evaluation of smartphone‐based testing to generate exploratory outcome measures in a phase 1 Parkinson's disease clinical trial

“…Although numerous commercial digital biomarker devices are available, common consumer technologies such as smartphones have the advantages of widespread availability, low cost, and high sensor quality. Several pilot research studies have successfully developed smartphone applications for PD . In these pilot studies, proof of concept was typically established in a clinical setting by demonstrating significant differences between individuals with PD and healthy controls, and/or significant relationships between the sensor‐based measures and the International Parkinson and Movement Disorder Society–Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS‐UPDRS) clinical gold standard .…”

“…Several pilot research studies have successfully developed smartphone applications for PD. 1,[9][10][11][12][13][14][15][16][17] In these pilot studies, proof of concept was typically established in a clinical setting by demonstrating significant differences between individuals with PD and healthy controls, and/or significant relationships between the sensor-based measures and the International Parkinson and Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) clinical gold standard. 14,[18][19][20][21][22][23][24] For example, Kassavetis and colleagues 18 tested 14 PD participants (mean disease duration 5 3.7 years) with the MDS-UPDRS 25 and a custom Android application with the following active tests: resting, postural and kinetic tremor, pronation-supination, leg agility, and fingertapping.…”

Technical and clinical view on ambulatory assessment in Parkinson's disease

“…Well‐established functional tests instrumented with IMUs such as the TUG , spontaneous sway, comparable with the Romberg test , and the sit‐to‐stand test have been the object of a number of validation studies. These have released decisive answers on the potentials of accelerometers and gyroscopes to characterize and objectively quantify functional deteriorations in patients with PD compared to controls , monitor disease progression , and objectify treatment outcomes (e.g., drugs, neurosurgery, or rehabilitation) .…”

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

“…Also in this case different approaches have been suggested and studied, in some cases, the sensors have been integrated with other sensors of the same kind conforming Body Area Networks (BAN) able to cover a wider range of symptoms or improving the accuracy in the detection and assessment of symptoms. In other cases, they were integrated with other different sensors or devices conforming more complex systems such as closed-loop system (HELP project [438]), telehealth systems (PERFORM [14]- [16] or SENSE-PARK [333], [334]), platforms to deal with the FoG using cueing (CuPID [408], [409] or REMPARK [453], [455]), complex system for tremor suppression (NEUROTREMOR [463])and also they have been integrated into a web-based applications enabling home monitoring of patients with (PD) using wearable sensors (Mercury [450], [452]). …”

“…The developed algorithm was based on the Dynamic Time Warping (DTW) for detection and duration assessment of turn state transitions, while a 1-dimensional DTW is used to detect the sit-to-stand and stand-to-sit phases. The feature set was a 3-dimensional vector which consisted of the angular velocity, derived angle and features from Linear Discriminant Analysis (LDA) [333], [334]. Also, using the cost inertial sensors attached on the lower back, Al-Jawad et al (2013) presented a quaternion-based extended Kalman filter (used as a data fusion algorithm) to characterize the postural steadiness during stance.…”