Parkinson's disease management through ICT : : the REMPARK approach / / Joan Cabestany, Angels Bayes, editors.

• Superior document: River Publishers series in biomedical engineering
• TeilnehmendeR: Cabestany, Joan,; Bayes, Angels,
• Place / Publishing House: Gistrup, Denmark ;, Delft, the Netherlands : : River Publishers,, 2017.; ©2017
• Year of Publication: 2017
• Edition: First edition.
• Language: English
• Series: River Publishers series in biomedical engineering.
• Physical Description: 1 online resource (250 pages) :; illustrations, tables.
• Notes: Includes index.

Parkinson's Disease (PD) is a neurodegenerative disorder that manifests with motor and non-motor symptoms. PD treatment is symptomatic and tries to alleviate the associated symptoms through an adjustment of the medication. As the disease is evolving and this evolution is patient specific, it could be very difficult to properly manage the disease.The current available technology (electronics, communication, computing, etc.), correctly combined with wearables, can be of great use for obtaining and processing useful information for both clinicians and patients allowing them to become actively involved in their condition.Parkinson's Disease Management through ICT: The REMPARK Approach presents the work done, main results and conclusions of the REMPARK project (2011 – 2015) funded by the European Union under contract FP7-ICT-2011-7-287677. REMPARK system was proposed and developed as a real Personal Health Device for the Remote and Autonomous Management of Parkinson’s Disease, composed of different levels of interaction with the patient, clinician and carers, and integrating a set of interconnected sub-systems: sensor, auditory cueing, Smartphone and server. The sensor subsystem, using embedded algorithmics, is able to detect the motor symptoms associated with PD in real time. This information, sent through the Smartphone to the REMPARK server, is used for an efficient management of the disease.

Table of Contents

Front Cover -- Half Title Page -- RIVER PUBLISHERS SERIES IN BIOMEDICAL ENGINEERING -- Title Page - Parkinson's Disease Management through ICT: The REMPARK Approach -- Copyright Page -- Contents -- Preface -- List of Contributors -- List of Figures -- List of Tables -- List of Abbreviations -- Chapter 1 - Parkinson's Disease Management: Trends and Challenges -- 1.1 Introduction -- 1.2 Impact and Strategies of PD at Different Stages -- 1.2.1 Patients in Early Stages -- 1.2.2 Moderately Affected Patients -- 1.2.3 Severely Affected Patients -- 1.3 QoL in PD -- 1.4 State of Art of Current Trends in PD Management -- 1.5 Needs and Challenges for Optimal PD Management -- 1.6 Conclusion -- References -- Chapter 2 - Objective Measurement of Symptoms in PD -- 2.1 Advancing Parkinson's Disease: Motor and Non-Motor Fluctuations -- 2.1.1 Motor Fluctuations -- 2.1.2 Non-Motor Fluctuations -- 2.2 Challenges in Documenting "Real-World" Fluctuating PD Symptoms -- 2.3 Emerging Technologies to Monitor Symptom Fluctuations -- 2.4 Challenges in the Use of Inertial Sensor Technology in Monitoring PD Symptoms -- 2.5 Conclusion -- References -- Chapter 3 - The REMPARK System -- 3.1 Introduction -- 3.2 REMPARK System Overview -- 3.2.1 The Immediate Level -- 3.2.2 The Mid-Term Level -- 3.3 Definition of the REMPARK System Main Characteristics -- 3.4 Subsystems Specification -- 3.4.1 Sensor Module -- 3.4.2 Auditory Cueing Subsystem -- 3.4.2.1 Gait guidance ACS functional description -- 3.4.2.2 Need of an adaptive ACS -- 3.4.3 Drug Delivery Pump Considerations -- 3.4.4 The smartphone Technical Requirements -- 3.4.5 The REMPARK Platform Architecture and Functionality -- 3.4.5.1 Important functional parts -- 3.4.5.1.1 Rule Engine -- 3.4.5.1.2 Disease Management System -- 3.4.5.2 Platform technical constraints -- 3.5 Conclusion -- References.

Chapter 4 - Assessment of Motor Symptoms -- 4.1 Introduction -- 4.2 Decision on the Most Relevant Symptoms to Be Detected and Assessed -- 4.2.1 Subjects -- 4.2.2 Questionnaire -- 4.2.3 Results -- 4.2.3.1 Analysis of the correlation between responses on clinical questions -- 4.2.3.2 Investigation of the clinical relevance of the motor symptoms in the three PD phases (i.e., mild, moderate and advanced) -- 4.2.3.3 Analysis of REMPARK utility for PD patients -- 4.2.4 Discussion and Conclusive Remarks -- 4.3 Methodology and Database to Monitor Motor Symptoms -- 4.3.1 An Artificial Intelligence Approach and the Need of Relevant Data -- 4.3.2 Protocol for the Database Construction -- 4.3.3 Gathered Database Description -- 4.4 Algorithmic Approach and Results -- 4.4.1 Dyskinesia Detection Algorithm -- 4.4.2 Bradykinesia Detection Algorithm -- 4.4.3 Tremor Detection Algorithm -- 4.4.4 Freezing of Gait (FOG) Detection Algorithm -- 4.4.5 Gait Parameters Estimation -- 4.4.6 Fall Detection Algorithm -- 4.4.7 ON/OFF Motor State Estimation -- 4.5 Conclusions -- References -- Chapter 5 - Sensor Sub-System -- 5.1 Introduction -- 5.2 Sensor's Data Processing Flow -- 5.3 Hardware Requirements -- 5.3.1 Memory Requirements -- 5.3.2 Sampling Frequency and Full-Scale Values -- 5.3.3 Time Restrictions on the On-Line Implementation -- 5.4 Sensor Device Components -- 5.4.1 Microcontroller -- 5.4.2 Accelerometer Details -- 5.4.3 Bluetooth Module -- 5.4.4 Power Management -- 5.4.5 External Memory Unit -- 5.5 Sensor Casing and Operation -- 5.6 Conclusion -- References -- Chapter 6 - User Interaction -- 6.1 Introduction -- 6.2 State of the Art/Competitive Analysis -- 6.3 Interaction Guidelines for Users with Parkinson's Disease -- 6.4 User Research and User-Centred Design Processes -- 6.5 Final Usability Tests -- 6.5.1 Research Questions -- 6.5.2 Sample.

6.5.3 Protocol, Script and Metrics -- 6.5.4 Results -- 6.5.4.1 Appointment test -- 6.5.4.2 Medication test -- 6.6 Conclusions after the User-Centred Process -- 6.7 Characteristics of REMPARK Smartphone Applications -- 6.8 Some Concluding Remarks -- References -- Chapter 7 - Actuator Sub-System: The Auditory Cueing -- 7.1 Introduction -- 7.2 Cueing Strategies for Gait in Parkinson's Disease -- 7.3 State of the Art: Competitive Analysis -- 7.4 REMPARK Auditory Cueing System (ACS) -- 7.5 Outcomes from Field Trials: Future Considerations -- 7.6 A Step Further in REMPARK: Automatic Drug Administration -- 7.7 Conclusion -- References -- Chapter 8 - Disease Management System (DMS) -- 8.1 Introduction -- 8.2 Disease Management System Application -- 8.3 DMS Functional Organization -- 8.4 Advantages Using the Disease Management System (DMS) -- 8.4.1 Advantages for the Clinical Team -- 8.4.2 Advantages for the Patients -- 8.4.3 Advantages for the Organization -- 8.5 Conclusions, Discussion and Vision -- References -- Chapter 9 - REMPARK System Assessment: Main Results -- 9.1 Introduction -- 9.2 Description of Main Communication Flows -- 9.2.1 Type of Transmitted Information -- 9.2.2 Security Aspects -- 9.2.3 Final Deployment and Implementation of the REMPARK Platform -- 9.3 Pilot for the REMPARK System Assessment: Description -- 9.3.1 Definition of the Pilots' Objectives and Eligibility Criteria -- 9.3.2 Design of the Study -- 9.3.3 Pre-Pilot Conclusions -- 9.4 REMPARK Pilots' Execution and Obtained Results -- 9.4.1 Performance of the System -- 9.4.2 Validity of the ON-OFF Detection Algorithm -- 9.4.2.1 The methodology -- 9.4.2.2 Validation of the ON-OFF diaries: available data -- 9.4.2.3 Results of the ON/OFF state detection -- 9.4.3 Non-Motor Symptoms Descriptive Analysis -- 9.4.4 Efficacy and Effectiveness of the Cueing System.

9.5 Health-Safety of the REMPARK System -- 9.6 Usability and User Satisfaction of the REMPARK System -- 9.7 Summary and Conclusions -- References -- Chapter 10 - Epilogue and Some Conclusions -- 10.1 Summary of PD Symptoms and the Influence on QoL -- 10.2 Existing Barriers of PD Management -- 10.3 The Role of the REMPARK System in the Context -- 10.4 Limitations of the REMPARK System -- 10.5 Clinical Applicability of the REMPARK System -- 10.6 As a Concluding Remark -- References -- Index -- About the Editors.