Stanford University School of Medicine researchers are developing a device called KeyDuo for remote monitoring of Parkinson’s disease. Photo by Helen Bronte Stewart
The number of people with Parkinson’s disease has doubled worldwide over the past 25 years. However, treatment and monitoring of this neurological disease appears to have lagged behind by decades. Clinicians typically use subjective rating scales to measure disease severity, but a shortage of doctors trained to treat Parkinson’s can mean patients miss clinic visits for months or even years.
This puts patients in a difficult situation, often not knowing how fast their disease is progressing or if their medication is working properly.
Now, researchers at the Stanford University School of Medicine have developed a simple portable device combined with a smartphone-connected platform that patients can use at home to measure the severity of their Parkinson’s disease symptoms in a quantitative and reproducible way.
It converts minute details about finger pressure into data that clinicians can use to remotely guide Parkinson’s treatment.
The research was led by Helen Bronte Stewart, MD, MSE, the John E. Cahill Family Professor and professor of Neurology and Neuroscience. The research, described in two recent papers, has received funding to further develop the technology from a series of awards, including a Wu Tsai Neuroscience Institute “Neuroscience: Translate” grant, participation in the Fogarty Innovation Program, and a Stanford Medicine Catalyst Award.
We spoke to her to find out more about how these technological advances, consisting of a digital platform called Quantitative DigitoGraphy Care and a small device called KeyDuo, will make a difference for patients and clinicians. This interview has been edited for clarity and length.
What are the current challenges in monitoring the progression of Parkinson’s disease?
Historically, monitoring Parkinson’s has relied on in-person exams, where tremor and bradykinesia (slowness of movement) are graded on a somewhat subjective clinical rating scale, while stiffness and stiffness are measured by the examiner passively rotating joints and describing their tightness.
In research, Parkinson’s exams are typically videotaped and viewed by an outside examiner to minimize variability in assessment. But that means all the data you get from physically touching the patient and feeling their joints is quickly lost. For a long time, there has been a huge unmet need for clinicians to have high-resolution metrics on Parkinson’s disease.
These technical challenges, plus the fact that only about 40% of Parkinson’s patients see a neurologist, often with months between appointments, make it extremely difficult for patients to access treatment and often leave them to fend for themselves and manage their own medications.
Only fellowship-trained movement disorder specialists (who account for 0.14% of physicians) receive extensive training in the clinical rating scales used to evaluate the motor symptoms of Parkinson’s disease. Very few physicians are confident in managing Parkinson’s disease.
Furthermore, the lack of objective and accurate measurements has hindered clinical trials for Parkinson’s disease, impeding the development of new treatments.
If you have diabetes, we have better ways to monitor your blood sugar so you know exactly when and how much of your medication to take. We need the same thing for Parkinson’s.
Where did the idea for the tactile measuring device come from?
I was running a clinic for performers with dystonia (a muscle disorder musicians can develop that interferes with their ability to play). We built a computerized keyboard so that we could measure the condition, and by chance, we had a pianist who had Parkinson’s try it out. He tested it on days when he was taking his Parkinson’s medication and days when he wasn’t, and we noticed a difference based on the keyboard data.
What sets this device apart from other keyboards is that it features tension-engineered levers that don’t just measure the number of single taps of the lever, but can detect exactly how hard you’re pressing, how fast the lever is moving, and how far down it goes.
As we worked with more Parkinson’s patients, we realized that with just two levers we could measure patients’ joint stiffness, which had never been measured before without an in-person evaluation. Patients tap repeatedly with alternating fingers on the levers for 30 seconds, and the device creates a real-time, high-resolution movement outcome assessment that doctors can review to determine treatment adjustments.
Can patients stay at home for monitoring?
Yes, patients can carry the device wherever they go. It’s light and fits in the palm of their hand. It works with a mobile app on their smartphone or tablet so they can take the test anytime, anywhere, and the results are sent in real time to the prescribing healthcare provider.
What has recent research found on this?
The first new paper, published in June in the journal npj Parkinson’s Disease, covered the technology and described a full set of tools to connect it to electronic medical record systems.
We followed the first eight patients who used the full system at home for 30 days, testing their symptoms twice a day, and found that it gave us insight into how their symptoms changed in response to the medication, not just on a given day, but over days and weeks.
In a recent paper published in the journal npj Parkinson’s Disease in August, we showed that our device can also detect the involuntary tremors associated with Parkinson’s disease.
This has previously been very difficult to capture even in clinical trials, but using statistical modeling, our group has shown that we can identify tremors with 98% sensitivity in both the timing and amplitude of the device’s lever presses.
Will this help standardize outcomes and improve patient care?
Results from the device are objective and validated, avoiding subjective rating scales and rating variability. The device also allows physicians to better manage patients between occasional in-person appointments. It also creates rich data points for physicians to evaluate exercise results and potential trends. Patients are suddenly interacting more frequently with their healthcare providers by using the tool remotely.
We hope that such continuous exercise monitoring systems will have a similar effect to continuous glucose monitoring for diabetes, allowing people to manage their medications more carefully and allowing healthcare professionals to care for patients between infrequent doctor’s visits.
For primary care physicians, who are often unaware of typical Parkinson’s disease testing methods and often feel anxious about monitoring patients with the condition, this tool could provide the data they need to improve their skills.
This kind of tool could also enable researchers to study new Parkinson’s drugs, using fewer participants, at less cost, and in less time to obtain data on early-stage treatments.
One reason is that it will be much easier to recruit patients and send devices without requiring multiple visits to specialized centers, and another reason is that these high-resolution indicators will make it clearer whether the treatment is working.
Further information: Shannon L. Hoffman et al., “Comprehensive Real-Time Remote Monitoring of Parkinson’s Disease Using Quantitative DigitoGraphy,” npj Parkinson’s Disease (2024). DOI: 10.1038/s41531-024-00751-w
Aryaman S. Gala et al., “Digital signatures of episodic tremor in Parkinson’s disease,” npj Parkinson’s Disease (2024). DOI: 10.1038/s41531-024-00754-7
Courtesy of Stanford University
Source: Q&A: New technology could improve care for Parkinson’s patients (September 24, 2024) Retrieved September 24, 2024 from https://medicalxpress.com/news/2024-09-qa-tech-parkinson-patients.html
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