The Utility of Objective Assessment Technologies in Parkinson’s Disease
Parkinson's Disease , Robotic Assessment , Kinarm
Parkinson’s Disease (PD) is the second most common neurodegenerative disorder worldwide and is characterized by the heterogeneous representation of bradykinesia, rigidity, tremor, and postural instability. Patients with PD also experience non-motor complications like autonomic, behavioral/mood and cognitive dysfunction. Treatments for PD include dopamine replacement therapies (DRTs) and deep brain stimulation (DBS). Currently, the assessment and progression of these signs and symptoms and effects of treatment are assessed by clinical scales like the Movement Disorder’s Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). However, clinical scale assessment is limited by their use of coarse categorical variables and subjective nature creating issues with inter-rater and intra-rater reliability. In addition, clinicians often rely on patient interviews to assess cognitive status. Technologies that assess a spectrum of PD signs and symptoms have the potential to complement the current clinical assessment of PD by providing objective measures free from clinical bias. However, many available objective assessment technologies focus on the quantification of a single sign or symptom of PD and oversimplify the complexity of the disease. In this project I tested the utility of the Kinarm robotic platform and a movement tracking touchscreen in the assessment of PD motor and non-motor signs and symptoms. First, I explored the Kinarm robot’s ability to quantify bradykinesia, rigidity and postural instability and generate cumulative motor scores to determine the effects of DRTs and STN-DBS. Next, I used a reverse reaching task to simultaneously assess the motor and cognitive effects of STN-DBS. I converted this task onto a movement tracking touchscreen to allow for portable assessment. Then, I tested if the reverse reaching task could be used to confirm electrode localization in the STN. Finally, I tracked the longitudinal assessment of PD motor symptoms over time. Both technologies were shown to quantify bradykinesia, loss of response inhibition and treatment with DRTs. The Kinarm robot was also able to quantify rigidity, postural instability, the effects of DBS electrode implantation and the effects of DBS of the subthalamic nucleus. In sum, these technologies can aid in the titration of PD treatments and provide clinically relevant information regarding patient disease profiles.