Summary rehab technology: assessment & training in PD
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Course
Rehabilitation technology in neurological pop
Institution
Katholieke Universiteit Leuven (KU Leuven)
Summary of the assessment & training lesson in PD given by Prof. M. Gilat from the subject of rehab technology. It is a summary of the powerpoint slides and additional items noted during the lesson. The slides were in English and my own notes are always in Dutch as much as possible. It is therefore...
Rehab technology: technology based assessment and
training for PD
INFO EXAMINATION
- 3-5 MC questions PD / +-30 MC total
- Theory (50%)
o Course material for PD
Slides
Article on VR in PD – see pdf Canning et al 2020
- Group written report + oral presentation (50%)
ASSESSMENT OF GAIT&BALANCE IN PATIENTS WITH PD USING WEARABLE TECHNOLOGY
INTRODUCTION WHY WEARABLE TECHNOLOGY IN PD?
Waarom wearable technology gebruiken
- Gedetailleerdere info & acurratere info
Self report ≠ Capacity ≠ Performance
Ecological validity
Discriminative ability (aid diagnosis)
Objective outcome measure to assess physical activity
Objective outcome measure to assess symptoms
Objective outcome measure to assess responsiveness to therapy
Objective outcome meaure to predict conversion (diagnosis/symptom)
Waarom gebruiken??
- Eliminate human error / bias
- Safe time and money
Voornamelijk PD maakt gebruik van wearables
Slechte correlatie tussen hoe gang echt is en gemeten in een lab
CAPACITY ≠ PERFORMANCE
- Capacity
Bste van P wanneer gemeten in een lab/ thuis met supervisie
As tested in the lab supervised
As tested at home supervised
= TEST met instructies en supervisie van een therapeut
- Performance
Zonder begeleiding/ supervisie
Hopen meest natuurlijke gangpatroon & gedrag van P zien
Monitored during actual free living unsupervised
Fysieke capaciteit die de P gebruikt in de functionele omgeving zonder instructies/supervisie
Technology can help us to bring capacity and performance measures closer together
Nala Melis Pagina 1
, Rehab technology: technology based assessment and
training for PD
Motorcircuit gemodulerd (hoofdzakelijk) door substantia nigra dopamine
- Indien voldoende dopamine in stritaal circuit = bewegen zonder na te denken
- PD= dopamine neuronen degeneratie
1st aantasten posterieure deel striatum, nadien ook anterieur deel
- Motorcircuit
Motor cortex
Cerebellum
Striaum
brainstem
Verlizen mogelijkheid automatsche bewegingen putamen vnl. verantwoordelijk voor auto.bew
- Gaan andere circuits gebruiken: profontale cortex + parietale cortex
- Extra visuele & sensorische info om beweging te begeleiden
- Veel meer aandacht nodig
- Gaan na testen bij thuiskomen wandelen zonder extra aandacht circuit
Ciruit vraagt veel energie
Roblemen terug bovenkomen
White coat effect
- Dokter kijkt toe wanneer P beweegt/ wandelt
- P is bewuster van beweging
- Geen extra circuits gebruiken
- Geen echte representatie van problemen krijgen
Bij welke test doet de PD patiënt het beste?
- Capaciteit > performance
- Meer aandacht bij capaciteitstest (cognitief)
Andere P met andere aandoening kunnen thuis in vertrouwde omgeving net beter doen = meer op gemak.
1. INERTIAL MEASUREMENT UNIT
1.1. VALIDATION
Wearables op iemand plaatsen & zo echte performance in thuissituatie bekijken
Hoe meer sensoren= hoe accurater data= hoe ↓ gebruiksvriendelijk
Early validation accuracy Mid-stage validation clinical efficacy
Nog steeds white coat effect
Free-living
Heel grote EU-
trail
Cohort validatie
studie
, Rehab technology: technology based assessment and
training for PD
Most commonly used wearable sensors for gait & postural instability in PD in research settings
IMU – 3-axial
- Gyroscope: position against gravity
- Magnetometer: detection of environment
o Ook positie van li en re been tov elkaar, adhv magnetisch veld
spatiele componenten
- Accelerometer: body acceleration
- APDM- opal system
5 lichaamssensoren
Heel P vriendeljk
Data processing in real time
- CuPiD: can connect with Bluetooth connections to a smartphone
Single accelerometer (ACC)
- Activity-monitoring with one single sensor
- Applied at the lower back (dimension) with adhesive tape
- Meet 7 dagen de activiteit
- Gegevens van lange periode met maar 1 IMU
These measures are becoming smaller and cheaper and now can be used wirelessly and in combination
with smartphone or laptop processors.
1.3. WHY DMO’S PARTICULARLY IMPORTANT FOR PD?
DMO= digital measurement outcome
These pictures provide simplified representations of compensatory networks.
- We can assume that sensory and cognitive compensatory resources will become more integrated with
the motor system, as an adaptive response in early disease. In moderate disease, compensatory NWs
likely become increasingly entangled. And eventually in later stage PD, brain networks turn out to
betrokken bij het ziekteproces may incur ongewenste adaptatie. What I am describing here is still
speculative of course, but the point I am making is that this left-over resilience will determine how
people respond to training.
De-automaticity and loss of motor vigour
- Compensatory networks more active in PD (dependent on sensory or cognitive networks)
- Parkinson is a learning disease with retention and transfer deficits
Effect DMOs
- Spontaneous automatic behaviour and mitigate the ‘white coat’ effects during assessment
- May help stimulate movement and exercise
- May help learning retention and transfer to other settings
PHYSICAL ACTIVITY IN PD – DMO’ S
There are discrepancies and we still know relatively little
- Self-reported physical activity ≠ objectively measured
- Self-reported exercise ≠ actual exercise compliance
o The under-adhering tend to over-report compliance
Due to DMOs we now know that
- Mild to moderate PD are on average 30% ↓ active > healthy control
Nala Melis Pagina 3
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