CleveMed Blogs

Kinesia is a system for objectively monitoring and tracking the severity of Parkinson’s disease symptoms in conjunction with clinician evaluations using the Unified Parkinson’s Disease Rating Scale (UPDRS). The device uses tiny motion sensors (accelerometers and gyroscopes) to collect patient symptom data and, using a Bluetooth radio, wirelessly transmits that information to a PC. An addition to the system has just been released which includes automated tremor scoring based on the 0-4 scoring method of the UPDRS. Before Kinesia, there was no objective way to consistently track symptoms, making this a large advance in the way Parkinson’s disease patients are monitored.

The Kinesia patient unit is worn on the hand and wrist while patients follow video instruction for completing upper extremity motor tasks. After the completion of the tasks, algorithms in the software automatically score three tremor tasks for evaluating rest, postural and kinetic tremor on a 0-4 scale based on the UPDRS. In addition to the scoring being automated and repeatable, the scores are provided with better resolution than the whole numbers given with the UPDRS. Kinesia will assign scores such as 1.29, 3.75 or 0.84 to provide clinicians with a more exact picture of a patient’s symptoms. Reports can be generated and tremor symptom history can be viewed by their clinician, assisting them in making decisions regarding the progression of the disease, the patient’s current medication or other methods of treatment. A peer reviewed publication documenting clinical utility was accepted by The Movement Disorders Journal and is currently available online at http://www3.interscience.wiley.com/journal/121634261/abstract

There are many other symptoms that affect PD patients outside of tremor, including bradykinesia (slowed movements or hesitations), rigidity, gait and balance issues and dyskinesias (wild, involuntary movements caused by an overabundance of dopamine in the brain – the result of a patient being overmedicated). Automated tremor scoring is only the beginning of the development of Kinesia . Researchers at CleveMed are in the process of conducting a large clinical trial involving three movement disorders centers and one hundred fifty PD patients. The data collected during this study will aid in the development of algorithms for automated scoring of bradykinesia and dyskinesias. The overall goal is to include scoring for a large majority of the motor symptoms that affect PD patients.

Kinesia is a compact patient worn device that was developed to measure and assess the severity of the motor symptoms associated with Parkinson’s, including tremor and bradykinesia. For more information on Parkinson’s, click here. Currently, symptoms are assessed using a subjective rating system called the Unified Parkinson’s Disease Rating Scale, or UPDRS. During a typical exam, patients are instructed to perform a series of motor tasks for evaluating symptoms. While the tasks are completed, a clinician watches and visually assess the symptoms, assigning a 0-4 score based on the severity with 0 being the absence of symptoms and 4 being the most severe.

Because of the subjective nature of the UPDRS, there is definitely room for error. Studies have shown that clinicians can score the same symptom severity differently on different days and different clinician scores can vary for the same severity level. Also, patient’s symptoms can vary greatly throughout the course of a day and a one time clinical visit can not capture these fluctuations. It is important to have a method that objectively and consistently tracks patient’s symptoms at the clinic and at home.

Better tracking of symptoms can be incredibly helpful for Parkinson’s patients. Medication is usually the first method of treating symptoms and there is a fine line between under-medicating a patient which can cause symptoms to still persist, prescribing just the right amount and over-medicating a patient which causes a patient to become dyskinetic, or to have wild involuntary movements.

Kinesia is a device that is worn on the hand of the patient while they complete tasks for assessing tremor and bradykinesia. The device then, using algorithms built into the software, automatically assigns a 0-4 score for the tasks. Kinesia provides a consistent repeatable method for evaluating and scoring symptoms and more objectively track the progression of the disease. The device can also be sent home with a patient and the tasks completed at regular intervals to monitor the fluctuation of the patient’s symptoms. Tracking these fluctuations with Kinesia could assist a clinician in regulating medication time and dosage, leading to increased time without symptoms and less of a risk of under or over medicating.

The latest version of Kinesia was just released in January, so check back regularly for updates on the device being used in the field, current clinical trials and new uses for Kinesia. Ultimately, the hope is to assist in creating an improved quality of life for Parkinson’s patients in the US and around the world.

In-lab sleep testing requires extensive resources: onsite staff, medical equipment, and a full bedroom set. Not only is this an additional expense for insurance payers, but the unfamiliar sleep setting can affect the patient’s normal sleep patterns and skew the test results. Expanding the labs to home sleep testing solves many of these problems.

Familiar Environment:

While some extreme conditions still require in-lab sleep testing, many patient populations are well suited for home sleep diagnostic testing. These groups include those tested for occupational reasons, patients with a high probability of sleep apnea, the home bound and those suffering from chronic pain. The unfamiliar in-lab environment can lead to increased anxiety for the patient and inconvenience to those caring for them. For patients with chronic pain who experience difficulty in traveling to a sleep lab. It also is more convenient for the patient’s caregiver who would normally be needed to accompany them during the overnight study. As the desire for home testing continues to grow, new technology will continue to improve diagnostic devices that will increase the reliability of home testing and will expand the number of patients that can be successfully tested in the home. Furthermore, moving a patient who requires a paid medical assistant can be expensive for the patient and/or the insurance payer.

Affordability:

The changing reimbursement and acceptance of home sleep testing by insurance payers and sleep professionals will open up opportunities for improved patient care and will provide sleep labs with a means to expand the reach of their sleep services.

Traditional Sleep Labs Can Expand:

In addition to these benefits for the patients, traditional sleep labs will also benefit from expanding their sleep services to include home testing. Typically overcrowded labs will only have deal with those who require in-lab testing, and they can service a larger total volume of patients since they do not all need to be onsite. Each patient population can then receive a faster diagnosis and therefore faster treatment initiation, without the need for additional beds for the sleep lab. The traditional sleep labs, by incorporating home sleep testing, dramatically improve the care for their patients and the ease of diagnosis for their staff.

Overall, home sleep testing will greatly improve the patient care, and new technologies will continue to improve the quality of at-home care.

This post draws on the experience of several experts at CleveMed and is an adaptation from “Home Sleep Testing Can Improve Patient Care,” by Sarah Weimer, as seen in Sleep Diagnosis and Therapy, January-February 2008

Sleep disordered breathing includes a group of disorders, such as obstructive and central sleep apnea, that are characterized by repeated arousals from sleep as a result of a cessation in breathing, causing highly fragmented and poor quality sleep. Many studies point to a strong link between sleep disordered breathing (SDB) and a number of disorders, particularly cardiovascular disease. Several other studies are finding that adverse surgical outcomes are more frequent in patients with sleep apnea, as both anesthesia and surgery exacerbate airway instability and affect homeostasis in that patient population.

Dr. Nancy Foldvary from Cleveland Clinic Foundation suggests that patients with sleep apnea may be at increased risk for postoperative complications with a greater need for intensive monitoring. Since SDB is a complicating factor in many surgeries, the ability to conveniently conduct a sleep study in those settings can improve the peri-operative management of care, particularly for bariatric and cardiac surgery patients who have high prevalence of obstructive sleep apnea (OSA) (Another potential application for wireless PSG is to diagnose those inpatients with cardiovascular disease who are also suspected of having OSA).

Dr. Nancy Collop with John Hopkins University summarizes that there is an urgent need to improve the diagnosis of sleep disordered breathing in surgical patients in order to avoid complications intraoperatively and postoperatively.

This post draws from the opinions of experts featured in the following news article: CleveMed receives $2.3 million in NIH funding for inpatient diagnosis of sleep disorders in cardiovascular surgery patients