CleveMed Blogs

To demonstrate the benefits of Kinesia, a compact patient worn device for assessing Parkinson’s disease (PD) motor symptom severity, and the tremor scoring feature recently released, CleveMed has launched the new interactive website UPDRS.CleveMed.com.

Parkinson’s disease motor symptoms are typically assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS), a subjective rating scale in which clinicians visually assess patient tremor symptoms and assign a 0 to 4 score based on severity. UPDRS.CleveMed.com highlights some of the reliability and consistency issues of the current method of PD patient evaluation.

The CleveMed UPDRS Scoring Challenge is an online educational tool intended for movement disorder clinicians and researchers, patients, caregivers or anyone interested in Parkinson’s disease motor symptom evaluations. The interactive site allows a visitor to view and rate a series of videos displaying Parkinson’s disease patients performing tasks for evaluating tremor. After each short video is complete, the user enters the score they feel is appropriate ranging from 0 to 4, 0 being the absence of symptoms and 4 being the most severe, and the next video starts. Once the twelve videos are scored, the user scores are compared to scores from two movement disorder specialists for the same videos. This demonstrates the variability in scores that can occur between different clinicians for the same patient, which is an issue with the subjective UPDRS. Scores are also compared to the automated scoring provided by Kinesia which demonstrates the benefits of having a device that can provide consistent, repeatable results.

Everyone is encouraged to try the site out and see how you would perform again actual clinicians when rating tremor symptom severity. If you find it interesting, please pass it along to others who may feel the same. Any comments, suggestions or questions on the site are welcome at any time.

As sleep techs, we analyze the sleep of our patients to ultimately help guide them to improved overall quality of sleep throughout their life both in and out of the sleep center. In order to accomplish this, I have listed a few tips that the sleep tech should keep in mind:

1. Being Considerate of Patient’s Needs

This means accommodating the patients’ own sleep schedules as much as possible, using a bundling of wires that makes them feel as comfortable as possible, assisting when needed, to give them an utmost sense of ease during the study. It is ideal for the Tech to control the environment but allow the patient a measure of his/her own sense of control.

2. Determining the Use of “Tools”

The prudent tech recognizes that no matter what comforts are offered, the patient is still outside their natural sleeping environment, fitted with electrodes and wires, and hence may not as comfortable as they wish to be. It helps to remember that beyond the basic amenities, every comfort offered to the patient during a study is a tool. It is better to not offer the patient every tool all at once, because in doing so, it leaves the tech with fewer tools to work with if things go bad. For example, automatically starting all patients with humidity might not be the best approach. It is better to talk with the patients first to feel what their comfort levels are. Another example of this could be Respironics’ C-flex feature. If the tech uses it without needing to, and the patient still has a difficult time, it is one less tool the tech can offer. It is best to use the minimum number of tools until deemed necessary.

3. Knowing Expectations

Know the expectations of your facility, doctors, and supervisors. Having worked in a wide variety of centers myself (Hospital, IDTF, Physician Owned, Privately Owned, PRN, FT, Nights, Days, Management) it is apparent that expectations vary by site. In order to provide the best patient care, there needs to be excellent communication and delivery of expectations. This goes both ways, so let your supervisors know what you expect from them, keeping an open working relationship.

4. Continuing Learning

It is most important to recognize that the field of sleep is rapidly changing, and the only way to keep up with these changes is through ongoing education. If you do not receive this from your current center/lab, take it upon yourself to seek out education whenever & wherever possible. Some good sources for this are binarysleep.com, aastweb.org, brpt.org (from the sleep tech’s perspective), and cpaptalk.com (from the patient’s perspective). Push yourself to new experiences. The more knowledge and experience you have, the more bargaining power you have. For example, many techs don’t like to score studies at night. Not only does this make you more valuable as a tech, but it makes you more aware of the patient condition and the sleep study in its entirety. If you offer to help out more, you could find yourself learning something along the way as well as perfecting your skills.

Sleep techs, you are welcome to add to this article with your comments.

A sleep study (also called a polysomnogram) is a test that records your physical state during various stages of sleep and wakefulness. It provides data that are essential in evaluating sleep and sleep-related complaints, such as identifying sleep stages, body position, blood oxygen levels, respiratory events, muscle tone, heart rate, amount of snoring and general sleep behavior.

Arriving at the sleep lab and initial paperwork:

If your physician feels you need a sleep study you will make an appointment for a test that will take place at night in the sleep center. After your arrive at the sleep center, you will be asked to complete questionnaires on your sleep the night before and a brief sleep history. Many sleep centers offer a video or other information about the sleep study or specific disorders such as sleep apnea, since a significant percentage of those who have sleep tests are suspected to have sleep apnea. The video may also address what you should expect during the sleep test to ease any concerns that you may have. Then you will be asked to change into nightclothes.

Applying electrodes:

After changing, the polysomnographic technologist will connect you to the electrodes that will record your brain waves and muscle movements throughout the night. This will not hurt or break the skin. The electrodes are placed in specific areas and applied with water-soluble gel and tape. The electrodes record brain waves, muscle movement, rapid eye movement (REM), air intake, and periodic limb movement. A microphone attached to your neck records snoring, and two belt-like straps around the chest and lower abdomen monitor muscle movement during breathing. Despite all of the equipment, most people say it doesn’t disrupt their sleep.

Testing electrodes and Monitoring:

After settling into bed, your technician may go to a monitoring room and ask you over an intercom to perform certain tasks that will show the electrodes are recording properly. You will be observed on a television monitor during the night, but that is to allow the technician to note your body movements during sleep.

Follow up:

A follow up appointment with your referring physician may occur after your initial sleep study. If your physician feels you have symptoms requiring a second night in the sleep lab; this may be scheduled prior to your follow up. During the follow up, the physician will discuss results, and may prescribe treatment for a sleep disorder.

List of things to do the day of your test:
• Do not drink alcohol or caffeine.
• Arrive on time, since setup takes some time.
• Bring a pair of comfortable bedclothes. Some patients like to bring their own pillows or blankets as well.
• Bring any medications you are being prescribed or will need to take during the hours you will be at the sleep center.
• Generally, you are asked to obtain a normal nights sleep the night before the test. Do not take naps on this day.

As promised in my earlier post “Tips for a Good Night’s Sleep” here is a guide to making your own sleep log. We discussed that if you can’t seem to get quality sleep despite efforts and suspect that you might suffer from a sleep disorder, it’s a great idea to create a sleep journal. This is a great source of information for you and for any medical professional you talk to about you sleeping problems. Some physicians suggest recording your sleep information for a week while others recommend recording for two weeks.

Make a chart (as shown below) where you record the following for a week or two:

• Day/Date
• Time in Bed: The final time of day you got into bed to go to sleep.
• Time out of Bed: The time of day that you got out of bed for the last time in the morning.
• Time Asleep: The estimated time of day you feel asleep for the first time.
• Awake Time: The estimated time of day you awoke for the last time in the morning.
• Anything Unusual (bathroom at night or trouble sleeping etc.)
• How many caffeinated beverages did you have that day?
• When was your last meal before bed?

Also note your height, weight and any medications you are on. I have attached a sample sleep journal below.

Also, thanks to everyone who participated in the comments and discussion regarding Tips for a Good Night’s Sleep!