CleveMed Blogs

Hello! My name is Danielle Madere, a recent graduate from Illinois Institute of Technology with a bachelor’s degree in biomedical engineering. In the past month, I was lucky to join the CleveMed family as their newest biomedical engineer.

My first two weeks on the job consisted of gaining familiarity with some of our devices: Kinesia, KinetiSense, and the BioRadio. There was also much training, many meetings, and assisting with grant writing.

In the coming months, I will be focusing a lot of my time on clinical studies for several movement disorder monitoring products that we are currently focusing on, specifically ETSense, ParkinStep, and PDRemote. I will be organizing meetings with patients, collecting symptom data, and performing some preliminary analysis to ensure the data we are collecting is valid.

I am very excited to work with CleveMed’s Movement team because I truly believe that our devices, such as Kinesia HomeView, will revolutionize the way clinicians treat movement disorders such as Parkinson’s disease. Presently, Parkinson’s disease symptoms are rated by the clinician, based solely on the clinician’s subjective opinion of the severity (UPDRS). Additionally, clinicians only see the patient for a very limited window of time in their office, which does not provide significant insight into the symptoms a patient faces at home, where treatment really matters. Kinesia HomeView will allow clinicians to observe the quality of life of a patient throughout the course of a day in the comfort of their own home, and adjust medication doses and frequency accordingly.

The more closely I interact with Parkinson’s disease and essential tremor patients, the more desperately I want to help improve their quality of life, and CleveMed gives me that opportunity, which I am eternally grateful for.

In recent years, exercise has steadily received more attention for its benefits in Parkinson’s disease (PD). Not only improving general health, but also alleviating PD-specific motor symptoms such as tremor and bradykinesia. Refer to previous blog entry to learn more about the progression of treatment options for PD patients as the disease advances and the potential benefits and advantages of incorporating exercise into the daily routine.

Continued efforts in research studies are being performed across the country to understand the neurophysiological link between exercise and PD-specific motor symptoms. However, clinicians are also promoting exercise to encourage patients in taking a more proactive role in their treatment. One such example, Drs. Riley and Walter at the University Hospital (Cleveland, OH) are hosting the Parkinson’s Disease Boot Camp, a hands-on learning experience highlighting exercise techniques from experts in the field (physical training, rehabilitation, dance, yoga, etc). The event will be held on Saturday May 22nd, 2010. For more information, click here!

CleveMed will also be participating in the event, using our Kinesia™ system to rate participants before and after exercise. Kinesia uses motion sensor technology to evaluate PD motor symptoms and advanced algorithms to automatically generate severity scores.

One of the most difficult aspects of monitoring Parkinson’s disease (PD) motor symptoms, is that the severity of tremor and bradykinesia (slowed movements) greatly fluctuates throughout the day.

When medication is at its peak effectiveness, the patient is said to be “On.” Similarly, when medication has completely worn off, the subject is said to be “Off.” Symptoms are often worst first thing in morning, but improve after the first dose of medication. However, as the medication wears off, symptoms return mid-day. These cycles of waxing and waning motor symptoms continue throughout the day. Controlling these “On” and “Off” cycles can be difficult, as patients with PD are typically evaluated in the neurologists’ office, which only allows the physician to capture a snapshot of motor symptoms. Furthermore, patients typically are instructed to refrain from taking medication the night prior to the office visit. A state of anxiety in this condition may amplify PD symptoms during motor evaluation. Monitoring motor symptoms at home would provide clinicians with improved tracking of these complex motor fluctuations and in-turn optimize medication dose to improve patient quality of life.

Kinesia is a compact wireless system developed by CleveMed to quantify movement disorder symptoms. In clinical trials, Kinesia objectively quantified tremor and bradykinesia in PD patients in the clinic. Objective symptom ratings output by the Kinesia system were highly correlated to clinician ratings. CleveMed has recently begun a clinical study in which the Kinesia system is being used throughout the day, at home, by patients with PD. Preliminary results demonstrate that Kinesia can capture the “On” and “Off” motor symptom fluctuations in a subject’s home. Monitoring PD symptoms on a more continuous basis at a patient’s home should improve clinical outcomes and decrease costs especially for disparate patient populations in areas not in close proximity to movement disorder specialists.

While most people know what tremor is when they see it, they may not realize that many different types of tremor exist and why it is important to recognize them. The current gold standard of visual assessment may be blind to subtle characteristics unique to different tremor types. Tremor is a common motor symptom associated with a number of neurological disorders. Defined as rhythmic, involuntary, to-and-fro movements of a body part, tremor is most common in the hands, but can occur in the arms, legs and head. Tremor can be an especially debilitating movement disorder symptom and make activities of daily living, such as dressing, eating and writing, difficult or sometimes impossible without the help of a family member of caretaker.

Several movement disorders produce tremor as a motor symptom. The two most common are essential tremor (ET) and Parkinson’s disease (PD). ET is a common disorder characterized by uncontrolled trembling of the hands and often involuntary nodding of the head. It is the most prevalent movement disorder, affecting nearly 10 million people in the United States alone. PD is a progressive disease associated with the destruction of brain cells that produce dopamine and characterized by muscular tremor, slowing of movement, partial facial paralysis and peculiarity of gait and posture. There are currently about 1 million people in the United States living with PD.

In addition to different disorders producing tremor, different tremor types may exist within a particular disorder, each with unique physical characteristics. Two of these important characteristics are amplitude and frequency. Amplitude refers to how big the movement is while frequency refers to the speed or rate at which the oscillation is happening. Rest tremor is one type that occurs when the affected limb is completely at rest. Resting tremors occur at a specific frequency, usually 4 – 7 Hz, and are most commonly associated with PD, but in some cases found in other movement disorders. Postural tremor occurs when a specific body part is held motionless against gravity, such as extending the arms out, pointing with the hands or sitting upright without back support. Postural tremor typically occurs at a frequency of 9 – 11 Hz and can be associated with PD or ET. Other types of tremor include kinetic tremor, which occurs during a voluntary movement such as writing, drinking or eating and intention tremor, which is unique in that is occurs during a visually guided movement toward a target destination.

Distinguishing tremor types and quantitative features is very important for research, clinical judgments and intervention efficacy. CleveMed has developed a device called Kinesia™ that can be used to detect and monitor subtle differences in tremor characteristics. Kinesia is a small wireless device worn on the patient’s finger and wrist to monitor three dimensional motion. Currently being evaluated in several clinical studies around the United States, this device is intended to help standardize tremor evaluations and provide clinicians with a tool to better quantify tremor features when the signs are too subtle for clinical differentiation alone. Improving and standardizing the clinical evaluation of tremor may ultimately improve the understanding of tremor subtypes, increase efficacy of interventions and maximize patient quality of life.