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      Wearable sensors objectively measure gait parameters in Parkinson’s disease

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          Abstract

          Distinct gait characteristics like short steps and shuffling gait are prototypical signs commonly observed in Parkinson’s disease. Routinely assessed by observation through clinicians, gait is rated as part of categorical clinical scores. There is an increasing need to provide quantitative measurements of gait, e.g. to provide detailed information about disease progression. Recently, we developed a wearable sensor-based gait analysis system as diagnostic tool that objectively assesses gait parameter in Parkinson’s disease without the need of having a specialized gait laboratory. This system consists of inertial sensor units attached laterally to both shoes. The computed target of measures are spatiotemporal gait parameters including stride length and time, stance phase time, heel-strike and toe-off angle, toe clearance, and inter-stride variation from gait sequences. To translate this prototype into medical care, we conducted a cross-sectional study including 190 Parkinson’s disease patients and 101 age-matched controls and measured gait characteristics during a 4x10 meter walk at the subjects’ preferred speed. To determine intraindividual changes in gait, we monitored the gait characteristics of 63 patients longitudinally. Cross-sectional analysis revealed distinct spatiotemporal gait parameter differences reflecting typical Parkinson’s disease gait characteristics including short steps, shuffling gait, and postural instability specific for different disease stages and levels of motor impairment. The longitudinal analysis revealed that gait parameters were sensitive to changes by mirroring the progressive nature of Parkinson’s disease and corresponded to physician ratings. Taken together, we successfully show that wearable sensor-based gait analysis reaches clinical applicability providing a high biomechanical resolution for gait impairment in Parkinson’s disease. These data demonstrate the feasibility and applicability of objective wearable sensor-based gait measurement in Parkinson’s disease reaching high technological readiness levels for both, large scale clinical studies and individual patient care.

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          A SELF-RATING DEPRESSION SCALE.

          W W Zung (1965)
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            Technology in Parkinson's disease: Challenges and opportunities.

            The miniaturization, sophistication, proliferation, and accessibility of technologies are enabling the capture of more and previously inaccessible phenomena in Parkinson's disease (PD). However, more information has not translated into a greater understanding of disease complexity to satisfy diagnostic and therapeutic needs. Challenges include noncompatible technology platforms, the need for wide-scale and long-term deployment of sensor technology (among vulnerable elderly patients in particular), and the gap between the "big data" acquired with sensitive measurement technologies and their limited clinical application. Major opportunities could be realized if new technologies are developed as part of open-source and/or open-hardware platforms that enable multichannel data capture sensitive to the broad range of motor and nonmotor problems that characterize PD and are adaptable into self-adjusting, individualized treatment delivery systems. The International Parkinson and Movement Disorders Society Task Force on Technology is entrusted to convene engineers, clinicians, researchers, and patients to promote the development of integrated measurement and closed-loop therapeutic systems with high patient adherence that also serve to (1) encourage the adoption of clinico-pathophysiologic phenotyping and early detection of critical disease milestones, (2) enhance the tailoring of symptomatic therapy, (3) improve subgroup targeting of patients for future testing of disease-modifying treatments, and (4) identify objective biomarkers to improve the longitudinal tracking of impairments in clinical care and research. This article summarizes the work carried out by the task force toward identifying challenges and opportunities in the development of technologies with potential for improving the clinical management and the quality of life of individuals with PD. © 2016 International Parkinson and Movement Disorder Society.
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              Gait variability and basal ganglia disorders: stride-to-stride variations of gait cycle timing in Parkinson's disease and Huntington's disease.

              The basal ganglia are thought to play an important role in regulating motor programs involved in gait and in the fluidity and sequencing of movement. We postulated that the ability to maintain a steady gait, with low stride-to-stride variability of gait cycle timing and its subphases, would be diminished with both Parkinson's disease (PD) and Huntington's disease (HD). To test this hypothesis, we obtained quantitative measures of stride-to-stride variability of gait cycle timing in subjects with PD (n = 15), HD (n = 20), and disease-free controls (n = 16). All measures of gait variability were significantly increased in PD and HD. In subjects with PD and HD, gait variability measures were two and three times that observed in control subjects, respectively. The degree of gait variability correlated with disease severity. In contrast, gait speed was significantly lower in PD, but not in HD, and average gait cycle duration and the time spent in many subphases of the gait cycle were similar in control subjects, HD subjects, and PD subjects. These findings are consistent with a differential control of gait variability, speed, and average gait cycle timing that may have implications for understanding the role of the basal ganglia in locomotor control and for quantitatively assessing gait in clinical settings.
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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: InvestigationRole: Project administrationRole: ResourcesRole: ValidationRole: VisualizationRole: Writing – original draft
                Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: SoftwareRole: Validation
                Role: InvestigationRole: Resources
                Role: Investigation
                Role: InvestigationRole: Resources
                Role: InvestigationRole: Methodology
                Role: Formal analysisRole: Investigation
                Role: MethodologyRole: Software
                Role: Funding acquisitionRole: MethodologyRole: SoftwareRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: Project administrationRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: InvestigationRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                11 October 2017
                2017
                : 12
                : 10
                : e0183989
                Affiliations
                [1 ] Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
                [2 ] Digital Sports Group, Pattern Recognition Lab, Department of Computer Science, FAU Erlangen-Nürnberg, Erlangen, Germany
                [3 ] ASTRUM IT GmbH, Am Wolfsmantel 2, Erlangen, Germany
                [4 ] Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratory of Movement Analysis and Measurement, Station 11, Lausanne, Switzerland
                Oslo Universitetssykehus, NORWAY
                Author notes

                Competing Interests: ASTRUM IT GmbH provided support in the form of salary for the thesis project of author J.B. Bjoern M Eskofier reports grants outside the submitted work from Bosch GmbH and Adidas Sport GmbH. Zacharias Kohl reports personal fees outside the submitted work from UCB Pharma GmbH, Actelion Pharmaceuticals, Desitin Arzneimittel GmbH, Ipsen Pharma. Jürgen Winkler reports personal fees outside of the submitted work from Abbvie GmbH & Co. KG. Jochen Klucken reports personal fees outside the submitted work from Teva GmbH, Licher MT GmbH, UCB Pharma GmbH, Ever Pharma GmbH, Desitin Arzneimittel GmbH, Abbvie GmbH & Co. KG, Biogen GmbH, GlaxoSmithKline GmbH & Co. KG. The other authors declare no competing interests. Jens Barth, Bjoern M Eskofier, Jürgen Winkler, and Jochen Klucken have a patent related to gait assessment pending (patent no. EP16174268.9). There are no further patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials.

                Author information
                http://orcid.org/0000-0002-7801-9743
                Article
                PONE-D-17-06837
                10.1371/journal.pone.0183989
                5636070
                29020012
                d1303c98-3aec-4f58-a9e1-1f3b652b4737
                © 2017 Schlachetzki et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 20 February 2017
                : 15 August 2017
                Page count
                Figures: 6, Tables: 2, Pages: 18
                Funding
                This research study was funded by the Bavarian Research Foundation (AZ-974-11) and the Emerging Fields Initiative (EFI Moves), Friedrich-Alexander University (FAU) Erlangen-Nürnberg. ASTRUM IT GmbH provided support in the form of salary for the thesis project of author J.B., but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Bjoern M Eskofier reports grants outside the submitted work from Bosch GmbH and Adidas Sport GmbH. Zacharias Kohl reports personal fees outside the submitted work from UCB Pharma GmbH, Actelion Pharmaceuticals, Desitin Arzneimittel GmbH, Ipsen Pharma. Jürgen Winkler reports personal fees outside of the submitted work from Abbvie GmbH & Co. KG. Jochen Klucken reports personal fees outside the submitted work from Teva GmbH, Licher MT GmbH, UCB Pharma GmbH, Ever Pharma GmbH, Desitin Arzneimittel GmbH, Abbvie GmbH & Co. KG, Biogen GmbH, GlaxoSmithKline GmbH & Co. KG. These funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the 'author contributions' section.
                Categories
                Research Article
                Biology and Life Sciences
                Physiology
                Biological Locomotion
                Gait Analysis
                Medicine and Health Sciences
                Physiology
                Biological Locomotion
                Gait Analysis
                Medicine and Health Sciences
                Neurology
                Neurodegenerative Diseases
                Movement Disorders
                Parkinson Disease
                Biology and Life Sciences
                Physiology
                Biological Locomotion
                Walking
                Medicine and Health Sciences
                Physiology
                Biological Locomotion
                Walking
                Biology and Life Sciences
                Neuroscience
                Sensory Systems
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Medical Doctors
                Physicians
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Medical Doctors
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                Research and Analysis Methods
                Research Design
                Cross-Sectional Studies
                Physical Sciences
                Mathematics
                Applied Mathematics
                Algorithms
                Research and Analysis Methods
                Simulation and Modeling
                Algorithms
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Limbs (Anatomy)
                Legs
                Feet (Anatomy)
                Toes
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Limbs (Anatomy)
                Legs
                Feet (Anatomy)
                Toes
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                All relevant data are within the paper.

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