{"id":4950,"date":"2019-11-01T09:30:24","date_gmt":"2019-11-01T14:30:24","guid":{"rendered":"https:\/\/wiparkinson.org\/?p=4950"},"modified":"2019-10-31T15:38:07","modified_gmt":"2019-10-31T20:38:07","slug":"a-wearable-device-is-changing-the-way-clinicians-manage-pd","status":"publish","type":"post","link":"https:\/\/wiparkinson.org\/a-wearable-device-is-changing-the-way-clinicians-manage-pd\/","title":{"rendered":"A Wearable Device Is Changing the Way Clinicians Manage PD"},"content":{"rendered":"

A recently published study in\u00a0Functional Neurology<\/em>\u00a0suggests that using data from an FDA-cleared watch-like device called the Personal KinetiGraph (PKG) provides an objective and more effective approach to assessing motor fluctuations in patients with Parkinson’s disease (PD) compared with patient-reported motor diaries.<\/p>\n

\u201cMotor fluctuations, including ‘wearing-off’ and dyskinesia, are associated with increased disease severity and disability, and PD patients experience decreased quality of life as their response to medical therapy becomes less predictable,\u201d said Echo\u00a0Tan, MD, a neurologist at Cedars-Sinai Medical Center and lead author on the publication. \u201cEffectively managing motor fluctuations is complicated by the lack of objective assessment tools, leading patients and physicians to rely on direct observation in the clinic or patient reports, which may be unrevealing, incomplete and unreliable. The results of our study demonstrate that the fluctuation score calculated by the PKG system provides objective quantification of motor fluctuations.”<\/p>\n

This may help improve the routine management of Parkinson’s\u00a0patients and enable more objective assessments in clinical trials of Parkinson’s therapies, she said.<\/p>\n

Tan told\u00a0MD+DI\u00a0<\/em>the study revealed that the\u00a0PKG system\u00a0(developed by Global Kinetics) and the algorithms for calculating a fluctuator score can differentiate between non-dyskinetic and dyskinetic patients. The fluctuator score does not,\u00a0however, have the sensitivity to detect mild wearing off because no prior study divided patients into more than a binary system. On the plus side, Tan said the PKG also can distinguish between exercise and dyskinesia on the graphical data obtained.<\/p>\n

The\u00a0fact that the fluctuator score was not sensitive enough to detect mild wearing off did come as a surprise to the investigators, but the fluctuator score did show progressively increasing average score range between the four groups, Tan said.<\/p>\n

During a\u00a0BIOMEDevice Boston 2019 panel discussion,\u00a0Teresa Prego, vice president of marketing and marketing development at the\u00a0Melbourne, Australia-based company, said the integration of consumer wearables with wearables for chronic disease management has changed the delivery of care and where that care is delivered.<\/p>\n

“If I look at the PKG-Watch, for example, in Australia where there are great geographic distances between people with Parkinson’s and a care provider. They are using this remotely,” Prego said.\u00a0“So you’ll go and see your clinician, have an assessment, but then for the next year, there’s really no need to go into the clinic. You can make care decisions remotely. They’re wearing the vehicles to get that information to the clinician.”<\/p>\n

“This implies that it is better at detecting moderate to severe fluctuations,” she said.<\/p>\n

Most importantly, the device has changed the way Tan and her colleagues assess and monitor patients with Parkinson’s disease.<\/p>\n

“The PKG system can provide additional information about fluctuations that a clinic visit and history can not reveal,” she said.\u00a0“This is particularly useful for those patients who are not able to provide a good history \u2013 such as those with a language barrier or cognitive impairment.\u00a0It can show true objective levodopa responsiveness, motor fluctuations, daytime somnolence, and medication compliance.\u00a0“It can be an important triage mechanism for a referral to a movement disorder specialist, or for an advanced surgical therapy referral. It has provided another objective source of information for our clinicians in deciding how to change medical management. Patients also report that the medication reminder function on the device helps them with medication compliance, thereby also enhancing their motor function as well.”<\/p>\n

Parkinson\u2019s disease patients typically respond well to medical therapy in the first few years of their disease, but about 40% of the patient population develops fluctuations of response to\u00a0levodopa and dyskinesia after four to six years\u00a0of treatment. That percentage jumps to\u00a070% after long-term treatment of nine years or more, according to Global Kinetics.\u00a0The company said it developed the PKG system to address the lack of objective measurement tools for movement disorders and quantifies the kinematics of Parkinson’s\u00a0symptoms, including tremor, bradykinesia, and dyskinesia. An algorithm translates the raw data from these assessments into a fluctuation score\u00a0that can distinguish between patients with motor fluctuations and those without.<\/p>\n

The study investigators correlated PKG fluctuator scores (FS) with clinical motor fluctuator profiles in a case-controlled cohort of the study that included 60 patients attending the Movement Disorders Clinic at Cedars-Sinai Medical Center in Los Angeles, CA. Of the 60 patients in the study, six had incomplete data and were excluded from analyses, the company noted.<\/p>\n

Here are some key findings from the 54 subjects who completed a six-day PKG trial and completed a standardized motor diary:<\/p>\n