Parkinson's disease medication state and severity assessment based on coordination during walking

PLoS One. 2021 Feb 17;16(2):e0244842. doi: 10.1371/journal.pone.0244842. eCollection 2021.

Abstract

Walking is a complex motor function requiring coordination of all body parts. Parkinson's disease (PD) motor signs such as rigidity, bradykinesia, and impaired balance affect movements including walking. Here, we propose a computational method to objectively assess the effects of Parkinson's disease pathology on coordination between trunk, shoulder and limbs during the gait cycle to assess medication state and disease severity. Movements during a scripted walking task were extracted from wearable devices placed at six different body locations in participants with PD and healthy participants. Three-axis accelerometer data from each device was synchronized at the beginning of either left or right steps. Canonical templates of movements were then extracted from each body location. Movements projected on those templates created a reduced dimensionality space, where complex movements are represented as discrete values. These projections enabled us to relate the body coordination in people with PD to disease severity. Our results show that the velocity profile of the right wrist and right foot during right steps correlated with the participant's total score on the gold standard Unified Parkinson's Disease Rating Scale (UPRDS) with an r2 up to 0.46. Left-right symmetry of feet, trunk and wrists also correlated with the total UPDRS score with an r2 up to 0.3. In addition, we demonstrate that binary dopamine replacement therapy medication states (self-reported 'ON' or 'OFF') can be discriminated in PD participants. In conclusion, we showed that during walking, the movement of body parts individually and in coordination with one another changes in predictable ways that vary with disease severity and medication state.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Dopamine Agents / therapeutic use
  • Female
  • Gait / physiology
  • Humans
  • Hypokinesia / diagnosis
  • Levodopa / therapeutic use
  • Male
  • Middle Aged
  • Movement / physiology
  • Parkinson Disease / physiopathology*
  • Postural Balance / physiology
  • Psychomotor Performance / physiology*
  • Severity of Illness Index
  • Walking / physiology*
  • Wearable Electronic Devices

Substances

  • Dopamine Agents
  • Levodopa

Grants and funding

Tufts University School of Medicine was the sponsor. IBM Inc. and Pfizer Inc. funded this work. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.