April is Parkinson’s awareness month, a time to shed light on a disease that affects more than 100,000 Canadians. At the Movement Disorders Clinic housed in the Djavad Mowafaghian Centre for Brain Health, neurologists and researchers are working together to develop creative ways of using technology to help Parkinson’s patients.
Physicians from the clinic, along with researchers at the Pacific Parkinson’s Research Centre, are running a longitudinal monitoring research program that encompasses several research projects aimed at developing ways of monitoring patients in between clinic visits.
“We are keenly aware that we cannot monitor people with Parkinson’s as often as we would like, typically only once per year,” says Dr. Martin McKeown, neurologist and Director of the Pacific Parkinson’s Research Centre. “Symptoms of Parkinson’s can fluctuate—sometimes as often as hour-to-hour—due to a number of factors such as absorption of medication. Also, when we see people in the artificial setting of a hospital clinic it may not be representative of how people are managing in the familiar environment of their own home.”
The projects are funded by the Pacific Parkinson’s Research Institute and a Collaborative Health Research Projects (CHRP) grant.
One project—called the Confidential Automatic Monitoring Examination and Recognition of Disease Activity (CAMERA) study—is jointly overseen by Dr. McKeown and Dr. Z. Jane Wang and managed by Dr. José Wijnands. The study is looking to develop an at-home monitoring method to record a person’s movement throughout the day. The ultimate goal is to provide information on mobility using only advanced analyses of continuous visual recordings, so people do not have to remember to wear motion sensors. Due to potential privacy issues, this technology is being developed under the guidance of bioethicist Dr. Anita Ho, who is supervising feedback from Parkinson’s groups.
“The aim of the CAMERA study is to develop a privacy-compliant smart camera for disease monitoring in Parkinson’s disease and Alzheimer’s disease,” says CAMERA project manager Dr. José Wijnands. “The novelty of this smart camera is that it will allow for videos to be analyzed and de-identified in real-time so that the original image is never stored or transferred. We believe that this camera will allow individuals to maintain independence longer and provide valuable information that informs pharmacotherapy decisions.”
The second project involves developing an app as another way of monitoring mobility that can also be done remotely via telehealth. On a typical visit to the Movement Disorders Clinic, a patient living with Parkinson’s will undergo a mobility assessment where they do simple finger, arm, and foot motions. The app incorporates twelve of these movements, including tapping and tracing, and generates a mobility score which is stored as data for physicians to access.
Another project is focused on disease progression. As Parkinson’s progresses, many people struggle with motor fluctuations. When the effect of their medication wears off before it’s time to take the next dose, symptoms such as stiffness and tremor may return. In order to prevent this, the team is using a wristwatch that measures subtle changes in sweat levels—the same technology that’s used in lie detector tests. The idea is to determine if there is a correlation between medication wearing off and sweat levels increasing before people start to feel unwell. If there is, the wristwatch could eventually serve as a tool to remind patients to take their medication before their symptoms return. The team is also looking at how a smart pillbox could monitor dosage and timing of medication as another way to prevent motor fluctuations.
The driving force behind all this innovation is for physicians to eventually be able to track patients in between clinic visits. Data scientist Dr. Maryam Mirian is overseeing ways to analyze the large amount of data being collected by these technologies in a way that can help physicians monitor any changes in disease progression and symptoms.
This amalgamation of technology and healthcare designed by physicians, engineers and bioethicists has the potential to transform how we assess and treat people with Parkinson’s Disease. Dr. McKeown has always been a strong proponent of pairing technology with healthcare, and the current pandemic shows just how valuable this approach can be.
“The recent COVID epidemic has emphasized how telehealth approaches can be especially beneficial for people with Parkinson’s,” he says.