INNOVATION FUND Innovation, Integration, & Implementation Chronic Care and Patient Centred Care SHOWCASE 2016 INNOVATION FUND Innovation, Integration, & Implementation Chronic Care and Patient Centred Care SHOWCASE 2016

Precise evaluation of motor and non-motor dysfunction in patients with Parkinson’s disease using the KINARM

Chronic Care and Patient-Centred Care

SEAMO, Kingston General Hospital, Queen’s University
Ron Levy

ron.levy@queensu.ca

(613) 929-5281

levyr@kgh.kari.net

(613) 549-6666 x7444


Highlights

Transformation: Robotic technology for clinical assessment in Parkinson’s disease (PD) will improve health care delivery by allowing the precise and objective assessment of the neurological signs of PD.

Adoptability: The technology is easily adopted for clinical users and standardized reports are generated that compare a subject’s performance to other patients or healthy controls.

Outcomes: It can be used to measure a broad base of sensory, motor and cognitive impairments and the effects of parkinsonian dopaminergic medication and deep brain stimulation.

Innovation: It has the potential to change clinical practice by providing an automated objective approach to neurological examinations, that a traditional clinical exam cannot easily capture. It also has the potential to facilitate research into novel drugs or surgical therapeutic neuromodulation in patients.

Abstract

Parkinson’s disease (PD) is a neurodegenerative movement disorder that causes slowness of movement, rigidity, tremor, postural instability, and cognitive dysfunction. Disease progression and treatment efficacy are assessed with subjective clinical examinations that may be insensitive to subtle changes in sensorimotor or cognitive function. The purpose of this study was to use the KINARM robot to objectively and precisely quantify sensory, motor and cognitive dysfunction in patients with PD. The KINARM is an assessment device that can precisely measure arm movement with respect to visual and kinesthetic stimuli and can control whole arm movement (Scott SH, Dukelow SP. J Rehabil Res Dev 2011;48(4):335-54). We studied the effect of levodopa and deep brain stimulation on a battery of KINARM tasks. Clinical assessment in each treatment condition (levodopa, deep brain stimulation) was performed with the Unified Parkinson’s disease rating scale. KINARM testing was performed using a bimanual KINARM-Endpoint system that measures arm movement and can apply loads to control or alter hand movement. An integrated virtual reality system displays feedback on hand position and spatial goals.  Subjects grasped handles attached to the robots and performed five tasks in order to examine sensorimotor (“visually guided reaching”, “object hit”,“posture perturbation”), and cognitive domains (“reverse reaching”, “object hit and avoid”).

We demonstrate that the KINARM accurately captures the effects of dopamine replacement or deep brain stimulation on movement speed, accuracy, and posture perturbation. In addition, we were able to quantify adverse changes in cognitive executive functioning due to treatment. This study demonstrates that the KINARM is an objective tool that can quantify sensorimotor and cognitive function in patients with PD.

Themes & Abstracts

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