Smartphone Level Test Measures Disability in Several Neurological Domains for Patients With Multiple Sclerosis
Smartphone Level Test Measures Disability in Several Neurological Domains for Patients With Multiple Sclerosis
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DOI：
10.3389/fneur.2019.00358
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发表时间：
2019-05-28
影响因子：
3.4
通讯作者：
Bielekova, Bibiana
中科院分区：
文献类型：
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作者：
Boukhvalova, Alexandra K.;Fan, Olivia;Bielekova, Bibiana
我们的长期目标是采用智能手机嵌入式传感器，以患者自主的方式测量各种神经功能。中期目标是开发简单的智能手机测试（应用程序），并通过选择与临床医生测量的不同神经系统领域的残疾密切相关的最佳结果来评估这些测试的临床实用性。在本文中，我们使用了112名多发性硬化症（MS）患者和15名健康志愿者（HV）的前瞻性数据，以评估水平测试的性能和优化结果。测试的目标是倾斜智能手机，使一个自由滚动的球移动并保持在屏幕的中心。加速度计检测倾斜并以设定的时间间隔记录球的坐标。从这些数据中，我们得出了五个特征：行进的路径长度，在屏幕中心花费的时间，到中心的平均距离，在中心时的平均速度，以及球所经历的方向变化的数量。在中心的时间被证明是最敏感的功能，以区分MS患者HV，并与临床医生衍生的规模最强的相关性。在29例MS患者的独立验证队列中验证了其优效性。在一个独立的验证队列中，不同水平特征的线性组合未能超过中心时间。有限的纵向数据表明，水平功能是相对稳定的4个月内的个人，没有明确的证据学习。与先前开发的主要测量运动功能的智能手机测试相比，Level功能与反应时间密切相关，与小脑功能和本体感觉中度相关，验证了其在MS应用程序套件中的补充临床价值。水平测试在两个独立的横截面队列（原始和验证）中测量几个领域的神经功能障碍。一个正在进行的纵向队列进一步研究患者自主收集的粒度功能数据是否允许测量患者特定的残疾进展轨迹，以更好地指导治疗决策。
Our long-term goal is to employ smartphone-embedded sensors to measure various neurological functions in a patient-autonomous manner. The interim goal is to develop simple smartphone tests (apps) and evaluate the clinical utility of these tests by selecting optimal outcomes that correlate well with clinician-measured disability in different neurological domains. In this paper, we used prospectively-acquired data from 112 multiple sclerosis (MS) patients and 15 healthy volunteers (HV) to assess the performance and optimize outcomes of a Level Test. The goal of the test is to tilt the smartphone so that a free-rolling ball travels to and remains in the center of the screen. An accelerometer detects tilting and records the coordinates of the ball at set time intervals. From this data, we derived five features: path length traveled, time spent in the center of the screen, average distance from the center, average speed while in the center, and number of direction changes underwent by the ball. Time in center proved to be the most sensitive feature to differentiate MS patients from HV and had the strongest correlations with clinician-derived scales. Its superiority was validated in an independent validation cohort of 29 MS patients. A linear combination of different Level features failed to outperform time in center in an independent validation cohort. Limited longitudinal data demonstrated that the Level features were relatively stable intra-individually within 4 months, without definitive evidence of learning. In contrast to previously developed smartphone tests that predominantly measure motoric functions, Level features correlated strongly with reaction time and moderately with cerebellar functions and proprioception, validating its complementary clinical value in the MS app suite. The Level Test measures neurological disability in several domains in two independent cross-sectional cohorts (original and validation). An ongoing longitudinal cohort further investigates whether patient-autonomous collection of granular functional data allows measurement of patient-specific trajectories of disability progression to better guide treatment decisions.