Continuous Monitoring of Turning in Patients with Parkinson's Disease

描述（由申请人提供）：行走时安全转弯的能力是独立移动的重要运动技能，受衰老和神经系统疾病的影响。帕金森氏病（PD）患者的旋转通常会导致“冻结”和/或跌倒，并且通常与髋部骨折有关。然而，要求PD患者在临床环境中执行转弯通常不会揭示他们的损伤。有跌倒风险的患者将受益于一个系统，该系统可以识别和表征他们的日常移动行为，以预测他们的跌倒风险、治疗的益处或副作用以及疾病的进展。目前还没有一个系统可以在自发的日常活动中不显眼地识别和表征转弯性能。我们的长期目标是开发和商业化一个独特的系统，以测量移动性（步态和动态平衡），全天使用可穿戴传感器。我们的OHSU/PSU初创公司APDM正在开发系统，使临床医生和临床研究人员能够使用其核心技术“Opal”运动监测器监测移动性和临床运动症状。我们已经通过ITUG应用程序在临床环境中建立了自动表征步态和规定的180度转弯的价值。我们现在想添加一个新产品，将移动监控带入家庭和社区。这种新的仪器化系统（ITurn）将允许患者自我监测自己的日常活动，并允许临床医生审查患者的日常活动的天数或周数。本申请的目的是开发一种新的方法来识别和量化个人在日常生活中所做的转弯。具体目标是 一期工程为：1）开发一种新的算法，用于识别和表征Opal可穿戴传感器自发活动期间的转向事件，2）确定老年受试者和PD受试者使用对接为其传感器充电并在家中连续监测后将数据上传到我们的服务器的可行性。开发的算法以及为家庭使用而进行的硬件和软件调整将用于形成我们的第二阶段项目的基础，该项目将测试帕金森病患者全天测量转向缺陷的益处，以预测未来的福尔斯。除了直线行走外，还能监测转弯能力，这将为旨在改善行动能力障碍的药物和运动临床试验提供重大突破 并且为患者、护理人员和临床医生提供了一个强大的新工具，这些患者、护理人员和临床医生希望获得关于他们在自己的环境中安全行走的能力的更准确信息。 公共卫生相关性：该项目旨在开发和测试一种在日常活动中对帕金森病患者的旋转困难敏感的旋转测量仪器的可行性。我们将使用我们的初创公司APDM生产的特殊可穿戴传感器，让患者记录并上传他们自己的日常移动性能。更精确的转向运动测量将改善老年人和神经系统疾病患者平衡障碍和跌倒预防的干预。

DESCRIPTION (provided by applicant): The ability to turn safely while walking is an important motor skill for independent mobility that is affected by aging and neurological diseases. Turning often results in 'freezing' and/or falling in patients with Parkinson's disease (PD), and is commonly associated with hip fractures. However, asking a PD patient to execute a turn in a clinical environment often does not reveal their impairments. Patients at risk for a fall would benefit from a system that identifies and characterizes their daily mobility behavior to predict their risk of falling, benefits or side effects of treatment, and progression of disease. No curren system exists that identifies and characterizes turning performance unobtrusively during spontaneous, daily activity. Our long-term goal is to develop and commercialize a unique system to measure mobility (gait and dynamic balance) using wearable sensors throughout the day. Our OHSU/PSU start-up company, APDM, is developing systems to allow clinicians and clinical researchers to monitor mobility and clinical motor symptoms using their core technology, 'Opal' movement monitors. We already have established the value of automatically characterizing gait and prescribed 180-degree turns in clinical environments during a Get Up and Go task with our ITUG application. We now want to add a new product that takes mobility monitoring into the home and community. This new, instrumented system (ITurn) will allow patients to self-monitor their own daily mobility and allow clinicians to review days or weeks of their patient's daily mobility. The objective of this application is to develop a novel method to identify and quantify turns made by individuals during their daily lives. The specific aims of this Phase I project are: 1) To develop a new algorithm that identifies and characterizes turning events during spontaneous activity with our Opal wearable sensors and 2) To determine the feasibility of having older subjects and subjects with PD to use a docking station to recharge their sensors and upload data onto our server after continuous monitoring in the home. The algorithms developed and hardware and software adaptations made for home use will be used to form the foundation of our Phase II project that will test the benefits of measuring turning deficits throughout the day in patients with Parkinson's disease to predict future falls. The abiliy to monitor turning performance, in addition to straight ahead walking, will provide a major breakthrough for pharmaceutical and exercise clinical trials aimed at improving mobility disability and provide a powerful new tool for patients, caregivers and clinicians who want more accurate information about their ability to safely ambulate in their own environments. PUBLIC HEALTH RELEVANCE: This project aims to develop and test the feasibility of an instrumented measure of turning during daily activities that is sensitive to the turning difficultis of patients with Parkinson's disease. We will use special, wearable sensors produced by our start-up company, APDM, to have patients record and upload their own daily mobility performance. More precise measures of turning mobility will improve intervention for balance disorders and fall prevention in the elderly and in patients with neurological disease.