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How Digital Health Technology can Help Manage Parkinson’s Disease during COVID-19 Outbreak Do-Young Kwon, MD, PhD. Department of Neurology Korea University [email protected]
How Digital Health Technology can Help Manage Parkinson’s Disease
during COVID-19 Outbreak
Do-Young Kwon, MD, PhD.
Department of NeurologyKorea University
Learning objectives
• To provide the understanding on what Digital Health Technology
• To provide an information on how to use Digital Health Technology to manage in a certain aspect of Parkinson’s disease
• To describe the impact of COVID-19 pandemic and possible use of Digital Health Technology to solve this concern
Outlines
• Concept and types of digital Health
• The growing importance of Digital Health during COVID-19 outbreaks
• How Digital technology can help manage PD in this period
How Digital Health Technology can Help Manage Parkinson’s Disease during COVID-19 Outbreak
- WHO Guideline: “A broad umbrella term encompassing eHealth (which includes mHealth), as well as emerging areas, such as the use of advanced computing sciences in ‘big data’, genomics, and artificial intelligence.”
Definition of Digital Health
- Healthcare that utilizes new digital technologies.
• It becomes more and more digital “HEALTH” than “Digital” health
• Soon, Digital health= health
Medicine has been a clinical science, supported by data.
Medicine is about to become a data science, supported by clinicians
- Human Longevity, INC.
Digital Health is all the rage worldwide- COVID-19 pushing for changes
Enspektos, LLC, 2015
Digital Health – evolving technologies
With development of sensors, signaling…
Data collection – AI, ML.
Analysis tech.- image, video clips
Streaming services
The growing Importance of digital health in COVID era
Non-contact (social/ physical distancing)
Stay connected (feeling of reassurance)
- Long-term monitoring- Keep personal intimacy- Continu communicattion
- Remote (keep distance)- Stay Safe
Dig
ital
Hea
lth
Parkinson patients during COVID-19
• PD patients- fragile, with multiple comorbidities
• WHO: Chronic neurological disorders like Parkinson’s: at high risk for severe COVID-19.
• the best preventive method is to avoid exposure to the virus. Which restrict their previous activity/exercises and limit their assess to the clinic.
• Neurologists should consider both maintaining pts in stable neurological conditions in many aspects while keeping patients safe during covid period
• This goal might be achieved by adoption of digital health tech.
Systemic
Mobility/ Dexterity
Vision/HearingMemory/ Cognition
Mental HealthParkinson’s
Disease
Reported preventive measures to COVID-19
• 99 PD patients
• 58.6%: Anxiety and worries about current situation
• 31.3%: Complained decreased their mobility
• 30%: Still nonadherent to preventive measures
Zipprich et al. J Clini Med 2020;9:1643.
Caring of chronic disease patients during COVID-19
https://proactive-md.com/caring-for-patients-during-covid-19/
4 strategies to cope with ongoing situations
Stay active & healthy
Stay safe
Continuing medical
care
Stay independent & connected
Digital health technology tools
Monitoring
Wearables
Web-based tools
Text message/E-mail
Assistive robots
Telemedicine
Social media/ Streaming
Stay safe
Long-term and continuous remote automated monitoring system (Smart home system) for frail elderly
① ②
③
④①⑤
① Time on bed, Detection of falling② Home training module- time, posture③ Toilet: time, pattern④ Door: frequency, pattern⑤ Walk distance, steps, moving time
Pressure sensor inserted textile-type floor mats
Camera & wearables Non-video based information Non-contact medical care service
Pattern Monitor• Falling detection• Unusual pattern
Activity monitor• Time and pattern of
toilet use• Time on bed/ exercise• Range of movement
Stay safe
• Detection of unexpected events- Falling, vital signs…. etc.
With combination of multiple sensors, detection of falls with accuracy 95%.
Ajerla et al. Wireless communications and mobile computing. 2019.
Automatically sending alarms to designated person
Wu et al. International Journal of Telemedicine and Applications. 2015
Stay safe- Remote health monitoring system
Stay active & healthy
Machado et al. Mov Disord Clin Practice 2020;7(1):7-15.
Schhirinzi et al. Mov Disord Clin Practice 2020
60%
General condition
74 patients, 50% womenAge: 61.3±9.3 yearsDisease duration-6.5± 4.5 years
78%
Under physiotherapy @centers
Sport activities during COVID-19
Stay active & healthy
Source of motivating their sports
86% 50%
Types of TBT use.
Assistive TBT useClassic exercises
74 patients, 50% womenAge: 61.3±9.3 yearsDisease duration-6.5± 4.5 years
Stay active & healthy
Schhirinzi et al. Mov Disord Clin Practice 2020
Lancet Neurol 2019; 18: 998–1008
Home-based, remotely supervised (n=130) exergaming type- aerobic exercise program to encourage long-term adherence
• Feasible• Good compliance• Level 1 evidence of effectiveness on off-
state motor scores. Cardiovascular fitness
Stay active & healthy
Exercise for affective symptom control in PD
• 138 PD patients
• Yoga program improved depression, anxiety and well-being sense as well as motor symptoms
Kwok et al. JAMA Neurology 2019;76(7):755-63.
Yoga vs. stretching and resistance training exercise
Continuing medical care
Fasano A et al. Mov Disord Clin Pract 2020;7(4):361-72.
Survey was obtained from 40 countries within the MDS regional sections
All forms of telemedicine for movement disorders increased globally, irrespective of country income categorization, as an immediate response to the pandemic. This was aided by widespread availability of technology and updated government regulations.
Hassan A et al. Mov Disord 2020. Accepted.
COVID-19 push telemedicine into mainstream of medicine.
Telemedicine
• Broadly defined, telemedicine is the use of technology for remote exchange of medical information for the purposes of providing medical care
Two methods of telemedicine to provide medical care
Schneider et al. Lancet neurol 2017;16:541
Telemedicine
Synchronous methods Asynchronous methods
Real-time• Information exchange for care and
consultation• Remote-site real-time clinical examination• Interactive communication
Long-term • Use store-and-forwarding technology• Information is transmitted, but not
reviewed in real-time• Monitor fluctuating symptoms and/or
diurnal changes
• Live audio/ video conference • text message, e-mail, transmission of still images and recorded video clip
• data from smartphone app and wearable sensors
• Remote signal monitoring system
Office-based versus home web-based clinical assessments for PD
Web-based assessments offer a feasible format for assessing PD-related motor impairment from home.
Web-based remote assessment had fewer missing rates (p=0.01)
Cubo et al. Mov Disord 2012;27:308-311
Abdolahi et al. Health Informatics J 2016, Vol. 22(2) 304–311
Feasibility study for non-motor symptoms of PD
Sekimito et al. Parkinson’s Disease 2019
PDQ-39 BDI
Telemedicine as a therapeutic tool- Depression
Dobkin RD et al. Neurology 2020;94:e1764.
Long-term monitoring of motor symptoms using devices
X Zheng et al. Frontiers in Neurology 2017;8:1.
Joshi R et al. Frontiers in Neurology 2019;10:1027.
Triaxis accelerometer and smartphone receiving data and uploading to a remote server for storage and analysis..
PD Patient views on telemedicine use
Spear KL et al. Journal of Parkinson’s Disease 9 (2019) 401–404Qiang et al. PRD 21(2015) 525-28
US National online survey781 individuals with PD responded. - Interest in telemedicine was high but tempered by the concern for loss of high touch care and technical adoption problem.
Question: : If the cost of a virtual visit and an in-person visit were the same, which you would prefer?”• in-person visit (43%)• some report preferring a virtual visit (25%) • no preference (23%).
65% of study participants preferred combination of on- and off-visit even though they are satisfied with telemedicine care.
Telemedicine for movement disorders is..
• Feasible and somewhat validated.
• Cost effectiveness with saving time and moving distance
• Comparable outcome to traditional care
• High satisfaction with Low missing rates
• Make medicine more personalized
• Non-contact approach (physical distancing)
• Accessibility
• Usability
• Reimbursement and licensing, regulations
• Technological limits
Barriers to widespread implementation of telemedicine
Schneider et al. Lancet neurol 2017;16:541
• Set up of the devices
• Internet connection/ speed
• Hearing/ vision problems
• Following the given instructions
Patients found difficulties in..
Need for user-friendly alternatives that can support healthcare
• Wearable sensors, mobile/web-based applications, servers for the storage and elaboration of acquired data, and smart interfaces for communication between patients, caregivers, and medical staff
The architecture of a general telehealth system.Rovini E et al. Telemedicine and e-Health 2019;25(3)
Special care center/ clinic Personal care Home-based healthcare
Stay independent & connected
App-based self management tools
Active monitoring features
Sustained phonation Rest tremor Postural tremor Finger-tapping Balance gait
Passive monitoring features
Data collected while carried smartphone during the day
- Time spent walking- Sit-to stand transitions
Smartphone-based active and passive monitoring digital biomarker is…
• Feasible • Reliable • Valid • Well correlated with clinical scales
Can use as a self-management tool@home.
Lipsmeier et al. Mov Disord 2018;33(8):1287.
Sensor-based Biofeedback device in the home setting.
Van Wegen et al. PRD 2018;46:S57-61.
Patients wear ambulatory sensor device on the sternum Vibrotactile feedback signal activated to the patients when trunk angle exceeds a pre-determined threshold value.
- Significant decrease (avg.- 5.4 degree) in trunk angle- correction of posture safely.
- Users reported the device is usable and beneficial for self-management of posture.
Medication adherence
Lakshminnarayana et al. Parkinson’s Disease;2017:3:2Trials 2014;15:374
• Evaluate the effectiveness of smartphone application use as a self-management tool.
Parkinson’s tracker app vs. treatment as usual 158 PD (app=68/ TAU 90)
• Application user significantly improved pill adherence• Regardless of age, sex, comorbidity number
• Support self-management strategy.
How to make patients keep connected during lockdown
• Loneliness: public health issue of growing concerns when family, relatives and friends are distant
• Loneliness during the pandemic is worse than before.
• Technological tools can make isolation feel less lonely.
Social media Social assistive Robots Robot pets Virtual reality Video calls, voicemail
SAR exercise coach for the elderly
Fasola J et al. Journal of human-Robot interaction 2013 Broekens J et al. Gerontechnology:8(2):94-103.
Categories of SARs for seniors
Limitations of Digital health
• Obstacles to technology adoption (age, confidence, dexterity)
• Concerns about data security, privacy, and access to data
• Reimbursement, regulation
• Still not widely used even to the researchers
• Few PD-specific validation study through clinical trial
• Development of devices mostly confined to motor symptoms
• Specifically designed device only for the elderly adults are essential
Change of Concepts in caring chronic neurological diseases
https://en.wikipedia.org/wiki/Neurotechnology
- In person clinical visit
- Momentary evaluation@ clinic
- A physician’s decision
- Online based, remote care
-Real time and Long-term data from real-world situations
- Multidisciplinary team approach
We are just in the starting point.
Digital health technology will change your life- like It or not.
TIME Photo-illustration
TIME’s new(?) cover: “Never Offline” - Sep.2014
Korea University Medical CenterDept. of Neurology. Movement Disorder ClinicKun-Woo Park MD, PhD.Seong-Beom Koh MD, PhD.
Dept. of Neurology. Ansan HospitalMoon-Ho Park MD, PhD.Jinman Jung MD, PhD.Sohyun Lim
Dept. of Biomedical Engineering, Konkuk UniversityJi-won Kim, PhD.Yuri Kwon, PhD.
Dept. of Brain and Cognitive Engineering, Korea UniversityJune Kang PhD.Dilara Derya PhD.Christian Wallraven PhD.
Special Thanks to..
