iPads for Balance? PDF Fellow Uses Everyday Technology to Help People with Parkinson’s

Sarah Ozinga 

Mobile devices such as smart phones and tablets have become part of daily life. Already there are applications, or “apps”, to help people with Parkinson’s disease (PD) remember to take medications on time or record their symptoms. Last summer, Sarah Ozinga recognized that these devices could also be put to work for another purpose and with support from PDF, she turned the iPad into a tool for measuring balance in people with PD. And she has her eye on using it as a means to help people with PD who have undergone deep brain stimulation (DBS) to achieve the best results from their surgery.

Mrs. Ozinga is pursuing her doctorate in biomedical engineering in a collaborative program with Cleveland State University and Cleveland Clinic, in Ohio. She studied the iPad for Parkinson’s as part of her dissertation research, in the laboratory of her mentor Jay Alberts, Ph.D. The project was launched with support from a PDF Summer Fellowship, a program which last year provided financial support to 15 students who, like Mrs. Ozinga, have ideas for advancing Parkinson’s research.

When Mrs. Ozinga joined the Alberts lab, she found that a group of colleagues were using iPads to measure the symptoms of concussions in athletes. She had worked with people with PD for several years, and she knew that balance difficulties are one of PD’s defining motor symptoms. Yet Mrs. Ozinga also knew that measuring a person’s balance, also called postural stability, is not simple. For one thing, the rating scales that clinicians customarily use to measure balance are often subjective. And while there are tools that offer precise measurements, they are expensive and time-consuming to carry out.

She also knew that the iPad comes with a built-in accelerometer and gyroscope, hardware that can measure movement. This device, she speculated, might have the capacity to sense the ways in which a person sways forward and backward, or side-to-side, while he or she is trying to maintain balance.

She used her PDF Fellowship to test the theory, by designing and testing an app that would enable the iPad to collect and store balance data when the device was strapped to a person’s lower back.

She also considered whether the iPad might be used to help with a set of challenges that are often encountered by people with Parkinson’s following DBS. In this surgical procedure, electrodes are implanted into a part of the brain that helps control the disabling tremors and dyskinesias that can accompany Parkinson’s. After surgery, it takes time for people with PD and their clinicians to find the ideal settings on their DBS programmers, during which time they may experience changes in movement and cognition. Mrs. Ozinga found a way to combine her app for balance, along with the DBS programmer data (for movement and memory), to potentially make it easier to find a person’s optimal level of electrical stimulation.

The initial results of her PDF-funded research show that the two tests together provide an objective means of determining the optimal settings for DBS stimulation, which would help to ease and control a person’s symptoms after surgery. More research will be needed before this tool is made available. In fact, Mrs. Ozinga is now recruiting participants for studies to further evaluate the potential for iPad apps in Parkinson’s.

Eventually, she hopes, “Using this portable product will make it easier for people to know if their DBS settings are working and to send that information automatically to their doctors.”

After she finishes her Ph.D. dissertation, what comes next? She says, “I picture myself staying in research, studying ways to use technology to help solve real-life issues for people with PD.”

Ms. Ozinga’s research was funded via PDF’s Summer Student Fellowships. In FY2014, PDF is investing $40,000 in this program.

This was posted a while back but it is getting more attention.

Smart Glasses Can Improve Gait of Parkinson’s Patients

 Neuroscience News

 October 16, 2013

 Featured, Neurology

A new app for intelligent glasses, such as Google Glass, will soon make it possible to improve the gait of patients suffering from Parkinson’s disease and to decrease their risk of falling. Researchers at the University of Twente’s MIRA Institute have received a grant from the NutsOhra fund for the development of the app.

The gait of Parkinson’s patients is often disturbed: sometimes this presents as a shuffling movement with the patient taking small steps, or it may result in the patient constantly looking for additional support. Gait disturbance also increases the chance of a fall, despite the progress made in terms of medication. Researchers have established that the gait of patients improves when they regularly see or hear a pattern. Examples might include stripes on the floor, or the regular ticking of a metronome.

Researchers are developing a new app which will be compatible with ‘smart glasses’. The app is designed to help improve the gait and reduce the possibility of falling for Parkinson’s disease patients.

The researchers, working under the leadership of Prof. Richard van Wezel, who is professor of Neurophysiology at the UT and is also attached to the Donders Institute in Nijmegen, are now looking at exploring the possibility of using the intelligent glasses, such as Google Glass, that are now coming on to the consumer market.

Intelligent glasses would be able to provide patients with the regular visual or audible patterns required. These patterns may take the form of moving stripes or shapes which the patient sees through the glasses, flashing shapes, or music with varying tempos. The latest intelligent glasses already have inbuilt cameras and accelerometers. By using these, it will be possible to determine which approach works best for each individual patient.

Notes about this technology and Parkinson’s disease research

The MIRA Institute for Biomedical Technology and Technical Medicine is working on the project together with the Donders Institute for Brain, Cognition and Behaviour (Nijmegen), the Medisch Spectrum Twente hospital and the VUmc University Medical Centre in Amsterdam.

“Fonds NutsOhra”, a fund that provides financial support for healthcare projects, has granted the sum of € 94,000 to the project.

Contact: Wiebe van der Veen – University of Twente
Source: University of Twente press release
Image Source: The image is credited to the University of Twente and is adapted from the press release.

#technology, #neuroscience, #Parkinsons

WHEN WEARABLE TECH SAVES YOUR LIFE, YOU WON’T TAKE IT OFF

FAST COMPANY

WEARABLE HEALTH TECH PROMISES TO SAVE LIVES, SO STARTUPS LIKE MC10 ARE WORKING TO CREATE SOMETHING YOU’LL NEVER FORGET TO PUT ON.

BY SINDYA N. BHANOO

  

The problem with wearables is that usually people stop wearing them. According to one recent report, one-third of users of activity-tracking wearables, like the Fitbit and the Jawbone, toss their devices aside after just six months.

To overcome this, a small cadre of companies has been furiously working to develop smaller, sleeker, more discreet devices that monitor health and wellness--in the form of temporary tattoos, band-aids, and ingestible pills.

MC10’s Biostamp is one of the contenders. Thinner than a band-aid, and the size of just two postage stamps, the Biostamp can be affixed to any part of the body. Its sensors can monitor temperature, movement, heart rate and more, and transmit this data wirelessly back to patients and their clinicians.

MC10’s Biostamp

The technology itself is nothing new. It might include, for instance, an accelerometer, a gyroscope, and an electromyography sensor to record muscle firings. This is about repackaging existing technology in a way that encourages regular, consistent use by patients.

Devices like the Fitbit, while small, still have a significant presence on the body, said Joseph Kvedar, a dermatologist at Harvard Medical School and the director of the Center for Connected Health, a nonprofit dedicated to improving health care with technology.

“We have the burden of engaging you,” he said. “We could get so much better data about you if you can just slap on your band-aid.”

The Biostamp has not been approved for use by the FDA yet, but MC10 is intensively testing the product with healthy volunteers and will soon start working with patients and a major pharmaceutical company.

“I expect this to be on patients by the end of the year,” said Nirav Sheth, the director of market development for medical devices at MC10.

For Parkinson's Patients, Communications With Doctors Is Life & Death

Sheth plans to focus testing on patients with movement disorders like multiple sclerosis, epilepsy, and Parkinson’s.

These are diseases where close monitoring of irregularities, seizures, and episodes can help doctors prescribe appropriate medications and accurate doses, Sheth said.

“We need to measure what’s clinically relevant,” he said. “And get the information back to the patients, pharmaceuticals, and clinicians.”

The impact, he believes, could potentially be life saving.

Last month, Peter Schmidt, a researcher at the National Parkinson Foundation, and Allison Willis, a medical doctor at the University of Pennsylvania, reported that better access to care from neurologists could prevent the death of almost 7,000 Parkinson’s patients annually in the U.S.

Sheth thinks that the Biostamp can help provide that care. With little effort, patients using the device could share data with doctors and receive immediate feedback.

“By providing information we can overcome distance and disability,” he said. “It’s that dual evil that prevents many Americans from getting the care they deserve.”

"The Internet of Healthy Things"

There are a number of other companies racing to track patients in real time. Proteus, a company based in California has created an ingestible sensor that is a small pill. They are still seeking FDA approval for their ingestible sensor to be integrated directly into a pharmaceutical drug.

Another company, Corventis, has created a band-aid that detects cardiac arrhythmias. And Given Imaging is working on PillCam COLON, a pill that transmits live pictures from a patient’s gastrointestinal tract.

A slew of products related to monitoring health will soon be available, Kvedar, the doctor at the Center for Connected Health, said. Smart pill caps that record whether a patient has taken their medication are on the horizon as well, and different technologies will soon integrate and work together.

“We call it the Internet of healthy things,” Kvedar said. “Having this objective data come through can be powerful.”

MC10 is privately held and still in its nascent stages, so Sheth did not disclose how much the device will cost. But it will be economical, said Elyse Winer, the company’s marketing and communications manager.

“We want people to afford and use these products,” she said. MC10’s Checklight device currently sells for $149.99.

There are a few kinks, of course, Sheth said. Since the Biostamp is a skin patch, wearing it for too long can cause contact dermatitis. So despite being waterproof and having a long battery life, patients will need to remember to remove and replace the device in some way about once a week.

Still, Kvedar, the doctor at the Center for Connected Health, thinks the next generation of devices, including the Biostamp, hold great promise.

Research has shown that devices with sensors can help lower the rate of ER visits, reduce trips to the doctor, and can keep people healthier, Kvedar said.

“We know that and we’ve already demonstrated that a number of times,” he said.

[Images courtesy of MC10 Inc]

A Few Ways We May Stop Parkinson's

FoxFeed Blog

A Few Ways We May Stop Parkinson's

Posted by  Maggie McGuire, July 22, 2014

Alpha-synuclein: that sticky protein that clumps in the brain cells of people with Parkinson’s. Scientists think that aggregates of alpha-synuclein — called Lewy bodies — are toxic, killing off cells and leading to PD symptoms. Therefore, avoiding or breaking up Lewy bodies is a major focus of research.

The Michael J. Fox Foundation funds a robust portfolio of projects that target alpha-synuclein, and we’re leading efforts to understand more about this protein, why it clumps together in the first place and how new cells are “infected” with Lewy bodies.

The projects we support that target alpha-synuclein to stop or prevent Parkinson’s disease take one of four approaches:

• Lower alpha-synuclein levels overall: Scientists hypothesize that less alpha-synuclein means less opportunity for Lewy bodies, so they are exploring ways to prevent the body from making this protein, such as interfering with gene signaling. Complicating this approach is that we don’t yet know the normal function of alpha-synuclein, and thereby the effect of wiping it out. However, pre-clinical models without alpha-synuclein appear to function normally, which is promising.
  • Read more about a project that took this approach.

• Break up Lewy bodies in the cells: Since clumps of alpha-synuclein clog up cells, researchers are working on a therapy that would break up Lewy bodies (like untying a knot) and allow the cells to function properly.
  • Learn about a project that’s using this method.

• Help the cells clear out Lewy bodies: A cell may stay healthy if it is able to rid itself of the Lewy bodies before they have harmful effects. Scientists are working on therapies to either directly degrade Lewy bodies or to bolster the cells’ cleaning mechanisms to flush out the alpha-synuclein clumps.
  • Read more about one target in this category.

• Catch Lewy bodies on the move: One theory proposes that Lewy bodies are released from cells and infiltrate others to spread the disease. Another suggests that the diseased cells give off a signal to other cells that makes the alpha-synuclein in those secondary cells start to clump. Either way, if a drug could stop the disease from spreading between cells, it would stop its progression.
  • Learn about a clinical trial of an antibody against Lewy bodies.

“We take a varied approach because we don’t want to put all our eggs in one basket,” said Kuldip Dave, PhD, who directs the MJFF alpha-synuclein portfolio. “We’re after a drug that can stop or slow the progression of Parkinson’s, and alpha-synuclein is a primary target. More approaches to treat the disease give us more chances of success.”

Why Do I Keep Doing This? Impulsivity

What You Need to Know

An impulse control disorder (ICD) is the inability to stop doing something that is harmful, or could become harmful, to yourself or others. Performing the harmful activity is believed to relieve anxiety and tension. Common examples of ICDs among people without Parkinson’s disease are kleptomania, compulsive gambling and pyromania. Scientists have known for over a decade that dopamine-related drugs for Parkinson’s could be linked to ICDs in some patients. However, it was not until 2004 that people living with Parkinson’s began to learn that ICDs could be a rare side effect of dopamine agonists. By 2007, researchers at the National Institute for Neurological Diseases and Stroke (NINDS) were reporting that these behaviors could affect up to 14 percent of Parkinson’s patients on dopamine agonists. Today, that number is thought to be even higher. Currently, most of the medications for Parkinson’s - including amantadine, levodopa, pramipexole, pergolide, ropinerole, selegiline and others, as well as surgical treatments such as pallidotomy and deep brain stimulation---have been linked to impulse control disorders in scientific studies.

The ICDs found in people living with Parkinson’s include:

•Compulsive gambling
•Compulsive shopping
•Hypersexuality
•Hoarding
•Compulsive computer usage

Compulsive gambling can include bingo, paper or electronic pulltabs, lottery tickets and “scratch-offs,” casinos, Fantasy Football or competitive bets between friends.

“I gambled away more than $450,000 that was supposed to be part of my retirement.” – Walter, diagnosed at age 62

Compulsive shopping involves buying things you do not need, and sometimes in large quantities.

“I bought 110 birdhouses last weekend. I don’t know why. They won’t do me any good. I live in an apartment.” – Carl, diagnosed at age 65

Hypersexuality can include demanding sex and becoming abusive if your demand is denied; talking about sex and your desire for sex at inappropriate times; cross-dressing; and having affairs outside of your committed relationship.

“A friend of mine who was a conservative Christian pastor with a large congregation called me one day. He wanted to let me know that he was leaving the state because he had left his wife of 20 years and their three children. He said he had discovered his ‘soul mate’ at a Parkinson’s support group. She was leaving her husband and two children. He told me that he thought the dopamine agonists that both of them were taking might have had something to do with the situation but that he felt helpless to stop himself. I have not heard from him or any news about him in five years.” – Name withheld by request

Compulsive computer use has yet to be officially characterized as an impulse control disorder. However, there are hundreds of anecdotal reports from people with Parkinson’s and their caregivers about the number of hours spent using a computer, typically “surfing” the Internet.

If you suspect you have an ICD, here is what you should do:

•Keep a drug diary and record changes in your mood or behavior, as well as physical responses.

•If you find yourself starting to engage in any of the behaviors listed above or doing things that you feel guilty doing, talk to someone about it! A support group member, your doctor or someone from your place of worship are potential resources.

•Let your family know what is happening, because the problem affects them, too. Realize that ICDs could be a significant stressor on a marriage.

What can be done to treat medication-induced impulse control disorders?

If the medications in question are dopamine agonists or monoamine oxidase (MAO) inhibitors (for example, Pramipaxole, Ropinirole, Rasagiline, Rotigotine patch), the doctor may have you

•Reduce the dosage of the medication.
•Taper off and stop the drug completely.
•Switch to a different medication.

If the likely cause of the ICDs seems to be related to levodopa or surgery, the physician may

•Have you see a psychiatrist to evaluate whether the behavior is Parkinson’s-related or a separate mental health issue.
•Refer you to a psychotherapist who will help you to identify any cues that trigger the urge to gamble or shop, and then identify actions you might take to deal with those urges.
•Connect you with a social worker or social service agency that can refer you to support groups that deal with impulse control disorders.
•Refer you to a psychiatrist who may prescribe naltrexone, a drug that is used to treat alcohol and narcotic abuse. It is generally considered when nothing else has worked.

Impulsive behaviors can affect you and your loved ones. Don't consider this a minor thing and seek help if you or your loved ones start noticing it.

Parkinson’s Progression Marker Initiative Reports Reduced Tau found in CSF of Parkinson’s subjects

Parkinson’s Progression Marker Initiative Reports Reduced Tau found in CSF of Parkinson’s subjects

The search for biological biomarkers to predict the risk or onset of Parkinson’s disease is important for the development of neuroprotective strategies that will benefit people who are at-risk, even before symptoms emerge.  Through the search for biomarkers, there is potential for a permanent cure, instead of temporary symptomatic treatments. The Parkinson’s Progression Markers Initiative (PPMI) has over 800 research subjects at 32 research sites in 13 countries of the world, a large observational study that is producing some fascinating results.

Ken Marek, M.D. is the president and senior scientist at the Institute for Neurodegenerative Disorders in New Haven, Connecticut and also clinical professor of Neurology at Yale University.  He is also the principal investigator for the PPMI study.  In the past he said, “The entire goal of this study is to help us to accelerate therapies. The general way in which we can do that is by simply having tools that can be used to objectively measure disease, but the more specific way is that many of these biomarkers will hopefully identify subsets of individuals who may be affected in different ways. For example, some individuals with Parkinson disease might have more of a synuclein problem, whereas others have more of a LRRK2 problem. Using these biomarkers to direct therapy will also be extremely valuable in making those therapeutic trials more likely to be effective.”

Dr. Marek presented the most recent data from this study at the 18th International Congress of Parkinson’s Disease and Movement Disorders in Stockholm, Sweden.

He reported that one recent, significant observation has been that in the cerebrospinal fluid (CSF) samples from people with PARKINSON’S so far examined, there has been a reduction of tau.  Tau is a protein abundantly found in neurons, but when it malfunctions and clumps together it contributes to neurodegeneration and is indicative of Alzheimer’s disease.  Because PARKINSON’S is also a neurodegenerative disease, there was an expectation to find tau elevated in the CSF of PARKINSON’S patients. .  So it was surprising to find that it was reduced.  Similar results were reported in two smaller studies.  “But our data is the biggest sample, it does seem to be a real finding” he said.  Then he added: “We can’t explain it at the moment.  It is leading to much discussion and additional research is needed to understand what we are seeing.”

The PPMI study has divided its research into four different categories.  They are looking at clinical measures, such as can be measured by the Unified Parkinson’s Disease Rating Scale; imaging, including Magnetic Resonance Imaging (MRI) single photon emission computed tomography (PET scan) and photoacoustic computed tomography.  The genetics category includes people with LRRK2 and synuclein mutations and there is a category for bio specimen samples of CSF, blood or plasma.

International Parkinson and Movement Disorder Society (MDS) 18th International Congress of Parkinson’s Disease and Movement Disorders Abstract 729

Medscape Medical News , Topic Alert June 20, 2014

Review by Marcia McCall

Picture Credit

http://commons.wikimedia.org/wiki/File:TANGLES_HIGH.jpg

Parkinson's Therapies in Development

The Michael J. Fox Foundation Mark on Therapeutic Development

The Michael J. Fox Foundation exists to speed development of a Parkinson’s disease cure and new treatments to improve quality of life for patients until the cure is found. Below we outline some drugs in the pipeline that we’ve supported — what researchers hope they do and where they are in the testing process. Click on the drug/compound name for more information and to learn about the role MJFF has played in its journey toward pharmacy shelves.

Learn more about participating in clinical trials.

Webinar: "Is Parkinson's One Disease or Many?" April 2014