To Örebro University

Objective: To design, develop and set up a web-based system for enabling graphical visualization of upper limb motor performance (ULMP) of Parkinson’s disease (PD) patients to clinicians.

Background: Sixty-five patients diagnosed with advanced PD have used a wireless handheld computer, consisting of upper limb motor tests (finger to tapping and spiral drawings), in their home environments over the course of a 3 year clinical study. For the tapping tests, they were asked to perform alternate tapping of two buttons as fast and accurate as possible, first using the right hand and then the left hand. The spiral test included tracing a pre-drawn Archimedes spiral using the dominant hand and the test was repeated three times per test occasion.

Methods: The system employs advanced graphics such as animations and time-series plots to visualize the ULMP of PD patients to three trained neurologists. Performance during spiral tests is shown by animating the three spiral drawings, allowing the neurologists to observe real-time accelerations (or hesitations) during the actual drawing. Tapping performance is visualized by displaying graphs like distribution of taps over the two buttons, deviation of taps on horizontal axis, deviation of taps on vertical axis, and tapping reaction time.

Results: Different scales are utilized by neurologists to rate the observed impairments. For the spiral drawing performance, neurologists rate firstly the impairment using a 0 (no impairment) – 10 (extremely severe) scale and secondly the probable cause for the said impairment using 3 choices including Tremor, Bradykinesia/Rigidity and Dyskinesia. For the tapping performance, a 0 (normal) – 4 (severe) scale is used for rating Speed, Accuracy, Fatigue, Arrhythmia and Global Tapping Severity. The system is currently in use and results (intra- and inter-neurologist agreements) will be available for the poster presentation.

Conclusions: In contrast from current approaches used in clinical settings for the assessment of PD symptoms, this system enables clinicians to animate easily and realistically the ULMP of PD patients who at the same time are at their homes.