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Sensor-based Gait Analysis: from translational research to telemedical application
Movement Disorder Unit
Department of Molecular Neurology
Prof. Dr. med. Jochen Klucken
Klinische Anwendung - Versorgungsszenario
Sym
pto
mau
sprä
gu
ng
Krankheitsverlauf
Diagnostik
TherapieD TD TD TD TD
Chronische Krankheit – Parkinson-Syndrom
Diagnostik
Therapie
Akute Krankheit
Inkomplette Remission
komplette Remission
Klucken et al. 2015
2
SektoraleVersorgung
Telemedizin-unterstützte VersorgungskonzepteIndividualisierter Patientenverlauf
Chronischer Verlauf:
Telemedizin
Medizinische Information
Telemedizin-Plattform – IT
Telemedizin-Technologien
Hausarzt FacharztKH/UK
Home-NurseSmart-Home-Tech.
Video-basiertesHome-Monitoring
Sensor-basierteGanganalyse
• Gait sequence (10 meter)
eGaIT – mobile gait lab
gait parameter validation
Rampp et al. TBME 2014Kanzler et al. EMBC 2015
Gait Parameter
Stride lenght eGaIT [cm]
Str
ide
len
gth
Gai
tRit
e[c
m]
S. Schülein et al., J NeuroEng Rehab 2017
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• ~2000 recordings>950 PD patients
>550 MS patients
>350 controls
>150 other movement disorder
Gait analysis in Parkinson‘s disease(from 40 meter walk)
Clinical databasePark_Dat
- Demography- Diagnosis- Motor. Scores (UPDRS, UHDRS)- Risk-of-fall (FESI, FOG)- Depression (BDI, Zung)- QoL (SF12)
Gait parameters in PD – „short steps“
Association to stages and symptoms
H&Y UPDRS-GAIT UPDRS-III
C I II III
C I II III
C I II III
C 1 2 3
C 1 2 3
C 1 2 3
C L M H
C L M H
C L M H
Stride length
Stride time
Stance Phase
Schlachetzki et al, PlosOne in revision
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Gait parameters in PD – „shuffling of gait“
Association to stages and symptoms
H&Y UPDRS-GAIT UPDRS-III
C I II III
C I II III
C 1 2 3
C 1 2 3
C L M H
C L M H
Foot clearance
Heel strikeAngle
Schlachetzki et al, PlosOne in revision
Multifeature-based Gait Signature
Pattern recogntion – “big-data mining”
Sen
sors
igna
l
Sensors 2015, TBME 2015,PlosOne 2013,EBMC 2012, 2014
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Individualized “eGaIT Score”
Gait signature correlating to the UPDRS-III
eGaIT
J. Barth
UPDRS-III Subscore(gait-related Items)
eGaI
Tsc
ore
eGait SCORE
ArztMultiparametrische Regressionsanalyse
UPDRS-III ItemHALTUNG
eGaI
Tsc
ore
0 1 2
UPDRS-III ItemGANG
eGaI
Tsc
ore
0 1 2
Clinical application – individual long termmonitoring of gait parameter and scores
Individuell bei der Apomorphine Pen Titration
Change of the UPDRS-III Change of the eGaIT Score
Cross-sectional bei der Rasagalin Initiierung
N=10,2,6,12,24 weeks after rasagaline initiation
J. Barth, H. GassnerF. Marxreiter
eGaIT score
UPDRS-III
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Continuous Gait Analysis @home
Mobility
F FFreezing
8 hour monitoring @home
ON OFF INTERMED.Motor Phases
eDiary
S. Reinfelder, F. Marxreiter
Event recordings
B. Eskofier, LMES. Reinfelder, F. Marxreiter
Home-MonitoringTelemedicine – individualised, objective
ON OFF INTERMED.Motor Phases
Gait ParameterStride Length(cm)
eDiary
Freezingpattern
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Classicalhealthcare
Telemedicine – Integrated Care Concepts – Individualized care
Chronic Disease:
Telemedicine
Medizinische Information
TelemedicalCommunication
plattform
PCP SpecialistKH/UK
Home-NurseSmart-Home-Tech.
Sensor-basedGait Analysis
Healthcare Technologies
Telemedizinische Home-MonitoringKommunikationsplattform
Digitale PatientenakteDatensicherheit – Privatsphäre
InteroperabilitätTI-Struktur, HL7, IHE
etc… etc… etc…
Kommunikationsplattform
IT – Lab
mHC -Tech
Hausarzt Spezialist Krankenhaus TelenurseCall-Center
Med.Info
Patient @Home
TechnologieSensorik
EMGECG, Spirometry
TemperatureInstrumentedGait Analysis
Video basedDiagnostics
Communikation
Activity
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Mobile Health Care Technologies – Gait analysis
objective diagnostics – clinical application
Prevention Early detectionInstrumented
TestsTherapy
monitoring
Clinical target parameter:Application: cross-sectional (clinical studies)
individual (long-term monitoring, clinical care)
Diseasespecific
Symptoms=
DifferentTechnologies
andAssessment
Concepts
Acknowledgement
BambergAschaffenburg
Erlangen
TennenloheHerzogenaurach
Rummelsberg
Funding/support:
Würzburg
TEVA Pharma GmbH
jochen.klucken@fau.de
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