The specific and ultimate goal of the REMPARK project is to develop a PHS with closed loop detection, response and treatment capabilities for management of Parkinson's Disease (PD) patients at two levels:
- At the first level, the project will develop a wearable monitoring system able to identify in real time the motor status of the PD patients, and evaluating ON/OFF/Dyskinesia status, with sensitivity greater than 80% and specificity greater than 80% in operation during ambulatory conditions and will also develop a gait guidance system able to help the patient in real time during their daily activities.
- At a second level, the intelligent analysis of data provided by the first level, supported with a disease management system will allow the neurologist in charge to access accurate and reliable information to decide about the treatment that best suits the patient, improving the management of their disease, in particular to adjust so called therapeutic window.
To achieve this global goal, four main objectives need to be achieved:
- Identification of motor status in real time
- Development of a gait guidance system
- Development of a user interface to collect direct feedback from the patient
- Development of a server to allow interaction with the doctor in charge and track the evolution of the patient's condition.
To achieve the described objectives, a telemedicine enabled Personal Health System (PHS) will be developed for the remote management of Parkinson's Disease in its medium and advanced stages. PHS is composed by two levels:
- The first level corresponds to the Body Area Network (BAN) and acts in the short-term. It is composed by the sensors, the actuators and the smartphone, which also acts as GPS for providing context-aware information and as an interface for the PD patient, to record their direct feedback especially regarding the non-motor symptoms. Communications among the elements of the BAN will be via low energy Bluetooth (4.0), allowing enough autonomy for the patient. This first level will work autonomously, constituting a closed and automatic loop. This level of the system will be auto-adaptive by means of a constant evaluation of the actuator's effect, correcting its behaviour in the short term. Different configurations are possible for different patients. For instance, some patients may react better to auditory cueing while others may react better to haptic cueing (provided by the FES device). The use of FES as step initiating device will be an option for those patients suffering frequent episodes of FOG, while others may not need it because they do not experience FOG episodes, or because the chosen cueing system is enough to prevent the FOG episodes. The adjustable drug delivery system will be investigated and tested in subsequent medical projects and the objective is to include it for those patients suffering from unpredictable OFF periods.
- The second level acts in the medium-long term and constitutes a closed semi-automatic loop, as it allows the intervention of medical professionals. The system will be able to send data to the server of the relevant health service provider, allowing the patient's neurologist to regularly follow the evolution of the patient's disease in a more effective manner, as well as being able to make better informed decisions about the adjustment of the pharmacological treatment of the patient, a key issue in management of this disease. Data on the server will be automatically included in an Electronic Health Record (EHR). The correct intelligent data treatment will help to evaluate and predict the evolution of the disease of a particular patient.
On this specific architecture, two different groups of algorithms will be running. The first group will belocated in the level 1 (BAN), and it will be responsible for the ON/OFF detection and the implementation of the gait guidance system. A second group of algorithms will be the responsible for the implementation of the Rule engine at the server level.
Validation is a very crucial process since it will assess whether the developed sensors and the entire system are in position to adequately address predefined requirements, especially in terms of sensitivity and specificity of the ON/OFF/Dyskinesia detection and the goodness of REMPARK actuators. In addition, REMPARK validation process will follow the scientific method, in order to end up with scientific evidence, and so be accepted within the medical community. Validation process is divided two different kinds of testing:
- First loop of trials to be performed in Spain, on a reduced sample of PD patients, in order to assess if, eventually, any improvements on the REMPARK system performance could be needed.
- Second loop to demonstrate and test the performance of the final system prototype using the representative PD patients sample in all 4 countries.
The potential impact of REMPARK infringes in three fronts: medical, social and economic benefits. Expected impacts that REMPARK will respond to, are the following:
- Reduced hospitalisation rate and improved disease management, treatment or rehabilitation at the point of need.
- Strengthened evidence base on medical outcomes, economic benefits and effectiveness of the use of Personal Health Systems.
- Reinforced medical knowledge with respect to efficient management of diseases
- Contribution to more sustainable European healthcare system, through provision of high quality, personalized care, with better use of the available healthcare resources
- Reinforced leadership and innovation capability of the industry in PHS, medical devices and services through introduction of new business models, creation of spin-offs and better exploitation of IP for products, standards and regulation
- Accelerated establishment of interoperability standards and of secure, seamless communication of health data between all involved partners, including patients
- Participation of essential stakeholders in production of end-to-end solutions for personalized care. Reinforced national or regional commitment in deployment of innovative services following R&D projects
- Improved links and interaction between patients and doctors facilitating more active participation of patients in care processes
|Project Name||PERSONAL HEALTH DEVICE FOR THE REMOTE AND AUTONOMOUS MANAGEMENT OF PARKINSON'S DISEASE|
|Project start date||1/11/2011|
|Project duration||42 months|
|Project Coordinator||University Polytechnic of Catalonia - CETpD, Technical Research Centre for Dependency Care and Autonomous Living|
Dr. Joan Cabestany Moncusi
Rambla de l'Exposició, 59-69 08800 Vilanova i la Geltrú, Spain.
Tel. (+34) 934016742 / (+34) 609766001
E-mail: joan.cabestany at upc.edu