A New Wrist-Worn Tool Supporting the Diagnosis of Parkinsonian Motor Syndromes.

To date, clinical expert opinion is the gold standard diagnostic technique for Parkinson's disease (PD), and continuous monitoring is a promising candidate marker. This study assesses the feasibility and performance of a new wearable tool for supporting the diagnosis of Parkinsonian motor syndromes. The proposed method is based on the use of a wrist-worn measuring system, the execution of a passive, continuous recording session, and a computation of two digital biomarkers (i.e., motor activity and rest tremor index). Based on the execution of some motor tests, a second step is provided for the confirmation of the results of passive recording. In this study, fifty-nine early PD patients and forty-one healthy controls were recruited. The results of this study show that: (a) motor activity was higher in controls than in PD with slight tremors at rest and did not significantly differ between controls and PD with mild-to-moderate tremor rest; (b) the tremor index was smaller in controls than in PD with mild-to-moderate tremor rest and did not significantly differ between controls and PD patients with slight tremor rest; (c) the combination of the said two motor parameters improved the performances in differentiating controls from PD. These preliminary findings demonstrate that the combination of said two digital biomarkers allowed us to differentiate controls from early PD.

Clinical assessment of a new wearable tool for continuous and objective recording of motor fluctuations and ON/OFF states in patients with Parkinson's disease.

Clinical rating scales typically includes subjective evaluations, and their time-limited duration may fail to capture daily fluctuations in motor symptoms resulting from Parkinson's disease (PD). Recently, a new tool (i.e. the PD-Watch) has been proposed for the objective and continuous assessment of PD motor manifestations based on evaluating frequency data from a wrist-worn tri-axial accelerometer and identifying specific movement patterns typically associated with disorders. This reduces the probability of confusing physiological or pathological movements occurring at the same frequency. In this work, we present a new method for assessing motor fluctuations through a wrist-worn accelerometer. We also explore the agreement between the continuous data generated by the proposed method and data reported in the patient diaries. In this study, twelve PD patients were recruited with an overall recording duration of 528 hours. Results of this preliminary study show that the proposed tool has suitable and adequate performances for analysing the motor signs of PD patients, and the estimated sensitivity, specificity, and accuracy of the tool are 85%, 94%, and 91%, respectively.

A wearable tool for continuous monitoring of movement disorders: clinical assessment and comparison with tremor scores.

BACKGROUND: The current gold standard for evaluating normal and impaired motor performances includes the use of the information provided by the patient and the Unified Parkinson's Disease Rating Scale (UPDRS). However, clinical rating scales are typically subjective and their time-limited duration may fail to capture daily fluctuations in motor symptoms resulting from Parkinson's disease. Recently, a new tool has been proposed for objective and continuous assessment of movement disorders based on the evaluation of frequential data content from multi-axial sensors and the identification of specific movement patterns typically associated with disorders. This reduces the probability of confusing physiological or pathological movements occurring at the same frequency with a different movement pattern. However, the data provided by the tool have not yet been compared with the information provided by the typically used clinical rating scales. OBJECTIVES: The aim of this work is to investigate the possible relationship between UPRDS scores and the information provided by the tool for continuous and long-term monitoring. MATERIALS AND METHODS: In this study, 20 patients with hand tremor were recruited. The UPDRS scoring was performed by a neurologist. Then, continuous monitoring was performed; data were acquired by means of the proposed wrist-worn-device "PD-Watch" for 24 h and then processed in order to get information and indexes on motor symptoms. Finally, these indexes were correlated to the UPDRS scores. RESULTS: Results show that the concise indexes provided by the tool correlate well with some items in UPDRS Part III, and this correlation has allowed to provide a more direct and immediate meaning to the values of the concise indexes detected by the tool. CONCLUSIONS: While results need to be extended with further studies, this can be considered useful information in the context of clinical trials and routine clinical practice for assessing motor symptoms and movement disorders.

A novel device for continuous monitoring of tremor and other motor symptoms.

The clinical assessment of Parkinson's disease (PD) symptoms is typically performed with neurological examinations and simple motor tests. However, this only takes into account the severity of motor symptoms during the length of the recording and fails to capture variations in a patient's motor state, which change continuously during the day. Most of the current methods for long-term monitoring of extrapyramidal symptoms are based on the use of a wearable magneto-inertial device that evaluates the frequential content of signals in the range of movement disorders. However, the typical daily motor activities performed by patients may have a power spectrum into the same range of motor symptoms, and habitual activity may be indistinguishable from that due to movement disorders. In this work, we report a new device and method for the continuous and long-term monitoring of tremor due to PD and other movement disorders to reduce the probability of mistaking the discrimination between extrapyramidal symptoms and normal daily activity. The method is based on the evaluation of frequential data content from multi-axial sensors and on the identification of specific movement patterns that Parkinsonian and extrapyramidal symptoms are typically associated with. In this study, 16 patients with movement disorders were recruited. While results need to be extended with further studies and clinical trials, the proposed device appears promising and suitable for the use as part of clinical trials and routine clinical practice for supporting the evaluation of motor symptoms, disease progression, and the quantification of therapeutic effects.

Simple and Rapid Bioink Jet Printing for Multiscale Cell Adhesion Islands.

A simple and rapid process for multiscale printing of bioinks with dot widths ranging from hundreds of microns down to 0.5 µm is presented. The process makes use of spontaneous surface charges generated pyroelectrically that are able to draw little daughter droplets directly from the free meniscus of a mother drop through jetting ("p-jet"), thus avoiding time-consuming and expensive fabrication of microstructured nozzles. Multiscale can be easily achieved by modulating the parameters of the p-jet process. Here, it is shown that the p-jet allows us to print well-defined adhesion islands where NIH-3T3 fibroblasts are constrained to live into cluster configurations ranging from 20 down to single cell level. The proposed fabrication approach can be useful for high-throughput studies on cell adhesion, cytoskeleton organization, and stem cell differentiation.