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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

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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