Telemedicine represents a possible solution to unload the healthcare systems from the costs associated with the ageing population. It allows continuous monitoring of patients in their home setting during daily-life activities, so that even subtle changes in their condition can be promptly detected. In this context, a smart ink pen was developed within the European MoveCare project to provide home-based continuous and accurate monitoring of handwriting. The pen is instrumented with triaxial accelerometers and gyroscopes - to evaluate motion and tremor - and a load cell to study the writing force. It features both internal storage capacity and BLE connectivity. In this thesis work, the pen was used to collect and quantify the execution of a traditional clinical writing test - the Archimedean Spiral - performed by both Parkinson’s Disease (PD) patients and healthy controls. Postural and resting tremor from both patients and controls were also evaluated. Fine drawing and tremor parameters were extracted. Statistical analysis was conducted to study the reliability of the extracted parameters, and their ability to discriminate between PD patients and age-matched controls. Spiral drawing resulted the most reliable task, with reliability increasing from the young healthy adults (43% of total features) to PD patients (73%). Indicators related to tremor were characterized by a lower reliability. As for between-group comparison, for the spiral task, the writing pressure exerted III by PD patients was reduced and less smooth compared to age-matched controls; in addition, they presented a less regular velocity. As for tremor, evaluated over all tasks, the proportion of power in the characteristic PD frequency band was significantly greater in patients. In addition, more repetitive and predictable tremor oscillation components characterize PD patients, especially in the postural task. The obtained results support the use of the smart ink pen to identify relevant aspects affected by PD. Compared to more simple resting and postural tasks, spiral drawing adds important information to this analysis. Further work should increase the sample size and evaluate simple daily-life writing.
La telemedicina rappresenta una possibile soluzione per alleviare il peso sui sitemi sanitari, dovuto ai costi associati al crecente invecchiamento della popolazione. Permette infatti il monitoraggio continuo dei pazienti nelle loro case durante l’esecuzione di attività quotidiane, in modo che persino sottili differenze nella loro condizione possano essere individuate prontamente. In questo contesto, una penna sensorizzata è stata sviluppata nel progetto europeo MoveCare per fornire un accurato e continuo monitoraggio della scrittura da casa. La penna contiene un accelerometro e un giroscopio triassiali, per valutare il movimento e il tremore, e una cella di carico per studiare la forza esercitata nella scrittura. Essa è in grado sia di salvare i dati on-board che di essere connessa tramite BLE. In questo lavoro di tesi, la penna è stata utilizzata per quantificare l’esecuzione di un tradizionale test clinico - la spirale di Archimede - eseguita da pazienti Parkinson (PD) e soggetti sani. Entrambi i gruppi sono stati valutati anche in task di tremore posturale e a riposo. Quindi sono stati estratti parametri relativi al disegno e al tremore. Un’analisi statistica è stata condotta per valutarne l’affidabilità e la capacità di distinguere tra pazienti e sani accoppiati per età. Il disegno della Spirale è risultato la task più affidabile, con affidabilità crescente da giovani (43% delle feature totali) a pazienti (73%). Indicatori di tremore sono risultati poco affidabili. Nel paragone tra gruppi, per la spirale, la pressione esercitata si è rivelata più V bassa e meno fluida per i pazienti; in aggiunta, la loro velocità era meno regolare. Per il tremore, valutato in tutte le task, una maggiore proporzione di potenza nella banda di frequenza caratteristica di PD è stata riscontrata nei pazienti. Inoltre, oscillazioni più ripetitive e predicibili caratterizzano il gruppo PD, specialmente nella task posturale. I risultati ottenuti supportano l’utilizzo della penna sensorizzata per l’identificazione di aspetti rilevanti influenzati dalla patologia. Rispetto a task più semplici, a riposo o di postura, la spirale aggiunge importanti informazioni all’analisi. La ricerca futura dovrebbe considerare l’aumento del numero di partecipanti e la valutazione di semplici task di scrittura.
Use of a smart ink pen for the evaluation of tremor
TOFFOLI, SIMONE
2019/2020
Abstract
Telemedicine represents a possible solution to unload the healthcare systems from the costs associated with the ageing population. It allows continuous monitoring of patients in their home setting during daily-life activities, so that even subtle changes in their condition can be promptly detected. In this context, a smart ink pen was developed within the European MoveCare project to provide home-based continuous and accurate monitoring of handwriting. The pen is instrumented with triaxial accelerometers and gyroscopes - to evaluate motion and tremor - and a load cell to study the writing force. It features both internal storage capacity and BLE connectivity. In this thesis work, the pen was used to collect and quantify the execution of a traditional clinical writing test - the Archimedean Spiral - performed by both Parkinson’s Disease (PD) patients and healthy controls. Postural and resting tremor from both patients and controls were also evaluated. Fine drawing and tremor parameters were extracted. Statistical analysis was conducted to study the reliability of the extracted parameters, and their ability to discriminate between PD patients and age-matched controls. Spiral drawing resulted the most reliable task, with reliability increasing from the young healthy adults (43% of total features) to PD patients (73%). Indicators related to tremor were characterized by a lower reliability. As for between-group comparison, for the spiral task, the writing pressure exerted III by PD patients was reduced and less smooth compared to age-matched controls; in addition, they presented a less regular velocity. As for tremor, evaluated over all tasks, the proportion of power in the characteristic PD frequency band was significantly greater in patients. In addition, more repetitive and predictable tremor oscillation components characterize PD patients, especially in the postural task. The obtained results support the use of the smart ink pen to identify relevant aspects affected by PD. Compared to more simple resting and postural tasks, spiral drawing adds important information to this analysis. Further work should increase the sample size and evaluate simple daily-life writing.| File | Dimensione | Formato | |
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https://hdl.handle.net/10589/169491