Quantifying turning behavior and gait in Parkinson's disease using mobile technology

Gait and balance impairments associated with Parkinson's disease (PD) are often refractory to traditional treatments. Objective, quantitative analysis of gait patterns is crucial in successful management of these symptoms. This project aimed to 1) determine if biomechanical metrics from a mobile device inertial measurement unit were sensitive enough to characterize the effects of anti-parkinsonian medication during the Timed Up and Go (TUG) Test, and 2) develop the Cleveland Clinic Mobility and Balance application (CC-MB) to provide clinicians with objective report following completion of the TUG. The CC-MB captured 3-dimensional acceleration and rotational data from people with PD (pwPD) to characterize center of mass movement while performing the TUG. Trials were segmented into four components: Sit-to-Walk, Gait, Turning, and Stand-to-Sit. Thirty pwPD were tested On and Off (12 h) anti-PD medication. Significant improvements (p < 0.05) between On versus Off conditions included: reduction in MDS-UPDRS III motor scores (10.7%), faster trial times (9.3%), more dynamic walking as evident by increased normalized jerk scores (vertical: 17.3%, medial-lateral: 12.3%), shorter turn durations (10.4%), and faster turn velocities (8%). Measures in Sit-to-Walk and Stand-to-Sit did not show significant changes. Trial time and turn velocity showed excellent test-retest reliability (ICC range: 0.83-0.96) across both medication states. A mobile device platform provided quantitative measures of gait and turning during the TUG that detected significant improvements from anti-parkinsonian medications. This platform is a low-cost, easy-to-use tool that can provide objective reports immediately following the clinical assessments, making it ideal for use in and outside the clinical setting.