The transformative shift in healthcare to in-home telehealth services is projected to deliver long term benefits beyond the COVID pandemic to vulnerable populations, and those underserved due to isolation from specialty care centers. For the neurologist, however, the shift away from in-person care has disrupted the ability to perform comprehensive motor assessments with current telehealth technologies. While video conferencing platforms have enabled some neurological evaluations of speech, facial, and upper body symptoms, most neurological disorders such as Parkinson's disease (PD) require a comprehensive visual examination of different movement tasks and motor symptoms that are all too easily obstructed by the narrow field-of-view and constrained 2D visual display of standard telehealth video-conferencing interactions. To overcome these limitations and offer quantitative outcomes, our team of computer vision experts is partnering with leading neurologists to develop a remote means of recording and quantifying prescribed neurological motor assessment tasks in the home using a smartphone (3D) depth-sensing camera to inform a subsequent telehealth visit with video samples and corresponding numerical outcome metrics. While developments from our group and others in the area of computer vision have used total body pose estimation algorithms and stationary 3D cameras to measure joint mechanics, our pilot work demonstrates the feasibility of a new approach to derive neurological outcomes of gait, transfer, and fine motor assessment tasks directly from depth data recorded from a nonstationary (handheld) smartphone. In Phase I we will build upon this work to develop simultaneous localization and mapping algorithms in Aim 1 to obtain outcome measures of motor impairment from n=10 participants with PD that achieve +/- 5% error with respect to gold-standard motion capture. Aim 2 will add guided instructions, compliance feedback, and summary reports to the software. The resulting NeuroVision prototype will be clinically evaluated for usability and perceived value among n=5 independent neurologists and n=10 of their patients with PD. Smartphone-based recordings will be acquired by the patient's care assistant or family member using the NeuroVision app in our laboratory. The resulting report will be provided to the referring neurologist, to be used to inform a scheduled telehealth visit. Our milestones are to achieve favorable Likert usability ratings (â¥8/10) and high ratings of perceived clinical value and acceptance from the neurologists. Focus groups involving the patient and caregiver will provide additional feedback for a designing a more complete Phase II NeuroVision system that meets in-home use requirements, supports a broader range of common neurological conditions, and provides a secure eHealth assessment report. The pre-commercial prototype will be tested for usability and clinical value in informing telehealth follow-up visits to meet the needs of a broader population of at-risk patients with PD, Essential Tremor, Stroke, and Huntington's disease currently in need of safe and reliable access to routine clinical care for health and quality of life.
Public Health Relevance Statement: PROJECT NARRATIVE The shift towards a greater reliance on telehealth delivery for neurological care has created a need for effective technologies beyond existing videoconferencing platforms to provide a surrogate means of assessing changes in motor symptoms without relying on in-person visits. This project addresses the need by developing NeuroVisionTM, a smartphone-based app for home use that leverages new depth-sensing camera technology to guide the user in recording prescribed motor assessment tasks in the home that are automatically quantified into clinical outcome measures with contextual video samples that are made available to the neurologist as an eReport to inform a telehealth visit with the patent. This project responds to the NIH mandate for more effective remote delivery of evidence-based practice during the global pandemics and beyond.
Project Terms: Algorithms; Architecture; Engineering / Architecture; Computer Vision Systems; computer vision; Face; faces; facial; Feedback; Focus Groups; Gait; Patient Care; Patient Care Delivery; Gold; Huntington Disease; Huntington Chorea; Huntington's; Huntington's Disease; Huntington's Disease Pathway; Huntingtons Disease; Joints; Laboratories; Lower Extremity; Lower Limb; Membrum inferius; Motion; Movement; body movement; Movement Disorders; Dyskinesia Syndromes; Movement Disorder Syndromes; Muscle; Muscle Tissue; muscular; Persons; NIH; National Institutes of Health; United States National Institutes of Health; Nervous System Diseases; Neurologic Disorders; Neurological Disorders; neurological disease; nervous system disorder; Neurology; Paralysis Agitans; Parkinson; Parkinson's disease; Parkinsons disease; Primary Parkinsonism; Parkinson Disease; Patents; Legal patent; Patients; Cyclicity; Rhythmicity; Periodicity; QOL; Quality of life; Software; Computer software; Specialty; medical specialties; Speech; Standardization; Apoplexy; Brain Vascular Accident; Cerebral Stroke; Cerebrovascular Apoplexy; Cerebrovascular Stroke; brain attack; cerebral vascular accident; cerebrovascular accident; Stroke; Technology; Testing; Video Recording; Videorecording; video recording system; Vision; Sight; visual function; Work; Measures; Caregivers; Care Givers; Family Caregiver; Family Care Giver; Family member; Healthcare; health care; Outcome Measure; Schedule; Specialist; Caring; Telemedicine; Guidelines; base; sensor; Procedures; Area; Clinical; Phase; Neurologic; Neurological; Ensure; Evaluation; motor disease; motor dysfunction; motor disorder; Body part; Visual; Individual; Neurologist; Populations at Risk; Summary Reports; Benign Essential Tremor; Essential Tremor; mechanical; Mechanics; Adopted; Involuntary Movements; Protocol; Protocols documentation; System; 3-D; 3D; three dimensional; 3-Dimensional; Visit; Services; kinematic model; kinematics; Structure; Participant; novel technologies; new technology; Devices; Reporting; intervention therapy; Therapeutic Intervention; Sampling; response; Vulnerable Populations; vulnerable group; vulnerable people; Cell Phone; Cellular Telephone; iPhone; smart phone; smartphone; Cellular Phone; Membrum superius; Upper Limb; Upper Extremity; body position; telehealth; Address; video conferencing; Videoconferencing; Symptoms; Evidence based practice; Adherence; Data; Motor; Resolution; research clinical testing; Clinical Evaluation; Clinical Testing; clinical test; Monitor; Process; follow-up; Active Follow-up; active followup; follow up; followed up; followup; Development; developmental; pandemic disease; pandemic; Instruction; cost; design; designing; novel strategies; new approaches; novel approaches; novel strategy; Outcome; Neurological outcome; Neurologic outcome; usability; motor impairment; movement impairment; movement limitation; prototype; clinical care; patient population; Secure; eHealth; e-Health; mobile application; mobile app; mobile device application; Caregiver support; Care giver support; motor symptom; smartphone Application; Android App; Android Application; Cell Phone Application; Cell phone App; Cellular Phone App; Cellular Phone Application; Smart Phone App; Smart Phone Application; Smartphone App; iOS app; iOS application; iPhone App; iPhone Application; sensor technology; sensing technology; wearable sensor technology; body sensor; body worn sensor; wearable biosensor; wearable sensor; wearable system; Multi-site clinical study; Multi-center clinical study; Multicenter clinical study; Multisite clinical study; COVID-19 pandemic; COVID crisis; COVID epidemic; COVID pandemic; COVID-19 crisis; COVID-19 epidemic; COVID-19 global health crisis; COVID-19 global pandemic; COVID-19 health crisis; COVID-19 public health crisis; COVID19 crisis; COVID19 epidemic; COVID19 global health crisis; COVID19 global pandemic; COVID19 health crisis; COVID19 pandemic; COVID19 public health crisis; SARS-CoV-2 epidemic; SARS-CoV-2 global health crisis; SARS-CoV-2 global pandemic; SARS-CoV-2 pandemic; SARS-CoV2 epidemic; SARS-CoV2 pandemic; SARS-coronavirus-2 epidemic; SARS-coronavirus-2 pandemic; Severe Acute Respiratory Syndrome CoV 2 epidemic; Severe Acute Respiratory Syndrome CoV 2 pandemic; Severe acute respiratory syndrome coronavirus 2 epidemic; Severe acute respiratory syndrome coronavirus 2 pandemic; corona virus disease 2019 epidemic; corona virus disease 2019 pandemic; coronavirus disease 2019 crisis; coronavirus disease 2019 epidemic; coronavirus disease 2019 global health crisis; coronavirus disease 2019 global pandemic; coronavirus disease 2019 health crisis; coronavirus disease 2019 pandemic; coronavirus disease 2019 public health crisis; coronavirus disease crisis; coronavirus disease epidemic; coronavirus disease pandemic; coronavirus disease-19 global pandemic; coronavirus disease-19 pandemic; severe acute respiratory syndrome coronavirus 2 global health crisis; severe acute respiratory syndrome coronavirus 2 global pandemic; clinical outcome measures; remote delivery; delivered remotely; Home; remote assessment; remote evaluation
