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Motion Capture Analysis of Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease

Motion Capture Analysis of Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease. Dunbar Alcindor MD Allegheny General Hospital 12/8/2012. Disclosures. None. Parkinson’s Disease (PD) .

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Motion Capture Analysis of Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease

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  1. Motion Capture Analysis of Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease Dunbar Alcindor MD Allegheny General Hospital 12/8/2012

  2. Disclosures • None

  3. Parkinson’s Disease (PD) • PD is a progressive neurodegenerative disorder associated with a loss of dopaminergic neurons in substantia nigra par compacta. • It affects approximately 1% of individuals older than 60 years. • Cardinal features include resting tremor, rigidity, bradykinesia, and postural instability.

  4. Parkinson’s Disease-Treatment • The goal of medical management is to provide control of signs and symptoms for as long as possible while minimizing adverse effects. • Medications usually provide good symptomatic control of motor signs for 4-6 years.

  5. Parkinson’s Disease-Treatment-Deep Brain Stimulation (DBS) • The subthalamic nucleus (STN) most common site for DBS-PD • STN-DBS has been shown to improve motor activity and ADL • The Unified Parkinson’s Disease Rating Scale (UPDRS), most common and well established measurement tool.

  6. The Unified Parkinson’s Disease Rating Scale (UPDRS) Total UPDRS consists of four parts • Parts I, II, and III contains 44 questions each measured on a 5-point scale (0-4). • I. Mentation, behavior, and mood • II. Activities of daily living (ADL) • III. Motor function • IV. Complications of therapy

  7. UPDRS Part III • 14 sections • Score 0-52

  8. The Unified Parkinson’s Disease Rating Scale (UPDRS ) • UPDRS scale has several limitations: • Inherent subjectivity • Requires specialized training to administer the test. • Early and mild motor disability with PD may not be detected with the UPDRS

  9. Motion Capture • Motion capture in movies, military , sports and medicine • Avatar • Star wars • Pirates of the Caribbean

  10. Objective • Can motion capture provide objective measures of a subject’s response to DBS treatment for Parkinson’s disease?

  11. Methods • 6 Subjects (3M,3F) • Idiopathic PD dx 8-16 yrs(mean 11 yrs) • Age range 51-67 years (mean 58 yrs) • Post DBS-STN 2-5yrs (mean 3.3 yrs) • Single surgeon and center • Dr. D.M. Whiting, Allegheny General Hospital

  12. Methods-MC • Kinematic data from 6 subjects (3M/3F) were recorded using a motion capture system consisting of 16 Vicon Vx infrared cameras. • The cameras record the 3-dimensional location of 60 reflective markers placed on the participant's body at 120 Hz.

  13. Methods-MC • Participants walked along a walkway(3 meters) at a self selected pace. • Medications withheld 12 hours prior to study • Pts were assessed with stimulator on and then off • 30 minutes between testing • Study approved by AGH and CMU IRB

  14. Methods • UPDRS Part III Motor component • Tremor- hands and feet • Action tremor • Hand pronation/supination • Gait • Arise from chair • Postural stability • Leg agility

  15. Methods • UPDRS Part III Motor component • Tremor- hands and feet • Action tremor • Hand pronation/supination • Gait • Arise from chair • Postural stability • Leg agility

  16. Methods • UPDRS Part III Motor component • Tremor- hands and feet • Action tremor • Hand pronation/supination • Gait • Arise from chair • Postural stability • Leg agility

  17. Methods • UPDRS Part III Motor component • Tremor- hands and feet • Action tremor • Hand pronation/supination • Gait • Arise from chair • Postural stability • Leg agility

  18. Methods • UPDRS Part III Motor component • Tremor- hands and feet • Action tremor • Hand pronation/supination • Gait • Arise from chair • Postural stability • Leg agility

  19. Methods • UPDRS Part III Motor component • Tremor- hands and feet • Action tremor • Hand pronation/supination • Gait • Arise from chair • Postural stability • Leg agility

  20. Methods • UPDRS Part III Motor component • Tremor- hands and feet • Action tremor • Hand pronation/supination • Gait • Arise from chair • Postural stability • Leg agility

  21. Results-UPDRS • UPDRS Scores for 6 subjects • Stimulator on and off • Average score On 1.5 and Off 15.3

  22. Results-Gait Analysis • DBS-STN On • Stride Length • Walked Faster • Tasked completed in less time Blue = Off Green = On

  23. Results-Gait Analysis • When stepping patterns were assessed, subjects took longer steps

  24. Results- Gait Analysis • Walked faster and completed their assigned task in less time in the On state

  25. Results-Gait • MC stepping patters during 3 meter walk

  26. Correlation of UPDRS Part III Motor Scores with DBS in On and Off Condition • On-Positive Correlation: • Step Height Variance • Speed Variance • Off -Positive Correlation: • Step width

  27. R Wrist acceleration during walking • Less oscillations, more fluid movement -On LWrist acceleration during walking

  28. Pelvis Accelerations • The pelvis angle(rad) recorded during walking in the Off state was lower and distance between peaks wider for AP and vertical accelerations. • Similar for both in M-L accelerations.

  29. Heel Clearance • Improved heel clearance seen with stimulator On • This was seen irrespective of R/L • Patients were able to raise their feet higher • Took less time to raise their feet

  30. Conclusion • UPDRS correlated when DBS-On for step height and speed, and DBS – Off for step width • MC in DBS-STN subjects in On State • Improved heel clearance • Wrist: Less oscillations, more fluid movements • Pelvis: more control and consistency • In AP and vertical acceleration during assigned walking task • Patients took less steps, longer strides and completed task in less time

  31. Conclusion • MC may be utilized to provide a non-invasive and quantifiable method of motor assessment in PD. • Our preliminary evidence suggest that MC may be more sensitive to certain motor problems than the UPDRS • MC data may someday be used to improve DBS parameter programming.

  32. Future Studies-MC and PD • How can we more accurately capture the cardinal symptoms of PD • Disease Progression • Overall effect of treatment • Are there any other subtle signs and symptoms that we can capture to accurately predict disease course

  33. Acknowledgements • Allegheny General Hospital-Division of Neuromodulation • Dr. D.M. Whiting • Dr. M.Y. Oh • Dr. N.D. Tomycz • Dr. B. C. Cheng • Allegheny General Hospital-Dept of Neurology-Movement Disorders Section • Dr. S. Baser • Carnegie Mellon University- Robotics and Computer Science Department • Dr. J. Hodgins • L. Trutoiu

  34. Acknowledgements

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