Ambulatory monitoring of postural instability and gait disorder in Parkinson's Disease.

Subjects are required to perform a predefined walking trail along a total of 75 m leveled walkway at self-selected preferred speeds. The measurements are subdivided in three sections which will be monitored with 6 sensors including a walking trajectory where tasks are performed which can elicit their walking disabilities and short while free walking (3 min). Furthermore the standard physiotherapy examination performed for Parkinson screening are included in the measurement. At last the UPDRS scale (part III) is obtained. Two questionnaires are asked to be filled in, the Falls efficacy scale and freezing of gait questionnaire. These measurements will be performed in a defined gym with an even floor at the physiotherapy department of hospital. Patients will be tested during their subjective on/off phase, using their regular medication regimen. The subjects will be summoned for a hospital visit to perform the gait trajectory, the measurement will take about one hour. The aim is to extract features out of the data that is registrated that can detect and classify PIGD.
In order to assess the performance of the subject reliable in the home environment with the sensor configurations, performances must be studied on controlled and known trajectories in advance. Therefore a trajectory is designed in which the likelihood of observing any axial disabilities is increased. The sensors only register movement and do no harm. If experiencing serious difficulties with the trajectories there is a risk of making missteps, entering a freezing condition or in worst case falling. The subjects are recruited from the Parkinson population at the Medical Spectrum Twente, Enschede, the Netherlands.

Presence of postural instability and gait dissorder PIGD (gait disorders, balance impairment, falls, fal-related injuries and FOG) are an important and disabling feature of idiopathic Parkinson’s disease (PD) where the level of functional ability is affected and has a significant impact on quality of life. For clinicians, it is currently difficult to adequately estimate the patient’s gait and balance problems in their clinical practice. For most Parkinson’s patients, the clinically based assessment does not adequately reflect their actual balance during daily life as it is only an impression at a given moment.

All measurements will be done in one time.
Quantification of walking is done by accelerometers and gyroscopes. One triaxiale accelerometer (Dynaport), and five triaxiale accelerometer plus triaxiale gyroscope (Xsens) will be fixed on the body in order to obtain the data. The Dynaport will be fixed only on the lower back as the Xsens sensors all are connected to each other and are placed on the lower back, thigh, shank and both feet.

Furthermore the activities are filmed. The assessment of the clinical state is done by clinical tests UPDRS (part III), Timed-Up-and-Go test, 10.

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