With the surge in wireless devices, a lot of attention and development is focusing on wearable devices for medical purposes. The concept behind these devices is the same as it is for any wearable device: a wireless-communications product, boasting new features and capabilities able to be worn by the user, theoretically makes life easier. Yet the technology used by the REMPARK system to monitor Parkinson’s Disease takes the wearable device to new heights. The system comprises three devices, which are connected to a smartphone, and then worn on the body. The first two tremor inertial sensors are attached to the wrist while the movement inertial sensor is connected to the waist. Both sensors are attached by Velcro. Together, these devices transmit gait measurements and other non-motor symptoms to the smartphone, which then signals a cueing device (either electronic in the leg or audible in the ear). The information is passed on to the patient’s neurologist, who activates the remotely controlled, externally attached drug-injection pump when necessary.
Every minute, the sensors send information related to the patient’s motor state via Bluetooth. The system relies on a commercial cellular network to transmit that information to the physician. The system runs on a lithium battery, which must be recharged every day. Dr. Joan Cabestany of the University Polytechnic of Catalonia is heading the REMPARK project. I was able to interview Dr. Cabestany to get more detail on the inner workings of this wearable device.
SM: At the “second level” of the projects objectives, which focus on disease management and information sharing, you explained that a neurologist will be able to determine treatment best suiting the patient. Are you creating technology that will administer medication directly or communicate the patient’s needs to medical professionals? In either of these cases, through what technology will you accomplish this?
JC: In the REMPARK project, "second level" is used for the identification of the disease management level, where data and information are available to the neurologist and other professionals. The REMPARK system will be able to transmit and make available patient data related to the evolution of his/her disease. We are referring to motor and non-motor perturbation data directly related to Parkinson’s Disease. These data should be added to the particular EHR of the patient, making it possible to improve disease-management capabilities. The main advantage is the possible identification of symptoms in real time and in a continuous way. Additionally, these symptoms are recorded in real time, giving the possibility of a quantification and real status identification.
Concerning the direct administration of medication, the answer is yes, referring to the technological possibility. We are testing, through laboratory experiments, the remote control of an apomorphine subcutaneous pump. The objective is to modulate the administration of medication depending on the activity and needs of the patient. Finally, it is also possible to establish that this "second level”permits the disease’s evolution to be analyzed by the neurologist, with real and long-term data obtained by the system from the patient. A feedback and communication channel is allowed in the system, permitting messages, appointments, comments, questionnaires and more to be sent to the PD patients.
SM: One of the four main objectives of the REMPARK project is “development of a gait guidance system.” What technology will you use to be able to create one standardized motion for every individual?
JC: The development of a gait guidance system is one of the objectives and challenges in the project. The main solution we are focusing on and trying to implement is based on the well-known "auditory queuing" techniques. After identifying the patient’s movement and motor problems, the system will generate auditory sequences in an automatic way through a smartphone. The audio sound is applied using earphones connected via Bluetooth to the smartphone.
SM: In the “Solution” section of your project description, you say that different configurations are possible for different patients. How will the device determine which work best and how to interchange them?
JC: In the REMPARK system, adapting to the user’s requirement is done using artificial intelligence methods: applying learning processes on the real data of a huge database constructed by the project for these purposes. The database has been constructed with the participation of 90 cooperating patients following a specifically designed protocol that tries to put in evidence as many motor symptoms that are related to the disease in ambulatory (non- laboratory environment) conditions as possible. The knowledge contained and extracted from this database is used to construct specific algorithms for the detection of the motor problems. These algorithms are designed to exhibit a high degree of generalization. So, when applied to new patients (not contained in the database), the results will be satisfactory and adapted to the actual patient.
SM: Currently, REMPARK is only being tested in Europe. What would need to happen for this kind of technology to become available in the United States?
JC: REMPARK is a project funded by the European Union under its 7 Framework Program. Currently, it is being tested in Europe. This kind of activity and experience could be tested and/or transferred to the United States. It is just a question of defining conditions, partners, necessary consortium and collaboration, to find the funding and go ahead with the experience.
SM: Is there anything else you’d like to touch on in order to give our reader’s a clearer picture of the engineering technology it takes to implement such a device?
JC: Just to point out that a very important part of REMPARK is the wearable sensor subsystem, able to measure patient movement and process data autonomously in real time. It is a light-weight device the size of a mobile phone that must be worn at the waist. This wearable sensor is connected to a smartphone via Bluetooth. This smartphone is responsible for the interconnection with the "second level" REMPARK system and, at the same time, for certain automatic reactions, like the generation of auditory queuing for gait improvement.