Technological Innovations, Challenges to Integration in Parkinson Disease Management

In managing Parkinson disease (PD), authors of a review article published in Frontiers in Neurology note that a multidisciplinary approach is warranted in which movement disorders experts, other medical specialists, and allied health professionals collaborate to address the expansive and differing symptoms of the condition.

While multispecialty care is typically implemented in multidiscplinary centers, an inconsistent clinical benefit and health economic impact has come from this strategy, say researchers. Notably, the current capabilities of digital technologies to supplant these centers may prove effective as patients with PD will be able to access care in their home and community.

“Digital technologies have the potential to connect patients with the care team beyond the traditional sparse clinical visit, fostering care continuity and accessibility,” said the review authors.

Examining advances in wearable and non-wearable technologies using artificial intelligence, defined as technology-enabled care (TEC), researchers sought to assess TEC under development and note any potential challenges that may affect full integration of technology in care for PD.

Delving into technological innovations within PD, inertial measurement units (IMUs) were cited as the most relevant to provide insight on patients’ clinical status and their response to treatment. Containing a triaxial accelerometer and gyroscope, IMUs have been embedded in devices worn by the patient in both the clinic and at home, which researchers indicate may more realistically portray motor function for clinical and research purposes.

Advances in TEC have contributed to the comparable efficacy between at home care and in the clinical setting, although researchers note that few models leveraging these services have been integrated into PD management. Notably, a multinational consortium called iCARE–PD was referenced by researchers, which aims to develop an innovative, pragmatic health care model that shifts the point of care from outpatient care to home-based community across a wider spectrum of disease stages in PD.

“This model consists of an integrated care network supported by a digital platform shaped as a virtual PD coach that incorporates principles of integrated care, self-management support, and TEC and integrates various eHealth solutions for patients with PD using codesign,” said the review authors.

This multi-faceted approach addresses a significant challenge brought by traditional models of care that perceive PD as a single chronic condition. However, to optimally bring this service and those similar to the forefront of care, researchers say that a standard definition of how to use a multidisciplinary approach is warranted to achieve accuracy, sensitivity, and reproducibility.

“For a successful implementation of TEC, it is urgent to create standards of validation for the intended clinical use of each technological modality and for their integration in a manner that is usable by patients,” conclude researchers. “Ongoing and future collaborative projects will inform how the future eHealth environment will emerge to reduce care inequities and provide a more comprehensive care for empowered patients.”

Reference

Luis–Martinez R, Monje MHG, Antonini A, Sanchez–Ferro A, Mestre TA. Technology-enabled care: integrating multidisciplinary care in Parkinson disease through digital technology. Front Neurol. Published online October 30, 2020. doi:10.3389/fneur.2020.575975