For those with Parkinson’s disease, hand tremors can severely affect quality of life, whether that’s picking up a fork or writing a note. And, according to the National Parkinson’s Foundation, there are up to 600,000 new cases of Parkinson’s diagnosed each year in the U.S.
Researchers at Sonoma State University in Rohnert Park, California, are at work on a project they hope will make tracking symptoms easier for those diagnosed with Parkinson’s and their doctors.
Dr. Farid Farahmand, an assistant professor with the school’s Department of Engineering Science, is working with some of his students to create a glove that will monitor hand tremors, particularly in relation to a drug modification.
Dr. Farahmand explained to Not Impossible Now how a visit to the doctor’s office got the project started, and some of the design challenges they’ve faced along the way.
NIN: You were first prompted to think about using technology to help Parkinson’s patients when you accompanied a friend with Parkinson’s to the doctor. What happened during that appointment that got you thinking?
Dr. Farid Farahmand: The doctor was asking my friend if a drug was working better because he’d changed the dosage. And I know that my friend forgets. We were having a conversation three days ago, and he was telling me, “Sometimes I feel a lot worse.” But then when we were at the doctor’s, he was telling me, no, I think it’s getting a lot better. So it’s completely subjective to the state and condition of the patient right at that moment that you ask hem. So the last two weeks, whether it was working or not, the true impact of the drug on the patient cannot be measured because they just don’t remember in most cases.
Do you think part of that is because he wants to be optimistic with the doctor?
Dr. Farahmand: It could be but also it also depends very much on how he’s feeling right now, because they have a lot of ups and downs. So if he’s feeling good right now, that’s what you get from him right now. And even if you’re completely healthy, it’s really hard to remember how I was the last several days. In another case, the doctor had told him whenever you feel bad, take the drug. Well, these drugs have a lot of side effects. In fact, recently they’d increased the dosage of the drug and what happened is he’s become very sensitive to sunlight so now he’s actually stopped taking the drug because he can’t even go outside. So there is no way of optimizing the usage of these drugs and taking the right dosage. That’s the really the key problem. And also doctors have a very hard time knowing whether the drug is really working or not.
What’s the usual way those with Parkinson’s track their daily symptoms? Are they expected to keep a diary?
Dr. Farahmand: Because many of the patients are very old, keeping a diary is difficult, even writing is not an easy thing for them. Also, the tremor can have a lot of other impacts that I’m not sure doctors really understand. For example, does it matter when you’re cold or when your blood pressure goes high, does it actually potentially affect the tremor?
How did you start the design process?
Dr. Farahmand: The basic plan was what if there was a way that we can actually measure the tremor over a two-day period, before you have the drug, after you have the drug, before you eat, after you eat, before you sleep, after you sleep. For example, do you have a lot of tremors while you’re driving or does it get better when you’re driving. The idea was primarily to understand the effectiveness of the drug and to also see whether it’s making it better or worse or it really doesn’t matter. We wanted to design the device so he could wear it long term, not just for a few minutes, but over a two-day period, and have a very simple tapping mechanism. For example, if he swings his hand in some way or if he taps on the glove, that just means he’s had the drug. So he doesn’t have to do anything or record anything, and we know these marking points throughout the day.
How did you design the glove?
Dr. Farahmand: The design is pretty simple. We’re using what’s called Initial Measurement Unit or IMU. It’s basically an accelerometer and a gyroscope, which is looking at movement in six different directions. The measurement itself isn’t very difficult, but we wanted to integrate that with other physiological parameters, for example, body temperature. If possible, can we include a blood measurement or heart rate? The idea is to have a device like this and can collect more data and combine the data together. Right now, we’re just looking at motion and movement and body temperature.
That’s the data gathering part, but the challenging part is to actually analyze it and figure out what is what. Also, being able to make the device very small but getting it to work over 48 hours, or at least 24 hours, because for someone who is old and there’s a good chance their eyes aren’t working that well so to pull the glove off and then put the charger back in, especially for someone living alone, these could be very challenging especially if you have tremor in your hands. So the idea is to make sure this thing runs by itself. There’s almost no maintenance and no worry about anything.
What are all the components of the glove?
Dr. Farahmand: The glove is something we purchased from CVS, the kind you wear if you have carpal tunnel. What’s in it is the battery, a microcontroller, which records all this data and inputs it on an SD card, and a bunch of sensors. But you can also turn it into a real-time device so the doctor can say hold your hand straight or up and he or she can actually look at the data in real time. But for a patient who takes the glove home, all they have is the glove, which they wear, their fingers are actually free so it’s like a half-glove that just covers the palm of your hand.
What are some of the roadblocks you and your team have experienced?
Dr. Farahmand: The biggest thing is the algorithm and making sure we can actually detect different activities and really tell the difference. Also, at the moment, we have been able to find batteries that fit in this glove, but if we want to make them really small that could be an issue, finding a small battery that can work continuously for 48 hours.
Have you done any trials with Parkinson’s patients?
Dr. Farahmand: We’ve had about six patients and currently we do see very clearly different patients with different severity of tremor. We can definitely tell frequency of the tremor, we can tell how severe the tremor is, if they’re in early stage or late stage. We can clearly see the data. We visit them before they typically take their drugs and then we meet with them a couple of hours after and then we ask them to do certain movements, like hold their hands up, sit down, walk. There are a total of five different activities.
How is the doctor is seeing the data?
Dr. Farahmand: We’ve developed an application, a GUI interface program. So the doctor removes the SD card from the glove and puts it into the computer and can read the data.
What are you the next steps for this project?
Dr. Farahmand: Right now, we’re working on software and trying to make it as user-friendly as possible. At this point, we’d really like to get a couple of neurologists involved. We talk to patients on Parkinson’s forums and volunteers, but we want some consistent medical feedback to look at the impact of this. I think something like this could be useful for a company like Pfizer because they spend a lot of money on drugs so it would be good to figure out which one is better and under what circumstances or which patients drugs work for.
What has the patients’ feedback on the experience of wearing it?
Dr. Farahmand: We have learned a lot. We were initially looking at this from the doctor’s point of view. But after talking to these patients and after they used the device, many of them were asking, ‘Why can’t I see what’s going on? I don’t just want to wear it, I want to see how things are going.” So that’s another feature that we're working, to add some sort of light ribbon that can go on and off or the intensity of the light changes so they can see if it’s getting better or worse. So enabling the patient with respect to their own health.
It sounds like there’s a potential psychological benefit as well.
Dr. Farahmand: If you can visually show them, it’s very interesting to them, and kind of quantifies what is happening to their tremor and shows them how the drugs are working. That kind of visual interpretation of the tremor, I think they find it very interesting. I think we’re finding if we can enable them in their own health, perhaps that can give them a little more peace of mind.
Top photo caption: Dr. Farid Farahmand with Janene Grippi. (Photo courtesy of Dr. Farid Farahmand)