Objective: To validate the vTUG as a means of remotely monitoring patient gait and balance in the home.

Background: The current regulatory gold standard for measuring the progression of motor signs in Parkinson’s Disease (PD) and for assessing drug efficacy is the Movement Disease Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). However, this scale cannot be used to monitor symptoms at home or in high frequency. The virtual Timed Up and Go test (vTUG) could provide a new, patient centred and home-based assessment of disease progression and drug efficacy in PD.

Method: Using a patient-centric approach, we used our Atom5TM smartphone platform to enable participants to perform the vTUG independently, and used computer vision and pose estimation to quantify section timing, posture and alignment. The first phase of the project with patients is an in-clinic feasibility study to assess whether patients with PD are able to follow in-app instructions to perform the vTUG task independently. The second phase will assess the feasibility of patients performing the vTUG in their own homes using their own smartphones or tablets, to determine whether patients require additional supervision and support, other than from their partners or caregivers.

Results: Preliminary data from tests with healthy volunteers suggests that video capture of the vTUG allows accurate timing of individual movement stages, in addition to the total time to complete – which decreases with practice, illustrating a clear learning effect. We observed that the perspective of the video determines the parameters that can be quantified using computer vision techniques. The front facing view provides insights into symmetry of movement, leg alignment and base of support, whereas the profile view is impractical due to domestic space constraints. We found that  instructions must be clear in order to standardise movements, particularly strategies for turning, which vary significantly between individuals.

Conclusion: Remote assessments, which are not affected by the stress and fatigue of travelling to clinical sites, are more likely to provide a true picture of disease state. Such assessments need to be clinically robust, and ensure that patients are able to navigate the interface easily to provide good quality data.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/validating-a-virtual-timed-up-and-go-vtug-test-in-parkinsons-disease/