Accelerated launch of video visits in ambulatory neurology during COVID-19: Key lessons from the Stanford experience.
Cognitive associations with comprehensive gait and static balance measures in Parkinson's disease.
Parkinsonism & related disorders
2019; 69: 104?10
The COVID-19 pandemic has rapidly moved telemedicine from discretionary to necessary. Here we describe how the Stanford Neurology Department: 1) rapidly adapted to the COVID-19 pandemic, resulting in over 1000 video visits within four weeks and 2) accelerated an existing quality improvement plan of a tiered roll out of video visits for ambulatory neurology to a full-scale roll out. Key issues we encountered and addressed were related to: equipment/software, provider engagement, workflow/triage, and training. Upon reflection, the key drivers of our success were provider engagement and a supportive physician champion. The physician champion played a critical role understanding stakeholder needs, including staff and physicians' needs, and creating workflows to coordinate both stakeholder groups. Prior to COVID-19, physician interest in telemedicine was mixed. However, in response to county and state stay-at-home orders related to COVID-19, physician engagement changed completely; all providers wanted to convert a majority of visits to video visits as quickly as possible. Rapid deployment of neurology video visits across all its subspecialties is feasible. Our experience and lessons learned can facilitate broader utilization, acceptance, and normalization of video visits for neurology patients in the present as well as the much anticipated post-pandemic era.
View details for DOI 10.1212/WNL.0000000000010015
View details for PubMedID 32611634
Feature visualization and classification for the discrimination between individuals with Parkinson's disease under levodopa and DBS treatments
BIOMEDICAL ENGINEERING ONLINE
Gait and balance impairments are cardinal features of Parkinson's disease (PD) that require cognitive input. However, the extent to which specific gait and balance characteristics relate to cognition in PD is unclear. In addition, independent models of gait and balance have not been developed from the same cohort. We aimed to i) develop models of gait and balance in a large PD cohort and ii) determine which gait and balance characteristics best related to cognition.One hundred and ninety-eight people with PD were recruited to the Pacific Udall Center. Using six inertial sensors (APDM, Inc.), comprehensive gait measurements were collected over a 2-min continuous walk and comprehensive static balance measures were collected during a 60-second standing task. Six domains of cognition were assessed: global cognition, attention, executive function, language, memory, and visuospatial function. Correlations and hierarchical linear regression determined independent associations.Principal components analysis identified a gait model containing four domains accounting for 80.1% of total variance: pace/turning, rhythm, variability, and trunk. The balance model contained four independent domains accounting for 84.5% of total variance: sway area/jerkiness, sway velocity, sway frequency anteroposterior, and sway frequency mediolateral. Gait domains of pace/turning and variability were strongly associated with attention and executive function. Sway area and jerkiness of balance associated with attention and visuospatial function.Gait and balance characteristics were associated with specific types of cognition. The specific relationships between gait or balance with cognitive functions suggests shared cerebral cortical circuitry for mobility and cognitive functions.
View details for DOI 10.1016/j.parkreldis.2019.06.014
View details for PubMedID 31731260
Platelet mitochondrial activity and pesticide exposure in early Parkinson's disease
2015; 30 (6): 862-866
Over the years, a number of distinct treatments have been adopted for the management of the motor symptoms of Parkinson's disease (PD), including pharmacologic therapies and deep brain stimulation (DBS). Efficacy is most often evaluated by subjective assessments, which are prone to error and dependent on the experience of the examiner. Our goal was to identify an objective means of assessing response to therapy.In this study, we employed objective analyses in order to visualize and identify differences between three groups: healthy control (N = 10), subjects with PD treated with DBS (N = 12), and subjects with PD treated with levodopa (N = 16). Subjects were assessed during execution of three dynamic tasks (finger taps, finger to nose, supination and pronation) and a static task (extended arm with no active movement). Measurements were acquired with two pairs of inertial and electromyographic sensors. Feature extraction was applied to estimate the relevant information from the data after which the high-dimensional feature space was reduced to a two-dimensional space using the nonlinear Sammon's map. Non-parametric analysis of variance was employed for the verification of relevant statistical differences among the groups (p < 0.05). In addition, K-fold cross-validation for discriminant analysis based on Gaussian Finite Mixture Modeling was employed for data classification.The results showed visual and statistical differences for all groups and conditions (i.e., static and dynamic tasks). The employed methods were successful for the discrimination of the groups. Classification accuracy was 81 ± 6% (mean ± standard deviation) and 71 ± 8%, for training and test groups respectively.This research showed the discrimination between healthy and diseased groups conditions. The methods were also able to discriminate individuals with PD treated with DBS and levodopa. These methods enable objective characterization and visualization of features extracted from inertial and electromyographic sensors for different groups.
View details for DOI 10.1186/s12938-016-0290-y
View details for Web of Science ID 000391062100001
View details for PubMedID 28038673
View details for PubMedCentralID PMC5203727
Mitochondrial dysfunction has been implicated in the pathogenesis of Parkinson's disease (PD), but the cause of this dysfunction is unclear.Platelet mitochondrial complex I and I/III (nicotinamide adenine dinucleotide cytochrome c reductase, NCCR) activities were measured in early PD patients and matched controls enrolled in a population-based case-control study. Ambient agricultural pesticide exposures were assessed with a geographic information system and California Pesticide Use Registry.In contrast to some previous reports, we found no differences in complex I and I/III activities in subjects with PD and controls. We did find that NCCR activity correlated with subjects' exposure to pesticides known to inhibit mitochondrial activity regardless of their diagnosis.Electron transport chain (ETC) activity is not altered in PD in this well-characterized cohort when compared with community-matched controls but appears to be affected by environmental toxins, such as mitochondria-inhibiting pesticides.
View details for DOI 10.1002/mds.26164
View details for Web of Science ID 000354731500021
View details for PubMedID 25757798
View details for PubMedCentralID PMC4439327