Parkinson's disease (PD) is a degenerative neurological disorder. It causes motor symptoms such as resting tremor, bradykinesia and gait disorders. The disease's progressive nature requires continuous monitoring of the motor symptoms to assist the neurologist in managing medication. With this purpose, Health Monitoring Systems (HMS) are used as a decentralized healthcare approach. On the other hand, most patients reject the current HMS solutions because they are invasive and stigmatizing. In this work, we present a non-invasive HMS for PD motor symptoms based on games. Because of the nature of games, the approach is able to collect data from patients without reminding them that they are under a disease's treatment. We validated our approach with 30 research subjects divided between PD group and Control group. We used Support Vector Machine (SVM) to identify the occurrence of PD's bradykinesia motor symptoms and reached a classification \textit{precision} of 92.31\%. Furthermore, 90,00\% of the patients approved our HMS considering it as non-invasive and easily integrated into their routine.

1. Motivation Objectives System Requirements System Development Experiments Conclusion
A Game-Based Approach to Monitor Parkinson’s
Disease: The bradykinesia symptom classification
CBMS 2016
Leonardo Medeiros, Hyggo Almeida, Leandro da Silva, Mirko
Perkusich and Robert Fischer
Federal University Of Campina Grande - BRAZIL
23/06/2016
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2. Motivation Objectives System Requirements System Development Experiments Conclusion
Summary
Motivation
Objectives
System Requirements
System Development
Experiments
Conclusion
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3. Motivation Objectives System Requirements System Development Experiments Conclusion
Health Monitoring Systems (HMS)
Designed to support continuous treatment by moving healthcare
services from the hospital to the patients’ home.
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4. Motivation Objectives System Requirements System Development Experiments Conclusion
The HMS’s Major Challenge
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5. Motivation Objectives System Requirements System Development Experiments Conclusion
Parkinson Disease (PD)
The symptoms associated with PD are caused by a degeneration
of dopaminergic neurons in the substantia nigra. Common
treatment focuses on drugs that activate dopamine receptors.
However, the medication’s effectiveness decreases over the years
requiring higher dosages
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6. Motivation Objectives System Requirements System Development Experiments Conclusion
PD’s Treatment and Disease Management
Clinical trial evaluation: subjectively and sporadically;
Motor fluctuations (on/off phenomenon).
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7. Motivation Objectives System Requirements System Development Experiments Conclusion
Bradykinesia Symptom
Bradykinesia describes a slowness in the execution of
movement. It is one of the four key symptoms of
parkinsonism, which are bradykinesia, tremor, rigidity, and
postural instability
The tremmor is the most visible PD’s motor symptom, but
the bradykinesia is the most
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8. Motivation Objectives System Requirements System Development Experiments Conclusion
Main Objective
A non-invasive HMS for Parkinson’s Disease motor symptoms
based on games to continuously provide data regarding patient,
without reminding the disease’s treatment
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9. Motivation Objectives System Requirements System Development Experiments Conclusion
Main Requirements
1. A contactless measurement of patient motor symptoms inside
the game environment;
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10. Motivation Objectives System Requirements System Development Experiments Conclusion
Main Requirements
1. A contactless measurement of patient motor symptoms inside
the game environment;
2. Use of a popular consumer electronic device as input to have
a non-invasive, cost-effective solution for home use.
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11. Motivation Objectives System Requirements System Development Experiments Conclusion
Who will use the Game-Based Health Monitor Approach
A person with age above 55 years old;
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12. Motivation Objectives System Requirements System Development Experiments Conclusion
Who will use the Game-Based Health Monitor Approach
A person with age above 55 years old;
A person with Parkinson’s disease;
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13. Motivation Objectives System Requirements System Development Experiments Conclusion
Who will use the Game-Based Health Monitor Approach
A person with age above 55 years old;
A person with Parkinson’s disease;
Neurologist and physiotherapist responsible for patient’s
treatment.
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14. Motivation Objectives System Requirements System Development Experiments Conclusion
Use Scenario
A PD’ patient play the HGM Client in home and seamlessly
provide the motor data;
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Use Scenario
A PD’ patient play the HGM Client in home and seamlessly
provide the motor data;
So, the motor signs are sent to HGM Server;
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16. Motivation Objectives System Requirements System Development Experiments Conclusion
Use Scenario
A PD’ patient play the HGM Client in home and seamlessly
provide the motor data;
So, the motor signs are sent to HGM Server;
The HGM Server process the user’s data and identify the
occurrence of the PD’s disease bradykinesia symptom;
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17. Motivation Objectives System Requirements System Development Experiments Conclusion
Use Scenario
A PD’ patient play the HGM Client in home and seamlessly
provide the motor data;
So, the motor signs are sent to HGM Server;
The HGM Server process the user’s data and identify the
occurrence of the PD’s disease bradykinesia symptom;
Then, the neurologist visualize the user’s health
information to assess the patient’s level of motor
deficiency.
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18. Motivation Objectives System Requirements System Development Experiments Conclusion
What was developed?
A semi-structured interview with healthcare professionals
associated to scientific references to identify the system
requirements;
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19. Motivation Objectives System Requirements System Development Experiments Conclusion
What was developed?
A semi-structured interview with healthcare professionals
associated to scientific references to identify the system
requirements;
The development of the Health Game Monitor (HGM) Client
(Catch the Spheres’ game);
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20. Motivation Objectives System Requirements System Development Experiments Conclusion
What was developed?
A semi-structured interview with healthcare professionals
associated to scientific references to identify the system
requirements;
The development of the Health Game Monitor (HGM) Client
(Catch the Spheres’ game);
The development of the HGM Server, responsible for
processing the data and making the results available to the
health professional;
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21. Motivation Objectives System Requirements System Development Experiments Conclusion
What was developed?
A semi-structured interview with healthcare professionals
associated to scientific references to identify the system
requirements;
The development of the Health Game Monitor (HGM) Client
(Catch the Spheres’ game);
The development of the HGM Server, responsible for
processing the data and making the results available to the
health professional;
Experimental studies with target users.
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22. Motivation Objectives System Requirements System Development Experiments Conclusion
Qualitative Research Analysis
The respondents suggested focusing on the bradykinesia motor
symptom due to its debilitating progress. Thus, treatment benefits
could be correlated with the increase of amplitude and angular
velocities of an arm’s adduction and abduction movements.
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23. Motivation Objectives System Requirements System Development Experiments Conclusion
Some Elicited Requirements
Easy and safe to use equipment
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Some Elicited Requirements
Easy and safe to use equipment
Incite the player to perform specific movements that are
required for the measurement
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25. Motivation Objectives System Requirements System Development Experiments Conclusion
Some Elicited Requirements
Easy and safe to use equipment
Incite the player to perform specific movements that are
required for the measurement
Game with clear and entertaining goal and adapted to the
user’s skills
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26. Motivation Objectives System Requirements System Development Experiments Conclusion
Some Elicited Requirements
Easy and safe to use equipment
Incite the player to perform specific movements that are
required for the measurement
Game with clear and entertaining goal and adapted to the
user’s skills
Provide a informative visual way to the healthcare professional
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27. Motivation Objectives System Requirements System Development Experiments Conclusion
System Architecture
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Biomechanical signal processing
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29. Motivation Objectives System Requirements System Development Experiments Conclusion
Ms-Kinect Joints Acquisition
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30. Motivation Objectives System Requirements System Development Experiments Conclusion
Angle over time with the peak and valley detection
technique
The cycle movement and transform the MS-Kinect data into
angles. Thus, we calculate the angular motion of the adduction
and abduction movements. 18 / 24

31. Motivation Objectives System Requirements System Development Experiments Conclusion
Some Elicited Requirements
Easy and safe to use equipment
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32. Motivation Objectives System Requirements System Development Experiments Conclusion
Some Elicited Requirements
Easy and safe to use equipment
Incite the player to perform specific movements that are
required for the measurement
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33. Motivation Objectives System Requirements System Development Experiments Conclusion
Some Elicited Requirements
Easy and safe to use equipment
Incite the player to perform specific movements that are
required for the measurement
Game with clear and entertaining goal and adapted to the
user’s skills
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34. Motivation Objectives System Requirements System Development Experiments Conclusion
Some Elicited Requirements
Easy and safe to use equipment
Incite the player to perform specific movements that are
required for the measurement
Game with clear and entertaining goal and adapted to the
user’s skills
Provide a informative visual way to the healthcare professional
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35. Motivation Objectives System Requirements System Development Experiments Conclusion
Developed Health Game Monitor: Catch the Spheres
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36. Motivation Objectives System Requirements System Development Experiments Conclusion
Case Control Study
A total number of 30 subjects participated where 15 subjects for
each group.
PD’ Group: 10 men and 5 women, between 51 and 65 years
(mean: 58);
Control Group: 11 men and 4 women, between 50 and 65
years (mean: 57).
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37. Motivation Objectives System Requirements System Development Experiments Conclusion
Procedure for Data Collection
The subject stands at distance of 2 meters from the motion sensor
at a place marked for that purpose on the ground;
The subject faces a projection of the game on a wall, centered over
the motion sensor;
The subject plays the game Catch the Spheres for 5 minutes;
The subjects end the game by reaching the virtual exit button.
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38. Motivation Objectives System Requirements System Development Experiments Conclusion
Data Classifier: SVM
In this work, we used Support Vector Machine (SVM) as the
supervised learning method. SVM seeks to find a margin that
separates all positive and negative example.
We choice this algorithm because he has a good generalization
to discriminate between two classes.
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39. Motivation Objectives System Requirements System Development Experiments Conclusion
SVM Classifier Performance
Predictive Class
Parkinson Control
Parkinson 12 3
Control 1 14
Classifier Metrics
TpRate 80.00%
FpRate 6.67%
Accuracy 86.67%
F-score 85.71%
Precision 92.31%
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40. Motivation Objectives System Requirements System Development Experiments Conclusion
Goal Question Metric (GQM) for User Acceptance
Based on the GQM paradigm, we defined two goals:
G1 : Analyze our HMS PD approach for the purpose of
evaluating with respect to usability from the view
point of the patients in the context of the game
Catch the Spheres
G2 : Analyze our HMS PD approach for the purpose of
evaluating with respect to fit to daily routine from
the view point of the patients in the context of the
game Catch the Spheres
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41. Motivation Objectives System Requirements System Development Experiments Conclusion
GQM Results
The measurements were collected we obtained the following result
indicating:
90% of the users felt motivated with the game;
80% would add this game-based monitoring approach into
their daily routine;
75% considered it safe for elderly users.
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42. Motivation Objectives System Requirements System Development Experiments Conclusion
Conclusion
In this work we presented a game-based approach to monitor with
a symptom classification Precision of 92.31%. Moreover, 90,00%
of the patients considered our approach non-invasive and easy to
integrate into their routine.
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43. Motivation Objectives System Requirements System Development Experiments Conclusion
Questions ?
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