title: A mobile cloud-based Parkinson's disease assessment system for home-based monitoring.
abstract: BACKGROUND
  Parkinson's disease (PD) is the most prevalent movement disorder of the central nervous system, and affects more than 6.3 million people in the world. The characteristic motor features include tremor, bradykinesia, rigidity, and impaired postural stability. Current therapy based on augmentation or replacement of dopamine is designed to improve patients' motor performance but often leads to levodopa-induced adverse effects, such as dyskinesia and motor fluctuation. Clinicians must regularly monitor patients in order to identify these effects and other declines in motor function as soon as possible. Current clinical assessment for Parkinson's is subjective and mostly conducted by brief observations made during patient visits. Changes in patients' motor function between visits are hard to track and clinicians are not able to make the most informed decisions about the course of therapy without frequent visits. Frequent clinic visits increase the physical and economic burden on patients and their families.
  
  
  OBJECTIVE
  In this project, we sought to design, develop, and evaluate a prototype mobile cloud-based mHealth app, "PD Dr", which collects quantitative and objective information about PD and would enable home-based assessment and monitoring of major PD symptoms.
  
  
  METHODS
  We designed and developed a mobile app on the Android platform to collect PD-related motion data using the smartphone 3D accelerometer and to send the data to a cloud service for storage, data processing, and PD symptoms severity estimation. To evaluate this system, data from the system were collected from 40 patients with PD and compared with experts' rating on standardized rating scales.
  
  
  RESULTS
  The evaluation showed that PD Dr could effectively capture important motion features that differentiate PD severity and identify critical symptoms. For hand resting tremor detection, the sensitivity was .77 and accuracy was .82. For gait difficulty detection, the sensitivity was .89 and accuracy was .81. In PD severity estimation, the captured motion features also demonstrated strong correlation with PD severity stage, hand resting tremor severity, and gait difficulty. The system is simple to use, user friendly, and economically affordable.
  
  
  CONCLUSIONS
  The key contribution of this study was building a mobile PD assessment and monitoring system to extend current PD assessment based in the clinic setting to the home-based environment. The results of this study proved feasibility and a promising future for utilizing mobile technology in PD management.
authors.affiliation: Biomedical Informatics Department, College of Health Solutions, Arizona State University, Scottsdale, AZ, United States. dpan3@asu.edu.
authors.forename: Di
authors.identifier: http://orcid.org/0000-0001-9515-5387
authors.initials: D
authors.lastname: Pan
authors.forename: Rohit
authors.identifier: http://orcid.org/0000-0001-9436-1920
authors.initials: R
authors.lastname: Dhall
authors.forename: Abraham
authors.identifier: http://orcid.org/0000-0002-9221-8933
authors.initials: A
authors.lastname: Lieberman
authors.forename: Diana B
authors.identifier: http://orcid.org/0000-0002-5427-7019
authors.initials: DB
authors.lastname: Petitti
keywords: Cloud application; Decision marking; Gait difficulty; Home based monitoring; Mobile App; Parkinson’s Disease; Smartphone; Telemedicine; Tremor; mHealth
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