Centre for Gerontology and Rehabilitation - Journal Articles
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Item Inter-rater reliability of hand motor function assessment in Parkinson’s disease: impact of clinician training(Elsevier, 2024) Kenny, Lorna; Azizi, Zahra; Moore, Kevin; Alcock, Megan; Heywood, Sarah; Jonsson, Agnes; McGrath, Keith; Foley, Mary J.; Sweeney, Brian; O'Sullivan, Sean S.; Barton, John; Tedesco, Salvatore; Sica, Marco; Crowe, Colum; Timmons, Suzanne; InterregMedication adjustments in Parkinson’s disease (PD) are driven by patient subjective report and clinicians’ rating of motor feature severity (such as bradykinesia and tremor). Objective: As patients may be seen by different clinicians at different visits, this study aims to determine the interrater reliability of upper limb motor function assessment among clinicians treating people with PD (PwPD). Methods: PwPD performed six standardised hand movements from the Movement Disorder Society’s Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), while two cameras simultaneously recorded. Eight clinicians independently rated tremor and bradykinesia severity using a visual analogue scale. We compared intraclass correlation coefficient (ICC) before and after a training/calibration session where high-variance participant videos were reviewed and MDS-UPDRS instructions discussed. Results: In the first round, poor agreement was observed for most hand movements, with best agreement for resting tremor (ICC 0.66 bilaterally; right hand 95 % CI 0.50–0.82; left hand: 0.50–0.81). Postural tremor (left hand) had poor agreement (ICC 0.14; 95 % CI 0.04–0.33), as did wrist pronation-supination (right hand ICC 0.34; 95 % CI 0.19–0.56). In post-training rating exercises, agreements improved, especially for the right hand. Best agreement was observed for hand open-close ratings in the left hand (ICC 0.82, 95 % CI 0.64–0.94) and resting tremor in the right hand (ICC 0.92, 95 % CI 0.83–0.98). Discrimination between right and left hand features by raters also improved, except in resting tremor (disimprovement) and wrist pronation-supination (no change). Conclusions: Clinicians vary in rating video-recorded PD upper limb motor features, especially bradykinesia, but this can be improved somewhat with trainingItem Wearable-enabled algorithms for the estimation of parkinson’s symptoms evaluated in a continuous home monitoring setting using inertial sensors(Institute of Electrical and Electronics Engineers (IEEE), 2024) Crowe, Colum; Sica, Marco; Kenny, Lorna; O'Flynn, Brendan; Scott Mueller, David; Timmons, Suzanne; Barton, John; Tedesco, Salvatore; Enterprise Ireland; AbbVie; Science Foundation Ireland; European Regional Development FundMotor symptoms such as tremor and bradykinesia can develop concurrently in Parkinson’s disease; thus, the ideal home monitoring system should be capable of tracking symptoms continuously despite background noise from daily activities. The goal of this study is to demonstrate the feasibility of detecting symptom episodes in a free-living scenario, providing a higher level of interpretability to aid AI-powered decision-making. Machine learning models trained on wearable sensor data from scripted activities performed by participants in the lab and clinician ratings of the video recordings of these tasks identified tremor, bradykinesia, and dyskinesia in the supervised lab environment with a balanced accuracy of 83%, 75%, and 81%, respectively, when compared to the clinician ratings. The performance of the same models when evaluated on data from subjects performing unscripted activities unsupervised in their own homes achieved a balanced accuracy of 63%, 63%, and 67%, respectively, in comparison to self-assessment patient diaries, further highlighting their limitations. The ankle-worn sensor was found to be advantageous for the detection of dyskinesias but did not show an added benefit for tremor and bradykinesia detection here.Item Regeneration in vulnerable communities: resident and stakeholder perspectives(Cogitatio Press, 2024) O'Sullivan, Siobhán; O'Connell, Cathal; Cullinane, Mark; Kenny, Lorna; Folan O’Connor, Elizabeth; Gaston, Sadhbh; Cork City CouncilThis article assesses the implementation of a regeneration programme in a disadvantaged area in the south of Ireland, with particular focus on how residents in vulnerable circumstances have been supported in the face of multiple crises including economic recession and austerity, service reductions and cutbacks, risk of poverty and social exclusion, and neighbourhood change. The article draws on longitudinal qualitative and quantitative data generated over the time frame of a decade through research with residents, community organisations, and the municipal authority. Drawing on the principles of sustainable regeneration, i.e., physical, social, economic, and environmental dimensions, the article explores the effectiveness and outcomes of regeneration strategies on improving estate liveability and the quality of life of residents across multiple themes and indicators. The key themes explored include supports across the life course, community safety and public realm, education and opportunity, and well‐being and resilience. Through this analysis, the article aims to better understand the experiences of residents in vulnerable circumstances and the impacts, both positive and negative, of a major regeneration programme on their lives.Item Specialist palliative care professionals’ views on access to their services for people with dementia(Taylor & Francis, 45407) Cronin, Lisa; O’Shea, Emma; Fox, SiobhánBackground: In Ireland and around the world populations are ageing, contributing to an increase in the number of people living with dementia. Dementia is a life-limiting condition and evidence suggests that people with dementia would benefit from specialist palliative care (SPC) input. There is ongoing investigation into how people with dementia access the services they need at the right time. Aim: The aim of this study was to explore how people with dementia access SPC services in a region in the Mid-West of Ireland, from the perspectives of key healthcare workers linked to the service. Methods: Semi-structured qualitative interviews (n=10) were conducted with healthcare professionals involved in the referral process of accessing SPC input, including consultants, specialist registrars, clinical nurse managers and an assistant director of nursing. The data was analysed using thematic analysis. Results: Overall four main themes were identified from the data: Capacity for providing SPC services to people with dementia; Appropriate Referrals and Recognising Need; Inadequate volume and inequitable geographical distribution of dementia services; Service integration and inter-professional collaboration. The underlying premise was the disease trajectory of dementia and a changing model of care. Conclusion: A needs assessment rather than a diagnosis is the referral process that underpins access to SPC for people with dementia. However, there is little consensus on ‘grey’ areas within this process and some SPC professionals may be less comfortable with treating patients with dementia. A different model of care is needed.Item Design of a multi-sensors wearable system for continuous home monitoring of people with Parkinson's(IEEE, 2024-03-11) Sica, Marco; Varnosfaderani, Omid Talebi; Crowe, Colum; Kenny, Lorna; Bocchino, Andrea; O'Flynn, Brendan; Mueller, David Scott; Tedesco, Salvatore; Timmons, Suzanne; Barton, John; Enterprise Ireland; AbbVie; Science Foundation Ireland; European Regional Development FundParkinson’s disease is a degenerative neurological disorder that impairs motor functions and is accompanied by a wide range of non-motor symptoms, such as sleep problems. Parkinsonism is assessed during clinical evaluations and via self-administered diaries and, based on these, the required medication therapies are provided to lessen symptoms. Tri-axial accelerometers and gyroscopes have the potential utility to objectively assess the patient’s condition and aid clinicians in their decision-making. People with Parkinson’s often have significant abnormalities in blood pressure due to comorbid age-related cardiovascular disease and orthostatic hypotension, which result in blurred vision, dizziness, and falls. Frequent blood pressure monitoring may aid in the evaluation of such events and differentiate Parkinson’s disease symptoms from those originated by hypotension. In the present paper, a novel technology for the remote monitoring of Parkinsonian symptoms is presented: the WESAA system. It consists of two devices, worn on the wrist and ankle; its main function is to record accelerations and angular velocities from these body parts, together with photoplethysmograph and electrocardiogram data. This information can be elaborated offline to measure common Parkinson’s disease motor symptoms (e.g., tremor, bradykinesia, and dyskinesia), as well as gait speed, sleep-wake cycles, and cuff-less blood pressure measurements. The overall system requirements, market overview, industrial design and ergonomics, system development, user experience, early results of the gathered inertial raw data, and validation of the photoplethysmograph and electrocardiogram signal waveforms are all thoroughly discussed. The developed technology satisfies all system requirements, and the sensors adopted provided outcomes comparable with gold standard techniques.