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What is Parkinson's disease and how can you perform a motor examination?

Parkinson’s disease is a progressive nervous system disorder which damages parts of the brain over many years. There is currently no cure for Parkinson’s disease however there are many treatments to alleviate pain. The motor symptoms of Parkinson’s disease are slowness in movement, shaking, rigidity, postural instability and difficulty with walking and gait. The most popular gold standard scale to use for motor assessment is known as Movement Disorders Society- Unified Parkinson’s Disease Rating Scale (MDS-UPDRS).

What is the Unified Parkinson's Disease Rating Scale (UPDRS)?

UPDRS scale is the most precise way to measure conditions of patients with Parkinson’s disease. The MDS-UPDRS scale consists of a range of ratings for Parkinson’s symptoms which covers all of the movement restraints of Parkinson’s disease. There are five sections and KELVIN-PD focuses on part three (Motor assessment) of the five parts. The motor examination is used to assess motor abnormalities in Parkinson’s disease. The items included are speech/facial expression, rigidity, tremor, bradykinesia, gait and postural stability. These are assessed by using a severity scale; the score scale ranges from 0 (normal/no impairment) to 4 (severe/cannot perform tasks or is very slow). The total motor UPDRS score ranges from 0 to 108. Only, a qualified assessor can provide the item scores rather than the patient themselves.

Instructions on how to perform an MDS-UPDRS assessment at home using KELVIN-PD

  1. You can register for KELVIN-PD by simply going onto the web page kelvin.machinemedicine.com/register or you can also click the link
  2. Then, if you are carrying out your own assessment, fill in your first and last name, and if someone else is carrying out the assessment they need to insert the patient’s name.
  3. Then fill in the organisation as ‘Patient with Parkinson’s (PwP)’,  email address and password.
  4. You will then receive an email from ‘support@machinemedicine.com’ with a link that you need to click to confirm your account. Please check your junk folder if you cannot find the email. 
  5. Once you click the link, it will automatically open up a new web page and take you to the assessments page of KELVIN-PD.
  6. Now add your doctor’s email through the same web page, by clicking on ‘Account’ at the top right corner. Under the ‘Manager’s section, you will see an option to type their email in and press ‘Add’. 
  7. You now have an account with KELVIN-PD and can use the KELVIN-PD app to record and upload your assessment.

For Android

  1. Please ensure there is a stable internet connection.
  2. On your homepage of the device, there is a ‘Play Store’ app, please click on this and open the app.
  3. Then, on the top part of the screen there is a search bar ‘Search for apps & games’ where you will type ‘Kelvin-PD’ and install the app ‘Kelvin PD’ and not ‘KelvinPD 18252A’.
  4. The app will start installing once you press the ‘Install’ button.
  5. The app will appear on your home screen and you can click on its icon and open it.
  6. Once opened, you can fill in your email address and password and click ‘Login’. Please ensure there is enough storage on your device before starting the assessment. 

For iOS

  1. Please ensure there is a stable internet connection.
  2. On your homepage of the device, there is an ‘App store’ app, please click on this and open the app.
  3. Then, on the bottom right part of the screen there is a ‘Search’ icon, click on this and it will lead you to the ‘Search’  page.
  4.  Click the search bar ‘Games, Apps, Stories and More’ and type ‘Kelvin-PD’ and install the app ‘Kelvin PD’.
  5. The app will start installing once you press the ‘Get’ button.
  6. The app will appear on your home screen and you can click on its icon and open it.
  7. Once opened, you can fill in your email address and password and click ‘Login’. Please ensure there is enough storage on your device before starting the assessment.

Prior to conducting the assessment please ensure you have completed the following below:

  • Created an account with KELVIN-PD.
  • Downloaded the KELVIN-PD mobile app onto your device.
  • A tripod to place your device on so that the recordings are steady.

 

  1. Once you log in, you will be directed to an ‘Assessments’ page. At the button of the screen it says ‘New Assessment’.
  2. Please click ‘New Assessments’ and choose the assessment type ‘UPDRS-part-3 v1.3’ .
  3. You will need to fill in the ‘Reference for this session’ .
  4. Select ‘No’ for ‘Is this going to be a rated assessment?’ and then press ‘Next’ at the bottom right corner.
  5. You can skip the ‘Medication’ page and click ‘Next’.
  6. You are now ready to record your videos. If you want instructional videos go to step 7 if not skip to step 8.
  7. If you want to view instructional videos, at the top right of the page , click ‘settings’ and select ‘Yes’ and ‘Close’. Then type in the comment section a letter and the videos will appear. 
  8. Please click ‘Record Video’ to start recording.
  9. Once you finish recording, the video will be automatically uploaded and you can press ‘Next’ and continue with your remaining assessments.
  10. If you wish to re-do your recording and replace the previous video, you can click ‘Record Video’ and re-record.
  11. Once you have finished recording for all your assessments, you will reach the ‘Confirmation’ page and click ‘Confirm’. 
  12. Once you click ‘Confirm’ your assessment will be automatically uploaded and will appear at the ‘Complete’ section of the ‘Assessments’ page.
  13. You can press ‘logout’ once you are finished. 

Instructions for recording MDS-UPDRS tests

For all the assessments please apply steps 1-6:

  1. To start the test, press ‘Record Video’
  2. Ensure that the full body is in frame facing towards the camera
  3. No other individual should be in the frame unless required to do so for certain tasks.
  4. Patient should be recorded with a plain white background
  5. Refrain from zooming into the moving part under examination
  6. At the end of the recording, upload it by clicking the check mark (✔) in the right upper corner in an Android device or “use video” in the lower right corner in an iOS device.
  1. Record the video and listen to the patient’s free-flowing speech and engage in the conversation if required. Some suggested topics: ask about the patient’s work, hobbies, exercise etc.
  2. Keep the device close to the patient to ensure the audio is recorded properly.
  3. Ensure the whole upper body is in frame, facing towards the camera.
  4. End the recording after 10 seconds and click next.
  1. Record the patient’s facial expressions without them talking for the first 10 seconds.
  2. For the final 10 seconds, record the patient’s facial expressions whilst they are talking.
  3. End the recording once you are done and click next. The recording does not need to exceed 30 seconds.
  1. Start recording and examine the patient by manipulating the patient’s limbs and neck while they are in a relaxed position. 
  2. Record all limbs in the same video.
  3. For the arms, test the wrist and elbow joints simultaneously; extend the arms out and in. Do this test on both their right and left arm.
  4. For the legs, test the hip and knee joints simultaneously; extending the legs out and in. Do this test on both their right and left leg. 
  5. For the neck, test the stiffness; moving the neck left, right, up, down.
  6. End the recording once you are done and click next.
  1. Record the patient whilst they are tapping their index finger on the thumb 10 times as quickly and big as possible. 
  2. Tell the patient to raise their hands to their face level, with the fingers pointing towards their side face and not towards the camera. 
  3. Do this test for both their right and left hands in the same video.
  4. End the recording once you are done and click next.
  1. Record the patient while they are making a tight fist opening and closing 10 times, with the arm bent at the elbow and facing towards the camera. 
  2. They should open and close the hand as fully and quickly as possible. 
  3. Do this test for both their right and left palm in the same video.
  4. End the recording once you are done and click next.
  1. Record the patient, while they extend their arm out in front of their body with the palm facing down; then have to turn the palm up and down alternately 10 times as fast and fully as possible.
  2. Do this test for both their right and left palm in the same video.
  3. End the recording once you are done and click next.
  1. Record the patient, whilst they place their heel to the ground (in a comfortable position) and then tap the toes 10 times as big and fast as possible. 
  2. Do this test for both right and left foot in the same video.
  3. End the recording once you are done and click next.
  1. Record the patient, whilst they place their foot on the ground and then raise and stomp the foot on the ground 10 times as high and as fast as possible. 
  2. Do this test for both their right and left foot in the same video.
  3. End the recording once you are done and click next.
  1. Record the video when the patient is sitting in a straight-backed chair with arms and feet on the floor, leaning back. Their arms must be crossing across their chest and then stand up.
  2. If the patient is not successful at this, then attempt this test up to a maximum of two or more times.
  3. If still unsuccessful, then let the patient move forward and arise with arms folded across the chest- with one attempt.
  4. If unsuccessful, allow the patient to push off using the arms of the chair-allow a maximum of three attempts. If still not successful, then assist the patient to arise.
  5. End the recording once you are done and click next.
  1. Record the patient while they are walking away and towards the examiner. The patient should walk at least 10 meters, then turn around and return to the examiner. 
  2. Ensure the patients entire body is included in the recording at all times.
  3. End the recording once you are done and click next.
  1. Record this video as you are standing behind the patient pulling their shoulders while they are standing upright, erect with eyes open and feet comfortably positioned parallel.
  2. The examiner (yourself) must stay behind the patient, sufficiently back, to allow enough room for the patient to recover independently. 
  3. Do not allow the patient to flex the body abnormally forward in anticipation of the pull. 
  4. End the recording once you are done and click next.
  1. Record the video whilst the patient is standing upright facing their side profile of the body.
  2. This can be recorded for 10 seconds, no more than 30 seconds.
  3. End the recording once you are done and click next.
  1. Record the video whilst the patient is extending their arms out to the front together, with their palms facing down for 10 seconds.
  2. The wrist should be straight and the fingers comfortably spread out so they are not in contact with each other.
  3. End the recording once you are done and click next.
  1. Record the video and have the patient perform at least three finger-to- nose manoeuvres: they touch their nose and touch the examiner’s finger at least three times from different positions for each arm. 
  2. The manoeuvre should happen slowly to avoid any hidden tremors during fast arm movements.
  3. Record the video for both arms in the same video.
  4. End the recording once you are done and click next.
  1. Record the video whilst the patient is sitting quietly and resting on the chair. Their arms should be resting on the arm of the chair and not on their laps. 
  2. Their feet should be comfortably supported on the floor for 10 seconds with no other directives.
  3. End the recording once you are done and click next.