Future Perspectives: Assessment Tools and Rehabilitation in the New Age

Abstract

The management of movement disorders (MDs) is a challenging task owing to the complexity of the disorders and the inability to monitor them in vivo. Parkinson’s disease (PD) is an MD that presents with many complex motor dysfunctions such as tremor, bradykinesia, rigidity, and gait impairments simultaneously. Current medical treatment options are not adequately targeting the patient’s individual needs and specific functional disabilities. Furthermore, exercise and traditional physical/occupational therapy fall short in this domain as well. In the larger context of rehabilitation, there are then two specific unmet needs: (a) objective personalized assessment of mobility in an ecological valid environment, such as the patient’s home or a similarly simulated environment, and (b) titration and optimization of the intervention, whether medical, surgical or physiotherapeutic, to the needs identified by the objective assessment of motor function. The possibility of using more objective and quantitative technology-based assessment techniques that are portable, wearable, and mobile has matured to the point that such devices are becoming cost effective and soon will be readily available. Conducting traditional assessments in a laboratory or clinical environment does not provide a realistic measure of the patient’s ability to perform daily tasks. The technology should be sent to the patient’s own home, or the environment simulated within the laboratory. Detailed at-home monitoring is now becoming available owing to the increasing affordability of wearable sensor technology and accompanying analysis software. The simulation of environments is becoming possible through virtual reality (VR) technology and has demonstrated great reliability and ease of use. VR allows the patients to experience a more natural environment that will allow assessment and potential training, while performing various tasks that participants would normally carry out during the day (e.g., crossing a busy street, grocery shopping, walking down a narrow hallway, etc.). This chapter reviews the current state of laboratory-based and wearable objective assessment tools. In addition, it explores the domain of VR in generating “real world” scenarios that can be used as ecologically valid assessment environments, which in turn can be considered for rehabilitative training.