A Study of Movement Disorders Using the QMAT At-Home Testing Device

Objectives

The purpose of this protocol is to improve the understanding of the pathophysiology of movement disorders and to assess movement in Parkinson s disease by performing small behavioral exercises and objectively measuring movements utilizing the QMAT at home testing device. These devices will be provided by the Kinetics Foundation. We have developed a series of motor tasks that can be performed with the QMAT, a home-based computer module, so that data on patient s movement can be collected frequently and prospectively without obligating the patient to come to a medical center. The study is designed to be observational in nature.

The QMAT device is being implemented to respond to the interest in objectified tests to monitor, analyze, and further understand the physiological aspects of Parkinson s disease. We will conduct:

• Training to patients to perform tasks on the QMAT device and transmit data at home.
• Training to investigators who do not have prior experience using the system
• Testing using the QMAT device that may increase knowledge of a disease process, responsiveness of treatment or be helpful in patient progress evaluations by analyzing data collected from the at home tests.

This protocol includes only non-invasive techniques with minimal risk to the participants. The technique has been piloted as part of the 10-N-0009 protocol, Physiological Investigations in Movement Disorders.

Study Population

We intend to study patients with diagnosis of Parkinson Disease.

We will enroll up to 60 participants in order to obtain 48 patients who complete the study.

Design

We will assign and train study participants to use the QMAT device at home. This is a portable device with a simple keyboard and pegboard interface, storing data from patient performance at home. There are 2 tasks that are performed using the device. The pegboard task involves transferring pegs from holes on one side of the device to the opposite side of the device. The finger tapping test and the digitography tasks involve having the subject press keys on the keyboard. At enrollment into this study, a time schedule will be discussed with the participant regarding the schedule that these at home tests require to be conducted. We will provide the device, all the components, and a data storage thumb-drive to each participant.

Outcome measures

i. Bradykinesia (fine motor movements):

The component of the apparatus that will test fine motor control will involve finger pads that will be tapped in alternating fashion by the patient for 30 seconds.

The primary outcome variable will be mean keystroke velocity (completed alternating cycles/testing period, expressed as cm/sec. Secondary outcomes will be mean frequency expressed as Hz, mean strike duration, expressed as m/sec and temporal variation of the duration of finger strike and frequency (issues of fatigue) expressed as the coefficient of variation (SD/mean). Variation in velocity will be expressed as the SD.

ii. Complex movements: (Pegboard or plugging device):

The At-Home device also contains plugging tasks. Primary outcome: mean movement velocity expressed as seconds per plugging cycle. This measure can be analyzed statistically for all movements to correct for outlier responses and errors. A secondary outcome will also be defatigation (i.e., the linear change of speed during a testing session, expressed as percent of the cycle-time. The variance of speed will be provided by the standard deviation. A regression analysis will allow estimates of the part of the variance that is declared by linear change over the complete task.