Laura Rocchi Dept. of Electrical, Electronic and Information Engineering, University of Bologna

1. Laura Rocchi Dept. of Electrical, Electronic and Information Engineering, University of Bologna l.rocchi@unibo.it

2. Main aims & Rationale October 2011 – September 2014 www.cupid-project.eu People with Parkinson’s disease (PD) suffer from motor and cognitive impairments that severely impact mobility, fall risk and multiple key aspects of functional independence. CuPiD is a 3 year EU project to provide personalized rehabilitation exercises for people with Parkinson’s disease at home. CuPiD aim at developing and test a combination of services for at home rehabilitationand training of major motor impairments caused by Parkinson’s disease. Recent work by the scientific community, including also CuPiD partners, has demonstrated that motor learning and rehabilitation principles can be effective in PD, thanks to still present plasticity. It is critical to make these rehab-like therapies accessible to patients in their home-settings since they need continuous training, being PD a chronic disease. On going, long-term treatment in a clinical setting is not feasible, cost effective or something that patients are likely to comply with year after year. *CuPiD is designed to meet this challenge*

3. Key components of CuPiD solution • Intelligent telemedicine infrastructure (tele-rehabilitation service) for remote monitoring and supervision of the rehabilitation program by a clinician. • Home-based rehabilitation system (based on unobtrusive wearable sensors, on-board intelligence for real-time feedback to the user to correct the movements, exer-gaming and modular, multi-modal restitution interfaces);

4. 1. Gait impairment in Parkinson’s Disease • Walking safely underpins the ability to perform with ease the everyday activities In people with PD as result of neuro-degeneration in the basal ganglia, motor control of repetitive sequences of movements is compromised in timing and size and eventually Freezing of Gait (FoG) may occur Patients… - Need to monitor walking quality and consciously correct deficits - Concentration is required to maintain the basic rhythm and safety External instruments… - Use of cueing as a compensatory rehabilitation strategy reduce interference and stabilize gait performance However results, yet positive, are small and not generalized

5. 1. Gait impairment in Parkinson’s Disease Open-loop modality of cueing supply has low efficacy  Closed-loop architecture based on accurate and real-time gait analysis may increase treatment efficacy Audio-feedback in closed-loop modality feedback Audio message / cue automatic gait performance evaluation / gait event identification Gait training and FoG prevention real-time gait analysis Gait features real-time computation Enabling technology components ≈ 2 yrs

6. 1. Gait impairment in Parkinson’s Disease Open-loop modality of cueing supply has low efficacy  Closed-loop architecture based on accurate and real-time gait analysis may increase treatment efficacy Audio-feedback in closed-loop modality feedback Audio message / cue automatic gait performance evaluation / gait event identification Gait training and FoG prevention real-time gait analysis Gait features real-time computation Enabling technology components

7. 2. Exer-gaming for training transitions and mobility The Exer-games were SPECIFICALLY DESIGNED to be personalized and therefore every game had configurable parameters that enabled the adjustment of the difficulty level, the duration of the game, the number of tasks, the complexity of the cognitive additional task and the different game modes Touch’n’Explode Stepping Tiles Up’n’Down. EXAMPLE A sample of Exer-Gaming is given by the task of reaching from a seated position to “touch” virtual balloons. The user views a human figure, an avatar, on the CuPiD Home system screen. The user wears CuPiD sensors on their arms and this enables the avatar to mirror their movements. By performing the correct movements the user can cause the avatar to reach, touch and burst balloons in the game.

8. Enabling technology and algorithms specifically developed for CuPiD Algorithms for real time gait features computation and gait training IMUs specifically developed Portable Apps Freezing of gait identification methods Algorithms for real time feedback restitution Motion tracking and graphical interfaces for Exer-gaming Telemedicine infrastructure Neuro-rehab exercises definition

9. September 2013 Pilots started @ patients‘ home! Validation phase: Stage 1 (sept 2013): 10 patients, 1 week -> technical refinements for usability Stage 2 (feb 2014): 6 weeks training 20+20 patients in 2 clinical sites (Leuven and Tel Aviv) Results so far prove very good acceptance and useufulness of the system

10. Main Lessons learned • Research needs to be patient-centred. Technologically-based solutions, even if advanced and smart, that do not meet the special needs of users will not work. Inclusion of highly qualified and experienced medical researchers and clinical centers is essential. • ICT-solutions may contribute to basic-research when providing tools that allow answering questions and verifying hypotheses more directly and effectively. In CuPiD this is the case of research on long-term potential of closed-loop rehabilitation protocols, which may benefit of customized systems specifically developed to implement this kind of rehab-protocols. • While tests of ICT-enabled solutions “on-field” are essential for continuous optimization and customized design of the prototypes, it is important to understand that 1) innovation & prototypes development; 2) systems engineering and 3) clinical validation are three very different processes, which cannot be implemented in the framework of a single project but may particularly benefit of long-term integrated funding strategies.

11. The real key element: the team University of Bologna - Italy www.cupid-project.eu Tel-Aviv Sourasky Medical Center – Israel Eidgenössische Technische Hochschule Zürich - Switzerland KU Leuven - Belgium Oxford Computer Consultants - UK CuPiD consortium,Oxford meeting (July2012) ST Microelectronics - Italy Fundació Illes Balears Innovació Tecnològia - Spain Italy