Development of a Novel System for Measuring Motor Skills in Patients Receiving Deep Brain Stimulation for Movement Disorders: pilot Data, Augmented Reality, and Future Directions

Introduction: Since its emergence in the 1980s, deep brain stimulation (DBS) has been effectively employed as a neurosurgical modality for treating a variety of movement disorders, such as Parkinson’s disease or essential tremor. Classically, DBS-related outcomes are assessed through physical examination. We plan to utilize augmented reality (AR) in conjunction with novel sensor technologies and game environment to allow for objective assessments of changes in movements related to DBS.

Methods: We have developed a series of virtual mazes of varying complexity that will move a frog along a path when our novel controller is clicked by the participant. The controller contains a force transducer to measure several different variables (inter-tap intervals for example). These measures can provide important new information on the impact of DBS placement under conditions of increasing cognitive-motor load. We will employ this system with an augmented reality headset in later versions to further immerse participants.

Results: For our pilot trial with ten healthy volunteers, mean inter-tap intervals were measured. All subjects were right-handed. Mean inter-tap intervals for the right hand (247 msec, 191 msec) throughout all mazes demonstrated obvious improvement with practice. While those for the left hand (191 msec, 163 msec) demonstrated similar improvements. Interestingly, there was no noticeable difference regarding dominance and mean inter-tap intervals.

Conclusion : This work represents a foundational step towards our goal of revolutionizing the assessment of movements in response to brain stimulation by reducing inter-observer variability through use of sensors and the gamified assessment program. The initial data described here demonstrates feasibility. Eventually, we hope to utilize AR in conjunction with our system to allow for objective assessments of changes in movements related to DBS in our patients. Being able to measure minute differences in motor skills will be of great value to clinicians and surgeons while implanting and subsequently programming DBS systems.