The Predictive Power of Functional Motion.

By Dr. Frank Fornari, Chairman and Founder, BioMech for BioTechnology Magazine

Motion is fundamental to health. When the ability to move is lost, so too is the ability for the human body to function as intended. In fact, every single movement the body makes is predicated on a pathological state that is as unique as a fingerprint, making motion a powerful indicator of a wide array of health issues.

Despite the importance of motion, however, the ability to objectively measure motion and make it clinically actionable has been elusive. From ataxia, Huntington’s, and Parkinson’s to Progressive supranuclear palsy, and tardive dyskinesia, there have been few if any objective tests to assess, stage how well a patient with a movement disorder was responding to therapy or medications.

Until Now.

Advances in artificial intelligence (AI), machine learning (ML), mobile technologies, and real-time interactive biofeedback have made it possible to capture motion data in clinical and real-world settings and deliver precise, accurate and reproducible therapeutic assessments and treatments that stratify risk, improve outcomes, and increase the efficiency of the healthcare delivery system.

Brian’s Story – Boxing with Parkinson’s

Brian Soucy has been living with Parkinson’s Disease since 2017, when he first noticed tremors in two fingers. By 2020, the engineer was formally diagnosed with the neurodegenerative disease for which there is no cure.

Things looked bleak. Medications helped with symptoms but came with side effects. Soucy’s search for options led him to a seemingly unconventional research project involving non-contact boxing. Three times a week, he takes part in Boxing for Parkinson’s classes and Atlanta’s Center for Movement Challenges. To determine whether the activity is slowing progression of the disease, the Center has partnered with BioMech Lab to assess and monitor participants’ movements.

Wireless motion-tracking sensors are being used to measure the balance and gait of the 53 Parkinson’s patients in the boxing program over six weeks. It takes just about 15 seconds to complete the assessments and the resulting data provides tangible insights into how the activity is impacting progression of the disease in Soucy and his peers.

Anecdotally, Soucy says he sees positive results from the activity – which has now been validated by objective, reproducible, longitudinal data that demonstrates considerable gait improvement of 16% and nearly 20% improvement in balance metrics.

Having the ability to measure patients’ metrics makes quickly and easily it possible to monitor their status.

A Functional Biomarker Primer

Significant strides have been made in the ability to not only measure motion, but to also convert the raw data rapidly into meaningful, actionable, and clinically relevant information that can be used to inform diagnoses and therapeutic decision support. AI, ML and sensor technologies capture in real-time relevant functional motion metrics to allow for the rapid evaluation, design and monitoring of key aspects of physical, surgical, pharmaco, and cognitive therapies.

In doing so, functional motion may become a biomarker to understand various pathological states – and quantifiably answer the basic yet critical question, “how are you today?”

It works with strategically placed sensors that allow for the noninvasive capture of normal and pathological motion data in several key categories to identify, assess, and properly transform a patient’s motion patterns.

For example, gait assessments enable early identification of chronic or acute neuromusculoskeletal pathology, facilitating timely intervention for optimal therapeutic outcomes while ongoing routine ambulation monitoring helps detect, treat, and correct pathological changes in their early stages. Balance is another fundamental diagnostic tool with clinical benefits across the healthcare spectrum. Essential to activities of daily life, when balance is compromised it is vital that the underlying pathology and appropriate therapeutic approach be quickly identified to maximize treatment outcomes.

Other aspects of a comprehensive functional motion assessment include:

• Symmetry: Because many pathologies manifest as asymmetrical movement, comparing any two points across the midline to determine the degree of symmetry can identify acute or chronic pathology and injury. This data can also be used to optimize the outcomes of physical therapy and corrective exercise.

• Angles: Comprehensive and ongoing range of motion assessments in all three planes (sagittal, coronal and transverse) are clinically meaningful as movement is dependent upon neuromusculoskeletal biomechanics and joint health.

• Cognition: The voluntary motor response to visual stimuli is a fundamental measure of health because it involves sensory perception and cognition. Evaluating these components demonstrates how well a patient can perceive and process stimuli in the environment.

Providing functional motion metrics immediately promotes treatment adherence and longitudinally determine progress. The patient now has measurable goals and the process becomes more enjoyable – a game rather than a task. Regular assessments over a patient’s lifetime help identify issues in their earliest, most treatable stages. It also enables orthopedic and physical therapy practices, chiropractors, family physicians and more to demonstrate to payers that their therapies and medical devices – spinal cord stimulators, joint replacements, etc. – are delivering the intended outcomes.

The quantitative measures and instant biofeedback that the technology provides have a dramatic rehabilitative impact by shifting the patient’s focus from pain to measurable performance.

Follow the Science

When it comes to therapeutic concepts, scientific validation is the holy grail. For functional motion, the body of scientific evidence is growing rapidly. Most recently, Gladstone C. McDowell II, M.D., founder and medical director of Integrated Pain Solutions in Columbus, Ohio, presented “An Objectional Analysis of Functional Changes with Spinal Cord Stimulation” at the American Society of Pain & Neuroscience 2022 Annual Conference, for which he was awarded Best Abstract.

The objective of his study was to understand the link between functional motion and pain in patients treated with spinal cord stimulation utilizing a system that provides objective data. Decades of experience and multiple studies have shown that spinal cord stimulation is an effective treatment for pain. Evidence also suggests a significant relationship between pain level and functional performance.

Dr. McDowell utilized a sensor-based motion analytics software platform to assess quantitative functional motion and cognition pre- and post-Spinal Cord Stimulator (SCS) trials and implantation phases. What he found was that patients diagnosed with chronic back and/or leg pain who received a SCS system realized significant and measurable improvement in functional motion.

The study also demonstrated that BioMech Lab – which Dr. McDowell used in his assessment – gait, balance and cognitive testing provide additional, objective, and actionable analyses with higher granularity and accuracy augmenting traditional subjective pre- and post-surgical assessment protocols.

Indisputable Outcomese

Anecdotal and scientific evidence continues to grow in support of the impact real-time, AI-driven functional motion data can have on health outcomes, quality, and costs. It is a powerful therapeutic decision support tool that delivers quantifiable improvement and functionality, while also providing long-term efficacy outcomes that drive reimbursement in a value-based care environment.

Ultimately, accessible, clinically relevant, and actionable functional motion data allows any clinical specialty to include critical functional motion analysis as part of the array of medically necessary tests that comprise a comprehensive diagnosis and treatment plan to achieve the quality outcomes for patients with movement disorders.