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Cited by 188Context-Aware Activity Recognition SystemsStroke Rehabilitation and RecoveryEEG and Brain-Computer Interfaces

Wearable sensors for clinical applications in epilepsy, Parkinson’s disease, and stroke: A mixed-methods systematic review

Open access
Johansson, Dongni, Malmgren, Kristina, Alt Murphy, Margit·2018·Journal of Neurology
DOI 10.1007/s00415-018-8786-yPMC PMC6060770
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Abstract

OBJECTIVES: Wearable technology is increasingly used to monitor neurological disorders. The purpose of this systematic review was to synthesize knowledge from quantitative and qualitative clinical researches using wearable sensors in epilepsy, Parkinson's disease (PD), and stroke. METHODS: A systematic literature search was conducted in PubMed and Scopus spanning from 1995 to January 2017. A synthesis of the main findings, reported adherence to wearables and missing data from quantitative studies, is provided. Clinimetric properties of measures derived from wearables in laboratory, free activities in hospital, and free-living environment were also evaluated. Qualitative thematic synthesis was conducted to explore user experiences and acceptance of wearables. RESULTS: In total, 56 studies (50 reporting quantitative and 6 reporting qualitative data) were included for data extraction and synthesis. Among studies reporting quantitative data, 5 were in epilepsy, 21 PD, and 24 studies in stroke. In epilepsy, wearables are used to detect and differentiate seizures in hospital settings. In PD, the focus is on quantification of cardinal motor symptoms and medication-evoked adverse symptoms in both laboratory and free-living environment. In stroke upper extremity activity, walking and physical activity have been studied in laboratory and during free activities. Three analytic themes emerged from thematic synthesis of studies reporting qualitative data: acceptable integration in daily life, lack of confidence in technology, and the need to consider individualization. CONCLUSIONS: Wearables may provide information of clinical features of interest in epilepsy, PD and stroke, but knowledge regarding the clinical utility for supporting clinical decision making remains to be established.

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Written from the paper’s full text.

TL;DR

This mixed-methods systematic review synthesized 56 studies on wearable sensors in epilepsy, Parkinson’s disease (PD), and stroke, covering seizure detection, motor symptom quantification, activity monitoring, adherence, missing data, and user experiences. Wearables show promise for clinical features of interest, but the review concludes that clinical utility for decision making remains to be established.

Key findings

  • Of 56 included studies, 50 reported quantitative data (5 epilepsy, 21 PD, 24 stroke) and 6 reported qualitative data (1 epilepsy, 3 PD, 2 stroke).
  • In epilepsy, wrist accelerometers detected 95% of motor seizures identified by video-EEG; convulsive seizure detection sensitivity was 90–92%, with false alarms varying across studies (e.g., 40 false alarms in 16/73 patients; 81 false alarms in 17/30 patients). Differentiation of psychogenic non-epileptic from epileptic seizures showed sensitivity 93–100% and specificity 75–91%.
  • In PD, wearables quantified bradykinesia, tremor, postural sway, dyskinesia, motor fluctuations, sleep, gait, freezing, falls, and physical activity; postural sway test–retest reliability was ICC 0.55–0.86, and mediolateral sway/jerk were sensitive to progression of postural instability.
  • In stroke, upper extremity activity, walking, and physical activity were studied; step counts showed good agreement with 3D gait analysis or video counts, step count/energy expenditure test–retest reliability was ICC 0.61–0.98, gait step count reliability was ICC 0.83–0.99, and arm activity test–retest was r = 0.81–0.9. Adherence ranged from 61–68% for separate days and 53% for two consecutive days in a 2-day step monitor study (n = 408), while PD wrist-sensor non-adherence over 7 days was 4%. Missing data averaged 10% for technical errors (range 6–14%), 12% for human factors (range 4–24%), and 19% combined (range 6–24%). Qualitative themes were acceptable integration in daily life, lack of confidence in technology, and need to consider individualization.

Methods

  • Mixed-methods systematic review with searches in PubMed, Scopus, Ovid SP, CINHAL, and Cochrane Library; English articles from 1995 to 2015, updated January 2017; PICO and SPIDER frameworks were used, with quantitative studies selected from PubMed and qualitative studies from Scopus.
  • Quantitative inclusion required peer-reviewed original studies using wearable sensors in epilepsy, PD, or stroke, monitoring movements/physiological signs with clinically relevant outcomes; excluded studies with fewer than 10 participants, conference proceedings, reviews, case reports, non-human studies, grey literature, and implantable sensors. Qualitative inclusion required peer-reviewed original studies analyzing primary qualitative data on patient or clinician experiences/preferences regarding wearables.
  • Reporting quality was assessed with STROBE for quantitative studies (12 key items, >50% cutoff) and CASP for qualitative studies; data extraction covered aims, sample characteristics, main findings, missing data, and adherence; qualitative data were synthesized thematically using NVivo. Meta-analysis was considered unfeasible due to large variation in study aims and designs.

Limitations

  • The paper states that meta-analysis was unfeasible because of large variation in study aims and designs; only half of eligible studies had sufficient reporting quality; no studies directly addressed the effect of wearables on decision making or clinical treatment outcomes, so clinical utility remains to be established; no epilepsy studies were conducted in free-living conditions; and free-living comparison methods were often subjective and retrospective.
  • Evident from the text: the search was limited to English-language articles from 1995–2015 (updated January 2017), and despite searching multiple databases, quantitative studies were selected from PubMed and qualitative studies from Scopus.
  • Evident from the text: the qualitative synthesis was based on only 6 studies, and reliability and responsiveness of wearable measures were studied only in PD and stroke, not epilepsy.

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Integrity signals

Registry

Crossref · 10.1007/s00415-018-8786-y

Cites

80 of 80 references verified0 citation errors · 0 not checkable

Statistics

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Claims the paper makes

0 of 191 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In total, 56 studies (50 reporting quantitative and 6 reporting qualitative data) were included for data extraction and synthesis.

    “In total, 56 studies (50 reporting quantitative and 6 reporting qualitative data) were included for data extraction and synthesis.”
    • Also stated in: § Results · plain
      “Thus, 50 studies reporting quantitative data and 6 studies reporting qualitative data were included for further data extraction and synthesis (Fig. 1).”
    Quote in the paperSubstantial claim
  • Findingcitation

    In epilepsy, wearables are used to detect and differentiate seizures in hospital settings.

    “In epilepsy, wearables are used to detect and differentiate seizures in hospital settings.”
    • Also stated in: § Studies reporting quantitative data · plain
      “In epilepsy, wrist-worn sensors with built-in accelerometers were used for detection and classification of seizures in hospital settings [14–18].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [14] Nijsen TM, Arends JB, Griep PA, Cluitmans PJ (2005) The potential value of three-dimensional accelerometry for detection of motor seizures in severe epilepsy. Epilepsy Behav 7(1):74–84. https://doi.org/10.1016/j.yebeh.2005.04.011 source

      Not checked in the free run.

    • cites [15] Beniczky S, Polster T, Kjaer TW, Hjalgrim H (2013) Detection of generalized tonic-clonic seizures by a wireless wrist accelerometer: a prospective, multicenter study. Epilepsia 54(4):e58–e61. https://doi.org/10.1111/epi.12120 source

      Not checked in the free run.

    • cites [16] Velez M, Fisher RS, Bartlett V, Le S (2016) Tracking generalized tonic-clonic seizures with a wrist accelerometer linked to an online database. Seizure 39:13–18. https://doi.org/10.1016/j.seizure.2016.04.009 source

      Not checked in the free run.

    • cites [17] Bayly J, Carino J, Petrovski S, Smit M, Fernando DA, Vinton A, Yan B, Gubbi JR, Palaniswami MS, O’Brien TJ (2013) Time-frequency mapping of the rhythmic limb movements distinguishes convulsive epileptic from psychogenic nonepileptic seizures. Epilepsia 54(8):1402–1408. https://doi.org/10.1111/epi.12207 source

      Not checked in the free run.

    • cites [18] Gubbi J, Kusmakar S, Rao A, Yan B, O’Brien T, Palaniswami M (2015) Automatic detection and classification of convulsive psychogenic non-epileptic seizures using a wearable device. IEEE J Biomed Health Inform. https://doi.org/10.1109/jbhi.2015.2446539 source

      Not checked in the free run.

  • Findingnone given

    In stroke, upper extremity activity, walking, and physical activity have been studied in laboratory and during free activities.

    “In stroke upper extremity activity, walking and physical activity have been studied in laboratory and during free activities.”
    Quote in the paperNot a substantial claim
  • Findingnone given

    In Parkinson's disease, wearables focus on quantification of cardinal motor symptoms and medication-evoked adverse symptoms in both laboratory and free-living environments.

    “In PD, the focus is on quantification of cardinal motor symptoms and medication-evoked adverse symptoms in both laboratory and free-living environment.”
    Quote in the paperNot a substantial claim
  • Findingown data

    All studies in epilepsy were conducted in a hospital environment.

    “All studies in epilepsy were conducted in a hospital environment.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 31
  • Classified as probably not a substantial claim. 24

  • May combine two claims.

    Findingown data

    Among the quantitative studies, 5 were in epilepsy, 21 in Parkinson's disease, and 24 in stroke.

    “Among studies reporting quantitative data, 5 were in epilepsy, 21 PD, and 24 studies in stroke.”
    • Also stated in: § Results · plain
      “Of the 50 papers reporting quantitative data, 5 (10%) were in epilepsy, 21 (42%) in PD, and 24 (48%) in stroke.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The search results from different databases were largely overlapping, but PubMed showed the best coverage for quantitative and Scopus for qualitative studies in terms of relevance and number of articles.

    “The search results from different databases were largely overlapping, but PubMed showed the best coverage for quantitative and Scopus for qualitative studies in terms of relevance and number of articles.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Three analytic themes emerged from qualitative synthesis: acceptable integration in daily life, lack of confidence in technology, and the need to consider individualization.

    “Three analytic themes emerged from thematic synthesis of studies reporting qualitative data: acceptable integration in daily life, lack of confidence in technology, and the need to consider individualization.”
    • Also stated in: § Studies reporting qualitative data · plain
      “Three analytic themes emerged in the qualitative thematic synthesis: acceptable integration in daily life, lack of confidence in technology, and the need to consider individualization (Table 4).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Qualitative data were reported in one epilepsy study, three Parkinson's disease studies, and two stroke studies.

    “Qualitative data were reported in one study in epilepsy, three in PD, and two in stroke.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In Parkinson's disease, 13 studies were conducted in a laboratory, one in a hospital environment, and 7 in a free-living environment.

    “In PD, 13 studies were conducted in a laboratory, one study in a hospital environment, and 7 studies in a free-living environment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The initial PubMed and Scopus literature search retrieved 1012 articles.

    “The initial PubMed and Scopus literature search resulted in the retrieval of a total of 1012 articles (Fig. 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Fifty quantitative studies were assigned sufficient reporting quality, and 6 out of 9 qualitative studies passed critical appraisal for methodological quality.

    “Fifty quantitative studies were assigned sufficient reporting quality and 6 out of 9 studies that reported qualitative data passed the critical appraisal for methodological quality.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In stroke, 4 studies were conducted in a laboratory, 6 in a hospital environment, and 14 used wearables in a free-living environment.

    “In stroke, 4 studies were conducted in a laboratory, 6 in a hospital environment, and 14 studies used wearables in a free-living environment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    210 studies were included in the full-text review, and 104 studies were eligible for quality assessment.

    “From these, 210 studies were included in the full-text review, and 104 studies were eligible for quality assessment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Wearables were also used in Parkinson's disease to quantify sleep disturbances, gait measures, freezing of gait, missteps and falls, and physical activity levels.

    “Wearables were also used to quantify sleep disturbances [30], gait measures [31, 32], freezing of gait [33, 34], missteps and fall [35, 36], and physical activity levels [37–39].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [30] Maglione JE, Liu L, Neikrug AB, Poon T, Natarajan L, Calderon J, Avanzino JA, Corey-Bloom J, Palmer BW, Loredo JS, Ancoli-Israel S (2013) Actigraphy for the assessment of sleep measures in Parkinson’s disease. Sleep 36(8):1209–1217. https://doi.org/10.5665/sleep.2888 source

      Not checked in the free run.

    • cites [31] Lord S, Rochester L, Baker K, Nieuwboer A (2008) Concurrent validity of accelerometry to measure gait in Parkinsons Disease. Gait Posture 27(2):357–359. https://doi.org/10.1016/j.gaitpost.2007.04.001 source

      Not checked in the free run.

    • cites [32] Esser P, Dawes H, Collett J, Feltham MG, Howells K (2012) Validity and inter-rater reliability of inertial gait measurements in Parkinson’s disease: a pilot study. J Neurosci Methods 205(1):177–181. https://doi.org/10.1016/j.jneumeth.2012.01.005 source

      Not checked in the free run.

    • cites [33] Yungher DA, Morris TR, Dilda V, Shine JM, Naismith SL, Lewis SJ, Moore ST (2014) Temporal characteristics of high-frequency lower-limb oscillation during freezing of gait in Parkinson’s disease. Parkinsons Dis 2014:606427. https://doi.org/10.1155/2014/606427 source

      Not checked in the free run.

    • cites [34] Morris TR, Cho C, Dilda V, Shine JM, Naismith SL, Lewis SJ, Moore ST (2012) A comparison of clinical and objective measures of freezing of gait in Parkinson’s disease. Parkinsonism Relat Disord 18(5):572–577. https://doi.org/10.1016/j.parkreldis.2012.03.001 source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    In Parkinson's disease, both accelerometers and gyroscopes were used, while step counts from accelerometers and energy expenditure during walking were investigated in stroke.

    “In PD, both accelerometers and gyroscopes were used, while step counts from accelerometers and energy expenditure during walking were investigated in stroke (Fig. 2 and Table 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Wearables showed good agreement with video-based ratings regarding the number of freezing episodes and the percentage of time with freezing of gait.

    “Wearables showed good agreement with video-based ratings regarding the number of freezing episodes and the percentage of time with freezing of gait [34].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Morris TR, Cho C, Dilda V, Shine JM, Naismith SL, Lewis SJ, Moore ST (2012) A comparison of clinical and objective measures of freezing of gait in Parkinson’s disease. Parkinsonism Relat Disord 18(5):572–577. https://doi.org/10.1016/j.parkreldis.2012.03.001 source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    In hospital environments, only accelerometer data were reported and measurements lasted between 1 and 9 days.

    “Only accelerometer data were reported and measurements lasted between 1 and 9 days.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    In free-living environment studies, wearing time varied between 8 h and 7 days and only accelerometer data were used.

    “The wearing time in studies conducted in the free-living environment varied between 8 h and 7 days and only data from accelerometers were used.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Test-retest reliability varied in different studies, but moderate agreements (ICC 0.54 and 0.68) were found for 3- and 7-day monitoring of daily activity counts.

    “The test–retest reliability varied in different studies, but moderate agreements (ICC 0.54 and 0.68) were found for 3- and 7-day monitoring of daily activity counts [56].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] Hale LA, Pal J, Becker I (2008) Measuring free-living physical activity in adults with and without neurologic dysfunction with a triaxial accelerometer. Arch Phys Med Rehabil 89(9):1765–1771. https://doi.org/10.1016/j.apmr.2008.02.027 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Older individuals and those with better balance self-efficacy and walking endurance showed better adherence.

    “Older individuals and those with better balance self-efficacy and walking endurance showed better adherence [63].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [63] Barak S, Wu SS, Dai Y, Duncan PW, Behrman AL (2014) Adherence to accelerometry measurement of community ambulation poststroke. Phys Ther 94(1):101–110. https://doi.org/10.2522/ptj.20120473 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    A study evaluating acceptability of wrist-worn sensors in Parkinson's disease reported that only two persons of 34 did not wear the sensors for the full 7-day period and the non-adherence time was 4%.

    “A study evaluating acceptability of wrist-worn sensors in PD reported that only two persons of 34 did not wear the sensors for the full 7-day period and the non-adherence time was 4% [64].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [64] Fisher JM, Hammerla NY, Rochester L, Andras P, Walker RW (2016) Body-worn sensors in Parkinson’s disease: evaluating their acceptability to patients. Telemed J E Health 22(1):63–69. https://doi.org/10.1089/tmj.2015.0026 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Participants with Parkinson's disease and stroke were mostly positive and agreed to use wearables both at home and in public environments.

    “Participants with PD and stroke were mostly positive and agreed to use wearables both at home and in public environments.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    A potential cause of embarrassment and stigmatization was anticipated when other people might ask or question what they were wearing, making their disease more apparent.

    “A potential cause of embarrassment and stigmatization was anticipated when other people might ask or question what they were wearing, and in this way make their disease more apparent.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Participants with Parkinson's disease and stroke reported difficulties in using the device correctly, handling technical errors, and charging the battery.

    “In addition, participants with PD and stroke reported difficulties in using the device correctly, handling technical errors, and charging the battery.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Participants with stroke wanted repeated instructions, confirmation, supervised practice, and external support for technical problems in follow-up sessions to improve their confidence.

    “They wanted repeated instructions, confirmation, supervised practice, and external support for technical problems in follow-up sessions to improve their confidence [68, 69].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [68] Mountain G, Wilson S, Eccleston C, Mawson S, Hammerton J, Ware T, Zheng H, Davies R, Black N, Harris N, Stone T, Hu H (2010) Developing and testing a telerehabilitation system for people following stroke: issues of usability. J Eng Des 21(2):223–236. https://doi.org/10.1080/09544820903333792 source

      Not checked in the free run.

    • cites [69] Cancela J, Pastorino M, Tzallas AT, Tsipouras MG, Rigas G, Arredondo MT, Fotiadis DI (2014) Wearability assessment of a wearable system for Parkinson’s disease remote monitoring based on a body area network of sensors. Sensors (Basel) 14(9):17235–17255. https://doi.org/10.3390/s140917235 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Both epilepsy and Parkinson's disease participants described waterproof design as a desirable feature of wearables.

    “Both epilepsy and PD participants further described desirable features of wearables, including the possibility of real-time analysis of data, getting reminders to take drugs and waterproof design [66, 67, 69].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [66] Zhao Y, Heida T, van Wegen EE, Bloem BR, van Wezel RJ (2015) E-health support in people with Parkinson’s disease with smart glasses: a survey of user requirements and expectations in the Netherlands. J Parkinsons Dis. https://doi.org/10.3233/JPD-150568 source

      Not checked in the free run.

    • cites [67] Hoppe C, Feldmann M, Blachut B, Surges R, Elger CE, Helmstaedter C (2015) Novel techniques for automated seizure registration: Patients’ wants and needs. Epilepsy Behav 52(Pt A):1–7. https://doi.org/10.1016/j.yebeh.2015.08.006 source

      Not checked in the free run.

    • cites [69] Cancela J, Pastorino M, Tzallas AT, Tsipouras MG, Rigas G, Arredondo MT, Fotiadis DI (2014) Wearability assessment of a wearable system for Parkinson’s disease remote monitoring based on a body area network of sensors. Sensors (Basel) 14(9):17235–17255. https://doi.org/10.3390/s140917235 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Both epilepsy and Parkinson's disease participants described the possibility of real-time analysis of data as a desirable feature of wearables.

    “Both epilepsy and PD participants further described desirable features of wearables, including the possibility of real-time analysis of data, getting reminders to take drugs and waterproof design [66, 67, 69].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [66] Zhao Y, Heida T, van Wegen EE, Bloem BR, van Wezel RJ (2015) E-health support in people with Parkinson’s disease with smart glasses: a survey of user requirements and expectations in the Netherlands. J Parkinsons Dis. https://doi.org/10.3233/JPD-150568 source

      Not checked in the free run.

    • cites [67] Hoppe C, Feldmann M, Blachut B, Surges R, Elger CE, Helmstaedter C (2015) Novel techniques for automated seizure registration: Patients’ wants and needs. Epilepsy Behav 52(Pt A):1–7. https://doi.org/10.1016/j.yebeh.2015.08.006 source

      Not checked in the free run.

    • cites [69] Cancela J, Pastorino M, Tzallas AT, Tsipouras MG, Rigas G, Arredondo MT, Fotiadis DI (2014) Wearability assessment of a wearable system for Parkinson’s disease remote monitoring based on a body area network of sensors. Sensors (Basel) 14(9):17235–17255. https://doi.org/10.3390/s140917235 source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Both epilepsy and Parkinson's disease participants described getting reminders to take drugs as a desirable feature of wearables.

    “Both epilepsy and PD participants further described desirable features of wearables, including the possibility of real-time analysis of data, getting reminders to take drugs and waterproof design [66, 67, 69].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [66] Zhao Y, Heida T, van Wegen EE, Bloem BR, van Wezel RJ (2015) E-health support in people with Parkinson’s disease with smart glasses: a survey of user requirements and expectations in the Netherlands. J Parkinsons Dis. https://doi.org/10.3233/JPD-150568 source

      Not checked in the free run.

    • cites [67] Hoppe C, Feldmann M, Blachut B, Surges R, Elger CE, Helmstaedter C (2015) Novel techniques for automated seizure registration: Patients’ wants and needs. Epilepsy Behav 52(Pt A):1–7. https://doi.org/10.1016/j.yebeh.2015.08.006 source

      Not checked in the free run.

    • cites [69] Cancela J, Pastorino M, Tzallas AT, Tsipouras MG, Rigas G, Arredondo MT, Fotiadis DI (2014) Wearability assessment of a wearable system for Parkinson’s disease remote monitoring based on a body area network of sensors. Sensors (Basel) 14(9):17235–17255. https://doi.org/10.3390/s140917235 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Some stroke participants suggested that sensors could be worn on the upper arm instead of the wrists to make them less noticeable.

    “some stroke participants suggested that sensors could be worn on the upper arm instead of the wrists to make them less noticeable [65].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [65] Simone LK, Sundarrajan N, Luo X, Jia Y, Kamper DG (2007) A low cost instrumented glove for extended monitoring and functional hand assessment. J Neurosci Methods 160(2):335–348. https://doi.org/10.1016/j.jneumeth.2006.09.021 source

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    Findingnone given

    Clinimetric properties were predominantly investigated in studies using discrete outcome variables such as activity counts or other acceleration-derived variables, in contrast to studies where complicated algorithms were developed and in which the correct classification and precision of these algorithms were usually tested.

    “Clinimetric properties were predominantly investigated in studies using discrete outcome variables such as activity counts or other acceleration-derived variables, in contrast to studies, where complicated algorithms were developed and in which the correct classification and precision of these algorithms were usually tested.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Technical errors and human factors influenced adherence and are important reasons for loss of data.

    “The current review also showed that technical errors and human factors influenced adherence and are important reasons for loss of data.”
    Quote in the paperSubstantial claim

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    Findingnone given

    This review included 22 studies conducted in free-living environments, 16 studies in laboratory, and 12 in hospital settings.

    “This review included 22 studies conducted in free-living environments, 16 studies in laboratory, and 12 in hospital settings.”
    Quote in the paperSubstantial claim

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    Findingown data

    We identified a wide range of outcome measures, but no studies directly addressed the question of the effect wearables may have on decision making or clinical treatment outcomes.

    “We identified a wide range of outcome measures, but no studies directly addressed the question of the effect wearables may have on decision making or clinical treatment outcomes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Critical appraisal of the reporting quality of quantitative studies was performed using the STROBE statement.

    “A critical appraisal of the reporting quality of the quantitative studies eligible for the review was performed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement [6].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Sufficient reporting quality was assigned to studies meeting 12 specified STROBE items, corresponding to more than 50% of all 22 items.

    “Fulfilment of these 12 STROBE items corresponds to more than 50% of all 22 STROBE items, a cutoff which has been used in several previous studies [9–11].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [9] Folletti I, Zock JP, Moscato G, Siracusa A (2014) Asthma and rhinitis in cleaning workers: a systematic review of epidemiological studies. J Asthma 51(1):18–28. https://doi.org/10.3109/02770903.2013.833217 source

      Not checked in the free run.

    • cites [10] Cheng HM, Guitera P (2015) Systematic review of optical coherence tomography usage in the diagnosis and management of basal cell carcinoma. Br J Dermatol 173(6):1371–1380. https://doi.org/10.1111/bjd.14042 source

      Not checked in the free run.

    • cites [11] Soares NM, Leao AS, Santos JR, Monteiro GR, dos Santos JR, Thomazzi SM, Silva RJ (2014) Systematic review shows only few reliable studies of physical activity intervention in adolescents. Sci World J 2014:206478. https://doi.org/10.1155/2014/206478 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There is growing interest in using wearable devices to detect seizures in epilepsy.

    “There is also a growing interest in using wearable devices to detect seizures in epilepsy [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Ramgopal S, Thome-Souza S, Jackson M, Kadish NE, Sanchez Fernandez I, Klehm J, Bosl W, Reinsberger C, Schachter S, Loddenkemper T (2014) Seizure detection, seizure prediction, and closed-loop warning systems in epilepsy. Epilepsy Behav 37:291–307. https://doi.org/10.1016/j.yebeh.2014.06.023 source

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    Study design and conductnone given

    Discrepancies in screening were resolved by discussions between the two reviewers until consensus was reached.

    “Discrepancies were resolved by discussions between the two reviewers until a consensus was reached.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Each title and abstract was screened for inclusion by two independent reviewers.

    “Each title and abstract was screened for inclusion by two independent reviewers (DJ, MAM).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    All 22 STROBE items were discussed between two reviewers before quality assessment to reach consensus.

    “All 22 items of the STROBE statement were discussed between two reviewers before quality assessment (DJ, MAM) to reach a consensus of understanding on each item of the checklist.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The first 20 articles were scored independently by two reviewers to ensure consensus.

    “The first 20 articles from an alphabetically sorted list were scored independently by the two reviewers to ensure consensus.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The rest of the included articles (n = 73) were scored by one reviewer, with uncertainties discussed and rescreened with the second reviewer.

    “The rest of the included articles (n = 73) were then scored by one reviewer (DJ), and any uncertainties were discussed and rescreened with the second reviewer (MAM).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The methodological quality of studies reporting qualitative data was assessed with the Critical Appraisal Skills Programme.

    “The methodological quality of studies that reported qualitative data was assessed with the Critical Appraisal Skills Programme (CASP) [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Programme CAS (2017) CASP (Qualitative Checklists). http://www.casp-uk.net . Accessed 29 Dec 2017

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Data extraction and synthesis used only studies with sufficient reporting quality.

    “The aim, sample characteristics, main findings, proportion of reported missing data, and adherence were extracted from studies with sufficient reporting quality only.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Monitoring of movement-related symptoms and deficits in a free-living environment is challenging.

    “Monitoring of movement related symptoms and deficits in a free-living environment is challenging.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Differentiating or quantifying disease-related movement patterns like epileptic seizures from common voluntary movements such as teeth brushing can be challenging.

    “Differentiating or quantifying disease-related movement patterns like epileptic seizures from common voluntary movements such as teeth brushing can be challenging.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning

    As these phenomena influence quality of life and can be influenced by changes in treatment, improved detection and evaluation with wearables can be expected to improve disease-specific quality of life and other measurements of disease burden.

    “As these phenomena influence quality of life and can be influenced by changes in treatment, improved detection and evaluation with wearables can be expected to improve disease-specific quality of life and other measurements of disease burden.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    One explanation is that gyroscope signals consume more battery power and in this way limit the measuring time.

    “One explanation is that gyroscope signals consume more battery power and in this way limit the measuring time.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    For the detection of seizures, which are relatively rare and brief events, the requirement for accuracy is greater than for detecting symptoms of Parkinson's disease and activity measures in stroke.

    “For the detection of seizures, which are relatively rare and brief events, the requirement for accuracy is greater than for detecting symptoms of PD and activity measures in stroke.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    These themes reflect some challenges that need to be met for wearables to be integrated in clinical practice.

    “These themes reflect some challenges that need to be met for wearables to be integrated in the clinical practice.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Clinical scales may adequately reflect the patients' symptoms or disabilities, but they are often limited by the predefined ordinal scoring levels and lack sensitivity to more detailed and subtle changes in the clinical status.

    “Although the clinical scales may adequately reflect the patients’ symptoms or disabilities, they are often limited by the predefined ordinal scoring levels and lack sensitivity to more detailed and subtle changes in the clinical status [22, 37, 70, 71].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [22] Mancini M, Carlson-Kuhta P, Zampieri C, Nutt JG, Chiari L, Horak FB (2012) Postural sway as a marker of progression in Parkinson’s disease: a pilot longitudinal study. Gait Posture 36(3):471–476. https://doi.org/10.1016/j.gaitpost.2012.04.010 source

      Not checked in the free run.

    • cites [37] Cavanaugh JT, Ellis TD, Earhart GM, Ford MP, Foreman KB, Dibble LE (2012) Capturing ambulatory activity decline in Parkinson’s disease. J Neurol Phys Ther 36(2):51–57. https://doi.org/10.1097/NPT.0b013e318254ba7a source

      Not checked in the free run.

    • cites [70] Kubota KJ, Chen JA, Little MA (2016) Machine learning for large-scale wearable sensor data in Parkinson’s disease: concepts, promises, pitfalls, and futures. Mov Disord 31(9):1314–1326. https://doi.org/10.1002/mds.26693 source

      Not checked in the free run.

    • cites [71] Bustren EL, Sunnerhagen KS, Alt Murphy M (2017) Movement kinematics of the ipsilesional upper extremity in persons with moderate or mild stroke. Neurorehabil Neural Repair 31(4):376–386. https://doi.org/10.1177/1545968316688798 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    To improve precision, patient-specific algorithms have recently been suggested in epilepsy.

    “To improve precision, patient-specific algorithms have recently been suggested in epilepsy [73].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [73] Cuppens K, Karsmakers P, Van de Vel A, Bonroy B, Milosevic M, Luca S, Croonenborghs T, Ceulemans B, Lagae L, Van Huffel S, Vanrumste B (2014) Accelerometry-based home monitoring for detection of nocturnal hypermotor seizures based on novelty detection. IEEE J Biomed Health Inform 18(3):1026–1033. https://doi.org/10.1109/jbhi.2013.2285015 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning

    The idea of measuring multiple physiological modalities can also be transferred to the detection of non-motor symptoms in Parkinson's disease.

    “The idea of measuring multiple physiological modalities can also be transferred to the detection of non-motor symptoms in PD.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    The practical problems of processing and storing large volumes of data will increase with the use of multiple sensors and modalities.

    “The practical problems of processing and storing large volumes of data will, however, increase with the use of multiple sensors and modalities.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    For monitoring motor fluctuations in Parkinson's disease or physical activity levels in stroke, 7 days would be ideal because of expected variations between activity during weekdays and weekends, although 1-3 days may be more practical.

    “For monitoring motor fluctuations in PD or physical activity levels in stroke, 7 days would be ideal because of expected variations between activity during weekdays and weekends, although 1–3 days may be more practical.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    For monitoring seizures in an epilepsy outpatient, 1 month or more could be needed.

    “For example, 1 month or more could be needed for monitoring seizures in an epilepsy outpatient.”
    Quote in the paperNot a substantial claim
51 of 51

  • The paper relies on this without support.

    Wearable technology is increasingly used to monitor neurological disorders.

    “Wearable technology is increasingly used to monitor neurological disorders.”

  • The paper relies on this without support.

    In neurology, wearables offer new possibilities to achieve continuous and objective symptom monitoring in clinical as well as out-of-hospital settings.

    “In neurology, wearables offer new possibilities to achieve continuous and objective symptom monitoring in clinical as well as out-of-hospital settings.”

  • The paper relies on this without support.

    There are several general problems in using wearables across neurological diseases where solutions from one disease area might be generalizable and of interest to the other.

    “The different needs for monitoring in the diseases addressed in this review create specific challenges for the use of wearables, but there are also several general problems, where solutions from one disease area might be generalizable and of interest to the other.”
3 of 3

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Related

Authors
Johansson, D., Malmgren, K., & Alt Murphy, M.
Affiliations
University of Gothenburg (SE)
ORCID
Venue
Journal of Neurology
Publisher
Springer Science and Business Media LLC
Published
2018-02-09
Volume
265
Issue
8
Pages
1740-1752
ISSN
  • 0012-1037 (ISSN-L)
  • 0340-5354
  • 1432-1459
DOI
10.1007/s00415-018-8786-y
PMC
PMC6060770
OpenAlex
W2789915296
Cited by
188
References
81
Citations by year
2026: 9 · 2025: 22 · 2024: 16 · 2023: 25 · 2022: 23 · 2021: 24 · 2020: 34 · 2019: 26 · 2018: 9
FWCI
2.73
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Neurology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • Stiftelsen för Strategisk Forskning (grant SBE 13-0086)
  • Västra Götalandsregionen (grant ALFGBG-429901)
Topics
  • Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Context-Aware Activity Recognition Systems
  • Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
  • Life Sciences › Neuroscience › Cognitive Neuroscience › EEG and Brain-Computer Interfaces
Keywords
wearable sensors, epilepsy, Parkinson's disease, stroke, seizure detection, physical activity, user experience, technology acceptance, free-living monitoring
MeSH terms
Wearable Electronic Devices, Epilepsy, Humans, Parkinson Disease, Stroke

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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