Technology has revolutionized care for people with movement disorders. From wearables for better symptom management, to deep learning algorithms that help those with dystonia to implantable deep brain stimulators for everything from epilepsy to essential tremor to Parkinson’s disease, technology has made giant leaps in just the last decade in helping people with movement disorders get better care. That trend should only accelerate going forward as our understanding of what these conditions are and how best to treat each afflicted individual continues to improve and a wider variety of devices become available. Soon the very real potential to improve quality of life for millions around the world living with a movement disorder might be within our collective grasp.
However, getting there will require tech companies, academic centers and governments to start investing much more heavily in these technologies and take a more focused approach to how they choose to spend their resources. Below is my list of initiatives tech companies could be focusing more of their efforts on that would enable those living with a movement disorder to live a little better tomorrow than they can today.
1) Virtual Clinics
Problem: Today patients are forced to travel great distances to specific centers often located in the middle of giant cities to get access to the care they need. In addition, movement disorder clinics find themselves unable to keep up with demand forcing patients to have to deal with ever growing wait times just to be seen. Even those that do get in often get just 20-30 minutes with their neurologist every 6 months, not to mention all the other specialists they need to learn to navigate to optimize their care.
Solution: Bring multidisciplinary clinics to patients. Soon virtual environments, avatars and motion capture tech will allow patients to visit clinics that can offer wholistic models of care from anywhere. In those virtual environments patients could choose either live or virtual Movement Disorder Specialists, Speech Language Pathologists, Cognitive Behavioral Therapists, Physiotherapists, and tailor their own recovery to fit their individual needs. And as our ability to virtually record people’s movements continues to improve so will our ability to track symptoms of disease, augmenting what clinician are capable of and allowing many more individuals to get the care they need. Finally, since many of the clinical specialties can be gamified, therapy itself can become much more entertaining for all involved.
2) Earlier Diagnosis
Problem: Tens of millions of people around the world are currently undiagnosed because they simply cannot get access to the right specialists. Plus navigating our healthcare systems, knowing where to go to get the care each person needs, is no easy task. In addition, tens of millions more are in the prodromal (meaning pre-diagnostic) phase of a disease as many of these disorders can have a 10-20 year prodrome.
Solution: Give everyone a smartwatch. Between wearable devices like smart watches and rings and the ubiquitous nature of cell phones we can already track an individual’s movements and get a much better sense of their specific needs than ever before. In addition, we can today refer those diagnosed to nearby movement disorder centers or in the future send them VR kits and bring the clinic to them. Also we need to do more to identify those early in the prodromal phase of a disease because from exercise and lifestyle changes to stress management techniques to a wide variety of clinical trials testing all sorts of promising new therapies in development, there is a lot one can do to potentially slow their progression. However doing any of these raises a ton of ethical concerns around how to deliver these diagnoses at scale. If I were one of these big tech companies I would hire a Patient Advisory Board to help craft these messages asap.
3) Devices
Problem: Today there are a slew of implantable tech devices one might get to help manage their disease. From deep brain stimulators(DBS) for Parkinson’s Disease to heart devices for Afib to closed-loop insulin pumps for type-1 diabetics. The problem is that they often require a second device to operate, which are often clumsy and add another thing to keep track of, and many of them are not nearly as effective as they could be. This is particularly problematic for the growing number of patients with more than one device (ie. those with a pacemaker and DBS) as too often devices interfere with one another.
Solution: Marry Big Tech and Neurotech. Not only would more crosstalk between external devices and implants allow patients to live more hassle free, but many of these tech companies are much better positioned to safely develop the next generation of devices themselves. Of course there are a ton of concerns that would need to get sorted before anyone would choose to implant the latest Samsung DBS or Apple pacemaker (just examples), but just imagine a world where your headphones or earbuds are able to give accurate EEG readouts and deliver focused ultrasound therapy and the possibilities that opens up for those suffering from afflictions like treatment resistant depression. Or a world where your watch (which can accurately predict when you might need more stimulation) can communicate with your DBS or transcranial magnetic stimulation device to stimulate parts of the brain in need. The possibilities that would open up for us to not only better understand how our brains work but also track and deliver therapy to those in need are vast.
4) Digital Endpoints
Problem: Today regulators still insist on using outdated clinical metrics such as the UPDRS as the endpoint in clinical trials. Not only do scales such as these force patients to have to travel to clinical centers just to be assessed, but because they must be conducted in artificial clinical environments they rarely capture how patients actually respond to a given therapy.
Solution: Adopt digital endpoints. A concerted effort is direly needed to push regulators to adopt better endpoints in clinical trials. Thanks to the work of companies like Koneksa and Rune Labs we have much better means of measuring symptoms in real world environments. However, companies and the FDA are still hesitant to adopt new endpoints and no one wants to be the first to do so. This is where big tech companies could play a pivotal role in assuaging the concerns of regulators by demonstrating the comparative value these new means have to offer to clinical trials. As Drs. Kristen Sowalsky and Fay Horak from APDM Wearable stated, “Digital endpoints of movement impairment specific to early PD are meaningful to patients, more sensitive to disease progression than conventional clinical scales, and a critical tool in the future success of clinical trials to provide effective treatments for PD patients.”
Just The Beginning…
From Digital Twins in clinical trials to drones delivering medications to giant leaps made in the resolution of brain images, the possible role technology can play in helping patients is just in its infancy. However it must be stressed that all of the above need to be done while ensuring patient data is secure, centralized and that patients are in control. No one is better situated than big tech companies to realize this future. What’s needed is for them to begin working more with academics, pharma and biotech companies and regulators to recognize the transformative potential innovations such as those listed above could have on society and invest the capital that is needed today if we are going to realize the potential to help so many in need tomorrow.
All images above were created using meta.ai