Mobile Integrated Assistance to Empower People Coping
with Parkinson’s Disease
Carla Pereira Patrícia Macedo
Escola Superior de Saúde ESTSetúbal
Instituto Politécnico de Setúbal Instituto Politécnico de Setúbal
campus do IPS, Setúbal, Portugal campus do IPS, Setúbal, Portugal
carla.pereira@ess.ips.pt patricia.macedo@estsetubal.ips.pt
ABSTRACT
In this paper, we present the design of a mobile application to
empower an integrated assistance to support users of the triad:
“people with Parkinson’s disease, their carers and healthcare
professionals”. Starting from a deep study of this triad’s needs, a
mobile application was designed to support not just the
communication between the triad users, but also to help them
finding relevant knowledge to support their clinical issues as well
as allowing the supervision of patients` daily routine and the
recommendation for daily exercises. This application aims to
facilitate the access to knowledge and provide professional
support for both people with Parkinson’s disease and carers in
their homes to improve the remote healthcare assistance.
Categories and Subject Descriptors
H.5 [Information Interfaces and presentation]: User Interfaces;
K.4.2 [Social Issues]: Social Issues––Assistive technologies for
persons with disabilities
General Terms
Experimentation, Design, Human Factors, Theory
Keywords
Parkinson’s disease; mHealth; mobile computing; IBM Watson
1. INTRODUCTION
Mobile technology is transforming the way people communicate
around the world, which has also impact in the health services
provided. The concept of mobile health (mHealth) is changing
how health care is delivered, with an increased support to the
management of chronic diseases [1], such as Parkinson’s disease
(PD), which is the second most common neurodegenerative
disease. It is estimated to affect more than 1 per 1 000 people in
Europe and around 20 000 people in Portugal, changing both
people with Parkinson’s disease (PPD) and family’s lives [2].
Most studies in this field have investigated the use of mobile
applications (apps) to home-based monitoring and assessment of
motor complications [3, 4]. Recently, apps have been developed
mostly to recommend and give instructions about home exercises
(e.g., Parkinson Home Exercises [5]). However, research findings
about its effectiveness are scarce.
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ASSETS '15, October 26-28, 2015, Lisbon, Portugal
ACM 978-1-4503-3400-6/15/10.
http://dx.doi.org/10.1145/2700648.2811394
Rui Neves Madeira
ESTSetúbal
Instituto Politécnico de Setúbal
campus do IPS, Setúbal, Portugal
rui.madeira@estsetubal.ips.pt
Moreover, in the health services provided is important not only to
involve the person (PPD), but also the carer/caregiver [6]. For
both, it is important to understand the disease and its progression
as a way to manage symptoms and find solutions for their daily
challenges, as well as to maintain the communication with health
professionals for an effective shared decision-making between the
triad [7]. Additionally, nowadays, it is becoming very time
consuming for healthcare professionals searching for credible
information and maintaining updated about the best evidence
available. The use of cognitive systems, such as IBM Watson can
make processes more efficient and support an improvement of
patients’ outcomes [8]. According to literature and the study of
the triad’s needs, we proposed the development of an app that is
based on the empowerment of this triad’s users to help both PPD
and carers to cope better with the Parkinson’s disease.
2. PRELIMINARY USER STUDY
A survey was undertaken in order to explore the needs of each
group of participants of the triad. A questionnaire was used to
characterize the profiles of participants, based on mobile
technology as well as on their knowledge needs and the
functionalities they identified as helpful to have in the app.
Thirty-six users from the Portuguese Parkinson Disease
Association participated in the survey, including 11 PPD, 11
carers and 14 healthcare professionals (9 physiotherapists, 2
speech therapists, 2 psychologists and 1 neurologist).
Results highlighted the importance of developing a mobile
application to support a remote healthcare assistance, with most
of participants identifying it as “extremely relevant” (26/36).
Moreover, all user groups reported difficulty finding trustworthy
information about the Parkinson’s disease. Even for some
healthcare professionals (6/14), searching for reliable data to
support clinical decisions was identified as a need, which
emphasized the importance of incorporating Watson technology.
Moreover, participants rated several sentences using a 7-point
Likert scale (1- “totally disagree” to 7- “totally agree”). It is
noteworthy that all users reported the importance of finding easily
answers about the PD (mean=6.3; SD=1.3), being able to write
notes (mean=6.6; SD=0.8), having medication and exercise alerts
(mean=6.4; SD=0.9) and communicating with healthcare
professionals through the app (mean=6.5; SD=1.1).
3. MOBILE INTEGRATED ASSISTANCE
3.1 System Overview
The system, which we called Smoveen, consists of two main
components (see Figure 1): the server, which contains a central
database and manages all the requests from the diverse apps; and
the client, which can be a mobile or web app. A first mobile app
prototype is being implemented in Java for the Android platform,
taking into account the prospective market penetration. It is not
required to be always connected to the Internet to use the app, but
it will request connections periodically in order to do
synchronizations with the server. It connects to the server to
obtain and store the required data for all users. The Smoveen
system connects to the IBM Watson platform’s Q&A service.
Figure 1. The system architecture.
3.2 Rationale and Design
Smoveen is aimed primarily to the aforementioned triad, although
being available to the general public from GooglePlay store. We
considered the existence of “common users”, who can only
consult the essential information and ask open questions related to
PD (Figure 2 illustrates the use cases of the system).
Figure 2. Diagram of use cases.
The latter corresponds to the use case “Ask Watson” and it is
executed when the user is searching for credible information from
the inside of Smoveen, in order to have an integrated perspective
dealing with PD. Smoveen uses Watson’s Q&A service, which
interprets and answers user questions directly [8]. The service
returns candidate responses with associated confidence levels and
links to supporting evidence. The Smoveen app will treat these
data accordingly before showing them to the user. The user will
have an interface to classify the answers since this will help
training the Watson’s cognitive services. Moreover, right now, all
user questions should be put to Watson in English. However, our
system will have a Portuguese version and, in this case, we will
have to implement an intermediate module for translations since
some users are not used to the English language. The use cases
related to the modules Exercises and Calendar on the app will be
available only to the PPD and the carer (see Figure 3, 4th image).
On the other hand, the web app will be available only to the
healthcare professionals so they can manage their patients’
information, and submit therapeutic exercises to the system.
Figure 3. Examples of screens design [from left to right]: logo
(three heads representing the triad); login; menu with 2
options for common users; or 4 options for registered users.
4. FURTHER WORK
The preliminary study allowed us to gather initial feedback from
potential end-users, which has validated our project’s concept and
“sketches”. However, we will continue gathering feedback while
developing the first prototype, assessing each one of its modules
with the users. As part of this ongoing process, we are selecting a
group of end-users from the preliminary study which should
participate in all user tests.
5. REFERENCES
[1] Steinhubl, S., Muse, E., and Topol, E. 2013. Can Mobile
Health Technologies transform health care? The Journal of
American Medical Association, 310 (22), 2395-2396.
[2] European Commission. 2015. Neurodegenerative Disorders.
http://ec.europa.eu/health/major_chronic_diseases/diseases/
brain_neurological. Accessed 25th June 2015.
[3] Pan, D., Dhall, R., Lieberman, A., Petitti, D.B. 2015. A
Mobile Cloud-Based Parkinson’s Disease Assessment
System for Home-Based Monitoring. JMIR mHealth and
uHhealth, 3(1): e29.
[4] Patel, S., et al. 2009. Monitoring motor fluctuations in
patients with Parkinson's disease using wearable sensors.
IEEE Trans. Inf. Technol. Biomed, 13(6), 864–873.
[5] IAPRD.org. 2015. Parkinson Home Exercises app.
www.iaprd.org/publications.html. Accessed 11th Aug 2015.
[6] Tod, A., McDonnell, A., et al. 2014. Putting people with
Parkinson's in control: exploring the impact of quality social
care. Project Report. Sheffield Hallam. University, Sheffield.
[7] McLaughlin, D., Hasson, F., Kernohan, W.G., Waldron, M.,
McLaughlin, M., Cochrane, B., Chambers, H. 2011. Living
and coping with Parkinson's disease: Perceptions of informal
carers. Palliative Medicine, 25(2), 177-182.
[8] IBM. 2015. IBM Watson.
www.ibm.com/smarterplanet/us/en/ibmwatson/what-is-
watson.html. Accessed 25th June 2015.