Movement Disorders: Optimizing Technology to Improve Patient Care

As a movement disorders fellow a decade ago, I was intrigued by the multimodal nature of patient care. Management strategies regularly encompassed a range of interventions, including medications, therapy services, Botox injections, technological devices, and deep brain stimulation. Comprehensive, creative thinking “outside of the [medication] box” seemed essential to effectively manage the many symptoms affecting our patient population.

The recent growth in technology for movement disorders has largely targeted medication-refractory symptoms that plague patients. For our patients with advanced Parkinson disease, motor symptom fluctuations, including unpredictable wearing off periods and side effects such as dyskinesias, can be difficult to characterize and thus, difficult to treat. Dr. Hirczy and Dr. Schneider’s article highlights wearable devices that can help improve patient medication adherence and can provide symptom monitoring data for clinicians to review and incorporate into medication adjustments. Freezing of gait is another phenomenon that is particularly challenging to treat yet extremely impactful on mobility and fall risk. In this article, Dr. Sanderson discusses the headway made in gait evaluation technology and strategies to combat gait freezing. Speech changes in volume and clarity can also negatively affect patient quality of life and contribute to social isolation. Dr. Schuck reviews the different technological devices that can enhance speech and improve communication for those with Parkinson disease as well as other movement disorders.

Essential tremor is another condition that relies heavily on nonpharmacologic management strategies given limited medication options. This may include low-tech tools as simple as weighted utensils and oscillating spoons to stabilize tremors when eating. More advanced technology includes peripheral stimulation devices such as the Cala kIQ and Felix AI that are approved by the Food and Drug Administration as well as a multitude of medical and nonmedical products that address tremor control via different approaches. The article by Dr. Paller-Moore and Dr. Getchell illustrates (literally) the wide range of tremor-reducing devices available.

Of course, one of the most transformative technological advancements in movement disorders is the deep brain stimulator (DBS). A decade ago, the DBS system, including electrodes, generators, and programming platforms, was relatively primitive; clinician programmers were wired, bulky, monochrome blocks with limited capabilities, batteries were nonrechargeable, requiring replacement every few years. There was only one company on the market providing DBS technology. Today, we have multiple DBS companies offering advanced, complex systems for our patients. Rechargeable batteries can last up to 15 years; sophisticated electrodes allow for directional stimulation and brain wave sensing. And when it comes to programming, clinicians have a staggering amount of options, whether it is imaging guidance, automated programming, or adaptive DBS. Dr. Wagle Shukla and Dr. Khemani collectively highlight these impressive advancements in their respective articles.

The field of movement disorders was just dotted with technological offerings a decade ago; now, the landscape is burgeoning with innovations aimed at improving patient care. My sincerest thanks to all of the authors for sharing their expertise in this edition and illustrating how far our field has come. Continued growth and cultivation are to be expected, and I hope that, with further research and development, investment, and advocacy, we will be able to improve not only patient care, but also patient access to care.