1. March 21, 2011
Copyright 2011: Team Triangle
Kinect Abnormal Movement Assessment System (KAMAS)
Team TriangleClaus C Becker, MSc, PhD, MBA Greg Borenstein, MPS (candidate) Johnny Hujol, MSCS Daniel Karlin, MD, MA Greg Kust, MPH, MBA

2. March 21, 2011
Copyright 2011: Team Triangle
Executive Summary
Conceived and developed in 8 hours at Boston Code-a-Thon
Symptomatic diseases with excess of movement
Microsoft Kinect-based application to automate assessment
Home-grown and integrated open-source code
Multiple stakeholder perspectives (clinicians, payers, patients)
Framework for future development

3. March 21, 2011
Copyright 2011: Team Triangle
Overview of Movement Disorders
Focused on hyperkinetic movement disorders
Dyskinesias, Choreas, Akathesias
Neurological conditions affecting speed, fluency, and ease of movement; and the ability to stop movement
KAMAS matches & complements existing clinical practices for the diagnosis & assessment of movement disorders

4. March 21, 2011
Chorea van Sydenham
http://www.youtube.com/watch?v=RsIQFeYOkAg

5. March 21, 2011
Copyright 2011: Team Triangle
Prevalence and Severity

6. March 21, 2011
Copyright 2011: Team Triangle
Problem in Current Practice
Inadequate assessment of movement disorders (AIMS test)
Standardization
Frequency
Inter-rater reliability poor, masking progression
Disease progression, on a more granular & temporal basis
Current assessment every 3-6 months, at best
Gaps between assessments allow development of severe disease
Response to therapy (e.g. efficacy, dosing, adverse events)
Adherence to therapy
Remote monitoring

7. March 21, 2011
Copyright 2011: Team Triangle
Our Approach
Leverage MS Kinect
Processing application using PrimeSenses OpenNI middleware and OSCeleton library
Tracks spatial hand & knee movement
Calculates score based upon degree of involuntary motion
Clinical scorecard: Severity score compared to baseline
MPR* + Patient self-report + KAMAS** = Health Score
*MPR: Medicine possession ratio

8. March 21, 2011
Copyright 2011: Team Triangle
KAMAS Demonstration

9. March 21, 2011
Copyright 2011: Team Triangle
Clinical Benefits
Patient
Less disruptive / more convenient
Engaged participation and self care
Improved care
Closed feedback loops
Earlier detection of non-response and disease progression
Provider
Clinical effectiveness & dose modification
Adherence measures (prescription status)
Time efficient
Reliable, quantifiable scoring
EMR integration (video & data)
At home or in clinic

10. March 21, 2011
Copyright 2011: Team Triangle
Payer Benefits
Less $ waste (quick detection of ineffective therapy)
Avoid a lifetime of advanced disease costs
Reduce risk of expensive side effects and irreversible disease
Reduce hospitalizations and all cause total costs (1)
Clinical assessment without an office visit
Telemedicine compatible
Low cost, transparent, reproducible, auditable
Start-up costs not capital intensive
Efforts to promote medication adherencemay lead to cost savings for managed care systems3
1) Delea et al. CNS Drugs. 2011 Jan 1;25(1):53-66, 2) Wei et al. Amer J Ger Pharm. 2010 Aug;8(4):384-394, 3) Davis KL et al. Prevalence and cost of medication nonadherence in Parkinson's disease: evidence from administrative claims data. Mov Disord. 2010 Mar 15;25(4):474-80.

11. March 21, 2011
Copyright 2011: Team Triangle
Issues we wrestled with
Short timeline (ad hoc project)
Kinect development environment rapidly changing
Investment needed to further validate and develop for clinical use

12. March 21, 2011
Copyright 2011: Team Triangle
Next Steps
With interest from investors, refine software to include directions, progression measures, and increased range of movements
Data archiving and security compliance
Improve statistical treatment of data
Clinical validation possible at Tufts Medical Center

13. March 21, 2011
Copyright 2011: Team Triangle
References
http://www.neurologychannel.com/movementdisorders/overview-of-movement-disorders.shtml
http://www.nlm.nih.gov/medlineplus/movementdisorders.html
http://www.atlantapsychiatry.com/forms/AIMS.pdf
http://www.webmd.com
Delea et al. CNS Drugs. 2011 Jan 1;25(1):53-66,
Wei et al. Amer J Ger Pharm. 2010 Aug;8(4):384-394
Davis KL et al. Prevalence and cost of medication nonadherence in Parkinson's disease: evidence from administrative claims data. Mov Disord. 2010 Mar 15;25(4):474-80.
Rosenheck, RA. Evaluating the cost-effectiveness of reduced tardive dyskinesia with secong-generation antipsychotics. B J Psychiatry. 2007 (191): 238-245.