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Abstract:

Background: Telemedicine interventions support behavioral state-of-the-art treatment of obsessive-compulsive disorder (OCD) as therapy can be delivered in the patients' home environment, allowing for more ecologically valid symptom actualization and access to experts even in rural areas. Sensors to indicate a patient´s emotional state and gaze direction during exposures with response prevention help to adapt therapy individually and to prevent avoidance behavior. This study will investigate the feasibility and acceptability of sensor-based telemedical treatment for children with OCD in the home setting. Methods: We plan to develop the therapy system with 10 healthy children and 5-10 children with OCD, aged 12-18 years, and then to evaluate it by treating 20 children with OCD of the same age group in 14 weekly therapy sessions via teleconference. We will use eye trackers to record the patient´s gaze and pupillometry, while the heart rate is captured by an ECG chest belt to identify stress responses. Inertial sensors capture movements to detect behavioral patterns. An app is used to record the children's self-rated symptoms and emotional state on a daily basis. Pre- and post-study questionnaires on obsessive-compulsive symptoms, feasibility and acceptance of the therapy by children, parents and therapists will be evaluated. Conclusion: We expect this therapeutic approach to show good feasibility and significant symptom reduction, as well as improvement for psychotherapeutic interventions through direct feedback of physiological responses within therapy sessions. We will further explore the underlying mechanisms in OCD treatment before applying them to other disorders.

Authors: Klein, Carolin S. Hollmann, Karsten K\"uhnhausen, Jan Alt, Annika K. Pascher, Anja Ilg, Winfried; Thierfelder, Annika; Giese, Martin A.; Passon, Helene Ernst, Christian Matthias Kasneci, Enkelejda Severitt, Björn Holderried, Martin Bethge, Wolfgang Lautenbacher, Heinrich Wörz, Ursula Primbs, Jonas Menth, Michael Gawrilow, Caterina Conzelmann, Annette Barth, Gottfried M. Renner, Tobias J.

Research Areas: Clinical Movement Control and real-life Behavior Analysis for Assistive Systems

Type of Publication: Technical Report

Institution: SSRN

Type of Publication: preprint

Abstract:

In this manuscript, we describe the soft- and hardware architecture as well as the implementation of a modern Internet of Medical Things (IoMT) system for sensor-assisted telepsychotherapy. It enables telepsychotherapy sessions in which the patient exercises therapy-relevant behaviors in their home environment under the remote supervision of the therapist. Wearable sensor information (electrocardiogram (ECG), movement sensors, and eye tracking) is streamed in real time to the therapist to deliver objective information about specific behavior-triggering situations and the stress level of the patients. We describe the IT infrastructure of the system which uses open standards such as WebRTC and OpenID Connect (OIDC). We also describe the system’s security concept, its container-based deployment, and demonstrate performance analyses. The system is used in the ongoing study SSTeP-KiZ (smart sensor technology in telepsychotherapy for children and adolescents with obsessive-compulsive disorder) and shows sufficient technical performance.

Authors: Primbs, Jonas Ilg, Winfried; Thierfelder, Annika; Severitt, Björn Hohnecker, Carolin Sarah Alt, Annika Kristin Pascher, Anja Wörz, Ursula Lautenbacher, Heinrich Hollmann, Karsten Barth, Gottfried Maria Renner, Tobias Menth, Michael

Research Areas: Clinical Movement Control and real-life Behavior Analysis for Assistive Systems

Type of Publication: Article

Abstract:

ABSTRACT: Background: Clinical and regulatory acceptance of upcoming molecular treatments in degenerative ataxias might greatly benefit from ecologically valid endpoints that capture change in ataxia severity in patients’ real life. Objectives: This longitudinal study aimed to unravel quantitative motor biomarkers in degenerative ataxias in real-life turning movements that are sensitive for changes both longitudinally and at the preataxic stage. Methods: Combined cross-sectional (n = 30) and longitudinal (n = 14, 1-year interval) observational study in degenerative cerebellar disease (including eight preataxic mutation carriers) compared to 23 healthy controls. Turning movements were assessed by three body-worn inertial sensors in three conditions: (1) instructed laboratory assessment, (2) supervised free walking, and (3) unsupervised real-life movements. Results: Measures that quantified dynamic balance during turning—lateral velocity change (LVC) and outward acceleration—but not general turning measures such as speed, allowed differentiating ataxic against healthy subjects in real life (effect size δ = 0.68), with LVC also differentiating preataxic against healthy subjects (δ = 0.53). LVC was highly correlated with clinical ataxia severity (scale for the assessment and rating of ataxia [SARA] score, effect size ρ = 0.79) and patient reported balance confidence (activity-specific balance confidence scale [ABC] score, ρ = 0.66). Moreover, LVC in real life—but not general turning measures or the SARA score—allowed detecting significant longitudinal change in 1-year follow-up with high effect size (rprb = 0.66). Conclusions: Measures of turning allow capturing specific changes of dynamic balance in degenerative ataxia in real life, with high sensitivity to longitudinal differences

Authors: Thierfelder, Annika; Seemann, Jens; John, Natalie Harmuth, Florian Giese, Martin A.; Sch\"ule, Rebecca Schöls, Ludger Timmann, Dagmar Synofzik, Matthis Ilg, Winfried

Research Areas: Uncategorized

Type of Publication: Article

Abstract:

In modern psychotherapy, digital health technology offers advanced and personalized therapy options, increasing availability as well as ecological validity. These aspects have proven to be highly relevant for children and adolescents with obsessive-compulsive disorder (OCD). Exposure and Response Prevention therapy, which is the state-of-the-art treatment for OCD, builds on the reconstruction of everyday life exposure to anxious situations. However, while compulsive behavior predominantly occurs in home environments, exposure situations during therapy are limited to clinical settings. Telemedical treatment allows to shift from this limited exposure reconstruction to exposure situations in real life. In the SSTeP KiZ study (smart sensor technology in telepsychotherapy for children and adolescents with OCD), we combine video therapy with wearable sensors delivering physiological and behavioral measures to objectively determine the stress level of patients. The setup allows to gain information from exposure to stress in a realistic environment both during and outside of therapy sessions. In a first pilot study, we explored the sensitivity of individual sensor modalities to different levels of stress and anxiety. For this, we captured the obsessive-compulsive behavior of five adolescents with an ECG chest belt, inertial sensors capturing hand movements, and an eye tracker. Despite their prototypical nature, our results deliver strong evidence that the examined sensor modalities yield biomarkers allowing for personalized detection and quantification of stress and anxiety. This opens up future possibilities to evaluate the severity of individual compulsive behavior based on multi-variate state classification in real-life situations.

Authors: Thierfelder, Annika; Primbs, Jonas Severitt, Björn Hohnecker, Carolin Sarah K\"uhnhausen, Jan Alt, Annika Kristin Pascher, Anja Wörz, Ursula Passon, Helene Seemann, Jens; Ernst, Christian Lautenbacher, Heinrich Holderried, Martin Kasneci, Enkelejda Giese, Martin A.; Bulling, Andreas Menth, Michael Barth, Gottfried Maria Ilg, Winfried; Hollmann, Karsten Renner, Tobias Johann

Research Areas: Uncategorized

Type of Publication: Article

Abstract:

OBJECTIVES Clinical and regulatory acceptance of upcoming molecular treatments in degenerative ataxias might greatly benefit from ecologically valid endpoints which capture change in ataxia severity in patients’ real life. This longitudinal study aimed to unravel quantitative motor biomarkers in degenerative ataxias in real life turning movements which are sensitive for changes both longitudinally and at the preataxic stage.

Authors: Thierfelder, Annika; Seemann, Jens; John, N. Giese, Martin A.; Schöls, L. Timman, D. Synofzik, M. Ilg, Winfried

Research Areas: Uncategorized

Type of Publication: Article