SCIENCE TRANSLATIONAL MEDICINE | RESEARCH ARTICLE

PARKINSON’S DISEASE Copyright © 2022

The Authors, some
Monitoring gait at home with radio waves rights reserved;
exclusive licensee
in Parkinson’s disease: A marker of severity, American Association
for the Advancement
progression, and medication response of Science. No claim
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Government Works
Yingcheng Liu1†*, Guo Zhang1†, Christopher G. Tarolli2,3, Rumen Hristov4, Stella Jensen-Roberts2,3,
Emma M. Waddell2,3, Taylor L. Myers2,3, Meghan E. Pawlik2,3, Julia M. Soto2,3, Renee M. Wilson2,3,
Yuzhe Yang1, Timothy Nordahl5, Karlo J. Lizarraga2,3, Jamie L. Adams2,3, Ruth B. Schneider2,3,
Karl Kieburtz2,3, Terry Ellis5, E. Ray Dorsey2,3, Dina Katabi1,4

Parkinson’s disease (PD) is the fastest-growing neurological disease in the world. A key challenge in PD is tracking
disease severity, progression, and medication response. Existing methods are semisubjective and require visiting
the clinic. In this work, we demonstrate an effective approach for assessing PD severity, progression, and medication
response at home, in an objective manner. We used a radio device located in the background of the home. The
device detected and analyzed the radio waves that bounce off people’s bodies and inferred their movements and gait
speed. We continuously monitored 50 participants, with and without PD, in their homes for up to 1 year. We collected
over 200,000 gait speed measurements. Cross-sectional analysis of the data shows that at-home gait speed strongly
correlates with gold-standard PD assessments, as evaluated by the Movement Disorder Society-Sponsored Revision

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of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) part III subscore and total score. At-home gait speed
also provides a more sensitive marker for tracking disease progression over time than the widely used MDS-UPDRS. Further,
the monitored gait speed was able to capture symptom fluctuations in response to medications and their impact
on patients’ daily functioning. Our study shows the feasibility of continuous, objective, sensitive, and passive as-
sessment of PD at home and hence has the potential of improving clinical care and drug clinical trials.

INTRODUCTION PD specialist (5). Second, even when patients have access to a PD

Parkinson’s disease (PD) affects about 1 to 2% of people aged 65 and
older (1) and is the fastest growing neurological disorder in the world
(2). It is the prototypic degenerative movement disorder, character-
ized by a combination of slowness, stiffness, tremor, and postural
instability, that results in gait dysfunction. To date, there are no
drugs that can prevent or halt PD. The most effective medication
for improving symptoms is oral levodopa, a precursor of dopamine,
which is reduced in the disease. Response to therapy is robust early
in the course of PD, but as the disease progresses, individuals with
PD develop motor fluctuations, characterized by periods of good
medication effect (ON time) and periods of emergent PD symptoms
as the medication wears off (OFF time) (3).
Objective assessment of clinical progression and the impact of
medications on symptoms is essential for both PD drug develop-
ment and the delivery of medical care. Such assessment, however, is
challenging for two reasons. First, PD specialists are concentrated
in medical centers in urban areas, whereas individuals with PD are
spread geographically and have problems traveling to PD centers
due to old age, limited mobility, impaired cognition, and decreased
driving ability (4). As a result, many patients with PD (40% of pa-
tients with PD in Medicare data) are not seen by a neurologist or
1
Department of Electrical Engineering and Computer Science, Massachusetts Institute
of Technology, Cambridge, MA 02139, USA. 2Department of Neurology, University of
Rochester Medical Center, Rochester, NY 14642, USA. 3Center for Health + Technology,
University of Rochester Medical Center, Rochester, NY 14642, USA. 4Emerald Inno-
vations Inc., Cambridge, MA 02142, USA. 5Department of Physical Therapy & Athletic
Training, Center for Neurorehabilitation, Boston University College of Health and
Rehabilitation: Sargent College, Boston, MA 02215, USA.
*Corresponding author. Email: liuyc@mit.edu
†These authors are co-first authors.
specialist, the resulting assessment is episodic and semisubjective.
In particular, the Movement Disorder Society–Unified Parkinson’s
Disease Rating Scale (MDS-UPDRS), widely used for assessing PD
motor and nonmotor signs, is acquired through infrequent in-clinic
assessments, and could be biased by both patient’s state on that par-
ticular day, such as being tired after a long drive to the medical
center, and the subjectivity of patient or rater (6, 7). These semisub-
jective episodic assessments are also widely used in clinical trials and,
as such, affect the success of therapeutic development.
Thus, there is an urgent need for objective, accurate, and contin-
uous assessment of PD at home. Some researchers have looked into
the possibility of using wearable and portable devices to monitor
individuals with PD (8–11); however, solutions that require users
to wear and manage devices can be problematic in this population,
which, besides their motor difficulties, tends to be older, less tech-
nology savvy, and potentially cognitively impaired (12).
Here, we present an approach for continuous assessment of PD
at home without asking patients to wear sensors or actively measure
themselves. We have developed a passive activity monitor that looks
like a home Wi-Fi router. The device acts as low-power human radar;
it sends out wireless signals (1000 times lower power than home
Wi-Fi) and collects their reflections from the environment and nearby
people. We used advanced signal processing and machine learning
algorithms to analyze the reflected radio signals and extracted walk-
ing movements and trajectories through the home. We further ana-
lyzed these measurements to compute participants’ gait speed and
assessed its correlation with PD severity, disease progression, and
medication response, as illustrated in Fig. 1.
To evaluate our approach, we conducted two observational
studies in which we monitored 50 participants (34 with PD and 16

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A B C
Our sensor
Our sensor

Disease progression

Participant Disease severity

Walking trajectory Medication effect

Fig. 1. System overview. (A) Our sensor operates like a low-power radar. It transmits wireless signals that are only 1/1000 the power of a home Wi-Fi router, and passively
and continuously collects signals reflected from nearby people. (B) The collected radio signals are analyzed to extract participants’ movement trajectories and gait speeds.
(C) Using the large amount of trajectory and gait data collected across time, we evaluate PD disease severity, disease progression, and patients’ response to medications.

Table 1. Demographical and clinical characteristics. Unless otherwise specified, values are at baseline.
PD group (n = 34) Control group (n = 16)

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Demographic
Age (years), mean (SD) 69.4 (7.6) 66.4 (13.0)
Women 26% 50%
White 97% 100%
Hispanic/Latino 0% 6%
College graduate 85% 88%
Living with other individuals at home 79% 62%
Clinical
Taking levodopa 91% 0%
MDS-UPDRS total score, mean (SD) 56.9 (18.7) 4.6 (4.4)
MDS-UPDRS part III score, mean (SD) 30.8 (9.6) 0.5 (1.5)
Percentage participants completing baseline
100% 100%
MDS-UPDRS
Percentage participants in the longitudinal study who
completed MDS-UPDRS assessments at months 6 and 78%, 72% 92%, 75%
12 (PD, n = 18; control, n = 12)
TUG test (s), mean (SD) 10.1 (2.7) 8.6 (1.7)
H&Y score, mean (SD) 2.2 (0.6) 0.2 (0.4)
TMWT (m/s), mean (SD) 1.2 (0.2) 1.4 (0.2)
Years since PD diagnosis, mean (SD), [min, max] 6.9 (5.0), [0.9, 19.8] N/A

age-matched control subjects) continuously in their homes. The
first study enrolled 20 participants, who were monitored for 2 months.
The remaining participants (60%) are enrolled in an ongoing 2-year
observational study. The evaluation demonstrated that unscripted
gait measurements collected using our radio device provide a valid marker
of PD severity, progression, and medication response.
Now, most of drug clinical trials and medical care are limited to
subjective episodic PD measurements, typically conducted in a clinic.
In contrast, the approach described here demonstrates the feasibility
of assessing individual patients in their natural living environments to
obtain objective, detailed, and clinically meaningful measurements of
their disease. Furthermore, these measurements can be collected in a
passive manner without asking patients to wear sensors or interfering
with their lives. Our results also motivate the use of in-home
radio-­­based gait monitoring to study other diseases associated with
gait and motor dysfunction, such as Huntington’s disease (13, 14)
and multiple sclerosis (15).
RESULTS
Participant characteristics
We enrolled 50 individuals, including 34 with PD [age 69.4 (7.6)
years, 26% women] and 16 without PD [age 66.4 (13.0) years, 50%
women]. Among them, 40% were observed for 8 weeks, whereas
the rest were enrolled in an ongoing longitudinal study and were
monitored for up to 1 year. Table 1 summarizes the demographics

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A B
1.00 1.0
0.98
0.9

Gait speed (m/s)

0.95 0.8

0.7
Test-retest reliability

0.90
0.6

0.5
1 2 3 4 5 6 7 8 9 10 11 12 13 14
0.85
Size of intervals (days)
1.1

0.80 1.0

Gait speed (m/s)

0.9

0.75
95% CI 0.8

0.7
0.70
0 2 4 6 8 10 12 14 0.6
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Size of intervals (days) Size of intervals (days)

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Fig. 2. Test-retest reliability of in-home gait speed as a function of aggregation interval. (A) Test-retest reliability of aggregated in-home gait speed as a function of
the aggregation interval for all participants (n = 50). (B) Test-retest reliability of in-home gait speed measurements as a function of the aggregation interval for two exam-
ple participants. Top: A participant with PD. Bottom: A participant without PD.

and clinical characteristics of the participants, and fig. S1 provides
more details about their MDS-UPDRS and ON-OFF behavior. In
total, we collected over 200,000 gait speed measurements. The mean
(SD) baseline in-home gait speed among those with PD was 0.70
(0.085) m/s, and that among those without PD was 0.91 (0.075) m/s.
Thus, individuals with PD had about 23% lower in-home gait speed
than the control cohort (t = −8.10, P < 0.001).
Reliability of in-home gait speed measurements
Any measurement incurs some variability that is independent from
the disease and is due to noise in the measuring device or measure-
ment condition. For example, the person may walk slower than usual
if they are talking on the phone or may walk faster if they are trying
to reach a ringing alarm. Further, the radio device may introduce
some noise. Thus, it is important to average or aggregate individual
gait measurements to obtain a consistent measurement that reflects
the health status of the individual. To estimate the proper aggrega-
tion window, we computed the test-retest reliability (16). The re-
sults reported in Fig. 2A show that the test-retest reliability of gait
speed increases with longer averaging windows, and both the aver-
age and confidence interval (CI) cross the 95% threshold (n = 50)
for a window size of only 14 days [intraclass correlation coefficient
(ICC), 0.98; 95% CI, 0.97 to 0.99]. We also considered an alternative
method for aggregating the measurements by computing the 75th
percentile gait speed in each aggregation window. Such aggregation
method focuses on high-speed gait measurements, and hence better re-
flects performance during ON times, defined as periods of improved
mobility in response to levodopa. The results are similar; specifically,
the 75th percentile gait speed and the associated CI cross the 95%
threshold (n = 50) with a window size of 14 days. Overall, our anal-
ysis shows that aggregating gait measurements over 2 weeks or longer
leads to robust and repeatable results.
In-home gait speed as a marker of PD severity
Several prior studies have shown that gait speed is associated with
important medical outcomes, such as health status, cognitive func-
tion, dementia, and mortality (17–20). In this study, we investigated
whether gait speed measured passively at home provides a clinically
meaningful assessment of PD severity. To do so, we compared in-
home gait speed against common measures of PD severity such as
the MDS-UPDRS part III subscore and total score. Since the MDS-
UPDRS is assessed during ON time, we use the 75th percentile gait
speed for this correlation to bias the gait speed toward the ON state.
The results in Fig. 3 (A and B) show that among PD and control
participants, in-home gait speed is strongly correlated with both the
MDS-UPDRS total score (n = 50, r = −0.83, P < 0.001) and the part
III subscore (n = 50, r = −0.86, P < 0.001). Further, a subanalysis
focused on the axial symptoms as measured by the sum of items 1
and 9 to 13 in the MDS-UPDRS part III reveals that they, too, are
strongly correlated with in-home gait speed (n = 50, r = −0.83, P < 0.001).
We also used a covariate-adjusted linear model to validate that the
correlation between in-home gait speed and the MDS-­UPDRS,
both total and part III, is not affected by confounding factors such as
age, gender, or comorbidities (table S1). Given that MDS-UPDRS
is the key metric for evaluating disease severity in PD clinical trials,
this result demonstrates that in-home passive gait speed measure-
ments provide a clinically meaningful assessment of PD severity.
Figure 3C shows that the two common standards for assessing
PD severity, namely, the MDS-UPDRS and Hoehn and Yahr (H&Y)
stage (21), correlated strongly with in-home gait speed measure-
ments but had a weak correlation with in-clinic measurements of
Timed Up and Go (TUG) (22) and the Ten Meter Walk Test
(TMWT). This result is consistent with past work, which shows
weak correlation between in-clinic gait measures and MDS-UPDRS
(11, 23–25). The reason might be because gait speed measured in

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A 1.1 C

1.0 r = –0.83

In-home gait speed

P < 0.001

Ten Meter Walk Test

In-home gait speed (m/s)

Timed Up and Go
subscore

Hoehn and Yahr

0.9

MDS-UPDRS

MDS-UPDRS
total score
0.8

stage
0.7

part
0.6
1.00 –0.86 –0.83 –0.70 –0.33 0.40
In-home gait speed (<0.001) (<0.001) (<0.001) (<0.001) (0.020) (<0.01)
0.5

0 20 40 60 80 100
MDS-UPDRS total score MDS-UPDRS –0.86 1.00 0.92 0.80 0.33 –0.40
part sub-score (<0.001) (<0.001) (<0.001) (<0.001) (0.018) (<0.01)

B 1.1
MDS-UPDRS –0.83 0.92 1.00 0.83 0.41 –0.41
r = –0.86
1.0 P < 0.001 total score (<0.001) (<0.001) (<0.001) (<0.001) (<0.01) (<0.01)
In-home gait speed (m/s)

0.9 –0.70 0.80 0.83 1.00 0.35 –0.33

Hoehn and Yahr stage (<0.001) (<0.001) (<0.001) (<0.001) (0.014) (0.018)
0.8

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–0.33 0.33 0.41 0.35 1.00 –0.70
0.7 Timed Up and Go (0.020) (0.018) (<0.01) (0.014) (<0.001) (<0.001)

0.6
0.40 –0.40 –0.41 –0.33 –0.70 1.00
Ten Meter Walk Test (<0.01) (<0.01) (<0.01) (0.018) (<0.001) (<0.001)
0.5
0 10 20 30 40 50
MDS-UPDRS part subscore

Fig. 3. Correlation between in-home gait speed and standard PD outcome measures. (A) and (B) plot the 75th percentile gait speed (from the 14 days following the
baseline visit) against the MDS-UPDRS ON state at baseline. (C) Pairwise Pearson correlation between in-home gait speed, MDS-UPDRS part III subscore, MDS-UPDRS total
score, H&Y, TUG, and TMWT (n = 50).

daily home activities reflects the habitual gait performance (26, 27)
and is less likely to be confounded by observer or Hawthorne effects
(28). To further understand the relation between in-home and in-clinic
gait assessment, we compared the TUG and TMWT against the me-
dian (50th percentile), 75th percentile, and 90th percentile in-home
gait speed (table S2). We found that the correlation between in-home
gait speed and TUG/TMWT increased with the higher gait percen-
tiles, indicating that in-clinic measurements focus on patient capac-
ity, whereas in-home measurements focus on patient performance.
Overall, the results provide evidence of the feasibility of in-home
gait speed as a marker of PD severity.
In-home gait speed as a marker of PD progression
Next, we investigated whether the decline in gait speed over time
differs between participants with and without PD and whether such
a decline can capture disease progression among those with PD. This
analysis is performed on the participants in the longitudinal study.
To gain insight into how gait speed changes over time, we plot in
Fig. 4A the change in gait speed over 1 year for two participants
randomly selected from the PD and control cohorts who completed
12 months of monitoring. Regression analysis shows that the rate of
decline for the participant with PD was −0.030 m/s per year (95%
CI, −0.038 to −0.022; P < 0.001), which is faster than the gait de-
cline of the control participant, which was −0.014 m/s per year (95%
CI, −0.019 to −0.010; P < 0.001).
Simply looking at gait decline in the two participants in Fig. 4A,
one cannot judge whether the difference is due to the disease or
other differences between the two individuals. Thus, we used linear
mixed-effects models to analyze the rate of gait decline among the
PD cohort and the control cohort. The models included random
effects of slope and intercept for each participant and were adjusted
for demographic covariates. There was a significant decline in gait
speed over time of −0.026 m/s (95% CI, −0.034 to −0.019; P < 0.001)
per year for participants with PD and −0.015 m/s (95% CI, −0.025
to −0.004; P = 0.007) per year for control participants as shown in
Fig. 4B. These results show that older people, with and without PD,
slow down as they age further (19, 29–32). However, individuals with
PD slow down much faster than those without PD. In other words,
their gait speed declines almost twice as fast. To evaluate the statis-
tical significance of the difference in gait speed decline between in-
dividuals with and without PD, a group and time interaction term
was included in the model. We observed a statistically significant
interaction between group and time with a greater rate of decline in
the PD group (P = 0.04). These results confirm previous evidence
that changes in gait differ significantly between individuals with and
without PD (33), and demonstrate that such difference can be cap-
tured at home using passive and touchless measurements.
Another important finding is that PD progression was not cap-
tured reliably by changes in MDS-UPDRS at baseline, month 6, and
month 12. We applied a similar linear mixed-effects model to the
MDS-UPDRS values. The results show that the 1-year progression
in MDS-UPDRS did not achieve statistical significance (part III sub-
score model, P = 0.67; total score model, P = 0.71). This indicates
that in contrast to in-home gait speed, MDS-UPDRS part III and

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A B
0.86 0.64 0.02
A control participant A PD participant

0.01
0.84 0.62

Decline of gait speed (m/s)

0.00

Gait speed (m/s)

Gait speed (m/s)

0.82 0.60 –0.01

–0.02
0.80 0.58

–0.03

0.78 0.56
–0.04

–0.05
0.76 0.54 0 2 4 6 8 10 12
0 2 4 6 8 10 12 0 2 4 6 8 10 12 Time (month)
Time (month) Time (month)
Control cohort Control 95% CI Control individual

Gait speed Linear regression 95% CI PD cohort PD 95% CI PD individual

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Fig. 4. Decline in gait speed over 1 year. (A) Example trajectories of progressive decline in gait speed of participants with and without PD. Left: A participant without
PD. Right: A participant with PD. (B) Progressive gait speed decline over 1 year for the PD and control cohorts in the longitudinal study (n = 30), produced using a linear
mixed-effects model.

total assessments were unable to deliver sufficiently sensitive markers goal, we exploited the fact that patients usually have regular medi-
of 1-year disease progression in this population. This result is con- cation schedules, and hence, their motor fluctuations repeat around
sistent with past work that reported that the 1-year progression the same time across different days. Thus, for participants who were
in MDS-UPDRS part III was not statistically significant even with taking levodopa, we computed the intraday gait speed, which we de-
a population of over 200 individuals with PD (31). Table S7 fine as the gait speed of an individual as a function of the hour in the day.
shows that the lack of statistical significance can persist even in We compared the intraday gait speed of each participant with their
larger populations. ON-OFF states through the day, as reported in their Hauser diaries.
Last, to control for the effects caused by changes in symptomatic Figure 5 shows evidence that in-home gait speed can capture
therapy, we repeated the above analysis only for intervals without medication response and motor fluctuations. In particular, Fig. 5A
any changes in therapy. The resulting 1-year gait decline was −0.028 m/s plots the intraday gait speed of four participants with PD, along with
(95% CI, −0.037 to −0.018; P < 0.001) and was significantly higher the percentage of ON time, as reported in their Hauser diaries. The
than the control group (P < 0.034). We also applied the same statis- top graphs reveal that in-home gait speed oscillates in response to
tical analysis to the MDS-UPDRS total score and part III subscore, medication administration. One possible explanation for these oscilla-
for the same participants over the same period. The progression in tions is that they reflect the effect of medications in only controlling
MDS-UPDRS remained statistically not significant (P = 0.82 for the symptoms; thus, when the patient takes their medications, their
total score and P = 0.49 for part III subscore). Overall, the analysis gait speed improves, but within 1 to 2 hours, the medication impact
above shows that in-home gait speed might be a sensitive marker of wears off and the gait speed declines again, until the patient takes
PD progression. the next dose. The figure also shows that the degree to which the
oscillations are controlled differs across patients. For example, PD1’s
Gait speed as a marker of PD motor fluctuation motor symptoms are relatively well controlled; this is apparent in
and medication response PD1’s intraday gait speed, which is fairly stable throughout the day
Within 3 to 5 years of levodopa treatment, about 50% of individuals and night, and is confirmed in his Hauser diary, which reports no
with PD begin to develop motor fluctuations (34), characterized by a OFF time (compare that to PD2, PD3, and PD4, who experience
decline in the duration of benefit of each dose with emergent motor a large difference between day-time and night-time gait speed and
fluctuations, a phenomenon known as “wearing-off” or “ON-OFF” wide fluctuations in their gait speed throughout the day). Also, note
effect (3). Now, clinicians and researchers may assess such ON-OFF that the fluctuations are aligned with the medication times and the
symptoms using the Hauser diary (35), in which patients self-report percentage of ON time in their Hauser diaries.
the time they take their medications, and their functional status In addition, we found that changes in intraday gait speed profiles
every 30 min as ON or OFF (35). Filling in the Hauser diary impos- reflected adjustments in medication plan. Figure 5B depicts the in-
es a burden on participants and often results in low reliability due to traday gait speed of a participant with PD before and after his med-
poor adherence and recall bias (36, 37). ication adjustment. Before the medication adjustment, the patient’s
We examined the ability of our system to capture medication motor performance fluctuated widely throughout the day, showing
impact on motor fluctuations and ON-OFF symptoms. Toward this clear peaks and valleys. After reducing the dose and increasing the

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A PD1 PD2 PD3 PD4

1 2 3 1 2 3 1 2 3 1 2 3 4 5
1.1 1.1 1.1 1.1

1.0 1.0 1.0 1.0

Gait speed (m/s)

0.9 0.9 0.9 0.9

0.8
0.8 0.8 0.8
0.7
0.7 0.7 0.7
0.6
0.6 0.6 0.6
0.5
0.5 0.5 0.4 0.5

0.4 0.4 0.3 0.4

4 6 8 10 12 14 16 18 20 22 0 2 4 6 8 10 12 14 16 18 20 22 0 2 4 6 8 10 12 14 16 18 20 22 0 2 4 6 8 10 12 14 16 18 20 22 0 2
Hour in the day Hour in the day Hour in the day Hour in the day
1.0 1.0 1.0 1.0
Probability of being ON

0.8 0.8 0.8 0.8

0.6 0.6 0.6 0.6

0.4 0.4 0.4 0.4

0.2 0.2 0.2 0.2

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0.0 0.0 0.0 0.0
4 6 8 10 12 14 16 18 20 22 0 2 4 6 8 10 12 14 16 18 20 22 0 2 4 6 8 10 12 14 16 18 20 22 0 2 4 6 8 10 12 14 16 18 20 22 0 2
Hour in the day Hour in the day Hour in the day Hour in the day

1: Ropinirole 8 mg ER × 1 + Rasagiline 1 1–3: Pramipexole 0.75 mg × 1 + 1–3: C/L 25/100 mg × 1 1–5: C/L 25/100 mg × 1.5
mg × 1 + Amantadine 100 mg × 1 carbidopa/levodopa (C/L) 25–100 mg × 2
2: Amantadine 100 mg × 1
3: Ropinirole 8 mg ER × 1 45–55th 40–60th
Median ON OFF SLEEP
percentile percentile

B C
1.0
C/L 25/100 mg 2 tab 0.10 n=2
3 times a day
0.9
Gait speed (m/s)

r = 0.74 n=6
P < 0.001 n=1
0.8 0.09

0.7
0.08
0.6 Medication wears off
Variance of gait speed

0.07
0.5
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 0 1 2 3
Hour in the day n=9
1.0 0.06
C/L 25/100 mg 1 tab
6 times a day
0.9
Gait speed (m/s)

n = 16
0.05
0.8

0.7 0.04
Reduced motor fluctuation
0.6
0.03
0.5
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 0 1 2 3
Hour in the day 0.02

40–60th percentile Median gait speed Normal Slight Mild Moderate Severe

45–55th percentile Carbidopa/levodopa MDS-UPDRS functional impact of fluctuation subscore

Fig. 5. Intra-day gait speed capture of motor fluctuations, adjustments in medication plans, and self-reported disease impact on daily function. (A) Top
figures: Intraday gait speed distribution of four participants with PD measured using 2 months of data. The dashed black lines refer to the medication schedule.
Bottom figures: Normalized histograms of ON-OFF status of the participants in the top figures, over the same period, as reported in the participants’ Hauser diaries.
(B) Intraday gait speed profile of a participant with PD who experienced a medication adjustment. Top plot: Profile from the period following the baseline visit when
the participant took two tablets of carbidopa/levodopa (25/100 mg three times per day). Bottom plot: Profile from the period following the month 6 visit when his
medication dose was adjusted to one tablet six times per day, showing reduced motor fluctuation. (C) Relationship between intraday gait speed fluctuations and
self-reported disease impact on daily function, which is taken from the MDS-UPDRS functional impact of fluctuation subscore (n = 34). The figure also reports the
Spearman’s rank-order correlation.

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A 12 50
B
0.8
P = 0.03 P < 0.01 Decline before
11 hospitalization After being back
40
Time in bed per day (hour)

Gait speed (m/s)

Number of walks per day
0.7
10

30
9 In hospital
0.6
8 20
11 days
7 0.5 //
–14 –12 –10 –8 –6 –4 –2 0 12 14 16 18 20 22 24 26 28
10
6 Day w.r.t. hospitalization

Median 45–55th 40–60th 30–70th

5 0 percentile percentile percentile
Before After Before After
lockdown lockdown lockdown lockdown

Fig. 6. System-derived measurements reflecting symptom changes due to COVID-19 lockdown and hospitalization. (A) Changes in time in bed per day and num-
ber of walks per day before and after COVID-19 lockdown measurements (n = 17). (B) Longitudinal in-home gait speed trajectory of a participant with PD before and after
his hospitalization. This individual is a 75-year-old man with PD (baseline MDS-UPDRS part III/total score = 33/54) who was hospitalized for 11 days due to newly discov-
ered atrial fibrillation.

Downloaded from https://www.science.org on January 05, 2024

frequency of medication administration, the motor fluctuation was more time at home, and thus, our device captured more walking
mitigated, and the patient’s gait became more stable as shown in the events. Studies have also indicated increasing sleep hours (38, 39),
figure. Another example of how the intraday gait profile captures which is consistent with our findings in Fig. 6A.
the impact of medication adjustment is shown in fig. S2. Last, we found that the longitudinal gait speed trajectory was able
Next, we show that the variability in the intraday gait speed re- to detect changes leading to a major medical event. One of the par-
flects patients’ assessment of the disease impact on their daily ticipants was hospitalized because of onset of new symptomatic atrial
function. In particular, the MDS-UPDRS part IV asks participants fibrillation and coronary artery disease. He underwent cardiac cath-
to characterize the impact of motor fluctuations on their daily func- eterization surgery and was discharged home after 11 days. Figure 6B
tion and social interaction as one of the following: normal, slight, mild, shows the trajectory of his in-home gait speed before and after this
moderate, and severe. We compute the variance in intraday gait speed hospitalization. The trajectory demonstrates a decline in gait speed
for each individual with PD. Figure 5C shows a boxplot of the rela- starting about 6 days before hospitalization. On the day of hospital-
tionship between the variance in intraday gait speed and the disease ization, his median (IQR) in-home gait speed reached its minimum
impact on daily function as reported in the patient’s MDS-UPDRS value of 0.55 (0.14) m/s. After he was discharged from the hospital,
functional impact of fluctuation subscore. Admittedly, the number his gait speed improved but remained lower than his baseline.
of participants is relatively small (n = 34), and only one of them re- Overall, the results in Fig. 6 show that passive gait monitoring
ports a severe fluctuation impact; however, the results show that might help in managing the overall health of patients with PD and
variances in intraday gait speed are highly correlated with patient’s can provide context for some changes in their motor symptoms. It
perception of disease impact on their daily function (r = 0.74, P < also emphasizes the fact that gait speed is a general metric that is
0.001, Spearman’s rank-order correlation). affected by PD and other health issues including cardiac problems.

Insights into clinical and health-related events

To evaluate the system’s ability to detect additional health insights, DISCUSSION
we compared the system-derived clinical profiles against both gen- We demonstrated that a radio sensor can facilitate passive, touch-
eral events experienced by the population and serious health events less, and clinically meaningful assessment of PD at home. We
reported by the participants. We found patterns in the derived presented evidence that the device can help in assessing PD disease
measurements that are associated with coronavirus disease 2019 severity, tracking PD progression, and objectively monitoring
(COVID-19) stay-at-home orders and a hospitalization due to atrial PD-specific disease features, including response to medication and
fibrillation. fluctuations in motor functions. Further, it offers the ability to
For individuals monitored both before and after the COVID-19 zoom in on each individual with PD and observe changes in phys-
lockdown, we compared their time in bed per day and the number ical functions due to events of clinical importance (including both
of walking events per day. Since the device can localize people from short-term events such as medication adjustment and long-term
the radio signals reflected off their bodies, time in bed was comput- events such as the COVID-19 lockdown), demonstrating the bene-
ed by considering the total period when the person’s location was fits of this technology for personalized care and telehealth.
mapped to their sleeping area. After the COVID-19 lockdown, we Our study has used passively measured in-home gait speed as
observed an increase in the median [interquartile range (IQR)] time the key metric to characterize and monitor PD. The sensitivity of
in bed from 7.81 (0.87) to 8.18 (1.30) hours per day (P = 0.028) and in-home gait speed to PD severity and progression can be partly
an increase in the median (IQR) number of walking episodes from explained by the fact that gait requires a complex interplay between
12.68 (10.46) to 16.74 (18.80) per day (P < 0.01) (Fig. 6A). This be- motor, cognitive, musculoskeletal, and cardiorespiratory systems, each
havioral change can be partly explained by participants spending of which can be affected by PD progression (40). The importance of

Liu et al., Sci. Transl. Med. 14, eadc9669 (2022) 21 September 2022 7 of 13
SCIENCE TRANSLATIONAL MEDICINE | RESEARCH ARTICLE
assessing gait speed in the real-world environment is further demon-
strated by our data, which show that comprehensive clinical tests
such as the MDS-UPDRS correlate strongly with in-home gait
speed but correlate only weakly with in-clinic measures of gait
speed. These results are aligned with past observations that MDS-
UPDRS total and part III scores are weakly correlated with in-clinic
measures of gait speed (11, 23–25). Our results also show that
in-clinic gait measures such as TUG and TMWT correlate better
with the faster instances of in-home gait speed, which is consistent
with past reports (41) that in-clinic gait captures patient capacity,
whereas in-home gait captures patient performance. This indicates
that in-home and in-clinic gait measurements can play a comple-
mentary role in PD assessment.
The results in this study might have important implications for
clinical trials and the development of better and possibly personal-
ized therapies for treating PD. A key challenge for PD clinical trials
stems from the fact that the disease evolves slowly, yet MDS-UPDRS is
not sufficiently sensitive to small changes in symptoms. As a result,
PD clinical trials need to last for multiple years and enroll hundreds
of participants before differences in MDS-UPDRS can be reported
with sufficient statistical confidence (17, 20, 42, 43). In contrast, our
study shows that the decline in gait speed exhibits strong statistical
significance in less than 1 year, even when the sample size is rela-
tively small. This indicates that in-home passive gait measurements
have the potential to enable clinical trials with a shorter time span
and fewer participants, and ultimately accelerate the development of
new therapies. Table S9 provides an example of a hypothetical 1-year
clinical trial of a new PD treatment, demonstrating the potential for
large reduction in the required sample size.
Our approach has also the potential of facilitating recruitment
and improving retention in clinical trials. This is because it facili-
tates virtual trials in the participants’ homes, reduces the need for
clinic visits, and frees the patient and their caregiver from reporting
and maintaining symptom diaries.
The results in this study also have important implications for PD
clinical care. First, the ability to evaluate patients’ response to med-
ication is pivotal to PD medication titration (44). Our study provides
important insight into medication response and the relationship
between PD motor function status and in-home gait speed. Our ap-
proach could allow physicians to adjust the dose and then observe
the impact of the adjustment on motor fluctuations. We also pre-
sented several cases where the system captured changes in physical
function that reflect clinical and social events. These results suggest
that in-home free-living characteristics could have broader im-
plications, including being used as a tool to investigate behavioral
symptoms, evaluate medication adherence, and predict risk of hos-
pitalization. This technology might also have clinical utility for the
assessment of individuals with PD who have traditionally been un-
derserved, including those who live in rural areas and those with
difficulty leaving the home due to limited mobility or cognitive im-
pairment (45).
The study has also some limitations. First, the studied popula-
tion is relatively small. We note, however, that the power calcula-
tion (46) ensures that the number of participants is sufficient for
achieving statistical significance and justifies the statistical validity
of the results in the paper. Future studies with more participants are
important to confirm the wide applicability of the results across
diverse PD populations. Second, participants are monitored only at
home and only within space covered by the radio device. Third, the
Liu et al., Sci. Transl. Med. 14, eadc9669 (2022) 21 September 2022
evaluation of the system is limited by the precision of standard
PD ratings and patients’ self-reported outcomes. In particular, the
MDS-UPDRS ratings were acquired through episodic in-clinic as-
sessments and could be affected by patients’ physical status on the
day of in-clinic visit. Fourth, gait speed is a general metric not spe-
cific to PD and could be affected by other health issues. Our covari-
ate analysis, however, provides evidence that none of the common
comorbidities constitutes a confounding factor for our results. Last,
PD exhibits several gait impairments that are not studied in this
paper. Some impairments such as falls and freezing can potentially
be captured by our radio device (47, 48) and provide a natural topic
for future work. Despite the above limitations, we believe that the
study provides important insights and addresses key unmet needs
in clinical care and drug development in PD.
Our work is aligned with recent interest in leveraging digital
technologies for assessing PD. Technologies that use cellphones or
wearable devices are widely available and can be used inside and out-
side the home. However, they require patients to wear and charge
devices (11, 41, 49–52), and unless the movements are scripted
(11, 49), their correlation with the MDS-UPDRS is inferior to our
Downloaded from https://www.science.org on January 05, 2024
method (52). Technologies that use cameras can obtain more detailed
motion information, but they are invasive of patients’ privacy and
so far have been tested only in laboratory scenarios (53). By being
passive, unscripted, and contactless, our approach satisfies an unmet
need for assessing individuals with PD in their natural living envi-
ronment for months and years, with minimal overhead.
Last, we note that our findings open up new possibilities that
could improve clinical practice across other illnesses. The medical
literature shows that gait speed is a valuable metric for many diseases
and health conditions including cardiovascular diseases, cancer, de-
mentia, frailty, mortality, impaired mood, cognitive decline, ataxia,
Huntington’s disease, progressive supranuclear palsy, and multiple
system atrophy (14, 17–20, 54–65). Our study demonstrates the fea-
sibility of continuously monitoring this metric at home in a passive
manner. The monitoring device operates in the background, ana-
lyzing the reflection of radio signals. It tracks gait speed, its daily
fluctuations, and its changes over time and provides this informa-
tion remotely to the professional caregiver in a timely manner. Thus,
without asking patients to leave home or actively measure them-
selves, doctors can achieve safe and frequent health monitoring and
deliver more personalized care. This has important implications,
particularly in light of COVID-19 social distancing measures and a
growing population of individuals with chronic illnesses.
MATERIALS AND METHODS
Study design
Over a period of 3 years, we have recruited individuals with and
without PD to have the wireless devices installed in their home as
part of two observational research studies. The first study enrolled
individuals with and without PD at two sites (Boston University,
University of Rochester) with an observation period of 8 weeks. The
second study is part of the National Institutes of Health–funded
Morris K. Udall PD Research Center of Excellence at the University
of Rochester, which aims to characterize individuals with and with-
out PD at home using multimodal technologies. Those enrolled in
our Udall substudy have the device installed in their home over a
period of 2 years. By the time of writing, recruitment and study ac-
tivities are still ongoing in the longitudinal 2-year study. Hence, in
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this article, we consider only data from the first year of monitoring.
All participants with PD were screened and met the UK PD Society
Brain Bank Clinical Diagnostic Criteria; control individuals had no
evidence of primary or secondary Parkinsonism. After enrollment
and screening, a study coordinator installed the wireless device in
the participant’s home and connected the device to the patient’s
home Wi-Fi network. Study coordinators also created a basic floor
map of the monitored area to allow post hoc assessment of partici-
pant position in the home.
Enrolled participants underwent clinical assessments at baseline,
and in the longitudinal study, participants have visits at 6 months,
12 months, and 2 years after installation. During these visits, a move-
ment disorder specialist conducted PD assessments including the
MDS-UPDRS parts I to IV, H&Y stage, and TUG, among others.
The longitudinal study was started before and has continued during
the COVID-19 pandemic, resulting in a shift in clinical assessments,
with some visits being conducted remotely. However, all baseline vis-
its were conducted in person. During remote visits, measures that
require in-person assessment, including TUG and TMWT, were not
performed. The feasibility of remote performance of the MDS-UPDRS
has been reported previously. In addition to the clinical assessments,
participants with PD completed a home activity log (Hauser diary)
for 14 days after each in-person visit documenting self-reported
motor status (ON, ON with dyskinesia, OFF, or asleep) during each
30-min interval in the day. Participants additionally indicated whether
they took a dose of dopaminergic therapy during each 30-min interval. The
Hauser diary was self-reported on a paper form. All participants were
trained on the use of the form during the visit, but we cannot deter-
mine that patients reported their motor status in a timely manner.
Both the 8-week and the longitudinal studies collected MDS-­
UPDRS and H&Y stage at baseline for all individuals. In addition, the
longitudinal study collected MDS-UPDRS assessments at month 6
and month 12. Also, the longitudinal study collected disease duration,
whereas the 8-week study did not collect this information.
All study procedures were approved by the Research Subjects
Review Board (RSRB) at the University of Rochester (RSRB00001787
and RSRB00072169). Both the Massachusetts Institute of Technology
(MIT) Institutional Review Board and the Boston University Charles
River Campus Institutional Review Board ceded review to the Uni-
versity of Rochester RSRB.
In-home radio-based gait monitoring
Our wireless device hangs on the wall and continuously emits and
detects low-power wireless signals that reflect off nearby individu-
als, similar to radar (Fig. 1). As individuals move, the reflected sig-
nals change, allowing the detection and localization of motion in
an approximately 30-foot radius around the device (66). The move-
ment trajectory is analyzed with respect to time to calculate the par-
ticipant’s gait speed (67). This approach has been demonstrated to
yield a highly accurate measure of gait speed where the relative
error is between 1.9 and 4.2%, and the absolute error is between
0.015 and 0.023 m/s. For reference, we also provide a brief compar-
ison of the accuracy of gait speed measurements using wearable
sensors (table S4).
The device encrypts the data and uses the home wireless network
to upload it to a cloud server hosted by Amazon Web Services,
where it is processed to extract additional metrics of interest.
We note that the device can monitor participants even in the pres-
ence of other individuals in the home. Past work has demonstrated
Liu et al., Sci. Transl. Med. 14, eadc9669 (2022) 21 September 2022
methods that identify people using the radio signals that bounce off
their bodies (68–70). In this paper, we leverage the method developed
by Hsu et al. (67). Specifically, the device uses standard signal pro-
cessing techniques such as Frequency-Modulated Continuous-Wave
(FMCW) and antenna arrays to zoom in on radio signals from each
voxel in space and separate signals based on spatial locations. To
identify signals from the participant from others, participants are
asked to wear a coin-size accelerometer for the first 2 weeks of the
study. The accelerometer data are then used to train a machine
learning classifier that identifies the radio signals that bounce off
the participant from signals that bounce off other people and objects
in the house. Once the classifier is trained, participants do not need
to wear the accelerometer and can be identified solely from radio
signals using the aforementioned classifier. As shown by Hsu et al.
(67), this method is accurate and its average identification accuracy
across different homes and individuals is 90%.
The same radio device was used to detect errors in medication
self-administration (71) and monitor patients with Alzheimer’s dis-
ease (72), endometriosis (73), COVID-19 (74), and facioscapulohu-
meral muscular dystrophy (FSHD) (75). Also, we have explored the
Downloaded from https://www.science.org on January 05, 2024
use of the device with individuals with PD in a small pilot study
focused on sleep and daily activities (76).
Scalability and operation of the monitoring method
At the time of the writing, the radio device used in this paper is in-
corporated in a large number of clinical studies in neurological dis-
eases (77, 78), immune diseases (79, 80), and rare diseases (75, 81).
Some of these studies involve over 250 devices, and many of them
run for several years. Even larger trials that involve 500 to 1000 de-
vices, though will require more resources and planning, we believe
are feasible.
Operationally, the device is easy to deploy and configure using a
phone app. The app allows the participant to have a remote call with
a technician or engineer, who guides them through the deployment
process. Once deployed, the device does not need input from the
participant, who can go about their life with no overhead. The pro-
cess of collecting data and uploading it to the cloud is fully automated
and uses state-of-the-art security and networking protocols. Data
are processed using a pipeline of signal processing and machine
learning modules to output the desired physiological metrics for the
trial (such as gait, sleep, breathing, and scratching) in accordance
with the trial’s approved protocol. The resulting physiological sig-
nals are encrypted and stored in the cloud so that they can be ac-
cessed and analyzed remotely with proper security credentials. The
device and cloud do not collect or store personally identifiable in-
formation, and all data are stored in a coded form.
Statistical analysis
All statistical analysis was performed with Python version 3.8 (Python
Software Foundation) and R version 3.4 (R Foundation). All box-
plots are shown with a central mark at the median, bottom, and top
edges of the boxes at 25th and 75th percentiles, respectively, and
whiskers out to the most extreme points within 1.5 times the IQR.
In-home gait speed cross-sectional analysis
ICC was used to assess test-retest reliability. Nonoverlapping inter-
vals with various sizes were used to average the gait speed measure-
ments from the first 2 months after the baseline visit. We compared
aggregate mean values among those with versus without PD using
two-tailed independent sample t tests ( = 0.05).
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We assessed the correlation between in-home gait speed and
clinical PD outcome measures [MDS-UPDRS part III subscore and
total score (7), H&Y stage (21), TUG (22), and TMWT] at the base-
line visit using Pearson correlation. Baseline in-home gait speed
was measured from the first 14 days after the baseline visit. We used
the 75th percentile in-home gait speed to reflect gait speed during
ON time. These clinical PD outcomes were measured when partici-
pants were on medication.
Analysis of confounding factors
We have performed statistical analyses to ensure that the correla-
tion between in-home gait speed and the MDS-UPDRS (total
and part III scores) is not affected by confounding factors. In addi-
tion to demographics (age, gender, ethnicity, race, and education),
we consider the following 15 comorbidities: cognitive performance;
overall health; cardiac health; hypertension; vascular health;
respiratory system health; eye, ear, nose, and throat (EENT)
health; upper gastrointestinal (GI) health; lower gastrointestinal
health; hepatic health; renal health; other genitourinary (GU) health;
musculoskeletal and integumentary health; endocrine and metabolic
health; and psychiatric and behavioral health. We score cognitive
performance according to the Montreal Cognitive Assessment
(MoCA), which was collected for all participants. Other comorbid-
ities are scored according to the Modified Cumulative Illness Rating
Scale (MCIRS), which was collected for the participants in the
2-month study and assessed retrospectively based on the medical
history and standard guidelines (82) for the participants in the lon-
gitudinal study.
We follow the standard covariate-adjusted linear model analysis
(83, 84). In the core model, we regard MDS-UPDRS total and part
III as dependent variables and in-home gait speed as an indepen-
dent variable with demographic covariates controlled (model A).
We then augment this core model by further adjusting for potential
comorbidities (models B to P).
Table S1 summarizes the results. The first row in the table shows
the linear relation between gait speed and the MDS-UPDRS. The
other rows account for age, gender, and other demographic factors.
The different columns account for the impact of various comorbidities.
Note that there are two ways to show that a particular comorbidity
is not a confounding factor: either the comorbidity’s relationship to
the MDS-UPDRS is not significant (P > 0.05) or the relationship
of the comorbidity to the MDS-UPDRS may be significant but its
presence does not change the linear relationship with gait speed.
The table shows that demographics and comorbidity variables did
not constitute confounding factors.
In-home gait speed longitudinal analysis
We assessed per-participant changes in gait speed using linear re-
gression. We assessed the longitudinal changes in gait speed for the
PD and control cohorts using linear mixed-effect models. To com-
pare the gait decline rate of the PD cohort with the control cohort,
we used models that included a group × time interaction term (fixed
effect) to determine whether the change in gait speed over time dif-
fered significantly. We included a random effect for intercept and
slope for all participants. All models included demographic covari-
ates, namely, gender, age, race, ethnicity, and education.
Linear mixed-effects models for within-cohort analysis can be speci-
fied by the following formula. For the jth observed data point of subject
i, let SPDij represent gait speed and Tij represent time of observation
with respect to (w.r.t.) baseline. Let SPDbaseline,i represent baseline
gait speed of subject i. Let v ∈ covariate.
Liu et al., Sci. Transl. Med. 14, eadc9669 (2022) 21 September 2022
​​SPD​  ij​​  − ​SPD​  baseline,i​​  = ​u​  0i​​  + (​​  1​​  + ​u​  1i​​) × ​T​ ij​​  + ​​  ij​​  + ∑ ​​  v​​  × v​
where u0 ∼ Normal(0, u0), u1 ∼ Normal(0, u1),  ∼ Normal(0, ).
Notably, we did not include a fixed-effect intercept in the model
because we expect no gait speed decline at baseline.
For combined PD and control cohort analysis, we included the
group × time interaction term in the formula
​SPD​ ij​​  − ​SPD​ baseline,i​​  = ​u​  0i​​  + (​​  1​​  + ​u​  1i​​) × ​T​ ij​​+
​​    ​ ​​
​​  ij​​  + ​​  2​​  × ​cohort​  ij​​  × ​T​ ij​​  + ∑ ​​  v​​  × v
where u0 ∼ Normal(0, u0), u1 ∼ Normal(0, u1),  ∼ Normal(0, ).
Restricted maximum likelihood estimation was used for all models
to estimate the parameters.
Insights into various events at home
As an exploratory endpoint, we collected from each participant in-
formation on events of interest during the monitoring period, in-
cluding societal events, such as local lockdowns in the setting of the
COVID-19 pandemic, and personal medical events, such as hospi-
talizations and medication adjustment. We assessed the impact of
Downloaded from https://www.science.org on January 05, 2024
these events on system-derived measures. If an event was identified,
we retrospectively reviewed relevant data, such as changes in sched-
ule or time at home in response to lockdown orders, and used de-
scriptive statistics or demonstrative figures to illustrate the changes.
As this was an exploratory endpoint with numerous possible events,
we did not prespecify what would qualify as an event or which pa-
rameters we would assess.
In general, events of interest were identified through general knowl-
edge of societal changes, such as lockdown dates in geographic area,
recognition of a change in a parameter during routine data moni-
toring, such as participant out of range of the device for a prolonged
period, or by participants’ reporting of an event during a routine
study visit, such as hospitalization. If the event was noted during interim
data analysis, further clinical information about the event of inter-
est was obtained at the participant’s next scheduled study visit.
To analyze the impact of the COVID-19 lockdown, we computed
the number of walks per day and the time in bed per day for each
participant. One-tailed Wilcoxon signed-rank test was used to assess
whether there were significant increases or decreases in the mea-
surements. Prelockdown measurements were computed from
1 January 2020 to 1 March 2020, and post-lockdown measurements
were computed from 1 April 2020 to 1 June 2020. Participants whose
devices were installed before 1 January 2020 were included in the anal-
ysis. To compute the number of walks per day, we used the method
described in (67). To compute the time in bed per day, we used the
method described in (85).
SUPPLEMENTARY MATERIALS
www.science.org/doi/scitranslmed.adc9669
Methods
Figs. S1 to S3
Tables S1 to S9
Data file S1
References (86–92)
View/request a protocol for this paper from Bio-protocol.
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Acknowledgments: We thank J. Luo, T. T. Wu, and E. Hoque from the University of Rochester,
and members of the Katabi’s group at MIT for their comments on our manuscript. We would
also like to thank all the research participants for their time and contributions. Research
reported in this publication was supported by the National Institute of Neurological Disorders
and Stroke of the NIH under Award Number P50NS108676. The content is solely the
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responsibility of the authors and does not necessarily represent the official views of the NIH.
Funding: The work was supported by a grant from the NIH (P50NS108676) to Y.L., G.Z., C.G.T.,
S.J.-R., E.M.W., T.L.M., M.E.P., J.M.S., R.M.W., Y.Y., T.N., K.J.L., J.L.A., R.B.S., K.K., T.E., E.R.D., and D.K.
and by a grant from the Michael J. Fox Foundation (15069) to R.H. Author contributions:
Conceptualization: Y.L., G.Z., C.G.T., T.E., E.R.D., and D.K. Methodology: Y.L., G.Z., and
D.K. Software (data collection/visualization, machine learning, and signal processing): Y.L. and
R.H. Software (statistical analysis and validation): Y.L. and G.Z. Validation: Y.L., G.Z., R.H., and
D.K. Formal analysis: Y.L., G.Z., and D.K. Investigation: Y.L. G.Z., C.G.T., R.H., S.J.-R., E.M.W., T.L.M.,
M.E.P., J.M.S., R.M.W., T.N., K.J.L., J.L.A., R.B.S., K.K., and T.E. Resources: Y.L., G.Z., C.G.T., R.H.,
S.J.-R., E.M.W., T.L.M., M.E.P., J.M.S., R.M.W., T.N., T.E., E.R.D., and D.K. Data curation: Y.L., G.Z.,
C.G.T., R.H., S.J.-R., E.M.W., T.L.M., M.E.P., J.M.S., R.M.W., Y.Y., and T.N. Writing—original draft:
Y.L., G.Z., C.G.T., and D.K. Writing—review and editing: Y.L., G.Z., C.G.T., R.H., J.L.A., K.J.L., R.B.S.,
K.K., T.E., E.R.D., and D.K. Visualization: Y.L. and G.Z. Supervision: T.E., E.R.D., and D.K. Project
administration: S.J.-R., E.M.W., M.E.P., R.M.W., T.E., E.R.D., and D.K. Funding acquisition: E.R.D.
and D.K. Competing interests: T.N. has received research support from the NIH and the
Michael J. Fox Foundation. K.J.L. has research support from the NIH/NINDS, Acadia, AbbVie,
and Genentech. J.L.A. has received honoraria for speaking at the Huntington Study Group and
American Neurological Association; compensation for consulting services from VisualDx and
the Huntington Study Group; and research support from Biogen, Michael J. Fox Foundation,
and NIH/NINDS. R.B.S. has received compensation for consulting services from Parkinson’s
Foundation, Voyager Therapeutics, and Escape Bio and research support from the NIH,
Michael J. Fox Foundation for Parkinson’s Research, Biohaven Pharmaceuticals, Acadia
Pharmaceuticals, and Parkinson Study Group. K.K. has received compensation for consulting
services from Clintrex Research Corp., Roche/Genentech, and Novartis; research support from
the NIH (NINDS, NCATS) and Michael J Fox Foundation; and ownership interests with Clintrex
Research Corp., Hoover Brown LLC, Safe Therapeutics LLC, and Blackfynn LLC. T.E. has received
research support from the NIH, Michael J. Fox Foundation, and MedRhythms Inc. T.E. has
received honoraria for speaking engagements, educational programming, and/or outreach
activities through the American Parkinson Disease Association, the Parkinson’s Foundation,
the Movement Disorders Society, and the American Physical Therapy Association. E.R.D. has
Liu et al., Sci. Transl. Med. 14, eadc9669 (2022) 21 September 2022
received honoraria for speaking at American Academy of Neurology, American Neurological
Association, Excellus BlueCross BlueShield, International Parkinson’s and Movement Disorders
Society, National Multiple Sclerosis Society, Northwestern University, Physicians Education
Resource, LLC, Stanford University, Texas Neurological Society, and Weill Cornell;
compensation for consulting services from Abbott, Abbvie, Acadia, Acorda, Alzheimer’s Drug
Discovery Foundation, Ascension Health Alliance, Bial-Biotech Investments Inc., Biogen,
BluePrint Orphan, California Pacific Medical Center, Caraway Therapeutics, Clintrex, Curasen
Therapeutics, DeciBio, Denali Therapeutics, Eli Lilly, Grand Rounds, and Huntington Study
Group, medical-legal services, Mediflix, Medopad, Medrhythms, Michael J. Fox Foundation,
MJH Holding LLC, NACCME, Neurocrine, NeuroDerm, Olson Research Group, Origent Data
Sciences, Otsuka, Pear Therapeutic, Praxis, Prilenia, Roche, Sanofi, Seminal Healthcare, Spark,
Springer Healthcare, Sunovion Pharma, Sutter Bay Hospitals, Theravance, University of
California Irvine, and WebMD; research support from Abbvie, Acadia Pharmaceuticals, Biogen,
Biosensics, Burroughs Wellcome Fund, CuraSen, Greater Rochester Health Foundation,
Huntington Study Group, Michael J. Fox Foundation, NIH, Patient-Centered Outcomes
Research Institute, Pfizer, PhotoPharmics, Safra Foundation, and Wave Life Sciences; editorial
services for Karger Publications; and ownership interests with Grand Rounds (second opinion
service). D.K. and R.H. are cofounders of Emerald Innovations. D.K. receives research funding
from the NIH and Michael J. Fox Foundation and serves on the scientific advisory board of
Janssen and the data science advisory board of Amgen. The remaining authors declare that
they have no competing interests. Data and materials availability: All data associated with
this study are present in the paper or the Supplementary Materials. The code is publicly
available from the project’s website (https://rf-pd-gait.csail.mit.edu) or GitHub (https://github.
com/firstmover/rf-pd-gait). Additional data are available by request, subject to signing a data
Downloaded from https://www.science.org on January 05, 2024
use agreement (https://rf-pd-gait.csail.mit.edu).
Submitted 12 May 2022
Accepted 26 August 2022
Published 21 September 2022
10.1126/scitranslmed.adc9669
13 of 13
 Monitoring gait at home with radio waves in Parkinson’s disease: A marker of
severity, progression, and medication response
Yingcheng Liu, Guo Zhang, Christopher G. Tarolli, Rumen Hristov, Stella Jensen-Roberts, Emma M. Waddell, Taylor L.
Myers, Meghan E. Pawlik, Julia M. Soto, Renee M. Wilson, Yuzhe Yang, Timothy Nordahl, Karlo J. Lizarraga, Jamie L.
Adams, Ruth B. Schneider, Karl Kieburtz, Terry Ellis, E. Ray Dorsey, and Dina Katabi

Sci. Transl. Med. 14 (663), eadc9669. DOI: 10.1126/scitranslmed.adc9669

Smart gait tracker

Tracking progression of Parkinson’s disease (PD) requires long visits to the clinic and is subjected to several biases.
To facilitate objective evaluation of disease state in individuals with PD, Liu et al. developed a home device able to

Downloaded from https://www.science.org on January 05, 2024

detect and analyze movements of individuals while performing day-to-day activities. The device emits radio waves and
detects them after they bounce back off the people’s body, inferring gait speed. Testing in 50 participants showed that
the device performed better than the gold standard in tracking disease progression over time and was able to detect
positive response to treatment, suggesting that at-home continuous monitoring could improve disease management in
individuals with PD.

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