Kinect Abnormal Motion Assessment Score presentation from Health 2.0. See http://motionassessment.com for more.

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 PrimeSense’s 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 adherence…may lead to cost savings for managed care systems”3 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.