For Healthcare Professionals

Clinical application of the PKG® system

The PKG® provides objective, ambulatory, continuous assessment of motor complications associated with movement disorders including:

  • Assessment of bradykinesia, dyskinesia and tremor
  • Ability to correlate symptom fluctuations and their severity with respect to levodopa dosage
  • Self-reported levodopa compliance
  • A record of daytime sleepiness and immobility
  • Assessment of the risk of Impulse Control Disorders


Assessment with a PKG® can be useful in:

  • Establishing a symptomology baseline and monitoring response to treatment
  • Confirming an intervention has worked and guiding therapy optimisation
  • Discovering “off” times with current therapy
  • Establishing whether an advanced therapy should be considered
  • Identifying non motor symptoms of Parkinson’s Disease such as sleep and risk of ICD
  • Obtaining a comprehensive initial patient history

Assessment of Dyskinesia and Bradykinesia

The PKG® provides a measure of severity and proportion of time spent at various levels of dyskinesia and bradykinesia in relation to timing of levodopa medication. The main plot of the PKG® shows the median, 25% percentile and 75% percentile of the bradykinesia score (BKS) and dyskinesia score (DKS) of the patient over all days of recording compared with the BKS and DKS of a control group.


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Quantification of Motor Fluctuations

The PKG® is a valuable tool to provide an objective, quantitative rating of motor performance to effectively manage motor complications of Parkinson’s disease.

Variations in bradykinesia and dyskinesia over a single dose of levodopa indicate the onset of levodopa‑induced fluctuations. As the therapeutic benefit of levodopa progressively shortens, its first manifestation is usually “wearing‑off”. As dopaminergic treatment is increased to manage wearing‑off, periods of dyskinesia become apparent.

The PKG® Fluctuation and Dyskinesia Score (FDS) quantifies and summarises the interquartile range of bradykinesia and dyskinesia across all days of recording into a single score.



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Tremor Assessment 

Identification of tremor with the PKG® can be used to characterise “off” periods, support clinical impressions and clarify patient-reported symptomology. Tremor is variable throughout the course of the day and there is a tendency for patients to confuse tremor and dyskinesia. The PKG® provides a Tremor Summary showing the time during each day of the recording when tremor was present and its relationship to the consumption and timing of Parkinson’s medication.


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Daytime sleep and immobility

Excessive daytime sleepiness is common in Parkinson’s Disease. The PKG® provides an Immobile Summary showing the time during each day of the recording when the patient was wearing the PKG® Watch but was immobile. This sustained immobility may be indicative of periods of sleep and somnolence.


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Patient selection for a PKG® assessment

Over time, the symptom profile of Parkinson’s response to medication will continue to change. These changes can be difficult for some patients to recognise or interpret and therefore accurately communicate to clinical staff. In these situations, objective symptom assessment can be helpful in providing the most current, accurate patient history.


The following people with Parkinson’s may benefit from objective symptom assessment with the PKG®:


  • ‘‘4x4’’ ≥4 years post - initiation of levodopa and/or are needing ≥4 doses of levodopa per day
  • Changing or initiating new medication/advanced therapy
  • Have 3 or more consultations/year
  • Clinician not certain about primary symptomology outside of the consulting room
  • Have difficulty understanding/communicating their symptoms
  • New referrals with minimal information

For the complete list of published papers please click here