Konectom: App supports self-management of Multiple Sclerosis

Multiple sclerosis (MS) is a disease of the central nervous systems that requires regular checkups with the neurologist every three months. However, an exacerbation of MS, also known as a flare-up, can occur between these appointments. The Konectom smartphone app aims to close this diagnostic gap.

In this MEDICA-tradefair.com interview, Professor Tjalf Ziemssen talks about the benefits of the self-monitoring app in assessing multiple sclerosis disease progression, explains where it plays a crucial role, and reveals what's next for the project.

Professor Ziemssen, what is the idea behind the Konectom app?

Prof. Tjalf Ziemssen: The Konectom app aims to make multiple sclerosis (MS) easier to manage and treat. To do this, we must get a better description of the MS symptoms.

We perform neurological exams, but much of the information we collect in this setting cannot really illustrate the functional deficits of the patient. That means, while can carefully test the arm, reflexes, muscle strength and so on, it doesn't tell us how the fine motor skills are affected. We don't know if the patient can manage everyday tasks. There is also no continuous assessment of how the functional systems that can be affected in MS evolve between infrequent visits to the doctor. That's why we saw the need to give our patients a tool to self-monitor key neurological functions that indicate disease progression and keep a continuous record as a result. The app is a combination of brief mood and feelings questionnaires and a subjective health assessment, which are answered by using the corresponding emojis, and a mix of functional tests via the smartphone. Our objective with these tests is to monitor fine motor skills, upper extremity function, walking and cognitive ability and compare the results with our findings from the neurological exam.

How can this app specifically help with MS?

Ziemssen: Our vision for digital projects like Konectom is to build a so-called digital MS twin for every patient. A digital twin is a concept that is typically used in industry development. For example, when the automotive industry builds a car, the car's digital twin holds all its metadata. Our goal is to design something similar for people with MS.

The digital twin covers two areas: it holds patient data and procedures. The procedures are especially helpful for patients because it enables them to keep track of their next treatment or appointment. This information is also useful to monitor whether the treating physician pursues the scheduled treatment approach. The data comes from multiple sources such as Konectom.

How do patients respond to the app?

Ziemssen: The feedback is excellent. Our project also tries to gage how different types of patients are accepting of innovative ideas. Interestingly, we notice that older people who are traditionally not as active with digital media are likewise embracing the app.

As part of the Konectom project, we are also in close communication with patients and provide regular feedback, which is much appreciated. The patients perform the exams and functional tests at home using the app. The data is transmitted to us, and we deliver feedback on their progress and suggest changes if needed. This facilitates a doctor-patient dialogue that benefits both parties. We learn to understand MS better, which allows us to provide targeted therapy and give patients direct feedback.

To inspire long-term use of the app with MS patients, we think it won't be enough to simply have them perform exercises or tests. We believe it is essential to foster bidirectional communication with patients in the future. In doing so, our patients understand the importance of the collected data.

What's next for your project?

Ziemssen: We hope our project makes us become pioneers in this area, because we love to come up with innovative ideas that other centers can use. Having said that, we must also learn about the tips and tricks we need to get MS patients on board with this project. This should not just be a one-year study, at which point it is all over. Our goal is to use the study to integrate the app into clinical care standards. Our information also aims to prompt a more widespread use of smartphones as a tool in the healthcare setting.

In the next stage, we want to measure neurological functions via speech and language. Fatigue is a common MS symptom, and we believe we can assess it using voice analysis. We also know eye movement plays a critical role. Our goal is to use the smartphone camera for tracking in this case. We have already developed a jump analysis system, since jumps are more indicative and more challenging than having someone walk for a long time, for example. The latest technology in smartphones makes it possible to record and assess the quality of the jump and identify the neurological function that is likely affected.

Our objective is to measure any function that could be impaired by MS using a technology that does not require expensive measurement equipment but is accessible to anyone who has a smartphone.