The PKG Report is a structured summary of movement and sleep data collected through a wearable device (EmbraceMini) worn over several days. It is designed to help clinicians better understand patterns of Parkinson’s-related symptoms such as bradykinesia (slowness of movement), dyskinesia (involuntary movements), tremor, immobility, sleep quality, and walking behavior as well as patients’ response to medication over time, including per-dose response curves.
For more information about how Empatica supports Parkinson’s clinical care, please visit our website: https://www.empatica.com/clinical-care/parkinsons
For step-by-step instructions on how to generate these reports, please refer to the article available here: How to generate the PKG Report.
1. What the PKG Report Shows
The PKG Report summarizes continuous movement data collected in short intervals (typically every two minutes) over multiple days. By analyzing this information, the report provides an objective picture of how a person moves, rests, and sleeps in daily life, rather than relying on short clinic observations or memory-based symptom reports.
The focus is on identifying patterns across days, such as fluctuations in symptoms, response to medication timing, mobility levels, and sleep consistency.
2. Data Reliability and Recording Quality
At the top of the report, a coloured tick indicates data quality:
- Green or blue tick: sufficient data was collected.
For general reliability, at least three days of data are required. However, five or more days are preferred, particularly when evaluating bradykinesia and dyskinesia patterns. Longer recording periods help ensure the report reflects typical daily behaviour rather than an unusual day.
3. Daytime Summary (06:00–22:00)
The daytime summary shows how time is distributed across different movement states during waking hours. Walking and sleep periods are removed so the summary reflects actual symptom presence.
Time is displayed both as:
- A percentage of the recording period
- Hours and minutes
The categories include:
- Mild bradykinesia
- Severe bradykinesia
- Mild dyskinesia
- Severe dyskinesia
- Periods with no significant bradykinesia or dyskinesia
This section gives a high-level view of how much of the day is spent with controlled versus uncontrolled symptoms.
4. PKG Scores Table
The PKG scores table provides a concise snapshot of key metrics, each shown alongside a target range:
- Median Bradykinesia Score (BKS)
- Median Dyskinesia Score (DKS)
- Fluctuation Dyskinesia Score (FDS)
- Percentage Time Tremor (PTT)
- Percentage Time Immobile (PTI)
Lower BKS and DKS values are closer to the target range and generally indicate better symptom control.
- PTT above 1% suggests tremor is present.
- PTI above 10% during active daytime hours may suggest excessive daytime sleepiness (EDS). This can prompt clinicians to explore whether naps are intentional or related to medication effects or disease progression.
5. Gait Scores and Mobility
Gait scores summarize general mobility between 06:00 and 22:00 and include:
- Average steps per day
- Average duration of long walks (continuous walking periods longer than ~1 minute)
These two values together provide insight into walking behavior:
- Many steps with very short walks may indicate shuffling or frequent stopping.
- Fewer steps with longer walks may suggest stable walking but low overall activity.
6. Nighttime Summary and Sleep Metrics
The nighttime summary focuses on sleep-related measures recorded roughly between 23:00 and 06:00. Key metrics include:
- Percentage of time active, inactive, and immobile
- Percentage of time in sleep
- Sleep fragment duration (median uninterrupted sleep period)
- Sleep quality score
- Overall sleep score
Higher sleep scores generally indicate more consolidated and higher-quality sleep. Because these metrics rely on immobility thresholds, clinicians often review them alongside raster plots, especially if the patient’s sleep schedule falls outside standard nighttime hours.
A sleep score below 24 is considered trending toward abnormal sleep.
7. Weekly DKS and BKS Summary Charts
The weekly summary charts show dyskinesia (DKS) and bradykinesia (BKS) levels across the day, with seven days overlaid into a single visual.
Key elements include:
- Green shaded bands representing healthy control percentiles
- A median line showing the patient’s typical response
- Vertical red lines marking medication reminder times
- Small red rectangles indicating logged medication intake
These charts provide a visual overview of how symptoms fluctuate during the day and how they align with medication timing.
8. Tremor and Immobility Summaries
The tremor summary shows when tremor is detected, typically calculated between 09:00 and 18:00, the most active part of the day. Raster plots provide a fuller picture across all hours.
The immobility and inactivity summary uses colour coding to distinguish:
- Inactivity (e.g. sitting)
- Immobility, which may correspond to sleep (very high BKS values)
9. Daily Plots
Daily plots provide a 24-hour view for each day of the recording. They typically include:
- Bradykinesia
- Dyskinesia
- Tremor
- Immobility or inactivity
- Medication reminders and acknowledgements
These plots allow you to visually match symptom changes with medication timing, delays, missed doses, and daily routines.
10. Levodopa Dose Response (Peridose Curves)
Peridose curves show how bradykinesia (BKD) and dyskinesia (DKS) change around medication intake.
Key features include:
- Each horizontal line represents a window from 30 minutes before to 2.5 hours after a scheduled dose
- Small rectangles show when medication intake was logged (15-minute resolution)
- A red line underneath shows timing offsets
When all lines align at zero, medication was taken within ±15 minutes of the reminder.
Clear improvements after a dose suggest a good response, while flat curves may indicate delayed or reduced absorption.
11. Explanation of Scores (Back Page)
The final page of the PKG Report provides formal definitions for all scores and thresholds, including:
- Mild and severe bradykinesia and dyskinesia cut-offs
- Sleep metric calculations
- Gait score definitions
These definitions are based on published clinical validation studies and are consistent across PKG reports.
12. Clinician Notes
Before generating the PKG Report, clinicians or clinic staff may add internal notes within the platform. These notes are automatically included in the final report and are visible to anyone reviewing it.
These notes do not alter the data or scores shown in the PKG Report. Their purpose is purely informational, helping clinicians interpret the results in the appropriate clinical and personal context.