{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T03:05:22Z","timestamp":1783998322704,"version":"3.55.0"},"reference-count":21,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Hamburg Innovation GmbH","award":["C4T1057"],"award-info":[{"award-number":["C4T1057"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Hypomimia, the reduced facial expressiveness commonly seen in Parkinson\u2019s disease (PD), is clinically relevant, yet routine assessment usually relies on a single ordinal rating item in major rating scales such as the Unified Parkinson\u2019s Disease Rating Scale (MDS-UPDRS). This study aimed to develop and iteratively refine a wearable, cap-mounted device for hypomimia recording during routine inpatient ON\/OFF assessments and to examine its usability and technical feasibility. A staged co-development process with four prototypes was conducted. After clinician workflow requirements had been incorporated, Prototype 3 was evaluated during clinical routine using the System Usability Scale (SUS) and short free-text feedback. These findings informed a patient-centered redesign that resulted in Prototype 4. Bench testing confirmed stable operation, robust housing, and reliable closed Wi-Fi streaming. Usability improved from moderate in Prototype 3 (mean SUS 44.7, SD 18.2; n = 15) to good in Prototype 4 (mean SUS 80.0, SD 12.6; n = 50). Mixed-effects regression showed an increase of approximately 33 SUS points for the redesigned device (95% CI 27.7\u201339.4; p &lt; 0.001). Mean effective sampling rate was 4.79 frames\/s (SD 0.33), with face detection in 95.4% of frames. These feasibility and usability results indicate that technical robustness and patient-centered design are critical prerequisites for later clinical validation and support the integration of a wearable hypomimia capture device into routine assessments.<\/jats:p>","DOI":"10.3390\/s26144454","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T02:34:44Z","timestamp":1783996484000},"page":"4454","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["From Prototype to Clinical Workflow: Co-Developing a Wearable Hypomimia System for Parkinson\u2019s Disease"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1987-9427","authenticated-orcid":false,"given":"Alexander Johannes","family":"Wiederhold","sequence":"first","affiliation":[{"name":"Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9523-1970","authenticated-orcid":false,"given":"Lea","family":"Haidar","sequence":"additional","affiliation":[{"name":"Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7680-2147","authenticated-orcid":false,"given":"Monika","family":"P\u00f6tter-Nerger","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9301-8872","authenticated-orcid":false,"given":"Christopher","family":"Gundler","sequence":"additional","affiliation":[{"name":"Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Bianchini, E., Rinaldi, D., Alborghetti, M., Simonelli, M., D\u2019Audino, F., Onelli, C., Pegolo, E., and Pontieri, F.E. (2024). The Story behind the Mask: A Narrative Review on Hypomimia in Parkinson\u2019s Disease. Brain Sci., 14.","DOI":"10.3390\/brainsci14010109"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e095610","DOI":"10.1136\/bmjopen-2024-095610","article-title":"Global burden of Parkinson\u2019s disease from 1990 to 2021: A population-based study","volume":"15","author":"Li","year":"2025","journal-title":"BMJ Open"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1002\/mds.26424","article-title":"MDS clinical diagnostic criteria for Parkinson\u2019s disease","volume":"30","author":"Postuma","year":"2015","journal-title":"Mov. Disord."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1038\/s41531-025-01101-0","article-title":"Remote real time digital monitoring fills a critical gap in the management of Parkinson\u2019s disease","volume":"11","author":"Negi","year":"2025","journal-title":"npj Park. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1038\/s41746-022-00642-5","article-title":"Automated video-based assessment of facial bradykinesia in de-novo Parkinson\u2019s disease","volume":"5","author":"Novotny","year":"2022","journal-title":"npj Digit. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2422","DOI":"10.1111\/ene.14452","article-title":"Hypomimia in Parkinson\u2019s disease: An axial sign responsive to levodopa","volume":"27","author":"Ricciardi","year":"2020","journal-title":"Eur. J. Neurol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1002\/mds.22340","article-title":"Movement Disorder Society-sponsored revision of the Unified Parkinson\u2019s Disease Rating Scale (MDS-UPDRS): Scale presentation and clinimetric testing results","volume":"23","author":"Goetz","year":"2008","journal-title":"Mov. Disord."},{"key":"ref_8","first-page":"S83","article-title":"Video-Based Analyses of Parkinson\u2019s Disease Severity: A Brief Review","volume":"11","author":"Sibley","year":"2021","journal-title":"J. Park. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"107713","DOI":"10.1016\/j.cmpb.2023.107713","article-title":"Tabular data augmentation for video-based detection of hypomimia in Parkinson\u2019s disease","volume":"240","author":"Oliveira","year":"2023","journal-title":"Comput. Methods Programs Biomed."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1002\/mds.26642","article-title":"Technology in Parkinson\u2019s disease: Challenges and opportunities","volume":"31","author":"Espay","year":"2016","journal-title":"Mov. Disord."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Andreoni, G. (2023). Investigating and Measuring Usability in Wearable Systems: A Structured Methodology and Related Protocol. Appl. Sci., 13.","DOI":"10.3390\/app13063595"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1186\/s12984-021-00931-2","article-title":"Assessing the usability of wearable devices to measure gait and physical activity in chronic conditions: A systematic review","volume":"18","author":"Keogh","year":"2021","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e39954","DOI":"10.2196\/39954","article-title":"Measuring the Usability of eHealth Solutions for Patients with Parkinson Disease: Observational Study","volume":"6","author":"Bendig","year":"2022","journal-title":"JMIR Form. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e11474","DOI":"10.2196\/11474","article-title":"Participatory Methods to Engage Health Service Users in the Development of Electronic Health Resources: Systematic Review","volume":"11","author":"Moore","year":"2019","journal-title":"J. Particip. Med."},{"key":"ref_15","first-page":"1","article-title":"Co-designing a digital companion with people living with Parkinson\u2019s to support self-care in a personalized way: The eCARE-PD Study","volume":"8","author":"Grosjean","year":"2022","journal-title":"Digit. Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e11278","DOI":"10.2196\/11278","article-title":"Co-Designing an eHealth Service for the Co-Care of Parkinson Disease: Explorative Study of Values and Challenges","volume":"7","author":"Forsberg","year":"2018","journal-title":"JMIR Res. Protoc."},{"key":"ref_17","first-page":"1778","article-title":"Co-designing Digital Technologies to improve Clinical Care in People with Parkinson\u2019s Disease","volume":"38","author":"Monje","year":"2023","journal-title":"Mov. Disord."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e71600","DOI":"10.2196\/71600","article-title":"Integrating Patient Perspectives into the Digital Health Technology Readiness Framework: Delphi Study","volume":"27","author":"Montane","year":"2025","journal-title":"J. Med. Internet Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1080\/10447310802205776","article-title":"An Empirical Evaluation of the System Usability Scale","volume":"24","author":"Bangor","year":"2008","journal-title":"Int. J. Hum.-Comput. Interact."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Wiederhold, A.J., Zhu, Q.R., Spiegel, S., Dadkhah, A., P\u00f6tter-Nerger, M., Langebrake, C., \u00dcckert, F., and Gundler, C. (2025). Opportunities and Limitations of Wrist-Worn Devices for Dyskinesia Detection in Parkinson\u2019s Disease. Sensors, 25.","DOI":"10.3390\/s25144514"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1038\/s41531-025-00895-3","article-title":"Explaining facial action units\u2019 correlation with hypomimia and clinical scores in Parkinson\u2019s disease","volume":"11","author":"Jeancolas","year":"2025","journal-title":"npj Park. Dis."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/26\/14\/4454\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T02:37:24Z","timestamp":1783996644000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/26\/14\/4454"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":21,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["s26144454"],"URL":"https:\/\/doi.org\/10.3390\/s26144454","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]}}}