Max Little: A test for Parkinson's with a phone call

115,001 views ・ 2012-08-07

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00:00
Translator: Joseph Geni Reviewer: Morton Bast
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Translator: Núria Núñez Reviewer: Fran Ontanaya
00:15
So, well, I do applied math,
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Doncs bé, jo faig matemàtica aplicada
00:18
and this is a peculiar problem
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i això és un problema peculiar
00:19
for anyone who does applied math, is that
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per qui la fa:
00:21
we are like management consultants.
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som com els consultors de gestió.
00:23
No one knows what the hell we do.
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Ningú sap que coi fem.
00:25
So I am going to give you some -- attempt today
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Per això mateix avui intentaré...
00:27
to try and explain to you what I do.
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...explicar-vos què faig.
00:30
So, dancing is one of the most human of activities.
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El ball és una de les activitats més humanes.
00:33
We delight at ballet virtuosos and tap dancers
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Ens delecten els virtuosos del ballet i els ballarins de claqué
00:37
you will see later on.
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que veurem més endavant.
00:38
Now, ballet requires an extraordinary level of expertise
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Però el ballet exigeix un grau d'entrenament extraordinari,
00:41
and a high level of skill,
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un alt nivell de destresa
00:43
and probably a level of initial suitability
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i probablement una certa aptitud inicial
00:46
that may well have a genetic component to it.
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que bé pot tenir un component genètic.
00:48
Now, sadly, neurological disorders such as Parkinson's disease
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Malauradament, els trastorns neurològics com ara el Parkinson
00:51
gradually destroy this extraordinary ability,
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destrueixen gradualment aquesta extraordinària habilitat,
00:53
as it is doing to my friend Jan Stripling, who was
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com li està passant al meu amic Jan Stripling que, en la seva època,
00:56
a virtuoso ballet dancer in his time.
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va ser un virtuós ballarí de ballet.
00:59
So great progress and treatment has been made over the years.
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En els darrers anys s'ha progressat considerablement en el tractament.
01:02
However, there are 6.3 million people worldwide
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Tanmateix, hi ha 6.3 milions de persones al món
01:05
who have the disease, and they have to live with
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que pateixen aquesta malaltia i han de viure amb
01:08
incurable weakness, tremor, rigidity
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una debilitat incurable, tremolors, rigidesa
01:11
and the other symptoms that go along with the disease,
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i altres símptomes d'aquesta malaltia,
01:12
so what we need are objective tools
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o sigui que el que necessitem són eines objectives
01:15
to detect the disease before it's too late.
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per a detectar la malaltia abans no sigui massa tard.
01:18
We need to be able to measure progression objectively,
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Necessitem poder mesurar el progrés de manera objectiva
01:20
and ultimately, the only way we're going to know
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i, en definitiva, sols sabrem
01:24
when we actually have a cure is when we have
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si realment existeix una cura quan tinguem
01:26
an objective measure that can answer that for sure.
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una mètrica objectiva i certera.
01:29
But frustratingly, with Parkinson's disease
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Però és frustrant que per al Parkinson
01:32
and other movement disorders, there are no biomarkers,
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i altres trastorns del moviment no hi hagi marcadors biològics.
01:34
so there's no simple blood test that you can do,
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Per això mateix, no serveixen les anàlisis de sang
01:37
and the best that we have is like
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i la millor cosa que tenim és
01:38
this 20-minute neurologist test.
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un examen neurològic de 20 minuts.
01:41
You have to go to the clinic to do it. It's very, very costly,
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S'ha d'anar a una clínica a fer-se'l. És molt, molt car,
01:43
and that means that, outside the clinical trials,
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i això significa que, tret dels assajos clínics,
01:46
it's just never done. It's never done.
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mai es fa. Mai s'ha fet.
01:49
But what if patients could do this test at home?
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Però, i si els pacients el poguessin fer a casa seva?
01:52
Now, that would actually save on a difficult trip to the clinic,
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Això els estalviaria un viatge dificultós a la clínica.
01:54
and what if patients could do that test themselves, right?
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I si els pacients es poguessin fer l'examen ells mateixos?
01:58
No expensive staff time required.
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No caldria personal.
02:00
Takes about $300, by the way,
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Per cert, costa poc més de 200 euros
02:01
in the neurologist's clinic to do it.
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anar a fer el test a la clínica neurològica.
02:03
So what I want to propose to you as an unconventional way
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Per això mateix, el que us vull proposar com una manera poc convencional
02:06
in which we can try to achieve this,
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amb què podriem intentar aconseguir això,
02:08
because, you see, in one sense, at least,
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perquè, en certa manera almenys,
02:09
we are all virtuosos like my friend Jan Stripling.
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tothom és virtuós com el meu amic Jan Stripling.
02:13
So here we have a video of the vibrating vocal folds.
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Aquest és un vídeo de la vibració de les cordes vocals.
02:16
Now, this is healthy and this is somebody making speech sounds,
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Es tracta d'una persona sana que emet sons mentre parla
02:20
and we can think of ourselves as vocal ballet dancers,
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i ens podem veure com ballarins de ballet vocal,
02:23
because we have to coordinate all of these vocal organs
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perquè hem de coordinar tots aquests òrgans vocals
02:25
when we make sounds, and we all actually
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quan emetem sons, i tothom té
02:28
have the genes for it. FoxP2, for example.
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els gens per a fer-ho. El FoxP2, per exemple.
02:30
And like ballet, it takes an extraordinary level of training.
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I com al ballet, és necessari un nivell extraordinari d'entrenament.
02:33
I mean, just think how long it takes a child to learn to speak.
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És a dir, només penseu quant li costa a un nen aprendre a parlar.
02:35
From the sound, we can actually track
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A partir del so, podem en realitat seguir
02:38
the vocal fold position as it vibrates,
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la posició de les cordes vocals a mesura que vibren,
02:40
and just as the limbs are affected in Parkinson's,
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i de la mateixa manera que les extremitats es veuen afectades pel Parkinson,
02:42
so too are the vocal organs.
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el mateix passa amb els òrgans vocals.
02:45
So on the bottom trace, you can see an example of
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A la pista de sota, podeu veure un exemple
02:47
irregular vocal fold tremor.
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de tremolor irregular de les cordes vocals.
02:49
We see all the same symptoms.
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Veiem els mateixos símptomes:
02:50
We see vocal tremor, weakness and rigidity.
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tremolor vocal, debilitat i rigidesa.
02:53
The speech actually becomes quieter and more breathy
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En realitat, el discurs esdevé més assossegat i escanyat
02:55
after a while, and that's one of the example symptoms of it.
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i aquest és només un exemple dels símptomes.
02:57
So these vocal effects can actually be quite subtle,
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Aquests efectes vocals poden ser bastant subtils,
03:00
in some cases, but with any digital microphone,
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en alguns casos, no obstant, amb un micròfon digital,
03:03
and using precision voice analysis software
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i emprant un software de precisió d'anàlisi de veu
03:06
in combination with the latest in machine learning,
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junt a l'últim en aprenentatge automàtic,
03:08
which is very advanced by now,
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que ha evolucionat molt hui en dia,
03:10
we can now quantify exactly where somebody lies
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ara podem quantificar exactament on es troba una persona
03:13
on a continuum between health and disease
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en un continuu entre la salut i la malaltia
03:16
using voice signals alone.
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sols amb els senyals de la veu.
03:18
So these voice-based tests, how do they stack up against
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I com es comparen aquests exàmens de veu amb els clínics especialitzats?
03:20
expert clinical tests? We'll, they're both non-invasive.
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Bé, tots dos són no invasius.
03:23
The neurologist's test is non-invasive. They both use existing infrastructure.
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El test neurològic no és invasiu. Ambdós usen infraestructura existent.
03:27
You don't have to design a whole new set of hospitals to do it.
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No has de dissenyar un nou conjunt d'hospitals per fer-ho.
03:30
And they're both accurate. Okay, but in addition,
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I ambdós són exactes. Bé, però a més,
03:32
voice-based tests are non-expert.
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els exàmens de veu no són especialitzats.
03:35
That means they can be self-administered.
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La qual cosa significa que poden ser autoadministrats.
03:37
They're high-speed, take about 30 seconds at most.
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Es fan molt ràpidament, duren uns 30 segons com a màxim.
03:40
They're ultra-low cost, and we all know what happens.
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Són de cost mínim i tothom sap que ocorre
03:42
When something becomes ultra-low cost,
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quan una cosa té un cost tan baix:
03:45
it becomes massively scalable.
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apareix a escala massiva.
03:47
So here are some amazing goals that I think we can deal with now.
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Aquestes són algunes metes increïbles que podem abordar.
03:51
We can reduce logistical difficulties with patients.
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Podem reduir les dificultats logístiques dels pacients.
03:53
No need to go to the clinic for a routine checkup.
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No seria necessari anar a la clínica per a la rutinaria revisió.
03:55
We can do high-frequency monitoring to get objective data.
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Amb la monitorització d'alta freqüència podríem obtindre dades objectives.
03:58
We can perform low-cost mass recruitment for clinical trials,
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Podríem fer un reclutament massiu de baix cost per als assajos clínics
04:02
and we can make population-scale screening
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i, per primera vegada, revisions factibles
04:04
feasible for the first time.
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a escala general.
04:05
We have the opportunity to start to search
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Tenim l'oportunitat de començar a buscar
04:08
for the early biomarkers of the disease before it's too late.
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els primers biomarcadors de la malaltia abans que sigui massa tard.
04:11
So, taking the first steps towards this today,
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Per això mateixa, en donar avui les primeres passes en aquest sentit
04:14
we're launching the Parkinson's Voice Initiative.
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estem llançant la Iniciativa Vocal del Parkinson.
04:16
With Aculab and PatientsLikeMe, we're aiming
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Amb Aculab i PatientsLikeMe, volem
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to record a very large number of voices worldwide
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registrar una gran quantitat de veus arreu del món
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to collect enough data to start to tackle these four goals.
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per recol·lectar suficients dades i començar a abordar aquests objectius.
04:23
We have local numbers accessible to three quarters
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Tenim línies locals accessibles per a uns
04:25
of a billion people on the planet.
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750 milions de persones al món.
04:27
Anyone healthy or with Parkinson's can call in, cheaply,
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Qualsevol, amb o sense Parkinson, pot trucar a baix cost
04:30
and leave recordings, a few cents each,
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i deixar grabacions per uns cèntims.
04:32
and I'm really happy to announce that we've already hit
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I em complau anunciar que ja hem arribat
04:34
six percent of our target just in eight hours.
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al 6% de la meta ens sols vuit hores.
04:38
Thank you. (Applause)
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Gràcies. (Aplaudiments)
04:41
(Applause)
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(Aplaudiments)
04:48
Tom Rielly: So Max, by taking all these samples of,
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Tom Rielly: Aleshores Max, amb totes aquestes mostres de,
04:51
let's say, 10,000 people,
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digam 10 000 persones,
04:54
you'll be able to tell who's healthy and who's not?
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podem dir qui està sa i qui no?
04:57
What are you going to get out of those samples?
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Què trauran d'aquestes mostres?
04:59
Max Little: Yeah. Yeah. So what will happen is that,
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Max Litte: Sí, sí. El que passa és que
05:00
during the call you have to indicate whether or not
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durant la trucada has d'indicar si tens o no
05:02
you have the disease or not, you see. TR: Right.
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la malaltia. TR: És clar.
05:03
ML: You see, some people may not do it. They may not get through it.
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ML: Ja veuen, algunes persones poden no passar-ho. Pot ser no ho acabin.
05:06
But we'll get a very large sample of data that is collected
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Però obtindrem una mostra molt gran de dades recopilades
05:09
from all different circumstances, and it's getting it
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en diferents circumstàncies, i fer-ho
05:12
in different circumstances that matter because then
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en diferents circumstàncies és important perquè
05:14
we are looking at ironing out the confounding factors,
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estem buscant llimar els factors de confusió
05:17
and looking for the actual markers of the disease.
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en busca de marcadors reals de la malaltia.
05:19
TR: So you're 86 percent accurate right now?
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TR: Tenen un 86% de precisió en aquest moment?
05:22
ML: It's much better than that.
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ML: Molt més que això.
05:23
Actually, my student Thanasis, I have to plug him,
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En realitat, el meu estudiant Thanasis, he de fer-li propaganda,
05:25
because he's done some fantastic work,
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ha fet un treball fantàstic
05:27
and now he has proved that it works over the mobile telephone network as well,
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i ara ha demostrat que funciona en la red de telefonia mòbil també,
05:30
which enables this project, and we're getting 99 percent accuracy.
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la qual cosa agilita el projecte. Ara tenim un 99% de precisió.
05:34
TR: Ninety-nine. Well, that's an improvement.
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TR: Noranta nou. Bé, és una millora.
05:35
So what that means is that people will be able to —
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Aleshores les persones podran...
05:38
ML: (Laughs)
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ML: (Rises)
05:39
TR: People will be able to call in from their mobile phones
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TR: Les persones podran trucar des dels seus mòbils
05:41
and do this test, and people with Parkinson's could call in,
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i fer el test. Les persones amb Parkinson podrien trucar,
05:44
record their voice, and then their doctor can check up
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gravar la seva veu i després els metges podrien revisar
05:47
on their progress, see where they're doing in this course of the disease.
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el progrés, veure on estan en el curs de la malaltia.
05:50
ML: Absolutely.
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ML: Per descomptat.
05:51
TR: Thanks so much. Max Little, everybody.
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TR: Moltes gràcies. Max Little, senyors i senyores.
05:53
ML: Thanks, Tom. (Applause)
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ML: Gràcies, Tom. (Aplaudiments)
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