History of Movement Disoders: The influence of videography

Dr. Mattia Rosso: Thank you so much for the introduction and thank you for the [00:01:00] invitation, also.

Dr. Sara Schaefer: So before we get started, I do want to alert our listeners to past episodes that actually somewhat relate to today's episode. Most notably in our history series, we covered Charcot and his influence in neurology and movement disorders, including his use of photography and videography in episode 282 from January of 2026.

So the first thing that I'll ask you, Mattia, is what made you and your co-authors pursue this as a topic of interest and how did you collect all the information that you have in the article? 

Dr. Mattia Rosso: That's a great question. So first of all, I have a vested interest in the overlap between the humanities, the arts, and neurology.

And as part of our last year of training where I did my residency at the Medical University of South Carolina, we all do a grand rounds. So we give a grand rounds, we can pick any topic. And I was encouraged by my mentors there to pursue this interest that I have in the [00:02:00] overlap of film, video, and movement disorder.

So I thought that was a interesting topic one that hadn't been explored that much. And in doing this review of the literature, I found a lot of very interesting information about the history of film and the influence of film in neurology, but also I didn't find as much about video and movement disorders.

So what I ended up doing for my grand rounds is conduct a series of interviews with many experts in the field, including Steve Frucht, including Andrew Lees, Dr. Lang, Dr. Oaken, Dr. Tanner, the late Mark Hallett, Dr. Jankovic, Dr. Goetz, and also Dr. Fahn. And talking to them, I really found out about how intricately video and movement disorders were tied to one another.

So after giving grand rounds, one of my mentor said, Dr. Christine Cooper, really encouraged me to write this up. And that's when I reached out to Dr. Barton, who's an authority figure in the field of [00:03:00] describing how video is used in movement disorders. He's published on the topic before and together we really put these interviews together and we finalized our manuscript.

Dr. Sara Schaefer: So before we get into the use of videography in neurology and in movement disorders, can you just bring the uninitiated through a historical timeline of photography and videography in general? What decades and centuries are we talking about here? What's the evolution of the tech over time? 

Dr. Mattia Rosso: Yeah, absolutely.

There's so much to say about how photography came to be and, photography even goes back to the old days, even in the 1600s about camera obscura. But that's much different than what we think about with photography. So photography really starts in the mid-1800s and it grows gradually to something that was called the Daguerreotype, and then slowly to what we now think about photography.

So I would say photography starts out in the mid-1800s in [00:04:00] France, and then it slowly evolves and it becomes more and more accessible. But even if we look to the end of the 19th century, we're looking at very big cameras, large format cameras that also required a lot of time for the film to develop.

So they were completely unwieldy and mostly used for landscape photography. And then slowly, at the end of the 1800s is where we start seeing the birth of more of a motion type photography, and that's where, I think we'll probably talk about this later, but that's where we have a famous photographer by the name of Eadweard Muybridge, who's the first person to actually think about how sequential photographies could build what would then be thought of as a film.

And then from him we have really the birth of film. And then we have the birth of cinema at the end of the 19th century. And even still with the birth of cinema, with the Lumière brothers, we still had the [00:05:00] technology that was really expensive and also dangerous 'cause it was made of silver nitrate.

So slowly film becomes less dangerous, less expensive, but really for it to be accessed to the public in the form of home videos, we have to look at the mid 20th century, so the 1950s, and then slowly film becomes more and more portable. We have super eight film, which is much smaller, and we have the really, the access to portable cameras and portable video cameras in the seventies.

And then of course we know what happens next. We go from film, we go to video, and you can think about the video cassettes, VHS and smaller cassettes that some of us may have been exposed to. And then of course we know the digital revolution that happened in the late 20th century.

And then of course, the smartphone technology, which made everything more portable and much more accessible. 

Dr. Sara Schaefer: It's interesting what you [00:06:00] said in the article about how when they went from film to video, the actual quality went down, which is something that I hadn't thought about before. Can you just briefly touch on that?

Dr. Mattia Rosso: Yeah, absolutely. This seems so counterintuitive to many. But the whole point is that video was an extremely high quality medium. So if you were to look at early 20th century pre-code era film, you will be amazed by the quality of film and that's because it was analog. That's because it was as close as possible to actually capture in light.

So what happened then is that we go from analog to a different format, which is video. Which is much more granular. It's much less analog. And that's where there is a drop in quality. And we see this every time we go from analog to more of a digital format. There is really a loss of quality.

And slowly, of course, video caught up. And of course [00:07:00] now with digital video, we have extremely high quality but still the quality of the photograph or the quality of film is really hard to match. This is why great filmmakers may still use film to this date. 

Dr. Sara Schaefer: So you brushed over this a little.

Let's get into the weeds on the origins of actual videography and interestingly how film and neurologists have overlapped in this realm way back in the early 1900s. 

Dr. Mattia Rosso: Yeah, this is a fascinating story that he centered around one man, Eadweard Muybridge, who was an extremely peculiar person.

I encourage anyone who wants to go down a rabbit hole to read about him. But the long and the short of it is that he was a book dealer, then sustained the head strike, some authors say that his personality changed afterward. After sustaining this head strike he gets into photography.

He becomes a landscape photographer. So someone who you might think like Ansel Adams would take [00:08:00] pictures of landscapes. And then during his travels he comes across the patron and the magnet Leland Stanford, same Stanford of the Stanford University. And Leland Stanford wanted to settle a bet.

He wanted to settle a bet of how horses galloped. Do horses actually leave the ground with all four hoofs or do they still keep one leg on the ground while galloping. To do this, Muybridge really had to resort to a new form of technology. So he created this 24 camera rig with trip wires.

That was set in a way where the horse would run through the course and would then just run into the trip wires and the cameras would then be triggered. And in putting together these 24 photos he created really the first film. And so it's really fascinating that to settle a bet [00:09:00] on horse's gait, essentially he had to create film. And interestingly enough, even early on, he was talking about the potential for this new form of film, for this new form of photo, essentially, to really allow artists to understand how people walked, how horses galloped, how muscles were activated.

Dr. Sara Schaefer: This reminds me of something I learned in college, which is that, the definition of a gallop is that all four hooves come off the ground. And I learned this in the context of understanding that elephants cannot gallop because they're too heavy. Their fastest movement is an amble because their four hooves cannot come off the ground at the same time.

So maybe we would never have known that if it weren't for this eccentric man. Thank you for telling us about that little anecdote. Can you tell us about how videography made its way deeply into the world of movement disorders over the 20th century. 

Dr. Mattia Rosso: Yeah, it's a [00:10:00] fascinating story as well.

First of all, in the early 20th century, of course, there wasn't video. There was only film, and that was, as I said, very expensive. So there was an interest from neurologists in using film to film patients. This was very hard to come by. So you only have few people like Marinescu, Paul Richer, and a few others. 

And then, I think one of the most interesting people in the overlap of film and movement disorders that we can think about is Kinnier Wilson, because Kinnier Wilson, of course, is the original describer of Wilson's disease and has also described many other movement disorders. But he really used film to capture his patients and his collection is really one that is worthwhile going back to. And other figures that we're interested in movement disorders included James Purdon Martin who had also an extensive collection of patients with encephalitis [00:11:00] lethargica. And that collection is also very interesting to review. But really, the availability of film was minimal before the second World War. And then slowly after the second World War, we had more portable film like Super eight.

And that's where founders of our field, like Dr. Fahn and Dr. Marsden also, Dr. Lees started using these portable cameras, still film cameras to record patients. And that's where we had the birth of a few basal ganglia clubs. There was a basal ganglia club in New York founded by Dr. Fahn. There was also a basal ganglia club in Britain, founded by Dr. Marsden and Dr. Lees that had an interest also in using this film to really understand movement. Dr. Fahn and Dr. Marsden really came together to give a course, a very well received course at the American Academy of Neurology called, Unusual Movement Disorders. [00:12:00] And this was a very well attended course.

It was standing room only. It ran into the late hours of the night, well over the two hour limit that we think about. And during these sessions, they would just show film and then videos of patients they had recorded. And then slowly over time they also welcomed other contributions from the audience.

And it was so popular that at the end of the day it became a two day event. So they had one session and a second session. And during these sessions is where people started to realize that what they had learned about phenomenology was really diverse. So there was a lot of disagreement, a lot of polite disagreement about what phenomenology is.

And those sessions were really fundamental in defining phenomenology as we think about it today. And really was also the instigator for the creation of what would then become the Movement Disorder [00:13:00] Society, and really the creation of the field of movement disorders. 

Dr. Sara Schaefer: Yeah. And these informal and then formal sessions turned into video rounds across the world in all departments.

And the famous video challenge, which still sometimes runs quite a bit over because so many interesting cases are presented. So you touched on a few ways that patient videos serve purpose in our field, chronicling the nuances of abnormal movements for descriptive purposes, education beyond the clinical exam room, providing an opportunity to visualize patient progression over time, of course.

And also validating phenomenological descriptions and even scales at the level of the entire field of movement disorders. Can you speak to that last piece a little bit and how video has influenced our development of things like the UPDRS, for example? 

Dr. Mattia Rosso: Yeah, absolutely. I had a really interesting conversation just about this with Dr. [00:14:00] Goetz and Dr. Tanner a few years ago, and what they really taught me about, and which I hadn't thought about before, was really the importance of a video recordings when you're creating a scale. So when you're creating a scale, you want to have a scale where there can be agreement between experts. You also want to have items on the scale that can be easily reproducible.

So video was really important in validating these scales and was really important also in creating a form of training for fellows as well. We all know that the UPDRS scale has a video supplement where people can get trained, where fellows can get trained, and having that video availability to really allow fellows to reach the level where their rating is reliable is really important.

But again without video, I would say that forming a scale in something so variable as movement orders would be near [00:15:00] impossible. 

Dr. Sara Schaefer: Let's shift gears to logistics here. You talk a lot about the logistics over time in your paper. And as any movement disorders fellow or faculty member knows, you need to learn how to catalog, you know record good videos and catalog your video library.

This is something I'm still working on. How has that process changed over time? Tell us about the famous Blue Wall, for example. 

Dr. Mattia Rosso: Yeah. The blue wall is is certainly something that was adopted early on. I think it was adopted both by Dr. Jankovic at Baylor but also was adopted at Rush as well.

And the blue wall is important as a color because it was felt that it created the most contrast, which is something that's important to have, was especially important to have in the early days of video. Earlier on with film, of course it would've been black and white, so that wouldn't apply.

In terms of archiving and cataloging, that's also something that evolved over time. [00:16:00] Even taking a step back, if we think about how editing evolved that's something that has clearly changed a lot over time. So way back when movement disorder specialists would have maybe a Super eight film, so relatively small size of film, the only way to edit would be to snip the film and then to just glue it together to create an edit. Of course, things changed quite a lot with video, but still, even with video one needed specialized equipment to edit video, and that's where experts like Dr. Jankovic and Dr. Jankovic's wife actually built an editing suite.

So recording and editing suite at Baylor University. And again, this required a lot of expertise. And then clearly once we get into the digital area, the digital boom, and we all have smartphones and we all have video recording equipments, it's much easier to edit. It's also much [00:17:00] easier to record and therefore there will be more volume being recorded.

And then archiving also clearly changed drastically over time. Film archives exist, but they require a lot of maintenance. They require specific temperatures. Of course, the same can be said about video formats like VHS. Although, I will say that VHS is much more perishable than film if kept properly film is quite durable.

And then we had a big shift where we moved from having all these videos, these DVDs, these CDs. We then went all digital and that's where a lot of centers like, again Baylor, certainly University of Toronto, under the guidance of Dr. Lang and many other centers put a lot of effort in converting what was analog into full digital formats. So nowadays we have a very large ease of access to digital format. But this also requires us to be [00:18:00] really diligent with how we preserve this information. I will guide the readership and the audience here to a wonderful article by Dr. Dukar.

There's others, certainly in the literature about how to archive. And something that Dr. Dukar talks about is both having a HIPAA compliant drive where one can store these videos and then trying to have some redundancy with how patient videos are stored, so having an identifier for the patient, having also an identifier for the patient's condition or the patient's phenomenology and having multiple ways to reach that information.

Other ways are, of course, keeping a separate database of all the videos cataloged by phenomenology and duration and the physician who's following the patient's ID. But of course it's really important for all of this to be secure. And all of these to be also HIPAA compliant.

Dr. Sara Schaefer: So we talk a lot about, of course, the history of [00:19:00] videography. And you talked about editing with literal scissors and glue and how that's changed. And then we've been able to manipulate videos further by watching things in slow motion, which is something that I like to do in video rounds, for example.

And other ways that we've enhanced the usability of videos and movement disorders. What do you see in the future? Specifically there's a lot of talk in the field of medicine and about AI and machine learning, looking at videos and making determinations as to what might be going on with the patient.

Do you have a look in your crystal ball that you wanna share with us? 

Dr. Mattia Rosso: Yeah, I think there's certainly a huge technical potential with AI, with computer vision also, I'll mention that. And I think there are a couple of ways in which computer vision AI may be helpful.

The first thing that of course it may be helpful is in catalog inaccurately. The degree [00:20:00] of decrement that the patient with Parkinson's has, or the degree of titubation patient that a patient with ataxia has. And I think of these as very specialized tools that we can use to tailor specifically to a population.

What I also think would be interesting would be to use AI to allow us to understand a little bit more about the border zone. So we currently have these phenomenologies that are set in stone. But of course we know that movement disorders is all about these overlap and areas where there's some lack of clarity.

So I think for instance, having AI help us understand whether a jerk that we see is more of a dystonic jerk versus the myoclonic jerk would be interesting. I also think that AI may be interesting in having us look outside of movement disorders, for instance, looking at the presence at what patterns and flavors of slowness we have in upper motor neuron disorders or what flavors of slowness we have in psychiatric conditions.

I think that could give [00:21:00] us a good look at how to really divide these conditions and really also validating what we all know from our own expertise. I also think another use of AI could be to look at the patient in their homes and by saying this I'm trying to get at the concept that when a patient comes to our clinic, we only have a snippet in time and we have them do some movements which are certainly standardized and very helpful, but they may not really reflect how their day-to-day looks like.

So I think that could be a potential, really knowing how bradykinesia rigidity is affecting patients in real life. How their balance is affecting in a natural environment. That's another potential about this, that will guide the the audience to an article written by Luca Marsili, just in 2025 which is really interesting.

I think the final piece to think about is more a sort of an ethical and humanistic note. Here I will [00:22:00] guide the audience to an article written by Christos Ganos, Tony Lang and Michael Stanley just this year in Brain when they talk about certainly the huge role of video but also some of the ethical implications.

And one of the things that the authors do in the article, which I think is really interesting, is comparing a patient in the clinic to the patient in their natural environment and really asking the question of, with in the clinic are we really reflecting the whole story of the person?

So really having video also be a form of advocacy and looking to the patient's life, not just in the home, not just to measure the movements, but really to understand their narrative in a more holistic way. And finally the last note that I will add is, of course, we live in a world where video can be readily accessed by all. So we need to really reflect closely if we put a video of a patient on the internet, how that video may be used. So it's something [00:23:00] on an ethical note that I think we'll need to study and understand. 

Dr. Sara Schaefer: Absolutely lots of food for thought there. We've got 24 hour and multi-day home EEGs and things like that, and ways to monitor people in the home, and I hadn't thought about formalizing a home video situation and movement disorders or even how AI might be helpful to replace or as an adjunct to some neurophysiological evaluation of patient movements. Such as myoclonus, like you said. So lots to think about and I encourage all of our listeners to go and read the article which has even more interesting anecdotes that I'm sure will be of interest to all of our listeners.

Thank you for joining us today, Mattia. 

Dr. Mattia Rosso: Thank you all for listening. [00:24:00]