Objective. To evaluate integrated smartphone and smartwatch sensors and a custom movement disorder application to objectively measure cognitive and motor symptoms of acute mountain sickness in healthy participants exposed to a remote high-altitude (3,800) environment.
Method. Participants (n=3) with no relevant medical history completed a smartphone battery of cognitive, speech, and motor assessments at sea level and altitude at the University of California White Mountain Research Center. Sensors underwent technical validation to ensure recording reliability at altitude.
Results. All participants had hypoxia verified using reference oximeters (O2 sat 77-81% at altitude). None of the participants had AMS as measured by the Lake Louise score. Participants completed the movement disorder application battery of assessments on an Apple Watch 8 and iPhone 14. Raw performance and sensor data were analyzed using custom software. Relative to performance recorded at sea level, participants demonstrated: (1) slower reaction times on a visual short-term memory task; (2) reduced fine motor performance on a digital grooved pegboard task; (3) enhanced wrist-based accelerometer activity in the 3-10 Hz tremor frequency range during a structured arm stability task; and (4) greater accelerometer variability in trunk-based accelerometer activity during a structured gait and balance task. Sensors underwent technical validation at sea level and altitude. Integrated accelerometers were validated by placing the smartphone on a shaker table set to rotational speeds of 1, 2, 3, and 4 Hz. Fourier analysis revealed peak frequencies recorded by accelerometers corresponded strongly with the programmed rotation speed, which were consistent across sea level and altitude recordings. Integrated microphones were validated by placing the smartphone near a high-fidelity speaker playing standardized tones of 50-300 Hz in increments of 50 Hz, corresponding to the natural range of normal human pitch. Fourier analysis revealed peak frequencies recorded by microphones corresponded strongly with the standard tones, which were consistent across sea level and altitude recordings.
Conclusion. Remote high-altitude environments impose physiological stress and risk for hypoxia and acute mountain sickness. Given the remote nature of these environments, transporting and maintaining research-grade equipment at altitude proves challenging. In the current feasibility study, we evaluated integrated smartphone and smartwatch sensors and a custom movement disorder application to objectively measure cognitive and motor symptoms of acute mountain sickness in healthy participants exposed to a remote high-altitude (3,800) environment. Consistent with prior research using research-grade instruments, we replicated physiological effects of high altitudes on cognitive, fine motor, postural stability, gait, and balance abnormalities. Furthermore, we ruled out potential contributions of sensor integrity failures at higher altitudes by conducting a battery of technical validation experiments and demonstrating commensurate sensor fidelity across environments. Together, these results demonstrate the sensitivity of the movement disorder application to detect physiological symptoms previously demonstrated in high-altitude environments. Critically, further studies and a larger sample size is necessary to confirm the results of the current feasibility study.

**Objective.** To evaluate integrated smartphone and smartwatch sensors and a custom movement disorder application to objectively measure cognitive and motor symptoms of acute mountain sickness in healthy participants exposed to a remote high-altitude (3,800) environment.
**Method.** Participants (n=3) with no relevant medical history completed a smartphone battery of cognitive, speech, and motor assessments at sea level and altitude at the University of California White Mountain Research Center. Sensors underwent technical validation to ensure recording reliability at altitude.
**Results.** All participants had hypoxia verified using reference oximeters (O2 sat 77-81% at altitude). None of the participants had AMS as measured by the Lake Louise score. Participants completed the movement disorder application battery of assessments on an Apple Watch 8 and iPhone 14. Raw performance and sensor data were analyzed using custom software. Relative to performance recorded at sea level, participants demonstrated: (1) slower reaction times on a visual short-term memory task; (2) reduced fine motor performance on a digital grooved pegboard task; (3) enhanced wrist-based accelerometer activity in the 3-10 Hz tremor frequency range during a structured arm stability task; and (4) greater accelerometer variability in trunk-based accelerometer activity during a structured gait and balance task. Sensors underwent technical validation at sea level and altitude. Integrated accelerometers were validated by placing the smartphone on a shaker table set to rotational speeds of 1, 2, 3, and 4 Hz. Fourier analysis revealed peak frequencies recorded by accelerometers corresponded strongly with the programmed rotation speed, which were consistent across sea level and altitude recordings. Integrated microphones were validated by placing the smartphone near a high-fidelity speaker playing standardized tones of 50-300 Hz in increments of 50 Hz, corresponding to the natural range of normal human pitch. Fourier analysis revealed peak frequencies recorded by microphones corresponded strongly with the standard tones, which were consistent across sea level and altitude recordings.
**Conclusion.** Remote high-altitude environments impose physiological stress and risk for hypoxia and acute mountain sickness. Given the remote nature of these environments, transporting and maintaining research-grade equipment at altitude proves challenging. In the current feasibility study, we evaluated integrated smartphone and smartwatch sensors and a custom movement disorder application to objectively measure cognitive and motor symptoms of acute mountain sickness in healthy participants exposed to a remote high-altitude (3,800) environment. Consistent with prior research using research-grade instruments, we replicated physiological effects of high altitudes on cognitive, fine motor, postural stability, gait, and balance abnormalities. Furthermore, we ruled out potential contributions of sensor integrity failures at higher altitudes by conducting a battery of technical validation experiments and demonstrating commensurate sensor fidelity across environments. Together, these results demonstrate the sensitivity of the movement disorder application to detect physiological symptoms previously demonstrated in high-altitude environments. Critically, further studies and a larger sample size is necessary to confirm the results of the current feasibility study.

A feasibility study of smartphone sensors to assess effects of acute high-altitude exposure on cognition and motor function

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