Tech
Latest advances in neuro-rehab technology
RehabHub™
next-gen neuro-rehab
With its creation of a suite of sector-leading robotic rehabilitation technology, Fourier Intelligence is helping to push the boundaries of what is possible for a patient's recovery.
With its creation of a suite of sector-leading robotic rehabilitation technology, Fourier Intelligence is helping to push the boundaries of what is possible for a patient's recovery.
And by bringing these cutting-edge robotic devices for both upper and lower limb therapy together through the development of the RehabHub™, neuro-rehab is being stepped up further still.
By collecting a patient's data in real-time, clinicians are given new levels of insight into their recovery and progress, enabling them to tailor more bespoke programmes than ever before.
And in a unique innovation, RehabHub™ offers the potential for patients to play against each other while on different devices, using the gamification options offered by Fourier Intelligence's robotics to deliver a new kind of interconnectivity to traditional rehabilitation - making rehab fun while also maximising patient input and outcomes.
Launched in 2020, the RehabHub™ concept - which began in Fourier Intelligence's native Singapore - is now in countries worldwide.
Globally, there are more than 200 RehabHubs in operation, including the Shirley Ryan AbilityLab in Chicago, STEPS Rehabilitation in the UK and the Yongchi Rehabilitation Hospital in China, one of the most advanced rehab sites in the country.
"The RehabHub™ is helping to deliver better patient insight than ever before, supporting clinicians to give the highest quality of rehabilitation and enabling patients to secure the best possible outcomes," says Zen Koh, Co-Founder and Chief Executive Officer of Fourier Intelligence Global.
"The group therapy concept, which allows patients to play against each other, adds something new into neuro-rehabilitation, making rehab enjoyable and engaging while increasing motivation and inspiring
best performance.
"We are adding new RehabHub™ sites continually around the world, enabling more patients than ever before to experience our suite of robotic devices through our cost-effective approach and partnerships with key sites globally."
"This is a new approach to rehabilitation, and one which we are so pleased is being welcomed with such excitement and enthusiasm."
RehabHub™ brings together the suite of devices from the Motus series, which collectively give a comprehensive rehabilitation solution covering the upper limb and lower limb, wrist joint and ankle joint, as well as balance and coordination.
This approach covers the diverse training needs of all patients and accommodates their condition and unique needs at whatever stage of their recovery.
Fourier Intelligence's robots have advanced force feedback technology, which can effectively simulate a therapist's hand and offer on-demand assistance to the patient during training - optimising their participation in exercise.
Its creation of a digital platform for patients and therapists to chart their progress also enables the interconnectivity of equipment, users, and institutions. This gives the ability for challenges and friendly competition within a patient group, inspiring the best possible engagement and maximum repetitions with a rehabilitation session.
"Our mission at Fourier Intelligence from the outset has been to make a difference to patients' lives and to maximise their potential in their recovery," says Zen.
"We also want to push the boundaries of what is possible in conventional rehabilitation and use our technology to make positive change.
"Through our RehabHub™, that is made more accessible than ever before. We have worked with world-leading researchers, therapists, and patients to develop these solutions and to help inspire a new way of thinking in rehabilitation."
ArmMotus™ EMU
The ArmMotus™ EMU is the world's first 3D back-drivable upper limb rehabilitation robot, setting a new benchmark for intelligent rehabilitation devices.
The robot, launched last year, has been hailed as having the potential to redefine human-machine interaction and help set a new course in rehabilitation.
The device adopts an innovative cable-driven mechanism, combined with a parallel structure made of lightweight carbon fibre rods, which reduces the friction and inertia of the device.
This enables the control system to respond and execute more efficiently, resulting in higher compliance in work between the patient and machine. Its use of force feedback technology enables the device to simulate the therapist's hand, supporting the user to adjust the assistance or resistance according to different rehabilitation needs.
The ArmMotus™ EMU also allows training in sitting and standing positions and accommodating different training arms. By integrating different scenarios in a game, users can train on strength, motor control, and joint ROM in one session, making the process more efficient.
ExoMotus™ M4
The ExoMotus™ M4 uses robotic and sensor-based technology to give a comfortable and safe environment for gait training. The device had an integrated balancing support frame to enable patients with lower limb impairments to stand and walk to increase their activity level and help to regulate gait patterns.
Gait parameters are individualised, depending on the patient’s need, meaning it can be used at any stage of recovery and adapted accordingly. Users can perform sit-to-stand training early in rehabilitation to promote sensory input, improve cardiopulmonary function, and prevent muscle atrophy.
Changing the game
in concussion
Through its combination of cutting-edge science and use of existing technology,
MYndspan is helping to revolutionise the detection of concussion. NR Times speaks
to chief scientific officer Dr Benjamin Dunkley about its progress and potential
While awareness of the risks of head impact and concussion in sport continues to grow, backed by evidence of its neurological consequences, the ability to detect seemingly ‘invisible’ injuries has remained challenging.
Frequently, those who sustain a mild head injury can present as having recovered through a series of cursory assessments - although the true impact can remain hidden, particularly against a background of previous head traumas.
But in a huge boost for the diagnosis and detection of concussion, MYndspan has created the means to discover these unseen impacts using non-invasive Magnetoencephalography (MEG) brain scanning technology.
The use of MEG, which is already in use globally, has traditionally been used in diagnosing and monitoring epilepsy - but through its application in concussion, MYndspan has enabled a significant breakthrough in protecting athletes, in a move hailed as having “immeasurable value” by sports head injury charity Head For Change.
MYndspan - which is now commercially available in its first UK site, at Aston University, following successful pilots at the SickKids Hospital, Toronto, and The University of Helsinki - combines MEG scans with gamified tests of cognitive function, which measure a range of mental processes such as attention, memory and visuospatial processing, giving new levels of insight into brain health, which can then be benchmarked and reassessed over time.
And with research detailing the impact of head injury in sport leading to growing calls for change, MYndspan could have a key role to play in this, believes Dr Benjamin Dunkley, chief scientific officer at the business.
“North America had its watershed moment some time ago in realising concussion was really a silent epidemic, an invisible injury that was having a lot of impact on player welfare,” he tells NR Times.
“It was affecting people in the armed forces and their welfare as well, as well as young children, older adults.
“I think the UK is now having its moment that maybe we had in North America a number of years ago. It's really coming into the public awareness now in the UK.
“At MYndspan, we’re trying to leverage cutting-edge science alongside existing technology, to help to make positive change. At the moment, a lot of the decisions made are taken purely based on on people's reported symptoms. But with MYndspan, we can give people objective information about their brain.”
Dr Dunkley, an associate professor at the University of Toronto, first saw the power of MEG while studying in Cardiff, and realising its potential in wider neuroscience. He then moved to Canada, where he saw the role it could have in a wider forum.
“Straight away, I was immersed in this world of concussion, which was a big problem here,” says Dr Dunkley.
“Hockey, American football, these are very physical contact sports, and I was immersed in this issue and how some passive head impacts eventually led to all kinds of issues.
“There was also the death of a young girl called Rowan Stringer, following a second concussion within a week, she unfortunately died due to Second Impact Syndrome. There was outcry about the failings of amateur sports, head injury protocols, head injury assessments. It really hit a nerve here and very much resonated with the public consciousness that this is a big issue.
“People realised this is not just affecting adult professional sports players or guys in the military, it’s affecting your children too.
“When I was doing my post-doc with sick children, and we had an imaging scanner that was used with epilepsy and in pre-surgical mapping, we said ‘OK, why don’t we apply this in concussion?’
“It seemed like it could be a great tool for trying to understand these invisible injuries. We've tried MRI, we tried CT, and nothing was really working. These traditional ways of evaluation weren’t really fit for purpose in that regard.
“We don't really have a reliable biomarker currently, there's no way to evaluate these brain injuries, there's no really reliable way to prognosticate. After a concussion or an mTBI, 70 to 80 per cent of people do genuinely recover quite quickly and spontaneously, but the only relatively reliable prognostic marker is if you've had a previous concussion.
“So for every subsequent concussion, it increases chances that we have persistent post-concussive symptoms. Otherwise, there is no way of predicting this.”
Having also worked with the Canadian Armed Forces, Dr Dunkley saw its application in that field, too.
“I started working with the Canadian Armed Forces at a time when the war in Afghanistan was still ongoing,” he says.
“Brain injury and TBI was a real big problem in the forces as well as PTSD, and there are a lot of overlapping symptoms there.
“But these are psychological stress injuries, as well as brain injuries, and it's really difficult to tease them apart.
“None of the imaging that we have was fit for purpose in this regard. So there was a pressing need for a new way.”
Working alongside MYndspan founders Caitlin Baltzer, ex-VP of operations at functional brain imaging company Croton Healthcare, and Janne Huhtala - previously CEO of brain imaging leader MEGIN - Dr Dunkley’s research around the potential for MEG created a truly groundbreaking proposition.
To some degree, I guess it has been serendipitous that this technology existed and we've applied it in this context,” he says.
“MYndspan saw a need for this. Through leveraging the technologies available, this is a great way to help people understand their brain functioning.
“Through these brain injuries, whether an mTBI or continual impacts, the structural changes in the brain, which we can't see, cause a huge neurochemical cascade.
“There are a lot of inflammatory changes in the brain. There are all kinds of metabolic changes, all kinds of neural damage to these highways of the brain, and connections that link up the neurons that really serve all of our thoughts and feelings.
“It’s a case of converging evidence from from multiple lines, from neuropsychology, cognitive testing, symptomatology, clinical history. And this will be another piece of that puzzle. I certainly think the technology isn't far from giving people an accurate diagnosis - and it is already incredibly useful from baseline assessments.
“We can show that your brain hasn't quite healed yet, and that there’s a risk of exacerbating that injury and making it worse. We can see if there is residual dysfunction there and to monitor it over time.
“This evaluation of brain injury over time will really start to give us more information about when it’s safe to return to play, when military personnel can be deployed and return to work, when people can return to doing what they love. I think we have a huge part to play in that.”
Through continual advances in technology, MEG is being made even more accessible through its ‘miniaturisation’.
While traditionally available through large static scanners, its application can now also be through what can be equated to a portable cycle helmet, which also widens its potential into supporting children - a vital area to address, says Dr Dunkley.
“We think that kids are relatively robust and when they have a concussion, they will recover very quickly. But there's increasing evidence that’s maybe not the case,” he says.
“But we haven’t been able to scan them with traditional MEG, because it's just an adult system at the moment.
“The traditional systems currently have an adult-sized helmet, so it makes it difficult to to scan children probably below the age of about 10. We can go down to about six but often their heads are so much smarter than adults, the scanner moves around a lot and makes it difficult to pick up a good signal.
“Going forward, MYndspan will certainly look to build this into their system. There are some really exciting things on the horizon, and gaining this insight into children is a huge question, and one we want to address.”
And also, looking ahead, Dr Dunkley sees the potential of the portable MEG scanners being readily available for athletes as and when they need them.
“I think it's very close to being taken to a stadium. You could have an immediate pitch side evaluation, a head injury assessment, using this technology,” he says.
“It's not really a million miles away to envisage that potentially one of these systems would be stored in in the stadium, and eventually, in the back of the van and take them around to smaller stadiums pitchside. I don't think we're very far away from that.
“Sometimes scientists talk about experimental technologies that are a lot of years away. A few years ago, I would have said this was still a way away. But I have been really impressed with how quickly the tech has been moving. There is huge potential.”
After the successful pilots, its first UK site at Aston University launched earlier this year, and MYndspan is now looking to establish dedicated facilities in London and Toronto in the near future.
“The response at Aston has been fantastic. After a successful trial in in my laboratory, we are seeing great success in Aston,” says Dr Dunkley. “That's currently the UK hub, but we do share facilities with the University, so we're hoping to quickly expand into London and Toronto with our own sites.
“Currently, we are leveraging the existing store base of MEG scanners but we're very positive about having flagship sites in London and Toronto very soon that we can completely dedicate to this kind of service.
“We’ve got an amazing team with amazing expertise and we are very excited to see what the future will hold.”
Rehab after traumatic
brain injury:
building strength and
confidence with GripAble
When 26-year-old Martyn* experienced a traumatic brain injury just one day before he was due to start a plumbing training course, everything changed.
After four months in hospital, Martyn was finally discharged, but continued to experience weakness and reduced range of movement in his right hand, which had a significant impact on his function and participation in everyday life.
Feeling withdrawn and fatigued, Martyn struggled to stay motivated with daily rehab training – that was until he was introduced to GripAble, the mobile assessment and training platform for home-based rehabilitation, and its tailored programme of daily exergames.
This article explains how use of GripAble enabled Martyn to take control of his own recovery following his accident and confidently move forward with his life and career plans.
Traumatic brain injury
Martyn suffered a brain injury as a passenger in a road traffic collision, resulting in several bleeds on the brain and multiple fractures. Community assessment showed a number of physical impairments including higher level balance deficits, reduced wrist and elbow range of movement, and stiffness on his right side. Martyn also experienced pain in his right arm and reported it feeling weaker.
After four months of acute rehabilitation in hospital, Martyn was discharged home, but as he was independently mobile indoors and did not have a coordination impairment in his right arm, he wasn’t provided with a programme for his continued rehabilitation.
Previously a keen gym goer, Martyn stopped visiting the gym as he felt unsafe holding weights. His family also observed that he was carrying out everyday tasks like making a hot drink with his left hand only, as he feared dropping a heavy, hot kettle. Prior to his injury, Martin was right-hand dominant. Martyn’s rehabilitation required a multi-disciplinary approach to address his functional and participation-based limitations due to his physical and cognitive impairments post-brain injury.
Getting to grips
Once in the community, Martyn was assessed by an occupational therapist and physiotherapist to establish a better understanding of his neurological impairment.
Initial tests showed that he presented with 4/5 power in his right upper extremity for elbow flexion, wrist flexion and extension, and grip. To delve deeper into how his right-hand compared to that of his left hand, Martyn’s therapists used the GripAble platform to assess his grip strength, which showed a mean score of 23.7kg for his right hand, and 32.4kg for his left.
To help address this imbalance, Martyn was provided with a four-week, personalised programme of exergaming on GripAble to reach a minimum of 300 repetitions of grip and release per day for the first week, gradually increasing up to 600 repetitions at week four.
Martyn’s daily rehab schedule was kept flexible to allow for concentration, memory, and attention deficits as well as fitting around his social life supported by friends and family. He also followed a tailored resistance training plan with three sessions per week, as well as practicing ADLs (activities of daily living) to help build his confidence.
To promote adherence to his programme, Martyn’s therapist was able to review his training history though the GripAble platform and send encouragement emails and text messages to keep him on track. In just 28 days, Martyn displayed an improvement in his grip strength, with his right hand displaying an increase from 23.7kg to 29kg when assessed on the GripAble platform.
In just 28 days, Martyn displayed an improvement in his grip strength, with his right hand displaying an increase from 23.7kg to 29kg when assessed on the GripAble platform
Moving forward
By the end of the four-week programme, Martyn was confident about a phased return to exercising in the gym and lifting weights.
At this point in his rehab, a deficit was still observed between his left and right hands, but the training allowed Martyn to move onto exercises with higher loads and feel safe enough to do so, thus giving him a leisure activity to return to.
Martyn reported that GripAble allowed him to feel he was being productive in his rehab as, due to fatigue and coping with the mental effects of his accident, he previously did not always want to do his weight training exercises at home. Using exergames in short snappy sessions made him feel he had some control over his improvements.
Of his rehab experience, Martyn said: “My upper limb rehab was brilliant and the GripAble device helped a lot in terms of my grip strength. I was struggling, but after a few sessions on the GripAble device, my arm felt better and stronger. The games on the GripAble platform were very enjoyable and interactive, which helped me stay engaged and motivated me to complete tasks set by my physiotherapist. I looked forward to using GripAble as it helped me, but it was also fun.”
Martyn’s neuro-physiotherapist Bilal Sheikh commented: “I have always been interested in incorporating modern technology into rehabilitation, from using games consoles with people at risk of falls, to electrical stimulation bikes for people with acquired brain injuries and non-traumatic spinal cord injuries, to name a couple of examples.
“I found out about GripAble back in 2018 through my general research into what I could bring into my practice next and adopted the device in the rehab centre I worked at. Now that I am based in the community, GripAble’s portability, ability to track efforts and progress, take objective measures and generate reports makes it a very useful tool for me. The engagement and fun aspects created through exergaming really promoted Martyn's adherence to therapy which helped lead to such a significant change in his result within a month.”
Martyn has since signed up for a construction-related college course and is preparing to learn how to drive.
Affordable remote rehab
GripAble is a mobile assessment and
training platform which includes bespoke hand-held sensors, mobile hardware, software, in-built gamification and data services, to enable home-based rehabilitation for patients with a wide range of neurological and musculoskeletal conditions including upper limb spasticity.
GripAble’s unique handgrip sensor connects to a mobile app, allowing users to partake in specifically designed activities selected by their therapist, to train core hand and arm movements. GripAble has been designed with remote rehab at its heart to enable ongoing training at home, even when face-to-face therapy isn’t possible. With the cost of living hitting many hard, GripAble has launched an affordable monthly rental option for home-based customers.
At less than £1.50 a day, the rental has no minimum contract, making it an ideal option for people with short-term rehabilitation or training needs.
Chat to our friendly team of experts to see
if GripAble could help you, your family member, or your patients.
For more information, visit:
www.gripable.co
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