The importance of data in neuro-rehab

In determining a patient’s progress, and also in making the business decisions behind major investments in new rehab tech, data can play a crucial role. 

Jakko Brouwers, clinical director at Morrello, discusses the importance of meaningful statistics in ensuring the best outcomes for patients, and also in helping to create the next generation of life-changing technology

Having initially planned to become an engineer, Jakko Brouwers’ decision to move into physiotherapy is not as far removed from his original career plans as it may seem.

“I’ve always had a keen interest in engineering, and particularly how it could be used to improve lives and outcomes,” says Jakko, who decided against a career in ships engineering “as the ship was getting ready to leave Antwerp docks - it was that close”. 

“But I think there are a lot of parallels between rehabilitation and engineering. They are both about overcoming problems, and both in rehabilitation and in engineering, you would try and define the problem and look for solutions for that. 

“This engineering mindset has stayed with me during my physio career. It’s the same principles. You’re looking in your toolbox for what you have in there to help overcome problems and improve. And in physio and rehabilitation, that is what we are looking to do for the patient, to improve outcomes and transform patients’ lives.”

That engineering mindset, and with it the need for fact-based evidence and data, has also continued to influence Jakko - and has helped to shape the model of Morrello Clinic. 

“As healthcare professionals, We need to be more data driven and not subjective,” says Jakko. 

“A lot of decisions by therapists and healthcare professionals are not based on data, and are rather based on subjective feelings. 

“There are challenges with working with engineers though, as from an engineering point of view, you can very easily engineer something that makes no difference to patients’ lives, yet solves a problem.  

“It is important to define the problem, or rather the change that you would like to see. Therapists describe this as a goal: “for the patient to be able to do ”X”.

“But by having performance data available during the rehabilitation sessions, you are empowering the patient and creating a service that is focused on the end users’ needs, ie the patients’. You are focusing on what they really need to achieve and can see the progress they are making. 

“This data driven evaluation of performance is of huge value, both for the patient, and for the future development of technology. The amount of technology that has become available over the last 15 years is truly exciting, and by being patient-focused, we at Morrello are really keen to shape its further development.”

Data-driven insight 

While often a patient’s day to day progress is determined by how they feel, or the opinions of the therapist who is supporting their rehabilitation, the increasing use of data rich rehab tech is enabling a new level of insight. 

“But still, very often in clinical practice, clinicians are relying on a subjective analysis - so ‘I think that looks better’ or ‘Your knee seems slightly straighter than it was last week’. This has to change and we need to make data driven decisions,” says Jakko. 

“I ask my patients to provide the subjective rather than myself. I like to see the data and then ask the patient, “How do you think that went?”. 

“Often the patients can take a lot from the data, especially if it is graphically displayed. They may feel something is really hard, to walk or do a certain activity, and they aren’t making progress. But then you show them the data, and they can see that they are actually better now than they were before. That can help with motivation and with furthering improvements.

“Subjective feelings can be hard to validate - but by collecting data, and it must be the right data, we can really help.” 

Jakko’s focus on data and evidence-based outcomes is a key component in Morrello’s offering, with the neuro-physio provider continually looking for new technology that can benefit the lives of its patients. 

The ability to demonstrate that to the patients themselves is vital, says Jakko. 

“You can have someone telling you you’re doing great, but if patients can see the results themselves, it is much more meaningful,” he says. 

“For neuroplasticity, the patient needs to have that knowledge of results. They need to make sense of their performance. That can be an outcome on a VR game, achieving a task like bringing a glass to your lips and having a sip of water.

“If you imagine someone using a golf driving range in the dark, and they’re being told ‘That’s a good shot’. How do they get better? Your performance is never going to be as good as when the light is on, when you can see where the ball actually lands and you also have the data around distance and accuracy. 

“This is where technology can be hugely important, and can make the difference between a patient thinking they are not progressing, and knowing they are.”

Influencing next-gen tech 

While technology can give patients the knowledge of their progress and capability, equally patients are vital to the further development of such life-changing innovations. 

By consulting the ‘experts by experience’ - the patients themselves - rehab tech creators can gain unparalleled insight into how their technology is performing, and whether it is indeed giving the appropriate support to those who need it. 

This is key factor for Jakko, and informs Morrello’s approach to its investment in rehab tech. 

The provider already has an extensive portfolio of cutting-edge products, and trials a number of products each year - some even before they are readily available in the market - so its patients can help further shape their development. 

“We need to find what works for our patients and what they want. Often, our patients will tell us they’ve heard about a device, and if possible, we’ll get it in for a trial. I think it’s nice to do that with them, it’s something we can work on together,” says Jakko. 

“Patient feedback is really, really important. Certainly to us as therapists, but also to the product developers, who get to hear directly what is working and what isn’t.” 

One recent example was Morrello’s engagement with the Strolll device, an Augmented Reality (AR)-led gamified rehab approach which was requested by Morrello’s  Parkinson’s patients - or Parkinson’s warriors as they’re known at Morrello. 

Not only was the patients’ feedback conveyed to its creators, a WhatsApp group was created between patients and the Strolll software developers for instant answers and amendments to the technology. 

“As soon as the patients were giving feedback, saying they can’t find this button or don’t know how to operate this part, the software designers were immediately looking at the problem,” says Jakko. 

“They were instantly getting rid of glitches on individual devices. Some of our patients were reporting problems at 10am, and within 20 minutes they had a download of a new version of their software. 

“This kind of engagement was great, and the patients knew they were being listened to. They liked the fact it was not only improving their lives, but would benefit people who will use the technology in the future. 

“Even without these kinds of immediate responses, the opportunity to share feedback helps the product to get better, and helps us to use the technology better and also to become better at what we are doing and improving our ability to transform lives.”

Other recent trials have included the Keeogo, a powered knee-only exoskeleton designed for walking assistance, and the NeuroSkin artificial intelligence (AI) FES device, which is currently being tested by patients. 

“The patient feedback is very important to us, about how they feel it worked for them. What did they like about it? Would they have wanted to use it earlier? Would they have preferred it in a different setting? Our patients often come up with amazing ideas which help us adapt some of the technology,” says Jakko. 

“With a lot of technology, it is a big investment to make, so having this feedback and carrying out a trial is very important in knowing if it works for your patient population. If we don’t purchase something, it doesn’t mean it isn’t a great product - it’s just not meeting the exact needs of our particular patients.”

And as well as enabling best outcomes for patients, it provides valuable insight for professionals, both at Morrello and in the wider sector. 

“We share our findings with other clinicians through presentations at training events and conferences. We have also shared case studies online or through conventional media such as the BBC from some of our patients who discuss what they found useful in a product,” says Jakko.  

“It’s not just for ourselves, it’s important for this whole sector that other clinicians know this when they are thinking about investing in some equipment. 

“And for our staff at Morrello, they invest a lot of time in studying this equipment, and they are given time to do that. It’s important in our continuous professional development (CPD) to stay on top of new developments in rehabilitation and it’s part of our promise to staff that we will give them time and support to do that. 

“That way, they can really evaluate the device and its performance and see how this equipment will contribute to treatments in future.”