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A 20-year adventure in rehab robotics

Tech pioneer Hocoma has long been pushing the boundaries of innovation in rehab. Now marking its 20th anniversary, it plans to step up its ability to drive better patient outcomes, as Deborah Johnson reports.

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Back in 2000, the world was a very different place, particularly in terms of technology.

Many of the high-tech innovations we now accept as standard were not yet launched and healthcare remained one of the most traditional markets around.

Yet into this climate, Hocoma launched the prototype of its pioneering Lokomat, a robotic medical device which provides repetitive and highly physiological gait training to patients, enabling even some of the most impaired to learn to walk again.

While it has gone on to become one of the world’s leading robotic medical devices, in 2000, it was a significant and controversial disruption into a long- established and relatively low-tech rehab scene.

Clemens Muller, global head of clinical and scientific affairs at Hocoma, says: “Twenty years ago, gait rehabilitation was completely different.

Therapists had to physically move patients’ legs – a manual task that can be very tiring and requires huge effort, particularly when you are doing it many times a day.”

Gery Colombo, a trained electrical engineer with an interest in neural rehabilitation, founded Hocoma alongside Peter Hostettler, an economist, and Matthias Jörg, a biomedical engineer.

“The founders realised the need for a change to this way of doing things and to find a better solution,” says Clemens.

“They wanted to establish a venture which could use their specialist knowledge and go in a particular direction, with a purpose and intention.

“The goal was to change rehab as it was known. This was absolutely new; in fact so new and innovative that the world of healthcare rehabilitation wasn’t really ready for it.

“This was a challenging phase but one in which Hocoma needed to be really entrepreneurial with a very clear vision and focus and to keep on going.

“It did take a little while until it was accepted and it was a long journey for the founders.”

Despite the initial challenges of launching such a high- tech product, over the past two decades, the Lokomat has become one of the most widely used gait rehabilitation devices in the world.

It has helped to set an industry standard in rehab products for people with brain injury, stroke and other neurological disorders.

Hocoma recently installed its 1,000th Lokomat.

But it has also built on the success of its flagship product by launching an array of other devices.

Among its product portfolio is the Erigo, which assists with patient mobilisation in the earliest stages of rehabilitation; its Armeo range, which supports the recovery of arm and hand function; and its Valedo products that targets back pain.

The business is headquartered in Switzerland but works in 27 countries worldwide – and believes it is changing the lives of people in clinics across the globe.

Clemens says: “I think there are three drivers behind innovation in healthcare – social aspect, which includes demographic changes and the shift from using products which are based on evidence rather than just experience; the technology changes in the world as a whole; and the clinical changes, which are moving on quickly and have changed dramatically to encompass robotics and exploit the previously unused potential of this way of therapy.

“These drivers have changed, and continue to change, the landscape of the world in which we work. Hocoma has always been at the front pushing the boundaries and helping to change the resistance there was at the beginning of our journey.

“When you went to a rehab conference 15 or 20 years ago, there was only one tech provider there, which was us.

“But if you compare that to now, there can be anything up to 20 companies at an event, including start-ups that are working in technology fields like robotics or sensor-based equipment, offering products for inpatients and outpatients, for acute needs. So there is a huge selection now available.

“There is also the demand from the market to integrate technology. The key for us has always been how to integrate this technology into a routine of therapy to use it to its full potential.

“It is about not only being engineering-driven but understanding how to use that to make a bridge to the rehab world and understand the link to the human world – bringing the know-how and capability and opening that up for the needs of patients.

“As a market, we do need to do more homework in that area.

“Lots of clinics already have integrated the technology they are using very successfully, and with our products it makes us proud to see how the patient is being supported to the highest level.

“I have seen this happening in many clinics around the world and it gives me goosebumps to see how happy patients are with how it is working for them. It also makes a huge difference to the work and demands placed on the therapist, and that is something that also makes us so proud.”

Now celebrating its 20th anniversary, Hocoma’s ambition for the future is to continue changing lives and reaching out to millions more around the world.

A strategic move in achieving this came in 2017 when Hocoma joined its now-parent company DIH – bringing it under the same roof as other rehab technology developers including Motek.

“We have always been a pioneer since we were established so we will continue this with new and better solutions to benefit people’s lives.

“Our focus is on bringing solutions which are innovative, high quality, effective and efficient.

“The future for us will of course be affected by the healthcare market in general. We are seeing a rapid demographic change around the world and this will mean a change in the healthcare approach.

“There will be a search for solutions.

“With the huge move towards digitalisation through the Industrial Revolution 4.0, there will be a greater role played by artificial intelligence and virtual reality.

We will continue to develop as a business so we can continue to be at the front of what is happening.

“Traditionally, we have come up with a new innovation every year, which could be a new product launch, or else new features or a new version of an existing product, but we are always developing what we have to make it the best it can be.

“We are always learning by doing and have a network of research and academic partners all over the world and this enables us to come up with great products which deliver solutions.

“We are planning heavily in our development team and are continuing to develop our launch plan and product road map.

“We hope the global coronavirus outbreak and the shutdown we are seeing around the world does not affect our plans too much in the short-term, but we will have to see how that develops and adapt to that as we need to.”

As a business which has helped to change traditional practices and approaches in rehab globally, one area in which Hocoma would like to push for further change is in widening patient access to its own products, and other high-tech solutions.

“At the moment, it is not a given that all patients and all clinics will have access to our products. Of course technology has its price, but we need to address that at some point.

“We need to work with clinics and insurance companies to try and find a solution here and to shape the future of rehabilitation.

“It is important to find optimal solutions which increase access to technology, to improve the quality of rehab, while looking at the cost effectiveness of such products.

“Over the next five to 10 years, there are going to be more stroke, cerebral palsy and traumatic brain injury patients who are needing innovative solutions and our goal is to develop more solutions which will benefit them and the therapists.

“When money and costs are involved it can often be a long journey, but we believe if all stakeholders got together to find a way of best dealing with this, together we could deliver the best rehab to patients, and this is something we would like to be involved in delivering.”

www.hocoma.com

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Robot with ‘potential to redefine neurorehab’ unveiled by Fourier

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A robotic rehab device hailed as being instrumental in changing the future of neurorehabilitation has been unveiled to the world by Fourier Intelligence, after more than two years in development. 

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, the latest world-leading addition to Fourier Intelligence’s portfolio, is said to have the potential to redefine human-machine interaction. 

It is the first of its kind that applies the end-effector based concept into the 3D movement, bringing a new experience of robotics rehabilitation therapy. 

The product – revealed during RehabWeek 2021 – revolves around a cable-driven mechanism, that combines with a four-linkage structure, which reduces the friction and inertia during the movement of the system. This design also enables the control system to respond and execute more efficiently.

Zen Koh, co-founder and Global Hub CEO of Fourier IntelligenceZen Koh, co-founder and Global Hub CEO of Fourier Intelligence, hailed the robot as helping to redefine the future. 

“Current neurorehabilitation models primarily rely on extended hospital stays or regular therapy sessions which require close physical interactions between rehab professionals and patients,” he said. 

“The ongoing COVID-19 pandemic situation has challenged this model and as a result, many neurological patients are not receiving sufficient therapy. There is an urgent need to rethink conventional neurorehabilitation therapy.

“The new ArmMotus™ EMU provides that solution. The EMU, equipped with clinical intelligence, provides personalised therapy, technology-based solutions, coaching capabilities and remote monitoring.

“The implementation of fun functional games with embedded artificial intelligence also provides clinically motivating therapy to patients as well as giving caregivers and healthcare practitioners confidence.”Professor Denny Oetomo

The ArmMotus™ EMU, jointly built by Fourier Intelligence and the University of Melbourne Robotics Laboratory, has taken two years to bring to fruition and was led by Professor Denny Oetomo. 

“The robot offers large workspace with very minimal resistance and reflected inertia of the robot on the patient. This would allow the patient to move freely”, said Prof Oetomo.

“Combined with the appropriate gravity compensation of the weight of the arm, patients with weak or little arm function, is able to carry out therapy without exertion.”

Another key person to the success of the ArmMotus™ EMU, Dr Marlena Klaic, the translational research lead at Royal Melbourne Hospital, gave further insight into why robotic rehabilitation is important. 

“There’s a large and growing body of evidence suggesting that robotic devices can improve a patient’s outcome, including function, strength and ADL,” said Dr Klaic. 

“This evidence is growing even more rapidly in these pandemic times as more people are exploring digital and remote prevision therapies.

Dr Marlena Klaic, the translational research lead at Royal Melbourne Hospital“We conducted a user-based design study where we build and modify the robot based on the feedback from clinicians. Based on our results, we found that clinicians believe that robotic devices can be helpful in their practice. Patients and junior therapists are more frequently asking for robotic devices as part of their therapy session.”

Aside from exoskeleton and other one-dimension upper limb rehabilitation robots, EMU is based on terminal control and high technical content which is difficult to develop. It is China’s first breakthrough in this field. 

EMU uses the industry-leading force feedback technology platform, which was independently developed by Fourier Intelligence, to simulate the force exerted by a therapist. It also provides a large 3D trajectory training space which allows rehabilitation movements to be more realistic and guides users to complete various complex rehabilitation training.

Product director of Fourier Intelligence, Daris Yang, also explained the importance of having interactive rehabilitation programmes. 

“By equipping EMU with games such as table tennis, cooking, and fishing, this would simulate activities of daily living even more,” said Yang. 

“The boring and repetitive training actions in traditional rehabilitation makes it boring for patients to train for a long time. Our EMU game settings have completely rewritten the rehabilitation scene.”

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Brain Bank spearheads quest for CTE cure by 2040

Sportspeople are urged to play their role in making sport a safer place, as well as to follow the lead of Steve Thompson MBE in donating their brains to research

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Professional sportspeople were today urged to play their role in making sport safer as a pioneering project was announced with the aim of preventing new cases of Chronic Traumatic Encephalopathy (CTE) within five years and of finding a cure by 2040. 

The internationally-renowned Concussion Legacy Foundation has now come to the UK, following 14 years of research and advocacy that has led to change in sport, and support of players, around the world. Its founder, Dr Chris Nowinski, was instrumental in forcing NFL to change its protocols around head injury through his 2006 book ‘Head Games: Football’s Concussion Crisis’. 

And through the creation of the Concussion Legacy Project, a new brain bank in partnership with the Jeff Astle Foundation, it hopes to gather more vital research in this area to protect future generations of sportspeople.

England Rugby World Cup winner Steve Thompson MBE announced he had become the first donor to the Project. 

And Dr Nowinski called on sportspeople to take the lead in making sport a safer place for themselves, their teammates and future generations, as he bids to eradicate CTE. 

Research has shown CTE develops through repeated hits to the head over a period of time, which can begin in childhood in many instances. 

“This is the time for professional sports men and women to step up and join the fight to change the game, reduce the risk of CTE, change your destiny,” he told a press conference. 

“Make no mistake – some of you already have CTE and every header or tackle will be making it worse. You will have teammates who will have, or will develop, CTE. 

“Step forward and make a positive difference. Take advantage of this opportunity before it’s too late. It is too late for heroes like Jeff Astle and Rod Taylor, but it’s not too late for our children.”

Dr Nowinski, who is an advocate of non-contact sport until at least the age of 14, reiterated his fears for children if action is not taken now. 

“We should not be giving children a preventable brain disease before they are old enough to drive, vote, or take many decisions for themselves,” he said. 

“We need to stop hitting children in the head, we are giving them a life-long brain disease. The only way we know to prevent CTE is to limit the exposure to head impact and we have to do that.”

Dr Adam White was announced as executive director of the newly-created Concussion Legacy Foundation UK.

“We’ve long known about the relationship between sport and CTE, but we urgently need to better understand how CTE affects athletes and veterans, as well as their families, at every stage of their life,” said Dr White. 

“We have reason for hope. CTE usually begins in a person’s teens or twenties, which means we have a lifetime to treat patients, educate people and support their families. 

“We want to stop all new cases of CTE in the next five years and have a cure by 2040.”

Appeals were also made for sportspeople to donate their brains to the Concussion Legacy Project, following the brave lead of Steve Thompson. 

The project builds on the lead of the VA-BU-CLF Brain Bank in Boston, which has created the world’s leading CTE research program. To date, more than 1,000 brains have been donated and 600 cases of CTE diagnosed, which comprises about 80 per cent of the world’s confirmed cases.

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“I’m pledging my brain so the children of the people I love don’t have to go through what I have gone through,” said the former British Lion who was diagnosed with dementia at the age of 42. 

“It’s up to my generation to pledge our brains so researchers can develop better treatments and ways to make the game safer.”

“Brain donation is the most valuable gift of all for future generations of footballers,” said Dawn Astle, daughter of Jeff Astle. 

“It may be many years before this jigsaw is complete, but by adding each piece, one at a time, it is the only way we shall understand the true picture and so be able to make a better future for others. 

“The Jeff Astle Foundation encourages families of athletes and veterans to donate the brain of their loved one to the Concussion Legacy Project.”

The Concussion Legacy Project will be led by Dr Gabriele DeLuca, associate professor in the Nuffield Department of Clinical Neurosciences, University of Oxford, and director of clinical neurosciences undergraduate education at Oxford Medical School.

“Brain donation will allow us to better understand the complexities of CTE so that we can develop tailored interventions and treatments to prevent its devastating consequences,” said Dr DeLuca. 

In the next phase of the collaboration, Dr. DeLuca will lead clinical research efforts aimed at learning how best to treat common CTE-related symptoms, including problems with thinking and memory, mood, and sleep.

Athletes and veterans can pledge to donate their brains to CTE research at PledgeMyBrain.org.

The Concussion Legacy Foundation UK has created a 24-hour brain donation hotline for families to call and coordinate brain donations. Family members of athletes and military service members who wish to donate their loved one’s brain can contact the Concussion Legacy Project at 07534 029 223 and UK@concussionfoundation.org.

 

 

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Sexual trauma ‘could lead to neurological conditions’

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Traumatic experiences, including sexual violence, could be linked to dementia, stroke and other brain disorders in women, new research has indicated.

Links between such trauma and poor mental and cardiovascular health are already established – but a new study suggests they could also be linked to indicators of cerebrovascular risk that may be a precursor to neurological conditions. 

To date, little research has been done to examine the relationship between traumatic experiences, including sexual assault, and indicators of small vessel disease in the brain. 

But a new study from the University of Pittsburgh specifically investigated whether traumatic experiences were associated with white matter hyperintensities (WMHs), which are markers of brain small vessel disease. 

WMHs can be detected decades before the onset of dementia, stroke, and other neurological risk and can serve as early markers. 

Of the nearly 150 mid-life women involved in the study, 68 per cent reported having at least one trauma, with the most common trauma being sexual assault (23 per cent of the women). 

After evaluating the data, researchers concluded that women with trauma exposure had greater WMH volume than women without trauma. The particular trauma significantly associated with WMH was sexual assault.

Associations between sexual assault and WMHs persisted even after adjusting for depressive or post-traumatic stress symptoms, suggesting that sexual assault may put women at greater risk for poor brain health.

“The results of this study are noteworthy in that sexual assault is an unfortunate, yet all-too-common, experience for women; national data indicates that, on average, up to a third of women have had this experience,” says Dr Rebecca Thurston from the University of Pittsburgh and lead author of the study.

“This distressing experience is not only important for women’s mental health, but also their brain health. This work is a major step toward identifying a novel risk factor for stroke and dementia among women. 

“Not only do these results underscore the need for greater prevention of sexual assault, but also provide healthcare professionals with another indicator of who may be at most risk for stroke and dementia later in life.”

“Identifying early warning signs of stroke and dementia are critical to providing effective intervention,” says Dr. Stephanie Faubion, North American Menopause Society (NAMS) medical director. 

“Studies like this one provide important information about the long-term effects of traumatic experiences on a woman’s overall well-being and mental health.”

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