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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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Video: everyday vs specialist tech

Assistive technology Expert Andy Fell joins Irwin Mitchell law firm for an in-depth exploration of the very latest independence-boosting devices and platforms.

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Technology plays a day to day role in our lives and mobile phones, tablets, Alexa and Siri are common place.

Imagine the impact on your life if you were no longer able to interact with a touch screen or keyboard or give voice commands….

In this virtual event, Assistive Technology expert Andy Fell gives practical demonstrations of how everyday technology and specialist technology can be used to help give independence to those who need it most and why specialist technology may be needed.

During the event hosted by Lauren Haas, personal injury solicitor at Irwin Mitchell LLP, Andy goes into detail about what apps and gadgets are on the market, how everyday technology can be optimised such as the Amazon Alexa, and answered a number of questions ranging from touch screen sensitivity to smart watch reminders.

Case managers, ancillary medical professionals, as well as interested members in healthcare, social care, parents and clients may find this recording useful, as well as anyone caring for, working or living with people such as dementia sufferers or sufferers of other conditions which restrict their mobility.

Andy Fell is an independent disability and assistive technology (AT) consultant with almost twenty years’ experience working with all disabilities and age groups.

He is a qualified Rehabilitation Officer for the Visually Impaired and, since qualification, has lectured on the use of assistive technology and role of AT in the life of disabled people.

He has worked with a wide range of charitable organisations including British Dyslexia Association, was head of assistive technology for Guide Dogs for the Blind and National Disability Advisor for the Royal Yacht Association.

He has also worked for blue chip companies, the emergency services and various government departments including Department for Work and Pensions.

Andy is a fellow of the Royal Society of Arts, chairman and founding trustee of the Wetwheels Foundation and sat on the British Dyslexia Association – Workplace Assessors Professional Review Panel.

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The relationship between music and running

By Daniel Thomas, joint managing director of Chroma Therapies.

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By Daniel Thomas, joint managing director of Chroma Therapies

With its ability to produce new neural pathways, Neurologic Music Therapy is able to encourage movement, co-ordination, improve speech and language, and improve the ability to read/feel emotions, reactions and more, in people living with catastrophic injuries.

This is because music automatically connects to the brain. And this automaticity is what makes music so powerful.

Music also has to ability to push your training capabilities farther and faster especially in running.

This is why a running playlist is the ideal accompaniment to any runner.

Each songs tempo stimulates the brain, evoking a running response of either a faster pace or a steady rhythm depending on what you want to achieve.

For a faster pace, a good running playlist should contain songs with 150-180bpm.

Unfortunately, with not many songs out there using that speed (unless you enjoy rock, metal or speed garage for running) than the other option is to choose songs with 75-90bpm, as this tempo is perfect for a steady rhythm and maximising efficiency.

Do you recall an earlier blog where we discussed cadence and stride length using NMT for preventing falls in the elderly?

We suggested music with a high bpm count promotes movement, good cadence and walking speed, so songs like Nancy Sinatra’s ‘These Boots are Made for Walkin’, which has 85 bpm, is ideal.

BPM strongly correlates to step cadence.

Rhythmic Auditory Stimulation (RAS) is an important aspect of NMT.

Predictable rhythmic structure allows the sensori-motor system to move in sync with the beat.

This is, in essence, why music is important to runners, as it has the ability to communicate with the brain in order to help maintain a steady pace or increase speed depending on the bpm.

When it comes to mental wellbeing, we will always discuss music’s ability to improve mental wellbeing, and its effect can also be attributed to runners.

Music’s ability to improve stride, cadence and style, to produce better and better runs, and enable runners to achieve personal goals also have a positive effect upon mental wellbeing.

A sense of accomplishment. And with the right playlist, runners can end each run on a high.

We also like to discuss how NMT is more effective when it is personalised to that individual.

The same can be said in the case of a runner. A playlist that includes, not only songs with the ideal tempo for them, but also have some personal meaning, have the greatest positive effect upon runners.

The more enjoyable the run, the less fatigue is experienced. This may be due to the fact that music is able to interfere with the parts of the brain that communicate fatigue, essentially causing a distraction, so less fatigue is experienced.

For runners, the relationship between music and running can be seen to be just as effective and important as the relationship between music and recovering from a brain injury.

Its ability to improve running capability, speed, motivation, and promote mental wellbeing is what makes the difference between a run just being a run and reaching ‘Flow State’ – the mental state where the runner is in the moment of running – no distractions, and the run becomes…euphoric.

Read more: Running in the name of mental health

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Concussion could lead to depression, ADHD, dementia and Parkinson’s – study

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A new study has revealed a link between concussion and the risk of being diagnosed with attention-deficit hyperactivity disorder, mood and anxiety disorders, dementia and Parkinson’s disease later in life.

Despite ‘clinical recovery’ from concussion typically lasting one week, a team of researchers from the University of Manitoba suspected there may be longer term effects. They used 25 years of population-based health data between 1990 and 2015, involving almost 50,000 cases of concussion from people living in Manitoba, Canada.

They found that concussion was associated with an increased risk of being diagnosed with attention-deficit hyperactivity disorder (ADHD), mood and anxiety disorders (MADs), dementia and Parkinson’s disease.

After analysing the population data, they found that concussion was linked to an increased risk of diagnosis of ADHD, dementia and Parkinson’s.

Women who had a concussion were at greater risk of developing ADHD and MADs, but there were no differences between men and women for the risk of developing dementia or Parkinson’s.

Multiple concussions didn’t affect the risk of later being diagnosed with ADHD, but a second concussion increased the risk of dementia, while exposure to more than three concussions increased the risk of being diagnosed with MADs.

While previous studies have found links between concussion and ADHD, dementia, Parkinson’s and MADs, most have relied on patients self-reporting their symptoms, the researchers write.

However, this study can only show an association, not cause and effect.

The mechanism behind this increased risk is unknown, but the researchers state it’s possible that the pathways of some biomarkers that are dysregulated in ADHD, Mads, dementia and Parkinson’s, namely, cortisol, are also affected after a concussion.

The paper, published in the BMJ journal, states that future research is needed to explore the relationships between concussion and ADHD, MADs, dementia and Parkinson’s in other populations.

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