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Evolv Rehab – blazing a trail in virtual therapy

CEO David Fried discusses how Evolv has been at the forefront of digital rehab since 2011 and how it continues to expand

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Having pioneered virtual therapy solutions for patients since 2011, it’s safe to say Evolv Rehab was one of the first entrants to the now-thriving global telehealth marketplace. 

“Back then, telehealth was often a phone call, or maybe even a fax. The cloud back then was something you looked at in the sky,” recalls David Fried, CEO of Evolv. 

What started off as a small project for people with Multiple Sclerosis at an MS patients’ association in its native Spain has led Evolv to develop a whole new model of virtual support. 

Now a fast-growing medical device manufacturer that specialises in developing rehabilitation technology solutions, its expansion into the UK has seen it used in nationally-leading centres including the renowned UCL Queen Square Upper Limb Neurorehabilitation Programme and the Royal Hospital for Neurodisability.

Ongoing global roll-out is ensuring patients around the world – including in North America, Asia and across Europe – can benefit from its array of VR therapy solutions with motion capture technologies. 

Evolv – which spun out of the VR engineering firm Virtualware – works closely with Microsoft and the tech giant supported Evolv in its donation of its personalised telerehabilitation solution RehabKit to different hospitals globally during the pandemic including The National Hospital for Neurology and Neurosurgery (NHNN) in London and Mount Sinai Hospital in New York. Even Microsoft’s CEO Satya Nadella took notice when he spoke at a computer vision conference about Evolv’s pioneering use of the new Microsoft Azure Kinect camera sensor for stroke rehabilitation. 

With significant further growth planned, as the world continues to adopt technology in rehabilitation and healthcare after experiencing its positive impact during COVID lockdown, the Evolv story can all be traced back to that MS group in Bilbao. 

“Virtualware normally worked on bespoke projects for a wide variety of clients in different sectors, and this was a great one which really identified the benefits to patients of how VR and exergaming could work in clinical settings,” says David. 

“Therapists at the MS patients’ association were already using video games as a way of adding more activity into their mix of traditional therapies. 

“Playing video games, like the Wii Fit and those kinds of things, is great fun for sure, but the problem in people with MS playing a normal videogame is that six months ago you’re getting 1,000 points, three months ago, you’re getting 600 points. Now, you’re getting 200 points. You’re seeing your physical decline reflected in the score of the game. 

“So all those benefits of gaming – engagement, enjoyment, forgetting about your problems for 20 minutes while you’re playing – go out the window. 

“The therapists from the MS patients’ association came to us and said they love the concept of gaming, but these games are made for able-bodied people, who don’t have the physical impairments someone with MS might have. Could you build something specific for us?”

From that conversation came one of the earliest versions of gamified digital rehab technology, which comprised an exergame using a Microsoft Kinect 360 camera where the patient was represented as a virtual ‘stick person’ avatar reaching for targets in order to work on reach, balance and other motor functions. 

A study in 2012 of 20 MS participants who used the exergaming solution for two 30-minute sessions per week for 16 weeks not only showed improvements in the Functional Independence Measure (FIM) scale, static and dynamic balance, but also reduced levels of anxiety and depression.

And seeing the positive impact on the lives of people in this one group made the team realise the potential to replicate this globally, in other neurorehabilitation settings including stroke rehab.  

As advances came in technology and broadband access, with significant progress in widespread use of virtual reality – and its first telehealth project in Russia in 2013 – Virtualware became the first European firm to get CE marking for a VR therapy solution the following year.  

Keen to expand beyond Spain, the UK became the next target destination, with the UCL Queen Square Upper Limb Programme becoming its first adopter. Evolv has now grown its UK presence to the extent is has just opened its first base in London, with further expansion set to come. 

“The UK is a very forward-thinking place and we knew we needed to find a champion for this product,” says David, who took on the role of product manager of the VirtualRehab product. 

“Through a project with UCL, I met some folks from the Institute of Neurology Queen Square who introduced me to Professor Nick Ward, who at that time had just started the Upper Limb Programme. He was very interested in trying out new rehab technology solutions and his team effectively took us under their wing. 

“We’ve been able to ride that wave, if you want to call it that, as they’ve helped us to develop and validate the product. They have been absolutely fantastic, they’re a brilliant team and we really value the relationship we have with them.”

And through working with Professor Ward and his team, alongside other leading names globally, Evolv has developed a suite of products supporting the effective rehabilitation of people worldwide. 

Its EvolvRehab Body and EvolvRehab Hands programmes have been used in 22 countries around the world, and its Evolv RehabKit hardware system played an important role for significant numbers of patients during the pandemic. It has also developed a Falls Prevention programme for senior citizens that was co-designed with clinicians from Mount Sinai Hospital in New York. 

“Working with clinical partners on the development of our technology for stroke was fantastic, because a stroke patient receives multidisciplinary treatment including physiotherapy, occupational therapy, speech and language, and so on. It’s not just one therapist to treat everything and that was really fascinating for us,” says David. 

“It helped us see our goal, how patients could be receiving these different types of therapy at home, outside of a clinical setting, and how we can support that continuum of care from the hospital to home, or hospital to community to home. And that’s what we are now able to do.”

The at-home element, a phenomenon which continues to grow, is hugely important to Evolv’s continued development. 

“We realised telerehab would be key for improving patient outcomes right from the start with the MS group who asked us about using our system at home, and also with our first telerehab project in Russia back in 2013. Because of the distances there, somebody might have to travel six hours for a 45-minute therapy session,” says David. 

“But even though technology has moved on now, it’s the same principle. We know doing high-dose, high-intensity therapeutic activity is effective. And if it can be personalised to each individual, it’s even more effective. And if the therapist can connect remotely with the patient and maintain the contact with them, then it’s even more effective.

“Our RehabKit system is super simple to use, you press a button and you start your rehab. If you have a physical disability or a cognitive disability, you don’t need somebody else to do it.

“We tell patients that with the RehabKit, it’s like we’re giving them the keys to the car. If you want to drive it, you can go for a drive. If you want to leave it in the garage, that’s up to you, but you won’t get any better. 

“We’re helping patients to take control of their own care, so they know they are making a difference to themselves getting better, and that’s great to give them the means to do that.”

  • David Fried is a speaker at the Virtually Successful conference, hosted by Remote Rehab in association with NR Times, held online from January 24 to 28. To sign up at a special NR Times discounted rate, visit here

MND

New AI model helps discover causes of MND

Using the RefMap tool, the number of known risk genes for MND has risen from around 15 to 690

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A new machine learning model has been developed for the discovery of genetic risk factors in diseases such as Motor Neurone Disease (MND) using artificial intelligence (AI).

The tool, named RefMap, has already been used by the research team to discover 690 risk genes for MND, the vast majority of which are new discoveries.

One of the genes highlighted as a new MND gene, called KANK1, has been shown by the team to produce neurotoxicity in human neurons very similar to that observed in the brains of patients. 

Although at an early stage, this discovery has been hailed as potentially a new target for the design of new drugs. It could also pave the way for new targeted therapeutics and genetic testing for MND.

Researchers from the University of Sheffield and the Stanford University School of Medicine have led the research. 

“This new tool will help us to understand and profile the genetic basis of MND,” said Dr Johnathan Cooper-Knock, from the University of Sheffield’s Neuroscience Institute.

“Using this model we have already seen a dramatic increase in the number of risk genes for MND, from approximately 15 to 690.

“Each new risk gene discovered is a potential target for the development of new treatments for MND and could also pave the way for genetic testing for families to work out their risk of disease.”

The 690 genes identified by RefMap led to a five-fold increase in discovered heritability, a measure which describes how much of the disease is due to a variation in genetic factors.

“RefMap identifies risk genes by integrating genetic and epigenetic data. It is a generic tool and we are applying it to more diseases in the lab,” Dr Sai Zhang, instructor of genetics at Stanford University School of Medicine said.

Dr Michael Snyder, professor and chair of the department of genetics at the  Stanford School of Medicine and also the corresponding author of this work, added: “By doing machine learning for genome analysis, we are discovering more hidden genes for human complex diseases such as MND, which will eventually power personalised treatment and intervention.”

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Brain injury

Can VR help with sight problems after brain injury?

The development of new immersive game-based technology could help with visual neglect, researchers believe

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Research is underway to discover the role virtual reality (VR) could play in the rehabilitation of sight after traumatic brain injury. 

TBI can have significant impact on vision, causing impaired visual attention – also known as visual neglect – even when there is no injury to the eye. 

Individuals with visual neglect lose the ability to explore the full extent of their surroundings and have difficulty reading, locating personal belongings, finding their way to destinations, and many other daily activities. 

Visual neglect is caused by disconnected neural networks and has been studied extensively in stroke but remains largely unexplored in other types of brain injury.

Now, Kessler Foundation is embarking on a two-year study, A Virtual Reality (VR) Exercise for Restoring Functional Vision after Head Trauma, to look into how technology can assist. 

The project uses immersive VR technology developed with the armed services and provided by Virtualware, an award-winning VR technology company based in Spain. 

The to-be-developed treatment is an intensive, game-like rehabilitation program leveraging a combination of VR and eye-tracking technologies to implement an oculomotor exercise protocol based on smooth eye pursuit.

Dr Peii Chen, senior research scientist in the Center for Stroke Rehabilitation Research at Kessler Foundation, said: “Our study will fill this knowledge gap by exploring visual neglect in TBI and developing a new treatment modality.”

Smooth eye pursuit exercise is an evidence-based treatment that improves patients’ ability to move their eyes toward the neglected side of space and voluntarily pay attention to the entire workspace relevant to a given task.

This ability is fundamental to spatial explorations that are required in learning, reading, and way finding. 

Dr Peii Chen

Conventionally, smooth eye pursuit exercise for treating visual neglect requires intensive and close supervision from therapists. VR technology combined with eye tracking can reduce therapist burden. 

Research participants will experience a VR session of smooth eye pursuit exercise and share their feedback. 

The study will reveal the feasibility and benefits of applying new technologies to rehabilitative treatment activities.

Research participants will also undergo functional and structural neuroimaging studies of the brain. 

The study outcomes will broaden the understanding of spatial processing and visual cognition as functions of brain connectivity and advance the development of treatments targeting head trauma-related visual dysfunction.

“Knowledge gained from this clinical study will advance patient care by identifying the neural basis of visual neglect due to TBI at rest and during smooth pursuit eye exercise,” said Dr Chen. 

“Reaching our goals will lead to improved visual health and quality of life for civilians, as well as active-duty military and veterans with trauma-related visual dysfunction.”

Dr Chen has been awarded a $376,109 grant from the US Department of Defense, US Army Medical Research & Development Command, Congressionally Directed Medical Research Programs (CDMRP), Vision Research Program.

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Tech

Care provider to develop sector-leading VR training

Newcross Healthcare is sharing its in-house expertise for the benefit of the wider healthcare sector

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A care provider is building on its experience of using virtual reality (VR) for in-house training to create the first programme of its kind for healthcare, which is set to be rolled out across the sector. 

Newcross Healthcare first began to adopt VR around three years ago, but over the past year has upskilled its in-house learning and development team to create its own bespoke content to deliver new and engaging staff training. 

The team has created a number of programmes and ‘virtual shifts’ to enable staff to learn more about the Newcross business and its continuing staff development to deliver the best possible client care. 

Now, Newcross plans to take its expertise in VR to a new level, by expanding into learning and training through the creation of an ‘extended reality’ programme. 

The pioneering new training – which will be a first for the healthcare sector – will enable the recreation of emergency situations, including life-saving first aid, to help staff develop their skills, confidence and ability to remain calm for when confronted with such an event in real life. 

The system – which Newcross hope to deliver within the next six to nine months – will be used in-house initially, but can also be used by clients and other care groups to use VR training to help raise standards and innovation throughout the health and social care sector.

“Our experiences of creating these environments has now enabled us to to define what how we want to use this in a learning environment,” says Mark Story, head of learning and development at Newcross. 

“We want to use technology – it might be VR, immersive, 360 videos, augmented reality – to allow people to experience stress environments so they can get over the initial shock factor and be able to think clearly for when it happens in real life.

“Our focus initially will be on those topics for learning that people might feel shocked by when they first when they first come in or, by their nature, they’re stressful things. 

“If you’re training someone in basic life support or in seizures, for example, you can only really go so far. But by being able to recreate that environment, for if and when it happens to them, they will be more prepared. 

“It also has a role to play in keeping people’s skills fresh and up to date. With something like CPR, you hope that you never have to use it, but this could provide the opportunity to keep the skills at a simmer, as opposed to letting them go cold.

“That will be for internal staff for healthcare staff, nurses and carers, and shortly after that it will be made available for external healthcare professionals. Our ambition is to offer this learning to anybody that wants to access it.

Having invested in the development of its own in-house capability, Newcross is now able to deliver something new for the sector, building on the training currently available and creating a cost-effective new option for the marketplace. 

“There is other training out there, but what we found is that it’s either immersive, so gives a bit of an immersion into the situation, or it’s something that has a simulation and assessment of a physical activity, or it’s something that is kind of broadly virtual reality. 

“There doesn’t seem to be anything in there that brings these three pieces together, which immerses you, assesses you and and keeps you in that virtual reality environment. 

“So we think we can we think we can bring those things together in a new way for for healthcare. 

“What we’re creating isn’t entirely new, and certainly exists in high-end learning activities, like training pilots, for example, or training surgeons. We know these sorts of learning interventions do work but we’re looking to create them for the mass market, to get thousands of people engaged as opposed to a small number. 

“We want it to be democratised, to be cheap enough for us to develop and offer out to anybody who needs it. That’s what we’re working towards.”

 

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