The brain injury technology University College London has been working on for eight years looks decidedly unremarkable.
Barely noticeable in the neonatal skyline of equipment is a trolley housing a laptop and what looks like a projector.
Yet the data it offers clinicians could accelerate improved care for brain injured babies in their crucial first few days. Currently, when babies suffer brain injury at or soon after birth due to lack of oxygen to the brain, doctors must wait several days until the newborn is stable enough for an MRI scan. Only then, usually at least four days after the birth, can they detect and assess the injury.
In these days before the MRI, there is poor visibility on whether treatments are working or how severe the injury may be.
But a new device, which has now passed a feasibility test involving over 50 babies with hypoxic-ischemic encephalopathy, could close this window of missed opportunity.
Dr Ilias Tachtsidis, biomedical engineer and team leader on the project, explains: “We wanted to know, from day one, what is happening to the biochemistry of the brain tissue in these babies. EEG shows how well the brain is doing in terms of the neuronal activity but it doesn’t show anything about how well the brain is getting oxygen or using it to produce energy.
“The other instrument at the doctors’ disposal is the MRI, but it is very difficult to take a sick, one-day-old baby for an MRI scan. The challenge was to develop a device that we can use immediately after the baby is born to inform the clinical team about the brain health of that baby.”
UCL engineers, doctors and scientists have combined forces in overcoming this challenge since 2010 – supported by funds from the Welcome Trust and access to UCL Hospital. The product of their endeavours is a seemingly transformative piece of cotside kit for neonatal intensive care wards.
Its magic is made possible through a technology that started life in the late seventies and has since emerged as a game- changer in internal body monitoring. Broadband near-infrared spectroscopy uses light with wavelengths just beyond the red end of the rainbow and is invisible to the eye. This near infrared light can travel far into the body – even through bone – while other colours with shorter wavelengths are absorbed and don’t pass through.
Light can reveal changing oxygen levels in the blood pumping through arteries and veins. Certain molecules in the brain, such as oxygen-carrying chemicals in the blood and cytochrome c oxidase in mitochondria, change colour depending on their activity and oxygen levels.
Different colour molecules absorb and reflect different colours of light, so by measuring the colours of the light passing through the brain, it is possible to work out the volume and activity of these molecules.
This data shows doctors which areas of the brain are working properly or have been damaged due to a lack of oxygen.
In the device, near-infrared light travels down optical fibres and is shone on the baby’s head. Some of it passes through the skull and brain and comes back to the surface.
This returning light is picked up by another optical fibre and travels to a spectrometer, which measures the relative amounts of different coloured light in the beams.
The light is then split into a spectrum of its constituent colours, using a prism or ‘diffraction grating’. Then a camera detects the amounts of each colour of light.
Finally, a computer calculates changes in the way certain parts of the brain are using oxygen and generating energy, giving a readout of brain metabolism and activity.
Tachtsidis says: “Our feasibility study has shown that the measurements can identify and classify newborn babies from day one; which ones are going to have a severe brain injury? Which will have severe or mild neuro- development issues?
“Our technology has shown a very high specificity in terms of classifying where the babies are going to be at two years old and five years old, for example. Are they going to have neurodevelopment issues, cerebral palsy or cognitive issues? We can identify this in babies from day one.”
Given that the device is cheap, cotside, non- invasive and harmless, industry parties are understandably circling; and Tachtsidis is hopeful of an eventual mainstream roll-out. It could take several years, however.
“Launching a medical device is a long process that requires a lot of regulation. We’ve had quite a few phone calls asking about
the device from various industry players, especially those interested in intensive care. I am hoping, with the help of UCL, we can manage to disseminate the value of this technology to the industry and get closer to a widely-available device.”
Next on UCL’s immediate agenda is figuring out how the data generated by the technology can influence better outcomes for brain injured newborns.
“We have a long way to go,” he says. “We still have to test how we can use this technology to manage treatment. We now have technology that, very early on, can prognosticate the impact of the brain injury on the baby.”
According to the National Neonatal Database, around three in 1,000 babies born in England suffer brain injury at or soon after birth, due to lack of oxygen during delivery. In the US, this figure is estimated at between one and six. More than half of affected newborns will develop disabilities, while one in 10 dies.
The risk is higher in babies born before 37 weeks, where up to 26 in 1,000 babies are affected. The standard approach in hospitals is to cool the baby’s body temperature to slow their metabolic processes.
Often, babies are placed on a water-filled cooling blanket and monitored over several days. An IV may help to further reduce body temperature. According to one prominent expert in the field, Dr. Inder of Washington University School of Medicine, “neonatal therapeutic hypothermia can reduce the chance of severe brain injury by 25 per cent in term-born babies with poor transition or low Apgar scores after birth”.
Since the treatment is not effective in every baby, however, Tachtsidis believes the new light technology could save time by quickly identifying which newborns are not benefitting from it.
“The clinical team needs to know very early on if this is not working for the infants to decide what else they can do about [the injury]. They need a measurement that enables this.”
There are various hurdles to get through before UCL’s technology is commercially available to hospital management. “Clearly we are looking at how we can disseminate our work and roll it out to more hospitals.
“We also need to build a demonstrator unit and, once we have that, we can move towards a clinical trial. There may also be some education required in terms of helping clinicians to understand the data and act on it.”
If UCL’s bright minds can prove to the world that their creation is a worthy addition to the hospital cotside, it could be a revelation in brain injury care.
The impact of a brain injury at birth due to decreased oxygen (hypoxia) and blood flow (ischemia) can lead to intensive, life-long care needs. Speeding up the immediate response time to unfolding events in the brain might change the life trajectory of newborns.
In the UK, the healthcare sector’s approach to baby brain injury risk has been a contentious issue in recent years. In some quarters, the drive for natural births has been blamed for a seeming rise in maternity ward injuries.
Last year the Royal College of Midwives formally announced it had discontinued its 12-year campaign for normal births without medical intervention.
Meanwhile, a 2017 study by the Royal College of Obstetricians and Gynaecologists suggests that most baby brain injuries in labour are avoidable.
It analysed 1,136 stillbirths, neonatal deaths and brain injuries on UK maternity wards in 2015. Three quarters of the babies – 854 of which suffered a brain injury – might have had a different outcome if they had received different care, researchers said.
While baby brain injury is a medical issue that can have a profound effect on families, their financial impact is also under scrutiny.
A report by NHS Resolution last year showed that compensation claims for new-borns with brain injuries or cerebral palsy soared 23 per cent in 2016/17 to 232. Their collective claim value was £1.9bn. It is predicted that the per- child claim value could soon hit £20m, NHS Resolution said.
For all concerned – families, the NHS, neonatal professionals and, of course, the tiny patients who will enter the world fighting for survival – much is riding on the success of UCL’s promising project.
Find out more at www.metabolight.org
GripAble praised by MP
Stephen Hammond MP hails its innovation and “extraordinary” success to date and potential
The progress of GripAble has been hailed as “extraordinary” by its local MP, who praised its innovation and ongoing progress in transforming neurorehab and wider healthcare.
GripAble, the UK technology company digitising upper limb rehabilitation from hospital to home, welcomed Stephen Hammond, MP for Wimbledon, to its international sales and distribution centre.
Mr Hammond visited GripAble’s office in Wimbledon to learn how private equity investment has helped it to scale its industry-leading data platform and therapy services and expand GripAble into Europe and the US, as well as how an international company has successfully stemmed from the local business community.
During his visit, the MP met the GripAble team and listened to a presentation by GripAble co-founder and CEO Dr Paul Rinne, who shared the background to GripAble and its growth story to date, as well as plans and ambitions for the future.
Prior to becoming an MP, Stephen Hammond worked for a leading fund management company and multiple investment banks, so was particularly interested in the funding GripAble has received to date, including the recent close of its $11m funding round.
With more than 8,000 individuals having already used the platform, GripAble has established itself as a leading technology in the remote-rehab space in the UK, recording 100,000 activity sessions and 27 million movement repetitions across its users.
Stephen Hammond MP said: “GripAble proves that innovative companies of the future that are building products that will transform healthcare can be based anywhere, but I’m particularly proud that GripAble has started out in Wimbledon.
“It’s been wonderful to see the development of the company over the last two years since first meeting Paul, and I’m sure the developments over the next three years will be equally extraordinary, particularly with the backing of private equity investment.”
Dr Rinne said: “Today’s visit was a fantastic opportunity for us to showcase GripAble’s story and vision to a Member of Parliament and explain how private equity investment can help UK-based entrepreneurs take ideas from seed stage through to global scaling, and compete on the international stage.
“The investment we have received will accelerate GripAble’s journey to delivering end-to-end patient rehabilitation and connecting millions to their own personal home-based clinic.
“With the backing of investors such as IP Group and Parkwalk, we will benefit from a wealth of insight and experience that will support us in growing our platform in the US and expanding our clinical and commercial evidence base.
“It is great to be able to work with such supportive investors that make our lives so much easier.”
Cognetivity tech could revolutionise concussion detection
Having established itself in early-stage dementia, CognICA is now being used in a new concussion in sport study
A new study into concussion in sport will use the pioneering cognitive testing platform developed by Cognetivity to identify changes in brain health through repeated head impacts.
The research will see Cognetivity partner with Durham University and sports tech firm My Sports Wellbeing to look at concussions at all levels of sport, from high performance to community level.
Data will be collected through the CognICA platform, the groundbreaking AI technology developed by Cognetivity which has helped to revolutionise early-stage dementia testing and is now moving into new applications for its use, including concussion.
Professor Karen Hind from Durham University and her team will use the tool to detect concussion and investigate changes in relation to repeated sub concussions.
The goal of the study is to investigate the CognICA tool’s effectiveness in identifying changes in cognitive health due to concussion and repeated head impacts.
Up to 3.8million athletes sustain concussions annually, with statistics showing that between 56 and 89 per cent of concussions are missed or misdiagnosed, which often leads to the mismanagement of patients who are affected.
Through the use of the CognICA platform, which has proven its efficacy in dementia and its ability to detect small changes in cognition, Cognetivity believes it can have a key role to play in concussion and enable better outcomes for athletes of all levels.
“We are excited to work with Durham University and My Sports Wellbeing to understand more about the cognitive impact of concussions in sports and how CognICA can contribute to timely diagnosis and therefore better treatment and management of this serious global issue,” said Dr Sina Habibi, co-founder and CEO of Cognetivity.
“Improving assessment, treatments and care to elevate the overall lives of patients with brain injuries and cognitive impairments is a top priority at Cognetivity and we are hopeful that the study will yield important results to help us achieve that goal.”
Prof Hind is a prominent name in athlete health and wellbeing, and led the first independent study into the health of retired professional rugby players.
“We’re very excited to be working on this study. Cognetivity’s unique technology represents a promising way to assess cognitive health in athletes at risk of concussion, post concussion and in relation to sub-concussions,” she said.
“This study is part of our overall programme of research through which we seek to investigate and provide strategies to improve athlete health and welfare.”
MotusAcademy launches to advance rehab tech globally
MotusAcademy will advance knowledge sharing around rehab and assistive technologies, with plans already in place to expand on a global scale
The pioneering MotusAcademy has been formally launched to advance knowledge sharing of rehabilitative and assistive technologies, with plans already in place to expand further on a global scale.
The platform is dedicated to promoting continuing development and education in rehabilitation robotics, bringing together leaders in their field internationally for the advancement of the sector.
MotusAcademy, based in Zurich, Switzerland, has partnered with the International Industry Society of Advanced Rehabilitation Technology (IISART); the MINT Academy, created by Hobbs Rehabilitation in the UK; and the European Center of Neurosciences in Spain.
Now set to advance its ambitions further, MotusAcademy will establish its Asia Pacific Hub in Singapore by June 2022, with hubs also planned for North America, South America, the Middle East and Africa.
The platform offers educational resources which are freely available for the advancement of rehabilitative and assistive technology, supported by a minimum of four educational seminars held every year by each of the hubs.
MotusAcademy will also launch an official publication, the Journal of Rehabilitation Methods and Technologies (JRMT), which aims to be the leading journal to focus on emerging rehabilitative and assistive methods and technologies.
To mark its official launch, founding members attended a virtual event to celebrate the occasion.
The event featured leading names in rehab tech globally, including newly-elected MotusAcademy President, Professor Robert Riener, director of the Sensory-Motor-Systems Lab at ETH Zürich; Vice President, Professor Jose Pons, director of the Legs+Walking Lab at Shirley Ryan AbilityLab; and Zen Koh, incoming President of IISART and Co-Founder of Fourier Intelligence.
The scientific advisory board for MotusAcademy is represented by members of the GReAT network.
“The creation and formal launch of MotusAcademy marks a significant step forward in the fast-growing area of rehabilitative and assistive technologies, uniting global partners who share a vision to work together to improve lives of patients around the world,” says Professor Riener.
“As we create new hubs in more international locations, we will expand and grow knowledge and promote education even further.
“This is a global mission and we want to work as widely as possible. We look forward to collaborating with like-minded partners to jointly promote the advancement of this field.”
Zen Koh says: “Education is central to the development of rehabilitation robotics, and through MotusAcademy, we are dedicated to promoting this across the world, to people in a range of professions at all stages of their careers – whether they are engineering students or medical professionals, continued development is crucial to achieving the full potential of this sector.
“Collaboration is how we can collectively achieve success, and ultimately deliver the best possible outcomes for patients, so we are very pleased to be able to share MotusAcademy and its resources with the world.
“By working together, we can deliver positive change and realise what we can achieve in advanced rehabilitation robotics.”
More details on MotusAcademy can be found at www.motusacademy.org
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