Game changing neuro-rehab opportunities are emerging as a result of the coronavirus crisis, argues health and social care investment expert Boda Gallon.
The Impact of the Covid-19 pandemic has been multi layered. Yes, we’re faced with a fragmented health and social care system, continued uncertainty, and a gloomy economic outlook. There are, however, positive opportunities for investment and service redesign within NR and the wider specialist healthcare marketplace.
Increased investment interest for this most resilient of sectors, combined with a clearly identified need for positive change, should drive the creativity needed to embrace opportunities and deliver the much needed integration, improved productivity and efficiency of services across health and social care.
This positive outlook, however, still comes with a need to understand changes in our behaviour, to embrace change, to break down cultural barriers and focus on opportunity planning.
All of which is much easier said than done. A key lesson that has been brought home to us during the Covid-19 pandemic is that heroes are people. Ordinary, but extraordinary, people.
Once we get past fighting fires and lockdown fever most experts agree that things will never be the same. The key reason for this can be found in our primal brain and how we act and continue to live under a state of fear.
The neuroscientific term for this is “a somatic marker,” as coined by Antonio Damasio. I believe that Covid-19 is a negative somatic marker that we’ve
all had installed in our brains over the past several months and is likely to have a powerful, lasting impact on how we behave, but also a positive impact on the aspects of the cultural changes required for the health and social care marketplace to develop.
Change needs to go deeper, and Covid-19, as our generation’s negative somatic marker, is probably the best reason to change we will ever witness.
Covid-19 could also finally be the catalyst for the political will required to drive the full integration and parity between health and social care. It is no real surprise to find the recent disclosure of Camilla Cavendish’s plans that social care could be brought under the control of the NHS to honour Boris Johnson’s pledge to “fix the crisis in social care”.
This will also present opportunities and require new ways of working for people, but this will ultimately drive better and more seamless service experiences for all our patients, clients, residents, customers and consumers.
We are going to find ourselves in an entirely new online environment, with an entire generation of consumers and service commissioners expecting to interact via screens and having the aspiration and confidence of services being delivered in a ‘Covid-19 free’ environment.
This new virtual hybrid world will need to be delivered with empathy to help everyone overcome the negative Covid-19 somatic marker and still meet the basic human needs for relationships, touch and social interaction.
The perceived threat of Covid-19 does not mean that new services cannot be launched or repositioned. The opportunity is to develop more flexible services able to meet all the new behavioural, political, and environmental drivers of the ‘Covid-19 game changer’.
Providers and their people need to respond to this opportunity and reposition from fighting fires and coping around how things have always been, to repositioning ahead of the curve and innovating services towards what will be a new normal.
To date the adoption of digital technology to help improve productivity and efficiency across the system has often faced multiple cultural barriers, with people often sabotaging initiatives as they either feel their role, profession or revenue streams are threatened.
Covid-19 has forced everyone to look at the current barriers in a virtual way and employ different ways of working. Hopefully, this perceived threat now presents a clear opportunity for providers and professionals to deliver complimentary and long-term hybrid solutions for their clients and staff teams that embrace the best of digital and face to face interventions, training and support.
The delivery of community rehab has always faced productivity and efficiency challenges relating to logistics and the supply of and access to suitably skilled professionals, especially in more rural and harder to reach communities.
The proposed long-term somatic marker of Covid-19 now requires services and providers to be nimble to create longer term holistic solutions of their own, coordinating the much- fragmented array of technology options.
There is a need to embrace AR/VR/AI/IOT and to learn from and adopt best practice solutions from the UK and abroad to ensure much-needed efficiency, productivity and value are provided at the same time.
The positive outcome of this burgeoning digital transformation, like Covid-19, is also multi layered.
Offering a renewed focus on flexible working, employee support, management and an array of ‘wellbeing’ opportunities for staff recruitment and retention.
This digital transformation is most keenly required to help support and shape the future of various healthcare settings.
Existing commissioning and strategic planning intentions were already focused on provision away from hospitals and more institutional environments towards community settings with more holistic and social models of care.
The impact of Covid-19 will now hopefully see this process accelerated.
Although the wider roll-out of Covid-19 testing and potential vaccines is critical, providers need to review how the design and operation of care homes can be focused on delivering a ‘Covid-19 free’ moniker.
Enlightened providers need to ensure that cross infection mitigation and the flow of people, process and supplies are given an increased priority. The ability to offer digital triage and re-establish a more effective working relationship with GPs and primary care is essential to plan both avoidable admissions to and discharges from hospital and to provide the level of clinical support that has so often been missing during this pandemic.
Repositioning care homes from what has been perceived as the riskiest place for people to be towards being the safest environment possible has to be a clear goal; as well as a PR opportunity.
A focus on delivering flexible and safe space within residential services is essential to provide for increased independence, community and family integration and improved social inclusion.
New building designs in development need to respond to this now, and existing services will need to take a more strategic review of their estate for the medium and longer terms.
New models of care already seeking to deliver coordinated pathways from hospital to home, need the potential integration of health and social care to truly flourish and develop, but the vision must not stop there.
The extended integration and creative use of housing options is essential along with digital transformation to maximise potential clinical and financial outcomes and deliver the best quality of life for people. There is a lot to be learned from each other.
Previously fragmented sectors need to look vertically up and down patient pathways and supply chains, flex their services, upskill and share staff, embrace elements of isolated good practice and design into their own facilities and services.
Embrace the somatic change
To maximise value together, disruptive innovation driven by Covid-19 needs to be embraced. The independent sector can fully support NHS strategy by complimenting the NHS and building on the many successful collaborative partnerships developed during this pandemic.
Significant public goodwill and the potential political momentum to finally drive health and social care integration can now be leveraged to force past the multiple barriers to change.
Opportunity exists for game changers willing to take advantage of keen investor interest for a market that has proven to be the most resilient in the face of a global pandemic.
This inward investment into our sector can only be a further benefit forcing much needed change, new competition and opportunity to drive service innovation.
Ultimately and most importantly this will deliver better impacts and outcomes for service users, their families, and our colleagues.
We cannot afford to stand still and need to respond to the wider behavioural impacts of Covid-19 to reposition services, partnerships and networks to ensure new models of care and rehabilitation are (re)designed and delivered in more flexible and digital enabled environments.
This will ensure that proactive providers can truly respond to the future needs of customers, service commissioners and an emerging new normal to deliver even stronger, sustainable business models.
Proactive and future proofed business models are what any Investor from owner operators, to specialist private equity and bank funders will be looking to support and develop.
Hopefully, this article will help stimulate some debate and more ideas so we can share best practice and experience together.
Robot with ‘potential to redefine neurorehab’ unveiled by Fourier
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 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.”
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.
“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.”
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
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.
“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.
Sexual trauma ‘could lead to neurological conditions’
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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