28 April 2015
Technology Mooted as Cure for Asia's Array of Rehabilitative Needs
The problems of the growing elderly demographic and the need for increased levels of care could be met through the increased use of robotic aids and high-tech therapeutic systems, according to many attendees as RehabTech Asia 2015.
With some 650 million Asians currently suffering from some form of disability and with ever-increasing life expectancy a challenge for many countries, care and rehabilitation is a pressing need, as well as a growing business sector. For the 4,000-plus healthcare professionals who gathered at the RehabTech Asia 2015 event, the focus was on two key strategies – assistive and rehabilitative technologies and moving care to a community setting.
A leading proponent of robotic technology in rehabilitation is Zurich-based Hocoma. Co-founder and CEO of the company, Dr Gery Colombo, said: "Our first product was based on my PhD thesis and looked to develop a robotic therapy system for spinal cord injury patients. Today, that product is commercially available as Lokomat, a global industry standard, used in more than 60 countries around the world.
"Asia is one-third of our market, and growing, making RehabTech Asia one of the most important events on our calendar. It's the ideal platform to network with key opinion leaders, learn about new technologies and trends, as well as for interacting with our partners in the region.
"Hong Kong is an exceptional market for us and has the highest density of our machines. It is also the index market for China. A few countries in Asia, notably Hong Kong and Singapore, are very open to technology."
Another robotics company attending the show was UK-based Rex Bionics. Debra Leeves, the company's Vice-president for International Sales and Marketing said: "Rex enables disabled patients to transition from a wheelchair, to a standing position, and to walk. This can be either used in a therapeutic setting, or at home, to provide mobility.
"We are in talks with distributors in Europe, New Zealand and Australia. At the moment there is USFDA approval for hospital use, with home use expected soon, so we are entering that market later in the year.
"We're here at RehabTech Asia to source Asian distributors. Singapore approval is expected in Q3 2015. It's a fascinating city in terms of infrastructure and healthcare and we are looking for a hospital here that will act as a reference for the whole of Asia."
Eibo Schwitters, Director of Training and Education Department, Soreha China, was upbeat about the potential for robotics in Asia, saying: "Rehab medicine took off in the West in the 1980s and started in Asia about 10 years ago. There will be significant growth in the number of rehab centres for at least the rest of the decade. There will also be a need for at least 400 robotic machines – 200 for lower limbs, 200 for upper limbs – in China alone."
While therapeutic robotic technology may be advancing apace, opinions in the medical community may be struggling to keep up. Professor Albert Esquenazi, Chairman of MossRehab, based in Pennsylvania in the US, sounded a cautionary note, saying: "There have been massive advances in technology and in robotics in particular. Robotic devices can save a lot of manpower resources and are good at delivering repetitive exercises in a consistent manner. We now know that these kinds of repetitive exercises aid in motor function retraining, among other benefits.
"I see the adoption of robotics, however, as being slowed by the mindset of therapists and, in particular, by the cost factor."
The theme of personnel lagging behind technology was echoed by Dr Christian Jacobi, Director of the Brunei Neurological and Stroke Rehabilitation Centre (BNSRC). He said: "The bottleneck in rehab medicine is the lack of trained specialist personnel. The BNSRC is running trials with telemedicine as one avenue that is meeting with good results.
"We were the first in Southeast Asia to acquire three robotic therapy machines. Not only do we see improvements in motor skills, but also in oxygen consumption, heart rate, muscle activation, cognitive and other brain functions. More studies are, however, required to know what is the best methodology, for example in frequency, duration, and types of treatment for each ailment and patient."
Dr Karen Chua, Senior Consultant, the Rehabilitation Centre at Tan Tock Seng Hospital, Singapore, also believes that robotics can ease the therapeutic load. She said: "Today as many as four physiotherapists may be required to help one patient walk and they're exhausted by the end of the session. Robotic-assisted therapy requires one therapist per machine. In some ways, however, robotics are not better. For example, when it comes to walking velocity or in locomotor training, the current methods should be adhered to. Overall, though, cost will always be a key consideration in the adoption of robotics."
Dr Luh Karunia Wahyuni, President of the Indonesian Physical Medicine and Rehabilitation Association, addressed the situation for frontline caregivers, saying: "In a country as big as Indonesia, there is a huge gap in the quality of healthcare between urban and rural areas, and an overemphasis in Java. Today, we only have 484 rehab specialists, one-quarter of the way to our goal of achieving one specialist for every 20,000 people. Currently, about 300 of them are in Java. There is a need just to get rehab centres established in every province."
The situation is similar in Myanmar, according to Professor Khin Myo Hia, President of the Myanmar Society of Rehabilitation Medicine. Addressing the issue, he said: "There are 99 physiotherapy departments across the country and only 138 rehab specialists, covering only 31 townships, just one-tenth of the total number. For a population of 50 million there is a need for at least 1,000 physiotherapists in the near term. The poor infrastructure of Myanmar and the prohibitive costs of healthcare are among the barriers we have to address."
One strategy designed to meet increasing demand for rehabilitation has been designated as ‘aging in place' or community healthcare. Dr Wong Sweet Fun, Senior Consultant, Geriatric Medicine at the Khoo Teck Phuat Hospital in Singapore, said: "We are faced with an aging population and a rise in chronic illnesses. After gaining insights into the lifestyle and living conditions of our patients, we have implemented various programmes to make it easier for them to live and function within their community. These range from simple measures, such as grab bars and ramps, to motorised mobility devices, to nursing visits.
"Of the 400 patients in the trial, they have dropped from 3.5 hospital admissions per six months, to just 1.2 admissions."
Sarah Yong, Manager at the Serving People with Disability (SPD) non-profit group in Singapore, believes that the sector needs to shift focus. She said: "Technology should fit the client; not the client fit the technology. Assistive technology does not need to be high-tech. Among the tools we provide are simple devices, such as screen magnifiers, bigger or colour-coded keyboards, as well as custom input devices.
"We're providing more powered mobility devices, as more and more people live longer. They can still walk, but not very far, so such devices are vital to help them in their daily lives, just to get to the market, for example. Such assistive technology is becoming more mainstream and more affordable."
RehabTech Asia 2015 was held at the Singapore Expo Convention and Exhibition Centre from 26-28 March. Some 4,000 visitors attended the event, which included more than 150 healthcare exhibitors showcasing the latest technology and techniques for rehabilitation, daily living, homecare and nursing.
Ronald Hee, Special Correspondent, Singapore