The Smart Magazine About Medical Technology Innovations
New Horizons in Reduced Mobility
In this issue, we explore the new horizons broadened for people with reduced mobility thanks to innovative equipment that is becoming increasingly diverse and user-friendly. First-hand experiences of living with reduced mobility are resulting in pioneering products arriving on the market.
You’ll also read about the lack of surgical services in the world’s poorest regions and the use of artificial intelligence in gene therapy. And for those interested in Arab Health 2018, get a taste of some of the most innovative products presented at the fair.
Today, technology lies at the heart of equipment for adaptive sports, or parasports. As such equipment becomes increasingly diverse and user-friendly, the opportunities for people with reduced mobility to cultivate hobbies and practice both recreational and competitive sports are multiplying, fostering a more...
First-hand experiences of living with reduced mobility are resulting in pioneering products arriving on the market, such as the believed-to-be world’s lightest wheelchair Panthera X and the versatile M+D crutches.
Jalle Jungnell, founder and chief designer at Swedish wheelchair producer Panthera, came up with his groundbreaking, extreme light-weight model after breaking his spine in a motorcycle accident. Similarly, Max Younger, co-founder of US-basedMobility+Designed, conceived his flagship product, the M+D Crutch, after seeing the pain his father, Dan, an above the knee amputee, was suffering.
“Max always felt the standard design for crutches was a suboptimal solution that caused unnecessary pain,” explained Liliana Younger, chief brand officer and co-founder of the company. “It became his mission to come up with a better solution. “Seeing what Dan was going through enabled him to deliver a radically improved, end-user experience of decreased pain to hands and wrists, which can be caused by other types of crutches.”
Every Gram Matters
Former motorcycle racer and go-kart champion Jungnell went on to become a Paralympian, representing Sweden in basketball, and winning medals in curling at the Turin 2006 and Vancouver 2010 Paralympic Winter Games.
“When I had my accident in 1976 and became a wheelchair user myself, I basically switched overnight from rebuilding my motorcycle frames to building my own wheelchairs,” he said.
“In racing, I was living 24/7 with the philosophy that any extra gram you could reduce would increase your performance, and therefore your speed. I translated that into engineering, right from the first chair I built. Starting with basketball and other sports, but even more importantly, an active life, I also got a good idea what I wanted from a chair.”
Jalle Jungnell (left), founder and chief designer at Swedish wheelchair producer Panthera (Courtesy of MAGNUS BERGSTRÖM)
Believed to be the world’s lightest wheelchair, Panthera X is made from carbon fibre, chromoly and aluminium—and weighs in at just 2.1kg, explained Nils Sallnäs, managing director of the company. “Research began in 2005 and the product was ready to go to market in 2010. Now we construct, produce and sell rigid-frame, active wheelchairs for all ages.”
Panthera X has a carbon fibre chassis and backrest frame. By positioning the fibres in a certain direction, the team discovered they could further increase strength. There is a built-in rear axle and four positions for balancing the chair. Height and the angle of the backrest are adjustable; the height of the footrest can also be changed. The lightness and rigidity of the chassis make it easy to drive and lift into a car.
“Now we have the Panthera X and the result is 2.1kg.”
“Using the most extreme material and methods, and even developing new production methods, are things that have not been done before in our industry,” Jungnell said. “We set out to have a goal, which would not only impress the market but would impress ourselves if we succeeded – this totally unrealistic goal was a transport weight of 2kg.
Jungnell said he has fulfilled a dream. “Now we have the Panthera X and the result is 2.1kg. Being almost there, I still have to say that I’m very glad my obsession for weight has got us so close to the ultimate active chair.”
Walks of Life
Product development is also ongoing at Mobility Designed, where the first production batch of the M+D Crutch was released just over a year ago. Besides coming in a pair, the crutches can also be used individually as walking sticks, are as they are designed to fit either the left or right hand. The strain to the hand that typical canes can cause is relieved.
“Dan has always been our guinea pig,” Mrs. Younger admitted. “From day one, we have given him prototypes to test. As development progressed, we took them to a broader sample for more qualitative feedback.”
Dan Younger trying the M+D Crutches (Courtesy of Mobility+Designed)
The aim with the M+D Crutch is to enhance mobility and versatility, while reducing pain, particularly under the arms. Innovative features of the size-adjustable product include a hinged arm cradle, which can be molded to different sizes and offers enhanced motion, allowing the user to reach for objects, without removing the crutch.
“Mobility is such a central part of everyday life and when you are fully able you take it for granted.”
There are also flexible, quick-release armbands—made from an antimicrobial, hypoallergenic foam—which make strapping on and off easier, while simultaneously providing high levels of support. Ergonomic grips can rotate, permitting the use of hands for other purposes and rubber feet are shock absorbing, offering a strong grip, even on ice.
“The larger pieces of the crutch are made from nylon filled with long strands of glass,” Mrs. Younger explained. “This makes them strong and gives additional spring.”
Some 1,000 crutches have already been shipped across the U.S., as well as to Canada and Mexico. They will also soon be available in Europe. “Our aim now is to continue to listen to our users so we can focus on streamlining and making the crutches even more versatile,” she said. “Mobility is such a central part of everyday life and when you are fully able you take it for granted. If we can improve someone’s mobility even in a small way then we are very satisfied.”
Hélène Le Hors is a pediatric surgeon at Marseille’s Saint Joseph Hospital and president of HumaniTerra, a humanitarian NGO created 20 years ago to remedy the lack of surgical services in the world’s poorest regions. One of her missions is to operate on children aboard a hospital ship in Bangladesh.
Artificial intelligence could revolutionize gene therapy and precision medicine, making individualized treatment protocols the norm.
When research began on the human genome in the early 1990s, many doctors anticipated an age of precision medicine (PM), with patients taking highly customized drugs targeting the specific genetic drivers of their disease or condition. Today, as artificial intelligence (AI) and machine learning (ML) play a greater role in gene therapy, one-size-fits-all medicine is on the way out.
After years of setbacks, gene therapy is now generating headlines for all the right reasons. In March 2017, it was announced that a French teenager had been cured of sickle-cell disease after receiving gene therapy in 2015. Last year also saw the US Food and Drug Administration approve the first gene therapies for treating forms of leukemia and lymphoma, as well as retinal dystrophy, an inherited disease.
Artificial intelligence can help by boosting the precision of the editing process.
None of these therapies, based on now-outdated technology, benefited from AI in their development. Yet the rapidly increasing amount of genomic data being generated and shared underpins the demand for genetic treatments that are ever more efficient, stable and sophisticated. AI lies at the heart of this progression.
“Developing PM technologies such as gene therapy are driving the pharmaceutical industry toward drugs for ever narrower patient populations,” says Claes Gustafsson, co-founder and chief commercial officer at ATUM, a California-based bioengineering service organization which applies machine learning to gene synthesis. “Finding the intersect between the right drug and the right patient population is increasingly demanding AI.”
AI in Practice
Developments in “gene editing” mean scientists are now altering the DNA of living patients, offering unprecedented opportunities in genomic medicine. Yet editing DNA safely and accurately can be a tricky business. AI can help by boosting the precision of the editing process.
Using data derived from global gene expression studies and epigenetic experiments, Edinburgh-based gene control expert Synpromics uses ML algorithms to predict which genomic sequences are involved in cell type-specific regulation of gene expression. This has driven development of the company’s PromPT platform, which enables the design of “synthetic promoters” to regulate gene activity and precisely control protein production.
The revolutionary genome editing method, CRISPR-Cas9, generates questions.
ATUM, the largest US-based provider of synthetic genes for industrial and academic use, has employed AI/ML to develop its Leap-In transposase technology, which enables any recombinant DNA sequence to behave as a transposon. A transposon is a DNA sequence that can change its position within a genome, creating or reversing mutations and altering the cell’s genetic identity and genomic size. The company recently used ML-based engineering to make a frog transposon 300 times more efficient at introducing genes into mammalian cells.
“The algorithms just look at the data to find patterns.”
One of the most promising recent technological breakthroughs in genomic medicine is the development of CRISPR-Cas9 gene editing, which uses the Cas9 enzyme and a piece of RNA to mutate DNA. A dozen or so CRISPR-Cas9 trials are underway or planned, most led by Chinese researchers to combat various forms of cancer.
To boost accuracy in CRISPR editing, Microsoft’s new Elevation project uses genomic data and AI to predict where best to edit a strand of DNA to alleviate side effects and speed up the editing process. Elevation and a complementary tool for predicting on-target effects called Azimuth have been made publicly available for free.
Understanding the human genome and leveraging that understanding in genomic medicine are tasks requiring superhuman analytical ability. In this respect, AI is a game changer. “Given the scale of genomics data being generated, we are already at the point where computers are replacing human observers,” says Dr. Michael Roberts, founder and chief scientific officer at Synpromics.
With the human genotype and phenotype related through myriad biophysical processes and interactions, most of which are not fully understood, the challenges facing those involved in gene therapy are steep.
“The fact that these processes and interactions are so poorly understood is exactly why AI is so powerful,” says ATUM’s Gustafsson. “It doesn’t rely on ‘understanding’ how all the pieces fit together. The algorithms just look at the data to find patterns.”
The UAE’s healthcare market will experience 60% growth by 2021, and exceed 28 billion US dollars by this time according to MENA Research Partners. Thirty-five Finnish companies revealed the latest in healthcare technology at the Arab Health exhibition from January 29th to February 1st in Dubai. A leading developer of cutting-edge health technology solutions, Finland is among the top three strongest health technology economies in the world.
This year, rehabilitation solutions and preventive healthcare were Finland’s key focus areas at the conference. Meria Heikelä, Director of Health for Business Finland said: “Our vision is to move from the concept of ‘sick care’ towards keeping people healthy through ‘wellness care’. We have world-class research and innovative technology to support this. We want to improve healthcare through the use of digitization so that we can, for example, use rehabilitation solutions and preventive healthcare more optimally in the field of elderly care through virtual care.”
To improve the rehabilitation of the elderly, several Finnish healthcare technology companies have been grouped together under the DigiRehab consortium. The DigiRehab consortium plays an important role in ACTIVAGE, the EU Horizon’s 2020 flagship project that envisions building the first European IoT ecosystem across nine deployment sites (DS) in seven European countries for optimal elderly care.
Products Designed for the Elderly
SE Innovations Oy is part of the DigiRehab consortium and the Finnish DS deployment leader of the ACTIVAGE project. The company develops products such as apps, back-end cloud with big data and data mining as well as wristbands with sensors and other wearables. Their products, namely SENIORSome and SENEScreen, are designed for the elderly, especially patients with dementia or disabilities.
“Our vision is to move from the concept of sick care towards keeping people healthy through wellness care.”
Rauno Saarnio, Chairman and Partner of SE Innovations Oy said: “Several markets are fragmented in that they offer a variety of single healthcare services. We created DigiRehab consortium so that we could better serve hospitals by integrating services for elderly care such as exergaming, physiotherapy and memory tests. Through ACTIVAGE, we will define IoT protocol ecosystems that combine communications and secure connective technology that will be compliant throughout Europe.”
Here are a few products representing the best in Finnish innovation:
Optomed Oy works towards the enhancement of eye care around the world. They focus on the screening of diabetic retinopathy, glaucoma and AMD (age-related macular degeneration). They’ve come up with a pioneering hand-held fundus camera, the Optomed Aurora, that enables eye surface imaging and displays superior image quality. An ideal tool for helping diagnose diabetic retinopathy, its light weight allows fundus screening to be performed anywhere, in contrast with traditional desktop cameras.
The MediracerNCS is a user-friendly solution to diagnose immediate peripheral neuropathies (Courtesy to Mediracer)
Peripheral nerve disorders can be a nuisance when patients have to deal with tingling sensations, numbness or even pain. The MediracerNCS is a user-friendly solution developed by Mediracer to diagnose immediate peripheral neuropathies such as ulnar nerve entrapment at the elbow (UNE) or carpal tunnel syndrome (CTS).
Finland is among the top three strongest health technology economies in the world.
It is also used to monitor diabetic peripheral neuropathy (DPN) that develops over time. Vital components of the system are the MediracerNCS device, disposable electrodes, analysis software and a secure encrypted cloud.
Sooma Oy is a medical device manufacturer that focuses on treating depression by developing neuromodulation technology. The Sooma tDCS is a small, lightweight and non-invasive device that is a good alternative treatment of depression for those who cannot tolerate antidepressants or are pregnant or breastfeeding. The device uses a weak electric current of 2mA for a session of 30 minutes. Treatment is given once a day for five days in three-week cycles.
The head cap comes in various sizes which helps ensure that the electrodes, once inserted into sponge pouches filled with saline, are placed correctly on the dorsolateral prefrontal cortex—the region of the brain that studies show is affected by depression.
Sharecare is a health and wellness engagement smartphoneapp that helps patients manage their health information and habits, find their perfect doctor and even take a RealAge test. The goal? To create a secure place for patients to feel in control of their health and to connect with their doctors. Learn more in our interview with Jeff Arnold, CEO of Sharecare.
ME e-mag: How does Sharecare work?
Jeff Arnold: If Uber can put together a passenger-to-driver app, Sharecare can connect patients to doctors. The majority of people experience health problems away from their doctor. Sharecare aims to create more [interaction] between doctor and patient.
Through our program, people improve their health literacy and become more aware of their real age. When they enter the program, they’re given advice on how to navigate the healthcare system. They document their information in real time—when they take their medication, what their symptoms are. That’s given to the doctor on the spot, through the app.
It includes self-reported data, device-derived data and medical records, as well as lifestyle and regional data. Sharecare employs 750 nurses who connect with Sharecare members through a chatbot. We’re able to connect with them all day long. A lot of hospitals in the U.S. have invested in Sharecare, and doctors can prescribe the app to patients. Data from other platforms, like Facebook and Twitter, are integrated into the Sharecare app to help analyze social information on health situations.
If Uber can put together a passenger-to-driver app, Sharecare can connect patients to doctors (Courtesy of Sharecare)
ME e-mag: Can you tell us how Sharecare began?
Jeff Arnold: In 1998, I started WebMD. It’s a healthcare company that provides consumers, health institutions and physicians with medical information through the internet. It became the largest health portal in the world, with around 100 million people visiting the site per month. Our tag line at that time was, “Now health has a home page.”
“How do you have one platform where all your health information is in one place?”
Ten years later, [Sharecare President] Dawn Whaley and I met Doctor Oz and Oprah Winfrey. Together we brainstormed on how we might do WebMD over a decade later. We noted that nearly everyone has a smartphone with several applications. So we asked ourselves how everything could be grouped together into one app. How do you have one platform where all your health information is in one place? How do you organize all your wellness needs, your illnesses, your life values?
In 2010, we built Sharecare on behalf of the consumer. We make the person the middle point, the one who owns the data. Sharecare could then bridge together the person and professionals—insurance agents, physicians, nurses.
ME e-mag: To what extent has the system expanded?
Jeff Arnold: We’re already rather large in the United States, especially in Hawaii, where the whole state is involved. We currently have three international joint ventures which will take off next year in France, Brazil and Australia. We’ve already had 45 million people take our RealAge test on Sharecare. Our network of doctors has grown to 35,000. We see this as a global platform and hope to be in many countries by 2019.