July 24, 2019 | More than 2,000 rehabilitation professionals in a range of disciplines gathered in Toronto, Canada for the fourth biannual RehabWeek 2019. This combined event brought together seven professional organizations including the International Functional Electrical Stimulation Society, the American Congress of Rehabilitation Medicine, Rehabilitation Engineering and Assistive Technology Society of North America, the International Conference on Rehabilitation Robotics, the International Society for Prosthetics and Orthotics, and the International Industry Society in Advanced Rehabilitation Technology. The packed agenda included organization-specific scientific sessions along with combined keynotes, rapid-fire poster presentations, and panel discussions all centered around rehabilitation technology.
David Purtino from the Abilities Research Center at Mount Sinai kicked off the event with a keynote themed around the innovation mindset. Currently, it takes a health technology product an average of 17 years to go from concept to bedside. “We need to train everyone to think like an innovator,” he said. Debbie Backus, president of ACRM, echoed Purtino’s message with a keynote address stressing that technology innovation does not equate to adoption. “Ninety-eight percent of technology never reaches the end user,” she said. “Building partnerships from different stakeholders will bring different views and perspectives.” She presented several examples of technology adoption from other industries as a potential solution for the adoption challenge in rehabilitation technology.
Panels also discussed potential solutions for technology adoption such as training a technology specialist or implementing a model to include clinicians and end-users in the design process. Another panel explored the intersection of implanted neuromodulation, neuroscience, and rehabilitation. Seven panelists from various disciplines explored the commonalities and current state of neuromodulation for Parkinson’s disease, spinal cord injury, and epilepsy. Panelists offered advice about technology and clinical trial design making the case for closed-loop stimulation. Cathy Cavern, a physiatrist at the Toronto Rehabilitation Institute, gave pointed advice for trials: “Publish case reports, think about the user at the end, and look downstream for adverse effects.” Alfonso Fasano, a clinical investigator at the Krembil Research Institute, concurred but added that we need to understand the psychosocial effects of technology adoption.
Attendees came from around the world, particularly Asian countries. Paul Meadows, a seasoned veteran of neuromodulation start-up ventures, highlighted the successes and failures of bringing novel devices from bench to bedside. Yoichi Shimada provided an overview of rehabilitation technology in Japan highlighting Japanese technologies competing with their western counterparts such as the IVES two-channel upper extremity stimulation system or the Wilmo wearable surface stimulation for wrist extension. He also introduced the AKiTA robotic treadmill trainer and the AKiTA FES mobile cycling system—both developed in Japan.
Dingguo Zhang delivered an overview of FES in China and the growth of research in the region. Chinese research literature prior to 2010 accounted for 1,984 publications but from 2010 to 2018 there were 3,331 publications. Research is now focused on combined therapies such as FES and BCI as a closed loop system for upper extremity tactile function or FES and exoskeleton in the prototype of the FEXO. He concluded that we have come full circle in that electrical stimulation and the ancient art of acupuncture is a widely used treatment by Chinese practitioners.
Nur Azah Hamzaid gave a complementary talk about developments in Malaysia, particularly how they are measuring muscle fatigue in various modalities such as cycling or upper extremity exercise. She presented data measuring muscle fatigue using mechanomyography or MMG. Using this technology they are developing predictive strategies for optimum muscle performance in closed-loop electrical stimulation for standing with surface stimulation. They are also exploring this same model as applied to the prevention of pressure sores with electrodes integrated into bedsheets. Zhiyu Sheng from the University of Pittsburgh demonstrated their use of ultrasound as a predictive model for muscle fatigue.
While much of the discussion during the IFESS sessions were centered around using neuromodulation as a tool for rehabilitation, the robotic community from ICORR focused on repetitive motion as an alternative tool. The principle behind therapeutic repetitive motion is to harness the neuroplasticity of the human brain. Rehabilitative robotics now couple with sensory feedback mechanisms or virtual reality for patient engagement. Nitin Sharma of University of Pittsburgh and Yufeng Zhang from Stevens Institute of Technology each presented methods to use sensory feedback for ankle dorsiflexion and plantar flexion. There were also several presentations on the next generation of wearable devices like the soft fabric pneumatic actuators shown by Hye Ju Yoo of Seoul National University or Luca Tiseni of Scuola Superiore Sant’Anna presenting an assistive shoulder exoskeleton that merges soft and rigid technologies.
There were some heated discussions about the nature of pre-clinical testing and trials as a precursor to human translation and identifying mechanisms of action. Particularly for standing and stepping, some argue that there is no comparison between a bipedal creature and a quadrupedal such as a rat or feline. Alternatively, there is a counter argument that the pre-clinical models have provided guidance toward the development of initial human clinical trials. Although there was no settlement between the sides, there is an effort to use more predictive modeling for rehabilitation tools.
Milos Popovic from the University of Toronto was the spark plug to bring this event to Toronto and had a team behind him to implement the concept. RehabWeek has its origins in Europe with Hocoma, a Swiss company, taking the lead to initiate the event several years ago. Look for RehabWeek2021 to take place in Rotterdam, Netherlands.
