Neuro rehab using Virtual Reality
From Germany to Australia with Intensive Care
Giving Carers a Voice
The final participants of the Melbourne Health Accelerator Program winter program, are those who’s end customer is ultimately the patient or their family.
These are in some ways, the most disruptive startups. They don’t sell to big pharma, big hospitals or big governments. Their market is patients and carers. However this market is growing.
The funding of health care is shifting, from blanket coverage by governments and insurance companies, to pay-as-you-go and out-of-pocket-costs by individuals. This will put pressure on health services to become as competitive and consumer-orientated as other industries are. Startups who focus on patients as customers now, will be well placed to accomodate future changes.
Stroke is a leading cause of disability for Australians. Each year, there are 56,000 new incidents of stoke in Australia – That’s one every 9 minutes. There is a 70% survival rate, however many are left with some type of life changing disability. Providing rehabilitation treatment for stroke patients puts tremendous pressure on the health system, which is often not able to provide the resources that patients need.
There is an average 12 days wait for patients to receive their first rehabilitation session; in some instances this delay can hinder the chances of a full recovery. Additionally, many traditional techniques are not efficient. Commuting between home and out-patient rehabilitation centres is both costly and time consuming. It also puts emotional and financial strain on vulnerable patients. The repetitive exercise patients are required to perform are often boring, and have also been shown to be emotionally exhausting to patients.
These issues along with other minor factors, make the existing rehabilitation processes a target for improvement, both in costs and outcomes.
NeuroPhyte aims to provide stroke survivors with the technology that allows them high quality and quantifiable rehabilitation, from any setting. NeuroPhyte will provide an affordable and customisable service using the latest technologies (virtual reality, biosensors, cloud computing, machine learning, gaming). Real-life tasks can be simulated and practiced, while the patients progress can be accurately monitored. Any adverse reaction such as anxiety or stress can also be recorded.
The driving force behind Neurophyte is Mojtaba Kermani, a PhD student studying Neuroscience. At the end of 2015 he came up with an idea on brain training. He looked at applications on the market like Elevate and Lumosity, but found them lacking in academic rigour and proof of concept.
Mojtaba called his friend Safiollah Heidari who has a PhD in computer science, with expertise in cloud computing and Big Data and asked if he could create an application that would be an accurate tool for neuro rehabilitation. Safi suggested that they should combine Vitual Reality (VR) with a cloud platform and machine learning analytics to assess the data.
By early 2016 both Mojtaba and Safiollah had considered targeting different areas of clinical needs including aged care. The two of them finally came up with brain training for public health.
PhD in behavioural science and clinical psychology. 15 peer-reviewed publications in Neuroscience. 2 years experience in bioelectronics industry.
At this stage there was just the two of them working on an informal project, on a part time basis. Mojtaba and Safiollah thought VR would help simulate real life tasks, assisting the user to learn and improve on real skills rather than just game scores.
With this project in mind, the two tried to get into the Melbourne Health Accelerator Program at the beginning of 2016, however they were not accepted. They had no clear pitch, no Minimal Viable Product and no financial plan. Undeterred, they continued working on their project. However, they both realised that they needed others involved, to get a fresh perspective.
They turned to their group of friends from the University of Melbourne. Adel has a background in computer science, specialising in pricing models on cloud software and marketing of cloud computing. Amin is an electrical engineer specialising in circuit design and hardware implementation.
The four of them spent several months thrashing ideas out. During 2016 the four young men were having regular meetings to discuss and develop ideas.
PhD in Computer Science. Post-doctoral Fellowship. Cloud computing specialist.
The team of four PhD students started making a prototype in early 2017. They outsourced the actual software and hardware to a team in Iran, using Safiollah’s own company SiliconSoft to maintain quality and consistant work at an affordable price. One of the issues when creating a technology project, is the need to access a team of people who are all specialised their their particular field of expertise. The students could have created the entire project themselves, but it would have taken much more time.
The team has designed a glove for users to wear, that has a range of biosensors to collect constant feedback, while they are playing VR games to improve their mental ability. This glove is able to monitor both the users’ movements in space, as well as their physiological response to the games, such as raised heart rate and increased sweat.
The NeuroPhyte team were accepted into the Winter 2017 Melbourne Health Accelerator Program. Following discussions with the program’s mentors, Mojtaba and Safiollah started refining their ideas and technology, moving from brain training to neuro rehabilitation being used by stroke survivors.
They improved the functionality of the glove by adding electromyography and HAPTIC sensors. Embedding the sensors in Neurophyte’s glove gave a 360 degree view of the patients’ progress, allowing more accurate assessments to be made. The information from the glove is able to be transmitted to a cloud-based portal, which can be accessed by the team looking after the patient.
The platform will operate like an app store, displaying a range of neuro rehabilitation programs. Clinicians can choose from the list of programs and prescribe suitable games for patients to play, based on their requirements. Doctors can monitor the patients progress and adjust their treatment plans.
In future, the NeuroPhyte team plans to have Electroencephalography sensors embedded into the VR mask. This will allow them to assess electrical impulses generated by the brain during the game.
Their key value proposition is providing practical daily living activities in a virtual environment, faster rehabilitation and improved mental wellbeing. Their customers and payers are Physicians and Physiotherapists, Hospitals, Rehabilitation centres and patients. NeuroPhyte is currently looking for a strategic partnership with hardware providers.
The team of 4 PhD students started making prototype in early 2017. They outsourced the actual software and hardware to a team in Iran, using Safiollah’s own company siliconsoft to maintain quality and consistant work at an affordable price. One of the issues when creating a technology project, is the need to access a side team of people who are all specialised in their particular field of expertise. The team of four PhD students could have created the entire project themselves, but it would have taken much more time.
The team have designed a glove for patients to wear, that has a range of biosensors to collect constant feedback, while the patient is watching VR games to improve their mobility. This glove is able to monitor both the patients movements in space, as well as their physiological response to the rehab, such as raised heart rate and increased sweat.
The glove has HAPTIC sensors that can pick up heart rate, skin temperature and electromyography. The glove also has bio sensors that monitor spacial movement in 3 dimensions and the speed of movement. This gives a 360 degree view of the patients progress, allowing more accurate assessments to be made.
In future the NeuroPhyte team plans to have Electroencephalography sensors embedded into the VR mask. This will allow them too assess electrical impulses generated by the brain during the game.
The information from the glove is transmitted to a cloud-based portal, which can be accessed by the team looking after the patient. The platform will operate like an app store, storing a range of neuro rehabilitation programs. Clinicians can choose their favourite program and suggest that for patient to use. Doctors can monitor the patients progress.
The NeuroPhyte team were accepted into the Winter 2017 Melbourne Health Accelerator Program and have learn a great deal during the program.
Their key value proposition is providing practical daily living activities in a virtual environment, faster rehabilitation and improved mental wellbeing. Their customers and payers are Physicians and Physiotherapists, Hospitals and rehab centres and patients. NeuroPhyte is currently looking for a strategic partnership with hardware providers.
No postcode untouched - stroke statistics in Australia
Smart technology is not the only way to disrupt the health industry. Taking health services out of hierarchy-bound hospitals and bringing them to people in their own home is revolutionary. And that’s exactly what Intensive Care at Home does.
Patrik Hutzel is a Registered Nurse with extensive experience in Intensive Care, who comes from Germany. He is the founder of Intensive Care at Home, a unique service that allows people who are otherwise stable but have a tracheostomies and require ventilation, to have acute medical treatment and be with their families at the same time.
Patrik first discovered this service in Munich, Germany in 1999. He worked with intensive care patients in their own home for several years, then moved to England and completed post graduate studies. He discovered that in England there was no similar service. The English National Health Service is very bureaucratic, hospital focused, doesn’t face any competition and has no obligation to tailor care to patients wishes.
Patrik came out to Australia in 2005. He first worked at the Prince of Wales Private Hospital in Sydney and ended up being manager of Intensive Care until 2008. He moved to Perth and ended up running the Intensive Care Unit at the Mont Hospital Perth. Patrik moved to Melbourne in 2011, worked at the Alfred Intensive Care Unit and registered his business ‘Intensive Care at Home’.
Patrik feels that the Australia health system, like the UK, has no real drivers for reform.
In Germany there is legislation stating that if people want to have health care at home, then when ever that is possible, this should be allowed. This gives legal authority to people wanting home care and supports small companies that want to offer this.
“I feel Australia can be very conservative, with a one size fits all approach. Germany is more open to innovation, and accommodating of people with different needs.”
In Australia, health funding is fragmented across Federal and State departments and local councils. On top of that, there are a mixture of private health funds that pay for some in-hospital procedures, but not for community treatments. Out-of-pocket costs for private patients are common, as Doctors in private practice remain free to set their own charges and private hospitals and private Doctors don’t have to advertise their prices. The result is that a patient with just one medical condition, can require funding from up to a dozen different organisations, across their treatment pathway.
In this environment, finding funding for a home-based service that cared for unwell people who are are normally left in hospital, seems impossible. When Patrik rang the Health Department, Transport Accident Commission (TAC) and Intensive Care specialists, they all said he was crazy.
However Patrik had seen how successful this model is in Germany, saving money and giving people better quality of life.
He registered his business in 2011, got national accreditation and incorporated the company in 2012.
It didn’t take long for patients to start finding his service.
Intensive Care at Home’s first customer was in November 2013. A woman wanted to have Total Parenteral Nutrition (TPN) at home. Although it is common to do this procedure at home overseas, it had never been done in Australia. The hospital was very resistive to home care, and at one stage threatened the woman’s family with a Victorian Civil and Administrative Tribunal (VCAT) hearing, claiming the patient’s well being was at risk.
The patient and family had to pay for the procedure themselves, as no government department would fund it, even though the patient was under palliative care. Intensive Care at Home was able to help her, and she subsequently died peacefully, in her own home.
The same year Patrik got a call from a private hospital asking if he could help a young man who had a tracheostomy and needed continuous ventilation. The man was under the Transport Accident Commission (TAC) after being involved in a road accident as a child. At that stage he was receiving low-cost, home-care from unskilled workers. He was continuously deteriorating, then being being readmitted with infections to the hospital. Patrik contacted the TAC, who at first laughed at his suggestion of Intensive Care at Home.
Patrik kept ringing the TAC saying
‘I feel you could treat your customers much better than this.’
The TAC ignored Patrik and the client kept bouncing in and out of hospital. A year later Patrik finally got a call, saying he could cover just one shift a week.
By December 2014 Intensive care at Home was providing regular care for this young man, and during this time he was not readmitted to hospital.
A personal story
The next customer came in May 2015. A 60 year old woman wanted palliative care at home. She had a complex medical history including breast cancer and extensive chemotherapy, a spinal injury and a tracheostomy. This time it was the TAC that contacted Intensive Care at Home, and he provided care for the woman until she died peacefully, at home.
In August of the same year Patrik was contacted about a teenage girl with Retts syndrome, a rare neurological disorder. The girl was unable to talk, walk, breath independently and had regular seizures. This time the Department of Human Services paid for part time care. The family was happy with Patrik’s service but the funding was limited due to DHS guidelines and the family was left struggling to care for another child beside their sick girl.
In 2015 Intensive Care at Home was contacted about a woman under palliative care, who was a quadreplic in the last year of her life. She was receiving a type of non-invasive ventilation (called BiPap) which involves wearing a tight fitting mask attached to a pump. Like his other patients, this woman had been readmitted to hospital on a regular basis, after receiving unqualified care in the home. Despite the fact that the patient wanted Patrik’s service, the patient’s General Practitioner and the unqualified home care service objected strongly. Patrik was unable to take on the patient, despite the patient wanting Patrik’s service. The woman subsequently died of sepsis in hospital. Patrik was understandably frustrated.
Two months later a young couple was referred to Intensive Care at Home. One had a neuromuscular disease, the other had cerebral palsy. They were both living at home, using home carers. Patrik wasn’t familiar with the disability sector, didn’t feel he could adequately provide the best service and didn’t take on the case.
The next client was a child who was born premature at 24 weeks. The child spent the first 6 months of his life in a hospital Intensive Care Unit. He has cerebral palsy, a tracheostomy and is oxygen dependent. Intensive Care at Home began caring for the child at 40 hours a week, funded by the Department of Human Services.
Patrik also started a service called Intensive Care Hotline, in May 2013. This was in response to people contacting him from all around the world about their relatives in Intensive Care Units. He gives relatives information about their options including home care and having more involvement in the treatment plan. Most of his customers come from American and Australia, some are from Ireland and the UK.
Intensive Care at Home now employs a total of 12 staff and provides a unique alternative for people with serious medical problems, who want to stay at home. No client have ever been readmitted to a hospital’s Intensive Care Unit, while under this service.
While many people in the hospital industry are still sceptical about Intensive Care at Home, Patrik’s large blog post following and loyal customers who are prepared to lobby funding bodies to access his service show there is a large unmeet need in the community. Patrik’s knowledge of the service’s success in Germany keeps him positive.
“I know there is a real need for this service. I have so many people contacting me. They just want to know what their options are, and if they can take their loved one home.”
Finally, sharing experiences from the trenches of caring for sick people, aimed at giving support to the most important people in the health system – carers.
Martina Clark was also born in Germany. After leaving school Martina completed a traineeship as a wholesale company purchasing officer then came to Australia at 23. She worked in the telecommunication industry and banking. By 2011 Martina found herself working for a pharmaceutical company that specialises in oncology and immunology drugs.
Martina became friends with a woman called Anoula, who was a Global Study Manager in Oncology for Celegene. Anoula was in her early thirties, fit, healthy, enjoying a successful career and 5 months pregnant with her first child. A chest x ray after a prolonged cough brought a shock diagnosis. In the December of 2013, Anoula was diagnosed with rare type of lung cancer, stage 3b.
The Doctors advised Anoula to terminate her pregnancy and commence aggressive chemotherapy. Overnight, her life was turned upside down. She transformed from being a scientist who analysed statistics on cancer, to being a patient vomiting and exhausted after chemotherapy. Anoula took it in her stride, and described her diagnosis as being on a journey that taught her many things. Anoula remained employed after her diagnosis, had medical treatment and took a holistic approach to her illness.
However the cancer progressed, caring for Anoula became a full time job for her circle of family and friends. From administering medication, to managing all her appointments, to taking on all of the duties around the house. Every carer took turns sharing their roles and responsibilities for caring for her.
Martina joined Anoula’s husband, taking turns every third or fourth weekend to care for her friend and give Anoula’s husband a break. Finally, the cancer spread to Anoula’s brain and she was put under palliative care. She spent her last two weeks in hospital. Anoula died in 2015, two years after her diagnosis.
Martina was left with a deep sense of loss, loneliness, anxiety and exhaustion after the experience of caring for Anoula.
Hospitals are focused on sick patients. The health system currently has very few resources to care for the families.
Martina realised that there was a strong need to get support for carers, right from the beginning, to recognise their situation and provide resources and information to enable them to ask for help.
In October of 2016, Martina registered the business name Carers Couch and paid for a website to be created, so she could display the growing library of videos of carers, patients and health professionals, talking about the life changing experience of a diagnosis of serious illness.
The people she interviewed at first found it difficult to find their own voice.
The experience of serious illness is normally only told from the patients or Doctors point of view. Martina revealed the secret world of carers, the wife juggling family budgets, the husband organising endless medical appointments, children doing household chores. Caring is a very intimate role, but also a practical one. It normally goes on behind closed doors, an act of love keep secret.
While Martina invested her own money and time in Carers Couch, people involved in the health industry recognised the importance of her work, and offered to help. The site grew rapidly, and she currently has over 70 videos.
Since being accepted into the Melbourne Health Accelerator Program Martina has made contacts with a number of Melbourne cancer services, and is applying for funding to help grow her site into a fully-fledged carers resource.
Anoula’s husband is one of the people interviewed on the site. Like the other carers that Martina has interviewed, he is delighted to be given a voice, a place to express his feelings and a chance to share what he has learned on his journey, with others.
From carer to startup founder
“I want carers to be informed and feel empowered, not just living the patient’s life. Able to fulfil their role but also understand the importance of self care.”