Community Research and Development Information Service - CORDIS

H2020

SWORD Report Summary

Project ID: 672814

Periodic Reporting for period 1 - SWORD (Advanced Analytics Platform for Stroke Patients Rehabilitation)

Reporting period: 2015-07-01 to 2016-05-31

Summary of the context and overall objectives of the project

Annually, 16 million people worldwide suffer a stroke. From these, approximately 6.5 millions are left with some degree of physical impairment that will require long-term intensive and effective motor rehabilitation programs. In developed countries, the lifetime risk of having a stroke is 1:5. Furthermore, as populations continue to age, the global trend is for this value to rise, which signifies a growing market’s demand for rehabilitation services. Presently, the estimated annual cost for treating and caring for stroke survivors is set at €30 billion in Europe and €57 billion in the United States. In spite of the overwhelming costs involved, the most developed societies have been unable to democratize access to neurorehabilitation care and provide timely, intensive and effective rehabilitation programs to their citizens who have suffered a stroke. Current traditional rehabilitation services are costly and highly dependent on (scarce) specialized human resources
At SWORD Health we believe that the solution for this problem is in the wise combination of novel neuroscience-driven therapeutic methods with effective technologies that facilitate the dissemination of care and the use of all the knowledge produced in the rehabilitation of a large network of patients. Pursuing this vision, we have developed an innovative system that allows the sustainable delivery of a more efficient motor rehabilitation to stroke patients, providing a rich source of data for clinicians and decision makers.
The SWORD system was specifically designed to be used by the patient at the hospital or at home, with little or no supervision, extending the therapeutic footprint and empowering the patient with his rehabilitation. The proposed system enables patients to accelerate their recovery with a more intensive and a higher quality therapy. At the same time, SWORD incorporates data mining algorithms specifically designed so that clinicians get continuous access to valuable data and advanced analytics, in order to coordinate teams, improve care, accelerate recovery and reduce time to achieve functional outcomes. For rehabilitation centres, the SWORD system allows for a higher profit margin per therapy unit through a more efficient allocation of specialized human resources. The SWORD system is composed out of two interconnected parts:
1. The rehabilitation interface - a wearable system capable of analysing the motor performance of the patient, providing clear feedback regarding the quality of his training and how it can be improved. The patient’s kinematic data is acquired by a high-precision motion capture system and sent wirelessly to a mobile device (e.g. tablet) that is able to give real-time feedback about patient’s performance in either an audio, visual or haptic manner (defined according to the cognitive status of the patient). This wearable interface was tested in a randomized placebo controlled clinical trial and was proved to increase intensity of training and reduce the probability to perform errors from 1:3 to 1:9 (Nature Scientific Reports, 2014;4:5670).
2. The SWORD Core - a cloud platform that analyses all the data retrieved from each single rehabilitation session. The SWORD Core provides the clinical team with an interface (web app) that allows a faster and more detailed analysis of each patient’s recovery. It also enables the clinician to prescribe new rehabilitation sessions that are then remotely synced with the rehabilitation interface’s mobile device. In order to maximize these two components, the SWORD Core implements advanced machine learning techniques, leveraging big data and transforming a conventional subjective decision making process into a truly evidence driven one.
The SWORD system is endorsed by some of the most important rehabilitation centres in Europe (Rovisco Pais Rehabilitation centre in Portugal, Casa Di Cura Santa Maria Del Pozzo in Italy, Overpelt Rehabilitation Centre in Belgium or the Sahlgrenska University Hospital in Sweden) and the largest rehabilitation centre in the United States (Genesis Rehab Services). These endorsements validate the SWORD system as a global and promising commercial solution in the Stroke rehabilitation market.
The founding team of SWORD Health is multidisciplinary by nature, being composed by a neurologist (PhD), an electrical engineer (PhD), a software engineer and a hardware engineer with a proven track record on the development of disruptive technologies (e.g. COGWEB - fully applied in 26 major Hospitals in Portugal or Findster - a novel location system that raised more than $90,000 on a 2-month crowdfunding campaign). SWORD Health was established as a company in May 2013. In October 2013, SWORD Health accepted an investment proposal from a group of European Business Angels (Braincapital SGPS).
The SWORD project falls under the scope of the Call ICT-37-2014 - topic: Open Disruptive Innovation Scheme. This is because the present project focus on an early-stage, high risk, innovative SME proposing an innovative ICT system that reinvents and ultimately disrupt the motor rehabilitation industry. The SWORD project consists in the validation, fast prototyping and demonstration of a disruptive innovation bearing a strong EU dimension.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

During the period of report, the following objectives were achieved partially or totally:
• Optimize the mobile application – Completed
• Develop a scalable and robust web-based console – Completed
• Develop the SWORD analytics engine, implementing machine learning techniques to extract important metrics and parameters from data collected and stored in the data warehouse, and also develop off-line signal processing methods that are able to analyse patient data and generate automatic performance reports – In progress
• Validate and test our technology in a relevant clinical environment (rehabilitation centres, hospitals) – Clinical Trials are already being designed for implementation. In addition, three first national pilots are running.
• Implement a supply chain that allows the industrialization of the proposed solution – During the period of report Sword Health was in Amesterdam, The Netherlands, in a network meeting with hardware suppliers for motion trackers.
• Be present in the most important trade fairs in the area of medical devices – In the first 11 months of the project SWORD was presented in ChinaSourcing Summit, Aging 2.0 Summit Conference, Global Start-up and in the European Congress of Rehabilitation Medicine.
• Attract private venture capital – So far Sword Heath was present in Investment Roadshows in two events of Aging 2.0 Summit (September and November 2015) and pitching for stakeholders and investors in Austin Global Start-up.
• Perform the certification process that will grant the CE mark – In progress.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

> Progress beyond the state of the art

The project’s aim is to supply a high-tech solution enabling hospitals and medical specialist to provide a more intense and effective post-stroke rehabilitation in a clinical or ambulatory setting.
SWORD wants to deliver a mobile app and a web console able to give real-time feedback and that gives clinicians access to data and results. We intend to present a whole intelligence system which includes data mining, analytics, data warehousing and management, all together based on cloud technology that will enable to extract valuable metrics and parameters providing guidelines about intervention and future recovery.

We want to be “the” flagship company in the field of motor rehabilitation, serving an international market. Our vision meets the challenge of providing a more efficient rehabilitation therapy to patients without increasing its underlying costs. This can only be achieved with a correct implementation of technology that enables complex systems to be used by a patient at his home.

> Novelty of the project:
The majority of the systems on the market are either based on robotics, camera based or electrical stimulation systems. These types of systems imply a high complexity of use, demanding a constant supervision from a trained clinician and therefore are limited to be used outside the clinical environment or are not suited for a qualitative physical rehabilitation. Furthermore, the great majority of these systems lack the ability to extract important metrics and parameters from large scale patient data as these are not stored and analysed centrally using a networked and cloud infrastructure.
Robotic devices, due to their high cost and complexity, are only available in the clinical environment. The value proposition of a robotic device is based on its capacity to assist the movement of the user in a first post-stroke phase in the clinical environment.
Low cost camera based systems like Microsoft’s Kinect have the advantage of being portable and non-invasive but in the current state of art, lack precision, being unable to track - with the required accuracy - the three-dimensional kinematics of the patient. Although several companies exist that leverage this technology in the motor rehabilitation field (e.g., Reflexion Health or Jintronix), they are unable to achieve product/market fit due to the lack of clinical validation of its products. In the future due to advances in optical tracking technology this setup could become of interest to the SWORD, taking advantage of the modular design of our system.
Electrostimulation systems use either electromyography to detect muscle activation or functional electrical stimulation to externally activate the muscles of the upper-arm. In both configurations, the usability of the system is clearly diminished since there is the need to correctly place the surface electrodes. Contrary to robotic devices, electrostimulation systems present inconclusive data regarding its validity as an efficient rehabilitation tool in the post-stroke phase which, consequentially, is reflected in its market validation.
The SWORD system has a differentiated value proposition that, contrary to the existing technological solutions in the market, targets its use for full ambulatory use - the holy grail of motor rehabilitation – having been validated as an efficient rehabilitation tool.
Furthermore, our solution is also able to deliver continuous feedback not only to the patient but also to the clinician through continuous reporting and alert system. Through detailed analytics and machine learning techniques embedded in the SWORD Core, we are able to extract valuable information about the evolution of patients and predict key value outcomes and so have a timely impact at the process of recovery.

> Expected potential impact
a) Users / Market
Value Proposition
Our value proposition addresses the problem in post-stroke rehabilitation according to four distinct parts: Patients, Clinical Team, Health Care Public Systems and Private Health Care Institutions.
>> Value proposition for the Patients - For the patient the value proposition is clear. With the SWORD system the process of recovery takes place at home and the patient gets a significant increase in the intensity of rehabilitation that will lead to a faster recovery. Furthermore, the continuous documentation of the recovery process allows for a direct quantification of all the small victories that are crucial for his motivation and subsequent adherence to the (now) demanding rehabilitation program.
>> Value Proposition for the Clinical Team - For the physician that defines and evaluates the rehabilitation program for every single one of his patients, the SWORD system is going to represent a more efficient and effective tool to manage each rehabilitation program with a greater insight on whether the recovery process is performing according to what was expected initially. Furthermore, the SWORD Core gives clinicians access to data and results, and also a whole intelligence system which includes data mining, analytics, data warehousing and management, all together based on cloud technology. The latter enables the SWORD Core to extract valuable metrics and parameters using the large datasets providing guidelines about intervention and future recovery. As mentioned, based on results from a large network of rehabilitation centres and patients, the clinician can have access to suggestions and protocols that will help him to decide what the best rehabilitation treatment for each specific patient is. Also, it will allow him to compare his performance with other professionals, in terms of the rehabilitation success of patients in similar situations.
>> Value Proposition for the Health Care Public Systems - The SWORD system allows for a cost-effective therapy that provides a higher intensity of training, with a greater quality, while keeping costs low. Each stroke patient gets an effective and personally tailored rehabilitation program that increases his recovery possibilities. The SWORD analytics engine allows having a complete understanding of how therapies are affecting a patient or a group of patients from a specific population and have predictive indicators about the outcomes of these therapies. It is also possible to predict events based on rehabilitation history and clinical data of larger populations in order to support preventive initiatives (e.g. population survey, or medication effects in determined profile of patients). Through these analytics the SWORD Core offers visualization and dashboard tools regarding the rehabilitation progress and patients at risk of medical complications. Other trends such as those related to medication effects or clinical readmissions will help in the recovery of patients in less time, freeing up beds and enabling professionals to reduce costs.
>> Value Proposition for the Private Heath Institutions - The use of this pioneering system in outpatient rehabilitation clinics will represent a competitive advantage against more traditional approaches, since it will be used as an innovative tool to persuade families to bring patients to their facilities. Since the SWORD system can be used with remote supervision of the physician that can have access to his patients’ results through the web console, the institution can treat more patients and better (more follow-up and intensity of treatment) with the same staff costs. In fact, due to the complementary nature of the SWORD rehabilitation methodology that assumes both the learning process in the clinic and the training process at the clinic or home, the institution is able to devise a monthly rehabilitation program where it gives the SWORD system to the patient in order for him to train the new motor tasks (learned with the clinician).It will also be able to present better results than competition since it will have access to a powerful tool that will give information about best practices and treatment standards. This information will be available thanks to the great amount of information analysed by the system in order to obtain trends and optimize each treatment for each specific situation. Furthermore, the institution can compare its performance regarding competition and use it for marketing purposes. The system allows for the Clinic/Hospital to increase its average revenue per user. In terms of financial feasibility, for Clinic/Hospital, the therapy based on the use of the SWORD system implies low fixed costs and high contribution margins per therapy unit.

> Market size and trends
Due to the baby boomer generation, the market’s demand for rehabilitation services will continue to rise. It is projected that the prevalence of stroke will increase by 25% in the next 20 years. In Europe stroke accounts for around 2 Million people per year. Stroke is estimated to cost the EU economy over €38 billion a year. Of the total cost of stroke in the EU, around 50% is due to direct health care costs, 22% to productivity losses and 29% to the informal care of people with stroke .

> Competitors
Most of the systems on the market are either based on robotics (high complexity of use, demanding a constant supervision from a trained clinician), camera based (not yet suited for a qualitative physical rehabilitation) or electrical stimulation (lack in precision, usability).
As previously mentioned the SWORD system has a reduced cost and was specifically designed for ambulatory use, extending the therapeutic footprint and empowering the patient and relatives with his rehabilitation at home. This solution enables hospitals and rehabilitation centres to reach more patients and intensify therapy without increasing specialized health staff costs. The technology was validated as an efficient rehabilitation tool. Furthermore, our solution is also able to deliver continuous feedback not only to the patient but also to the clinician through continuous reporting and alert system. Through detailed analytics and machine learning techniques embedded in the SWORD Core, we are able to extract valuable information about the evolution of patients and predict key value outcomes and so have a timely impact at the process of recovery.

b) Company
> Business Strategy
Globally, the SWORD system was designed in such a manner that a patient can use it independently, without the need of direct supervision from a therapist either at the clinic or at home. Being able to provide simultaneous feedback on performance allows the patient to immediately recover from an error and prevent wrong and deleterious movements. In this way, the SWORD can be used as a rehabilitation tool allowing for each stroke patient to achieve a higher intensity of training that, if correctly implemented, will result in a faster recovery.
The SWORD system enables health institutions to reach more patients without increasing operative costs. We have made it affordable, since our objective is to democratize the access to more efficient rehabilitation services. Hospitals will have it at a low price, so all patients can get it.
Our vision for the SWORD system meets the challenge of providing a more efficient rehabilitation therapy to patients without increasing its underlying costs. We believe that this can only be achieved with a correct implementation of technology that enables complex systems to be used by a patient at his home.
For this purpose, SH will develop the motion quantification system jointly with our hardware partner and rent it to customers (institutions related to the rehabilitation of stroke patients). The software component will be licensed on a subscription basis to these institutions. Institutions can use the systems in-house (one system > several patients) or rent it to patients (one system > one patient) so they can do the rehabilitation exercises at home.

Related information

Record Number: 190207 / Last updated on: 2016-11-09
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