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Transforming Brain Rehabilitation

Periodic Reporting for period 1 - FBT (Transforming Brain Rehabilitation)

Berichtszeitraum: 2017-06-01 bis 2019-05-31

The problem: The world faces a global health challenge as 1 Billion people suffer from neurological disorders (220.7 million people in Europe alone), and characterized by motor, cognitive, and/or affective disorders, leading to morbidity and mortality. This poses a huge social and financial challenge for health systems internationally. Unfortunately, the world is moving fast towards an ageing crisis as international health systems are not well prepared for the change. This brings an increasing demand for fast and accurate clinical diagnosis, monitoring, and treatment.

Importance for society: There is therefore an urgent need for affordable, accessible, efficient, personalized, and scalable holistic brain tools to assist clinicians and improve the lives of the many in need worldwide.

Overall objectives: My goal is to democratize neurological diagnoses and treatments, finally bringing the neurology discipline to the 21st century, in line with many other medical disciplines. For that, I leveraged technological advancements – including depth cameras, smartphone sensors, cloud computing, and Big Data – to improve treatment, diagnosis, and symptom management of neurological patients.

Main project results: Created and validated two products providing holistic brain tools for the treatment and monitoring of neurological disorders, including a virtual reality full body motion-based platform for cognitive training (the Functional Brain Trainer), and a smartphone app with digital versions of standardized neurological assessments used as a clinical decision support software (EncephaLog).
I led/participated in multiple studies, clinical trials, development and validation of various applied technologies, including:

1. Movement induced cognitive training. I showed the feasibility, acceptability, and initial efficacy of a novel gamified movement-induced cognitive-training platform, the Functional Brain Trainer by Intendu (Figure 1): (1) Healthy adults benefit more from combined cognitive-control training and physical activity than from the same cognitive training lacking an active physical component. (2) People suffering from stroke or traumatic brain injury reported enjoyment and satisfaction from training with the platform in clinical / community settings, managed to perform increasingly more challenging cognitive tasks within game environments, and preliminary results showed improvements in functional tasks following training (published as a conference proceeding paper; Shochat, Maoz, Stark-Inbar, et al. Proc IEEE (2017). DOI: 10.1109/ICVR.2017.8007530.).

2. Validation of smartphone deployed gait assessment app. Gait disorders and falls are common, yet they are infrequently and subjectively evaluated. Completion-time of the Timed-Up-and-Go (TUG) test is an accepted biomarker for mobility and prediction of falls risk. We validated our app version, EncephaLog-TUG, which provides gait analysis in much more detail, offering 9 additional gait biomarkers on top of the completion-time. Healthy adults conducted TUG tests while simultaneously recorded by EncephaLog and motion sensor devices used in movement labs: motion capture cameras (MCC), pressure mat; and/ or wearable sensors (Figure 2). Results show high agreement between biomarkers, suggesting that EncephaLog can provide an accurate, yet simpler, instrumented TUG platform than more complicated and expensive alternatives (published as a journal paper; Tchelet, Stark-Inbar, Yekutieli (2019). Sensors, 19(23), 5179; https://doi.org/10.3390/s19235179).

3. Smartphone deployed cognitive battery. A major project I led in Montfort, is the development and initial validation of a cognitive battery, including digital versions of existing and accepted cognitive tests to assess memory, attention, inhibition. (Figure 3). Initial results from healthy individuals (5-90 years of age) who successfully completed our smartphone version of one attentional test - Flankers, show that adults are significantly faster than children and elders in responding to stimuli. While all age groups suffer from the expected perceptual cost when a central target is “flankered” by incompatible distractors, this cost is significantly larger in children.

4. Research and clinical validation of smartphone deployed motor biomarkers for treatment optimization, clinical decision support, and rehabilitation. As part of my role in Montfort, I helped with the development, clinical testing, dissemination, and grant writing for many studies to show various implications of EncephaLog, including the following clinical case-uses: (1) Improving diagnosis and treatment in normal pressure hydrocephalus (NPH). NPH is often underdiagnosed due to the similarity between its symptoms and those of other diseases. Using EncephaLog-TUG biomarkers and AI analyses, we improve the accuracy of NPH diagnose. The platform also enables efficacy assessment of brain shunts(Figure 4A). (2) Huntington’s disease (HD) patients cope with unique gait disturbances and frequent falls. We noticed a significant difference in the anterior-posterior sway profile (repetitive forwards-backwards movements during walking) between fallers and non-fallers (Figure 4B). Moreover, among fallers, rotation time significantly correlated with the number of falls. Thus these two biomarkers are suggested as predictors for increased falls risks in HD. (3) We tested whether EncephaLog can provide an alternative score to the two most common clinical Parkinson’s scales (mUPDRS and H&Y scales). 10 EncephaLog-TUG gait biomarkers from a random sample of
Taken together, my R&D activities support new technological applications, The Functional Brain Trainer by Intendu, and the EncephaLog smartphone-based platform by Montfort Brain Monitor. These digital health solutions provide easy and quick access to quantitative and actionable neurological insights throughout the full life cycle of many neurological diseases characterized by a wide range of symptoms.

Downstream demand drives the development of the neurology software industry. Over the next five years, the neurology software market will register a 8.5% CAGR (Compound annual growth rate) in terms of revenue and will be worth $780 million globally by 2024, from $520 million in 2019. Telehealth is becoming an integrated part of how health is delivered worldwide. The global telehealth market size was valued at €44.8 billion in 2018 and is projected to reach €240 billion by 2026, at a high CAGR of 23.4% in the same period. In Europe, it is estimated to grow from €9 billion in 2018 to €20 billion in 2026, at a CAGR of 14.1% in the same period.

Montfort targets a subsegment of the global telehealth market, the global remote patient monitoring (RPM) market. This market was valued at €770 million in 2018 and projected to reach 1.62 billion in 2026, at a CAGR of 13.5% in the same period. Europe holds a market share of 30%. Growing geriatric population and their rising demand for better lifestyle and cost-effective treatment is anticipated to drive the RPM market growth.

As the EncephaLog platform is already available for clinicians, we can finally bring neurology to the 21st century, beginning today.
Clinical case-uses of Encephalog motor tests for A) NPH, B) Huntington disease, C) A PD scale.
Validation study of EncheaLog TUG tests against well used movement lab tools.
EncephaLog Cognitive battery - the playlist, and screenshots from a few assessments.
The Functional Brain Trainer (Intendu). Note the Avatar, representing the player.