In a decisive step to enable more patients to gain greater access to innovative technology enabled rehabilitation, Tan Tock Seng Hospital through its Clinic for Advanced Rehabilitation Therapeutics (CART), inks partnerships with leading rehabilitation care partners, Fourier Intelligence (FI) and Stroke Support Station (S3), today. The alliances are marked as TTSH celebrates CART’s 10th anniversary and its expanded premises. CART, is the region’s first clinic to integrate robotics and virtual reality with conventional therapies, helped over 75,000 patients in the last decade.
Equipped with more state-of-the-art rehabilitative robots and a bigger gym, CART spans 19,935 square feet, four times bigger than the previous space. In addition to treating patients with conditions like stroke, brain and spinal cord injuries the clinic has advanced its services to care for amputees, patients with neurodegenerative diseases and neuro-oncology conditions and those who are ventilator dependent. The opening event is officiated by Minister for Health, Mr Ong Ye Kung.
Accessing Advanced Rehabilitation Care
With a rapidly ageing population and a higher prevalence of chronic diseases, there is a pressing need for increased community based rehabilitation. CART through a 3-year Master Research Collaboration Agreement with FI, a technology-driven company, will drive new care models to make robotic therapies more sustainable and accessible to patients in the community. Functioning as a living lab, it will also test-bed and contextualise FI’s technologies to local settings and bring them a step closer to benefit more patients.
For example, currently therapists measure and score patients’ balancing ability and fall risk manually and it is time consuming. The tedious process is now being studied using FI’s balance robot (BalanceMotus™) which can digitally track measurements faster with better precision. The device also has game-based features to train balance in realistic simulated environments. CART is evaluating the potential to enhance the user’s participation and customise it for geriatric patients as well. The partnership will also explore the possibility of optimising these robotic technologies in the premises of TTSH’s community care partners.
We look forward to enhancing and integrating the RehabHub model, artificial intelligence-enabled robotics and virtual reality system with team TTSH. We plan to implement it beyond the specialist hospital and into the community care settings,” said Mr Zen Koh, Fourier Intelligence’s Co-Founder and Group Deputy CEO. "Through this partnership, we will co-develop an accessible technology-based care model in Singapore. The long-term goal is to eventually share our (Singapore) experience and knowledge globally through Fourier’s 50+ global clinical and research partnership network."
Accessing Community Rehabilitation Care
CART’s Memorandum of Understanding with S3, a stroke focused community agency specialising in rehabilitating patients with assistive technology, is in line with the National One-Rehab framework, which aims to improve patients’ access to community rehabilitation. TTSH will refer stabilised stroke patients to S3 for continued active rehabilitation, wellness activities and access to its peer support network. This shared care model will allow both parties to better co-manage stroke survivors and ensure continued support through their rehabilitative journey. TTSH and S3 will also explore tele-collaboration and tele-consultation services.
We cannot emphasize enough the importance placed on care triaging and continuum of services for post-discharged stroke survivors and are grateful for this MOU with TTSH. For S3, the journey of post-hospital stroke survivors encompasses continued quality rehabilitation coupled with therapeutic wellness that can uplift and motivate them to reach their personal goals, strengthen family bonds and re-join their community."
- S3’s Executive Director, Ms Ng Rei Na
Innovating Rehabilitation Care
Partnerships like the above are crucial in empowering patients. Over the decade, CART has collaborated with several local and international industry players and academic institutions to strengthen its research and technological capabilities. This has allowed CART to build innovative rehabilitation programmes and therapies for patients (Refer to Annex A).
One of CART’s patient, 55-year-old Fabian, was diagnosed with stroke in 2021, and had difficulty participating in some of his daily activities due to reduced motor coordination and weakness in his right upper and lower limb. As part of his rehabilitative therapy, Fabian used H-Man, a portable artificial intelligence robot co-developed with Nanyang Technological University (NTU) and ArtiCares Pte Ltd, to help stroke patients improve their arm and hand functions. "My main goal was to re-integrate back to society and with the use of H-Man, I am able to train my arm to improve strength, coordination and function with daily practice. I am happy to say that I have returned to work and can now walk independently with a walking stick. My next goal is to return to driving!" said Fabian.
CART has been relentless in its pursuit of transforming patient care from the hospital to the community and home. It has embraced new technologies and combining them with conventional treatment approaches in seeking the best possible outcomes for patients. Its strategic partnerships with leading industry players, academics and community partners have contributed significantly to its remarkable growth and achievements in its first 10 years. We look forward to a dynamic partnership with Fourier Intelligence and Stroke Support Station to bring the best rehabilitative care for our patients,"
- Dr Loh Yong Joo, Head, Rehabilitation Medicine, Integrative & Community Care, TTSH
Looking towards the future, the team at CART will to extend service collaborations, build an ecosystem of innovation for collaborations between clinicians, therapists and researchers to design and co-develop new technologies, test-bed and validate novel devices.
Annex A
Examples of CART’s core clinical programmes that combine conventional methods and rehabilitation technologies.
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Total Walk-Robowalk Programme
Patients with severe lower limb impairments can relearn to walk using the
Lokomat®. It is a robot-assisted gait training system where patients are strapped on with a body weight-supported treadmill to intensify walking practice. This allows patients to practice up to 1,000 steps within 30 minutes compared to 100 steps via conventional therapy.
Together with the National University Hospital’s Paediatric team,
CART extended Lokomat® training to adolescents and started Singapore’s FIRST Paediatric Robotic Programme in year 2014.
Besides Lokomat®, CART also brought in advanced robotics such as
Ekso, a wearable exoskeleton inbuilt with programmable electric motors that moves weak legs in a normal physiological gait pattern and enables patients to achieve assisted walking. Last August, 60 patients clocked a total of one million steps using Ekso – A FIRST in Asia Pacific. As patients on Ekso are empowered to walk for a longer distance with the assistance of only a therapist compared to few therapists previously, it has improved treatment outcomes and productivity. -
Re-Arm Programme
For example,
Amadeo, provides support to the patient’s involved fingers for passive, active and resistive training. Complemented with the use of
Armeo Spring, it trains arm movements and grasp functions through calibrated interactive game-based exercises that are connected to an exoskeleton arm support. Movement gains from these robotic-aided therapies are then worked into functional skills to be useful for task performance.
Examples of ongoing research innovations with industry partners and academia institutions:-
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Brain Computer Interface (BCI)
This collaboration with the National Neuroscience Institute and the Agency for Science, Technology and Research (A*STAR) further progressed the science and practice of advanced brain computer interface applications for stroke rehabilitation.
BCI uses brainwaves to activate a robotic arm for training the upper limbs of stroke patients in our studies. Studies have shown that BCI-based therapy can help to improve motor outcomes. -
Mobile Robotic-Aided Balance Assistant (MRBA)
Ongoing research with Nanyang Technological University – Rehabilitation Research Institute of Singapore to develop
MRBA, a transformable robotic wheelchair which prevents falls and enables patients to safely practice walking and participate in daily living activities in home and institutional settings. The research is supported by the SG Healthcare and Assistive Robot-aided Programme. MRBA is now trialling at Yishun Community Hospital. -
H-Man
Singapore’s FIRST-of-its-kind portable medical artificial intelligence robot, designed to help patients undergo upper limb rehabilitation therapy at home. Co-developed with scientists from Nanyang Technological University and ArtiCares Pte Ltd,
H-Man is built to help stroke patients improve their arm and hand functions. The training exercises are presented in the form of video games, making training an engaging and user-friendly experience. After the session, H-Man can evaluate patients’ performance and send feedback to therapists wirelessly, improving productivity for rehabilitation care. A pilot study is ongoing to enhance H-Man’s features into a potential tele-rehabilitation service. A significant study that will allow suitable stroke patients to continue exercise safely with remote supervision in the comfort of their homes.