Stroke is one of the five most common diseases in the world and the number of stroke patients is increasing fast. This presents a huge challenge for healthcare, including an increasing demand for neurorehabilitation of patients suffering motor-impairment, and associated social and psychological problems. A newly launched Flagship project – the ‘Convergence Human Mobility Center’ – brings together researchers at TU Delft, Erasmus Medical Centre and Erasmus University Rotterdam whose aim is not only to design minimally-supervised, easy-to-use technology for home exercise and remote monitoring, but also to ensure that such healthcare is intuitive and easy-to-use by all sectors of society, including vulnerable patient groups increasingly at risk of healthcare disparities.

“We are looking at a huge challenge for the future,” says Professor Gerard Ribbers, Rehabilitation Physician at Medicine at the Erasmus Medical Centre in Rotterdam, and the project’s Main Lead. “We anticipate a 50% increase in stroke patients by 2040, meaning 700,000 patients in the Netherlands who will urgently need rehabilitation for motor impairments and help with dealing with the consequences of a stroke on a daily basis. We also anticipate a 70% increase in people with Parkinson’s disease, and an almost 100% increase in arthritis-sufferers – all of whom will need support.” But rehabilitation is labour-intensive and costly, and with the limits of financial, personnel and social sustainability in healthcare already fast approaching, it’s imperative that such help becomes more effective and efficient.

Vulnerable groups and technology

Technology can contribute: for example, home exercise can be supported by ultra-low-cost, easy-to-use robots with virtual exercise programmes tailored to the individual patient, and motion sensors can keep track of the patient’s recovery and treatment progress. However, it is vitally important that all patients can and will use these types of technology – and past experience suggests that this is not always the case. Flagship project Lead at Erasmus University Rotterdam is Professor Jane Cramm, a specialist in Health Policy Management: “In our experience, it’s relatively easy to deliver technology-based interventions if the patient is young or well educated but it becomes really problematic when you’re dealing with people with low cognitive skills, intellectual disabilities or a migration background. So if you want to prevent socio-economic health inequalities, you have to collaborate with vulnerable groups to tackle this problem of making technology accessible and easy to use for everyone.”

Engineers and clinicians

The Team Lead for TU Delft is Dr. Laura Marchal-Crespo, a mechanical engineer based at the department of Cognitive Robotics, but also affiliated to the Faculty of Medicine at the University of Berne in Switzerland: “As engineers, we’re fascinated by developing complex robotic solutions, but during my time at the medical faculty, we realised that our inventions often weren’t used by the clinicians and therefore wouldn’t be used by the patients in their homes because they were too complex, difficult to operate, or took too much time to set up with the patient. So for the past few years, we’ve been working with Gerard to co-create user-centred robotic devices that are inherently safe and that can be used at home straightaway because they are very intuitive.” For example, the deceptively simple Portable Hand Rehabilitation robot: “It only has one small motor and is based in a flexible shell and when you see it from outside, it’s really intuitive. The patient understands how to grab it and how to interact with it so we expect them to use it, even if they aren’t particularly technologically-minded.”

Of course, technology is only part of the solution to providing rehabilitation to increasing numbers of patients, and it’s not meant to replace the relationship between patient and therapist: “But we can imagine that it would be possible for one therapist to train five people at the same time using these devices, either in the hospital or at home,” adds Marchal-Crespo.

Convergence offers Multiple Perspectives

Working closely with the Rijndam Rehabilitation Centre in Rotterdam, the participants in this 5-year Flagship project are clear about the advantages of working with people from different institutions and across many disciplines. Cramm: “We’ve known that health inequalities have been increasing for decades and I think the complexity of the problems needs multiple perspectives so I’m really excited about Convergence – I’m learning a lot!”

It’s also instructive for clinicians and engineers to approach problems from a similar angle. Ribbers: “Clinicians often complain that engineers fantasise about solutions for which we clinicians have to find a problem, ha ha. So I think what really makes me enthusiastic about this cooperation is that from the very start, we have the chance to collaborate and work on a joint agenda and that is really, really a big challenge.”

“I completely agree,” adds Marchal-Crespo, “and what’s also important is education. For example, we have students here in TU Delft and if they don’t get the opportunity to collaborate with people in other fields such as clinicians and social scientists, it’s a missed opportunity. They go out into the real world and try to come up with complex solutions without really understanding the problem! So with this Convergence, what we’re providing is the opportunity to understand real-life problems from the user’s point of view and the possibility to open their minds to coming up with smarter accessible solutions.”