The History and Future of Clinical Rehabilitation: From the Horse's Mouth
Clinical Rehabilitation. Not words that most would search out of general curiosity, and even more so a service that most would not hope to require in their lifetime. This however does not discount this niche yet expanding sub-sector of the medical industry as one that is vital because of the life-changing results that it has created for lives, families, and communities across the globe.
History and founding demands for clinical rehab and rehab technology
It would be surprising to most that rehabilitation from a medical standpoint is not an invention of the modern world. In fact, physical rehabilitation in its many forms has existed in many ancient civilizations such as ancient Greece, the Roman Empire, the Chinese Dynasties and through Medieval times in Europe. Though methods, applications and scale may differ across time and location, most if not all forms of clinical rehabilitation have a single unified goal: to either improve the quality of life for those who have suffered and living with disabilities or help them achieve full recovery.
The demand that would eventually birth what we know today as clinical rehabilitation mostly started with the need to support those who have suffered physical trauma in military service. Fractures, broken bones, muscle tears or loss of limbs, clinical rehabilitation in the form of supportive physiotherapy, targeted motor-skill training and comprehensive exercises help those with physical disabilities redevelop physical functions and movements. This contributes to improved quality of life post-disability, which otherwise would likely be lived out with much personal struggle or under the care of others.
As time and medical knowledge progressed, clinical rehabilitation expanded its reach beyond just serving disabilities stemmed from physical injuries. Cognitive, neural, speech and even linguistics are some of the modern additions of clinical rehabilitation. The World Health Organization(WHO) provides a definition for modern medical rehab, setting for the industry a benchmark of goals of which all practice should aim to achieve. WHO defines medical rehab as: “A set of measures that assists individuals who experience, or are likely to experience disability to achieve and maintain optimal functioning in interaction with their environments.” One prime example of such a modern form of rehabilitation would be for recovering stroke patients, notably those who have suffered neurological impairment due to stroke. Modern rehabilitation technology allows stroke patients to return to their former quality of life to limited degrees, enabling them to function without constant assistance from others.
Disciplinary-diversity and areas of services in rehab
One primary challenge of rehabilitation is the need to address the individual needs of each patient. As cases of medical complications resulting in identical rehabilitation needs are rare to say the least, developing a rehabilitation program often demands a good amount of personalization towards individual patient needs, oftentimes requiring a team of experts to serve the needs of a single patient. This has inadvertently created an industry that is incredibly diverse in discipline, specialization and areas of service.
Within the knowledge of the general public, medical rehabilitation is usually viewed in three categories. They are Occupational, Physical and Speech. Occupational therapy deals with overcoming physical limitations caused by physical injury or limitations whereas physical therapy works towards pain-relief and motor-improvements. Speech-therapy is as the term says, addressing speech-related challenges in cases such as cerebral palsy or dyslexia. Within the circle of rehabilitation practitioners however, it is an unwritten understanding that it is a practice that is incredibly diverse in discipline.
It is also important to note that there is a vast portfolio of professionals within the rehab industry. Including the three most commonly known mentioned in the previous paragraph, physiotherapists, occupational therapists and speech therapists, there are many of those who provide deeply necessary skills and knowledge that augment and support the work of therapists. These roles include and are not limited to rehab physicians, rehab nurses, rehab engineers and even social workers.
When it comes to catering to the needs of a patient, therapy in rehab resorts to three models of approach. The first is Multidisciplinary where experts from multiple disciplines are required but the solution does not require interaction between the disciplines. The second is Interdisciplinary which although is similar to the first, alignment and interaction is required between the multiple disciplines in order to achieve rehab goals. Finally, we have Transdisciplinary which is a more advanced model, requiring individuals or teams of therapists to perform beyond the comforts of their expertise to better assist patients achieve recovery.
The diversity in rehab expertise that is needed to help individual patients often requires the collaboration of multiple rehab experts.
Key differences between traditional clinical rehabilitation and rehab technology
We’ve had the opportunity to look at the general historical development of rehabilitation and the modern rehab services that are available today. In comparison with its historical counterparts, the driving force in the rehab industry today is vastly different and expansive in its ability to propel the industry and in likelihood determine its future as well, introducing rehabilitation technology.
Rehabilitation technology is new services that share the same goals as traditional medical rehabilitation. The key difference however is in the tools used and its implementation. Rehabilitation technology leverages the availability of modern technology such as robotics, neuromodulation & stimulation, virtual reality, and in recent years the use of Artificial Intelligence and brain-computer interfaces, all in pursuit of faster recovery speeds. The diversity in rehabilitation technology is immense, with new designs and prototypes being developed constantly as new requirements surface.
The following are some examples of rehab technology
Additional technologies added to wheelchairs for those with targeted disabilities is one of the simplest examples of rehab tech. By adding motors and a steering system via joystick or voice command, the wheelchair is now a viable option for those who are unable to manoeuvre a wheelchair traditionally such as multiple limb amputees or one suffering from upper limb trauma.
Robotics in physical rehabilitation
Application of robotics in prosthetics-design has achieved new degrees of improvements in quality of life that were limited previously by the use of traditional prosthetics. Robotics are also applied in physical therapy in the form of movement therapy props where patients relearn motor skills and motions with robotics assistance. The use of exoskeletons as well are now possible, providing support for those with weakened muscular or skeletal health.
Transcranial Magnetic Stimulation (TMS)
Though not a new technology, TMS in the field of medical rehab is definitely a new development that is gaining recognition for its application in clinical rehabilitation. Using harmless magnetic waves directed towards targeted parts of the brain, TMS was initially applied as a treatment for depression but has now found significant positive effects as a treatment for chronic pain, PTSD and stroke.
As can be perceived in the examples, the key difference between traditional medical rehab and rehab technology is that technology has now enabled rehabilitation processes to take place beyond the constraints of a therapy session.
Why is rehab technology a necessity? Industry progress and advantages over manual therapy.
The necessity of technology’s advancement of the rehabilitation industry is one that carries with it many advantages that will further allow this segment of medicine to grow and progress.
Rehab-tech as mentioned previously allows rehab, recovery and therapy to take place outside of the traditional therapy session. This singular advantage speeds up a patient’s recovery. If rehab is limited to only sessions of therapy with the experts and doctors, recovery becomes reliant on the weekly or daily hours that you have to spend in therapy. Technology allows us to bring rehab into homes, into the environments we interact with and into our daily lives. This integration increases the practice of rehab work and therefore speeds up the recovery process, a key advantage that rehab tech has over manual therapy.
The previously tedious work of rehabilitation program design and resource challenges is easily addressed through the use of technology as well. With robotics, programming and computing taking over key therapy tasks using pre-designed and assigned analyses, doctors and therapists can now invest the saved time to further improve treatments and advance new systems for better rehab programs.
One other aspect of rehab tech that most experts overlook is the advantage of data collection. Incorporation of technology into rehabilitation programs allows every step, movement, motion and nerve connection to be analyzed and quantified, providing therapists with greater accuracy when it comes to fine-tuning therapy. Large quantities of data will also be useful when developing case studies for simulations, training and application in automated diagnosis and treatment.
Advanced rehab technology, the new kid in town
With technology as a key progress driver in rehabilitation, we can only expect advancements ahead of us. One such advancement we have since experienced in rehab tech is the use of Advanced Rehab Technology.
Much like was expounded in the segment on data collection advantages, Advanced Rehab Tech is able to treat complex disabilities such as multiple amputees. A current example would be the use of intelligent robotics technology where the integration of force-feedback technology in movement therapy provides multiple new layers of real-time and intelligent fine-tuning of therapy. Traditionally, robotic rehab systems provide a platform for consistency in motion in physical therapy but do not take into account the patient’s participation. With the use of intelligent robotic technology, systems are able to then detect the force and movement of a patient and decide in real-time if the patient requires less or more assistance to achieve better rehab results. The addition to any such robotics integrated with feedback systems of any form is that data collected opens up doors to new degrees of fine-tuning and patient analysis, allowing for ideal rehab programs to be delivered in less time.
Advanced rehab technologies at this point are incredibly costly on the initial investment point but will yield return in time and resource-saving factors, providing at the same time a speedy and long-lasting recovery to patients who may otherwise have to pay for months or years of sustained therapy sessions.
The future and possibilities of rehab technology
It would not be difficult to visualize the possibilities that technology will open up into the medical rehabilitation sector. It is however without a doubt that no matter the technology and method, any form of innovation, progress or advancement will take place for the same reason our ancient counterparts deemed medical rehabilitation a necessity: to achieve a better quality of life for those with disabilities and to give them an opportunity for complete recovery.
It is also a hopeful thought that as technological applications begin to become common in hospitals and therapy centres, the cost incurred for rehab and therapy will reduce as the result of technological-scalability. Scalability then makes way for availability, ensuring more if not most will have access to the rehabilitation that is needed for the possibility of better living quality.
Managing Director of Fourier Intelligence Global HQ
Owen Teoh is the Managing Director of Fourier Intelligence Global HQ and an advocate for robotics and advanced rehabilitation technology. He is an experienced leader with demonstrated accomplishments in the healthcare industry, skilled in the development of healthcare services and healthcare business operations. Additionally, he is a strong business management professional with a Master of Business Administration (MBA) focused on business strategies, management, and operations from the University of Strathclyde. Supported by his in-depth clinical and research knowledge in clinical rehabilitation, he holds a master’s degree in clinical rehabilitation from Flinders University, Australia.
Experienced as a physiotherapist in both in-patient and out-patient clinical settings, Owen led the setup of the first Hocoma Rehabilitation Robotics Rehab Centre in Malaysia in 2009, becoming the first certified robotic rehabilitation therapist in the region. In 2012, Owen was appointed as the team leader of the neurorehabilitation section at Subang Jaya Medical Centre, heavily involved in clinical service and the training of neurorehabilitation. His main responsibilities also include obtaining complete international accreditation, such as JCI audit.
In 2019, Owen was invited as a speaker for the 2nd International Annual Conference on Innovation in Rehabilitation Practice & Medicine held in the United Arab Emirates.
Owen is a certified instructor and user for multiple rehabilitation and medical technologies, ranging from rehabilitation robotics to shockwave therapy, hydrotherapy, Functional Capacity Evaluation, and Bobath certification. Utilising his expertise, he is now driving the adoption and education of healthcare technology in both clinical and research fields.