What technology-assisted advancements are evolving the healthcare sector? Ross Henry Law, senior reporter at National Technology News, investigates.

In a post-Theranos world, it is wise not to over-invest hopes in technological solutions to healthcare issues.

But while the former Forbes posterchild continues to serve her prison sentence at FPC Bryan, researchers around the world are making genuine, revolutionary developments in healthcare technology that could deliver life-changing results.

The kinds of technologies promising to revolutionise everything from finance to entertainment like artificial intelligence and machine learning are also being deployed by leading scientists to develop new healthcare innovations for diagnosis and treatment.

In this feature, National Technology News examines a handful of organisations at the bleeding edge of HealthTech and examines the projects they have been developing.

Restoring temperature sensation to amputees

Modern technology has created a world where artificial limbs are more functional and comfortable than ever before, but one of the final frontiers of their development is adding sensory capabilities – i.e. the ability for a prosthetic limb to detect sensory information like touch and temperature and transmit that information in a way that the brain perceives it as input to its own nervous system.

Researchers at Johns Hopkins Applied Physics Laboratory (APL) are looking to tackle this, and recently published a paper on the development of a wearable ‘refrigeration device’ known as a thin-film thermoelectric cooler (TFTEC) designed to help amputees feel temperature through their prosthetic limbs.

Luke Osborn, neuroengineering researcher and leader of much of Johns Hopkins APL’s non-invasive nerve stimulation work, says the team had originally been trying to figure out how to restore general function and sensation after limb loss and had been able to restore sensations of touch and pressure by providing nerve stimulation.

“The human ability to feel in our environment is not only about pressure and includes many other variables like wetness, pain, and temperature,” Osborn says. “We therefore had an interest and motivation in exploring how some of the more complex aspects around touch could be restored to amputees.”

Temperature was a particular aspect of touch sensation Osborn wanted to address and this is where Rama Venkatasubramanian, a semiconductor device engineer and chief technologist for APL’s thermoelectrics research, entered the picture.

Venkatasubramanian has been working on cooling technology for the US State Department’s Defense Advanced Research Projects Agency (DARPA) for almost 25 years.

“DARPA has been interested in cooling tech for many reasons since they have electronics, photonics and other management applications where you need to remove a lot of heat very quickly,” he explains. "There are plenty of applications in Department of Defence platforms for this type of technology, so DARPA has funded me for quite some time, and I started this work at Johns Hopkins in 2016 with the goal to develop this technology further.”

By 2019, Venkatasubramanian and his colleagues had significantly improved the performance of the cooling device and Osborn had begun exploring the development of cooling sensation touch experiences for amputees with another colleague. Despite this advancement however the researchers were still unable to accomplish their goals.

The type of devices Venkatasubramanian and his team were developing featured high-power cooling density that was fast acting – a requirement of providing cooling sensation to nerves is that this needs to be able to happen in “around a third of a second,” he explains.

He says that joining Osborn in the APL’s work around cooling sensation for amputees “seemed like a perfect fit.”

"Our device fit the requirements needed for this kind of stimulation, so I started working with Luke in early March 2020,” Venkatasubramanian says. “Within a few months, we were able to demonstrate that we could elicit this kind of cooling sensation in an amputee that APL had been working with for over 10 years.”

The TFTEC device Venkatasubramanian had been working on is based on semi-conductor materials.

“On one side of the thin film device, which is about 25 micrograms, you have electrical contact and on the other side, you have another contact, and you inject current from one end to the other,” he explains. “Depending on how you inject current, you can either have cooling at one end or heating at the other end.”

The essential effect is that electrons are carrying heat from one end to the other.
“This particular idea is not anything new,” Venkatasubramanian notes, “but we are now perfecting the materials that make the process work and to enable wider use as in the case of applying the device to prosthetics.”

But while the idea is not a new one, its implementation still provided the researchers with hurdles to overcome.

Osborn says one of the biggest challenges in making this device work with temperature response for patients’ prosthetic limbs initially centred on nerve stimulation. He explains the difficulty of deciding “where to provide and put it on the body so somebody felt like the sensation was emanating out of their missing hand or arm.”

He continues: “Every individual is different, and we approached this by mapping out the entire arm and hand of each individual we work with. We realised this works because the sensory nerves will regrow into skin, so we basically had to find where these were before providing the stimulation.”

Venkatasubramanian added it was not surprising this was an initial obstacle. "Even for a normal hand, people's architecture is very different, and due to an accident or other reasons, each surgeon may terminate the skin at different points making the regrowth of nerves somewhat of a random process."

“What we found was that every individual has their own unique site location on their body which we stimulate, and they feel it in a unique spot on their missing limb," Osborn explains.

Osborn adds that once the appropriate nerve stimulation location in their test subjects was found, the locations remained stable and were there even the next year, “as evidenced by an individual who returned a year later and the same spots they stimulated were still in the same location and they still felt them in the same way."

Osborn goes on to note that another of the other big challenges when he and a former colleague were thinking about how to restore temperature sensation to amputees lay in developing the technology to provide a cooling sensation very quickly in order for somebody to feel it.

"If you have a very slow temperature change, you don't notice it as much,” he explains. “The challenge was in providing a technology that provided a cooling sensation extremely quickly – within hundreds of milliseconds – as the thin film thermal electric device we use does."

Looking ahead, Osborn and Venkatasubramanian are convinced the technology could have a role to play in several other areas including mixed and virtual reality.
"What’s exciting is this technology now gives us the ability to create more realistic and complex haptic sensations of touch,” Osborn says.

The researchers envision TFTEC folding into haptic feedback functionality for mixed reality, VR, and communicating across the globe where you may not physically be there but have the ability to experience “rich and more complex touch sensations virtually.”

Venkatasubramanian is hopeful the technology could also be applied to pain reduction and pain management.

“We think the device could be potentially useful is in the emerging body of work wherein studies are beginning to show that thermal control functions could be used to brighten nerve fibres – that way we don't feel pain.”

Research in recent years has shown that increasing temperature rapidly and then providing active cooling immediately, “quietens nerve fibres to the point they don't feel pain,” Venkatasubramanian adds.

"This is another possible application for our technology as it is intrinsically suited not only for heating and cooling, but also doing it at the speed you would need for these functions,” he concludes.

AI-assisted stroke detection

In the coming years AI will permeate through to all aspects of life, processing huge amounts of information, automating tasks, and providing insights in a fraction of the time that it would take a human. Its viability however depends on the source and quality of data, and it is with this in mind that Oxford University healthcare spinout Brainomix is focusing on using the technology to detect strokes.

George Harston, consultant physician in stroke and general medicine at Oxford University Hospital’s NHS Foundation Trust and chief medical and innovation officer at Brainomix, says that one of the main challenges of delivering effective stroke care is dependent on doctors’ ability to interpret brain scans effectively.

"We're nowadays using increasingly complex imaging," he says, "including putting contrast into veins in a scan to light up the blood vessels – an approach which helps to identify blocked blood vessels, thereby helping observing doctors to better characterise the extent of the injury and the tissue at risk in the brain.”

Harston explains that AI functions as “more of a decision support tool to assist doctors.”

Harston demonstrates his case with a non-contrast CT scan, noting that the it is difficult to draw strong conclusions from the grey image of the brain by the naked eye alone.

"Our technology automatically straightens and corrects the brain image for any distortions, and then you also get a machine learning algorithm which then goes over the brain scan,” he says.

Harston continues his demonstration with a brain scan covered by a red shading overlay. "That's the output of this AI algorithm, which shows where the algorithm is confident that there is early injury to the brain," he explains.

"With this overlay, it's much easier to identify than in the standard grey CT scan," he says, noting that the AI overlay can immediately identity the areas of ischemic injury on the brain.
Harston argues that this AI-assisted scan provides greater insights such as “what percentage of injury there was in a given region just by looking,” with AI standardising the assessment and even able to highlight any occlusion of blood vessels.

“Information like this can help practitioners with more nuanced assessments,” he says, explaining that being to determine that there being no collateral blood flow, for example, can “swing a practitioner’s decision about whether someone is going to benefit or come to harm from receiving treatment" and that such an occurrence is far easier to determine with the assistance of AI.

The digital pill

For patients which chronic diseases and illnesses, managing medication can be a complicated task and requires significant care to ensure that medications and treatments are correct. Cambridge-based DeepTech electronRx is attempting to eradicate that complexity via its proposed ‘digital pill’.

The tech promises to detect patient vitals and serve as a prognostication tool via a smartphone API that can, within 60 seconds, “capture cardio-respiratory functions.”

Dr Bipin Patel, chief executive at the firm explains: “My motivation is all around how we can potentially create therapeutic outcomes by intervening at the nerve level. If you could understand the communications that run backwards and forwards between nerves and if you were able to electronically intervene, you could create a therapeutic benefit."

The company, which is currently in the clinical study phase and anticipates filing for regulatory approval for its first application in the coming months, envisages using a mobile phone’s camera to measure patient diagnostics.

Via this information on a patient’s vitals, a digital signature could be created to ensure better understanding and treatment of symptoms.

"When you see a physician, they are only looking at you for a five to 10-minute period and you have to explain everything,” Patel says. “The physician doesn't really understand what has happened to you over the past months or even the past few days, but if you had a digital signature that showed, for example, that you'd been wobbling about, then that would serve to give a more comprehensive insight into what could be wrong with an individual."

Patel explains that by measuring such diagnostics, what the API would also be looking for trends around factors which may be changing.

"If you're an individual who happens to have asthma, for example, that is going to be a function of what’s happening in the atmosphere and whether an individual has been exposed to something like an antigen in the air and that is where you really want to pick this up. Push notifications could highlight that your respiratory patterns have changed, and this becomes an early warning system.”

Patel notes that one of the key values of the digital pill concept lies in the fact it could be “highly scalable and easy to democratise."

"This type of tech would allow us to monitor the key vital signs we need to monitor to determine whether a patient is at risk, and we are on a roadmap towards distilling this all down and dropping it all into a simple mobile phone,” Patel says.

He concludes: "To really do this, if mobile phone companies can envisage having a mobile phone that can monitor the health of a patient in the home, and in a medically and clinically acceptable way, you then are taking out a significant chunk of use of resources and queuing in the NHS."

The business case for healthtech

There are clear opportunities for technologies once disparate and unrelated to the sector to have a meaningful effect on healthcare. Successful application of these technologies could considerably reduce the burden on doctors and put a dent in the NHS’s ever-present of long waiting lists.

As AI, ML and other technologies continue to develop, the stage is set for ever more valuable use cases being applied to a range of healthcare areas. Such projects have the potential to realise new methods of diagnosis and achieve new techniques for managing and potentially even eliminating the worst health conditions we face.

The application of technological advancements explored here are just a glimpse of broader developments in healthtech a bright sign of things to come as developing technologies are increasingly applied throughout healthcare.

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