Some of the things I'm going to be talking about today really relate to the use of of real world environments. I'm going to be talking about some applications which I think Anand could be interested in because one of those is the use of digital technologies for neuro rehabilitation using a combination of games and immersive technologies. I'm going to try and rattle through this presentation quite quickly because the beginning part of it is really to do with a bit of background to digital therapeutics and I wanted to start by just seeing if I can define digital therapeutics. When I first became involved with the international society for digital medicine I couldn't get my head around why they called it digital medicine because how can you use digital as a form of medicine? So I tried to persuade them to change it to the international society of digital health which would include diagnostics and other things but in the six years that I've been involved with ISDM I now can see quite clearly how you can use digital technologies for medicine in the form of therapeutics, so the first part of my presentation is really to set the scene as to why digital therapeutics is particularly important in today's environment. I'm going to be talking and giving examples of digital therapeutics for mental health and well-being and also for physical health and well-being but before that I'm going to go very quickly through a series of slides which explain something about the challenges which go beyond coronavirus to something more fundamental about life in the 21st and 22nd centuries. So what we've seen over
the last century or so is a real increase in life expectancy and this has created its own challenges because we've got a growing number of people who are in my age group. I'm 72 so I am in the aging society already and I'm very conscious of the fact that there's a smaller and smaller number of people who are working to provide the income to be able to support this aging population. So this is represented in this graph that shows that from 1945 when we had approximately 40 percent of people working compared to the retired population to predictions now going down to about 2.9 of the population. Now added to that, we all know that we have quite a number of challenges that you will all be familiar with - our lifestyle, smoking, obesity, loneliness, social isolation. The number of people and the resources available to support them particularly when they need care - all of these things go to create a problem with the sustainability. I'm just showing a picture as an example of this. This is actually my mum - my mum she was taken into a hospital unconscious and in fact when I went to see her, she was in acute care and the the nurse talked me through the Liverpool pathway to explain that my mum was suffering from, or she was exhibiting what they call chain stoking - a form of breathing which is - you probably aware is what people have when they're close to death so she was trying to prepare me for the worst and I thought to myself you're actually enjoying this you know. I got the impression that it wasn't
something that she really felt bad about doing - I got the impression that she almost enjoyed having to go through this process with me and the second thing was and I said to her chain stoking? that's my mum's snoring you know I know how my mum snores she spent a lot of the day asleep so I was quite familiar with that anyway to cut a long story short she was put into, when they when they stabilized her condition she was put into an isolation ward and I went to see her and the consultant came into the room and again said you know your mother is extremely ill and I said well when I came in she recognized me - she opened her eyes and the doctor was dumbfounded he couldn't believe it so he said - he went to the bottom of the bed - he said Mrs Wortley can you hear me? if you can hear me raise your hand. My mum's hand went went up and so from there on they went from a situation where they were really withdrawing all the support to help her recover to help her to she did actually go back again into another another nursing home so these challenges are related the fact we are living longer and as I found out with my mum and my my partner's father we need more medical care as we age a few people able to support them and society is changing exponentially and one of the reasons why COVID is so severe is the fact we've got such social mobility - social mobility we travel a lot - I haven't been able to travel for for two years and it was you know a big blow to me but the fact that we are able to travel so much or have been able to travel so much is one of the reasons why pandemics are not going to be a rare event they're going to be something which is with us for a long time so coronavirus - what it's done is exposed our vulnerability to unsustainable public services but it's also accelerated the use of digital technologies for a range of situation now we have a number of choices I think when we're trying to deal with tackling the problems that we have today with medicine and these choices I would describe as being clinical cures and we've already seen the effectiveness of vaccines in the coronavirus situation but added to that we can also deploy legislation as the government has done having lockdowns and rules that prevent us from spreading infection and the third thing we can do is to accept some sort of personal responsibility for looking after our own health and this is where we have a bit of a dilemma because I think it's a little bit of a paradox it's almost like having an angel and a devil sat on our shoulder - on the one hand we're seeing the fantastic advances in technology that give us confidence that you know these things are going to be sorted out so don't worry about it we will have technology that will solve the problem and on the other hand we can see technology as something that gives us some empowerment on taking responsibility for our own health and so whether you're familiar with the locus of control but research shows that younger people today increasingly are feeling that they don't have power over their own future they feel that technology is actually making them more dependent on technology and with that they don't feel they have either the control or the responsibility over their future and I think that's a that's a real issue because we have to take responsibility for our own health if we're going to make this transition from cure to prevention that's absolutely vital to the future of sustainable health care so how can we influence lifestyle behaviours and circumstances at an individual level but also at scale and the way I described it is that we need to create a kind of ecosystem where we provide personalized gamified and validated behavioural change changing people's behaviour - helping them to live a healthier and more fulfilled longer lives is critical to the future of our healthcare services and these in my experience are the most important factors in trying to influence that - diet, exercise, hydration, sleep, mindfulness and stress management, and a social support network so a lot of the things that I work with and a lot of things thatIi use myself in my own personal health management are related to these kinds of factors and I'd be happy to share with you some of the devices and applications that that I use to manage my own manage my own health so what we're using technology to do are first of all to look at things the factors that influence our personal health management create benchmarks for ourselves - if we don't know where we stand in the health spectrum, we can't possibly be able to measure how we're improving on that then we need, from a gamification point of view, to set achievable goals - now in my case when I started on this road some seven years ago I gamified my own health and my my achievable goal was ten thousand steps a day because that was the mantra of the day so in the last seven years I've walked at least five miles every day apart from probably less than one percent of the days so wherever I am - today I walked down to Bournemouth beach and I will do my my five miles during the day and I use my my Fitbit and devices to to to achieve that so it's very much a personalization of healthcare not everybody can do ten thousand steps and not it's not appropriate for everybody but what you need to do is to identify those things in your life that you can change and find the technologies and the methodologies to allow you to do that and what you finish up creating i think is what this personalized gamified and validated health ecosystem so i am particularly interested in working with Bournemouth i've been to many international conferences and i know Bournemouth has a very good reputation already and so i'm keen to try and leverage your reputation my contact network and experience to help bring people and funding and reputation to your university so now to get to the kind of meet and the demonstrations of digital medicine and digital therapeutics we're talking about life after COVID 19 what are the kind of things that are going on already and how do they work well one of the partners that i that i work with is an Italian serious games company they they've done almost 20 EU funded projects and their speciality is gamified health so they have applications for uh particularly for people with neuro rehabilitation people recurring from a stroke, Parkinson's disease etc um and so they have this gamified environment it's not virtual reality environment but it uses Microsoft Kinect or equivalent devices and just got a little video to show you an idea of how it works so you can see the patient is just using the hand to navigate around the maze so it tracks motion and it deploys it in a game environment and this can help not just with physical rehabilitation but also with cognitive rehabilitation by uh giving people challenges so for example with dementia sufferers uh they have a typical kitchen environment where people have to pick coloured cans off the shelf and put them on the table so they're exercising their body but they're also exercising their mind as well so there's a range of different kind of applications that they work with so that's Rehability as a project and i know that the company behind them are always interested in collaboration with university so that the information that is collected from Rehability goes to a physiotherapist dashboard so the physiotherapist can remotely manage the patient so the patient can be at home do these exercises in front of their own television and the data is captured by the the system and the physiotherapist can adjust the exercises in the games and the complexity according to how the patient is doing but at least it gives them an ability to manage patients remotely without the patient having to travel to a dedicated rehab adaptation facility now this is something that i've been using myself you can see me with my Oculus quest headset on there and i'm using a little um a desktop bike which you can put on the floor and you can cycle with or you can put on a table as i'm doing here and you can do exercises and what i've been using it is with um a software via virtual reality software application called VZFIT which allows you to carry out exercises and you can choose your virtual environment so it is about creating and sharing virtual rides so this is a little video i've made showing myself with the oculus quest so i'll start the exercise and you can see uh i chose the environment and this is a us environment and i'm busy excitedly through a virtual environment but because it works with um with google earth google maps i could cycle from this building into Bournemouth station or wherever i want i can create my own customized environment is i found myself a little bit disoriented because the way that Google Earth captures images and you perhaps can see this is that as you're driving along it has incremental steps and that can make you feel a little bit dizzy and sick so there are limitations to it but there are other applications to work on a mobile phone and Holofitt is one example of that this is something which i think has a lot of impair potential and i i would love to work with with you on a funded project to evaluate its potential i call it 360 and 360 living memorials and it's about capturing the memories of older people and recording um family events so the a it can help the person with their with their memory and stimulate their cognitive ability but also from a family point of view when that person passes away they can have the same experience of being in the room with that person so what you see on the screen here um is my partner's late father he died in October 96 years old and there's a VR video with his girlfriend she's 92 and they've been together for eight eight years and sadly because of both of their conditions we had to separate them because we couldn't look after both of them so Eric stayed with us and his partner went to live near her family but i took the opportunity to record some uh vr videos and i created a kind of harry potter environment using uh real world images and i i just like to just show you a quick video here's Eric and this is actually taken from the application so this is our living room and you can see talking pictures unless you family tree displays when you go over this and as you roll over you get these pictures of the family when when it's developed fully uh if you click on someone in the family um you will get their memories so here's Eric and his girlfriend and if i click on that they're talking about when they first met on a Saga holiday and this is in a VR environment you can see me standing there talking to them and so this is available for their family and above the fireplace there are these talking videos of my my wife my partner's sisters and if you click on a picture frame uh you get Eric telling about talking about his his early life so i i think there's many different applications and i i love doing the lunch time to show you some of those applications the other thing i would like to to show you is has anyone heard of Alcove VR no i think it's a wonderful application particularly for uh for families and dementia patients in fact the environment was created to be able to build your own personalized space so what you get is an apartment like this that you can invite other people to so other people wearing oculus quest can actually join you in your apartment you can watch videos together you can listen to music together you can go on tours around the world and you can personalize your environment with your own pictures so if i go into the next slide this is actually captured from my oculus quest jags about a bit so i i've uploaded some of my own virtual reality videos um so i love steam trains but i also love drones and this is a 360 degree drone photograph shot in Kuala Lumpur at night so i turned it into a still image and within this alcove environment you get the virtual reality experience of actually flying through uh Kuala Lumpur so uh getting very quickly towards the end of my my presentation now um when we're talking about these digital therapeutics for older people solutions are already available for both physical and mental health and these solutions can do with some research and validation and lots more solutions will will come along and if i'm trying to sell myself i have a lot of contacts who are working in this space so i would love to engage them with you to create win-win situations that will bring funding and projects into you but it's important that the solution must be plug and play for older people particularly one of the disadvantages of the Oculus quest is that it's not a plug-and-play environment what i had to do with uh with Eric was to basically to load the the the VR experience and put the headset on on him to watch it um and because he's not familiar with the controllers i had to cast the the video onto the television set so i could see what he saw and i could control it for him.
2022-01-31