Tech for a Better Tomorrow
The booming medical industry in Singapore reflects the innovative and creative thinking of mavens that artfully combines science, compassion and empathy to provide services and care for patients that are truly ahead of the times.
By Joseph Lim & Leela Jesudason
ingapore’s medical technology (medtech) industry is thriving; a fertile hotbed for professors, scientists, researchers and clinicians. Teeming with ideas and innovations, it has drawn many companies to establish their presence in the region by setting up offices and research facilities on this island-state.
A wide range of companies is leading the charge. From big players such as the Agency for Science, Technology and Research (A*STAR) to much smaller set-ups like Spectrum Learning Pte Ltd, this industry is carving out a name for Singapore as a credible incubator for tomorrow’s medical and health technology.
Experts in the medtech industry cite that the industry is projected to grow to over US$300 billion in 2017 with a CAGR (Compound Annual Growth Rate) of 6%. A*STAR reported that Singapore’s medtech sector has grown 2.5 times over the past decade, and in 2011 the industry created 9,000 jobs and produced $4.3 billion in output. In addition, A*STAR and EDB(Economic Development Board) have devised a training programme with Stanford University to help nurture medtech talent and incubate their ideas in Singapore.
Another noteworthy collaboration, the A*STARCIMIT (Centre for Integration of Medicine and Innovative Technology), witnesses a consortium of 13 hospitals and engineering schools in Boston, USA, to bring great minds together to share knowledge and integrate clinical solutions for improving patient care where Singapore’s hospitals and polyclinics are ‘test beds’ for these innovations.
“Singapore’s medtech industry benefits a lot from its local capabilities such as engineering, manufacturing, and the clinical community. Our medtech industry is now so vibrant that it is attracting much interest from external communities from the USA and Japan. We have funded over 50 projects in the past few years, and some of them have gone into spin-offs and licensing,” says Professor Tan Sze Wee, Deputy Executive Director, Biomedical Research Council, A*STAR and Programme Director, Healthcare and Lifestyle Programme, A*STAR.
Singapore’s vision to be an Asian Biopolis — a leading international biomedical sciences cluster, where companies can impact global health by building synergies across research, development and manufacturing — is already materialising. Any medtech company that takes its idea from prototype to human trials is always optimistic about the outcome, of which there are examples featured here, though there are countless other such innovations being created almost on a daily basis. Even independent companies not funded by the government are also making headlines with their technologies. For medtech in Singapore, the future is certainly looking bright and promising.
A current innovation in tackling the rise of dementia cases is gaining considerable traction because of its potential practical usefulness. The elderly often suffer from memory loss and age-related cognitive decline (ARCD) and mild cognitive impairment (MCI). This is not limited to ‘remembering things’. Even language and thinking skills can be impaired, as well as the ability to make sound judgements. While MCI may not be life-threatening in its early stages, it can lead to an increased risk of dementia, Alzheimer’s, or other neurological deteriorations that may become an impediment to daily life.
Dr Guan Cuntai, Head of the Neural and Biomedical Technology Department, Institute for Infocomm Research, A*STAR, and Associate Professor Lee Tih Shih, Neuroscience and Behavioural Disorders Programme, Duke-NUS Graduate Medical School Singapore, realised the void in detecting these mental conditions early and pooled their expertise to develop EncodeMCI.
Dr Guan Cuntai’s EncodeMCI memory game which can be of significant use to an ageing population.
“Today’s MedTech doctors now provide valuable information for engineers to work on and design complex algorithms.”
— Dr Guan Cuntai, Institute for Infocomm Research
This unique innovation is essentially an attention-memory training system based on Brain Computer Interface (BCI). Much like playing a memory game, the patient is set up for an electroencephalogram (EEG) where small electrodes are placed around the skull to pick up the electrical activity of the brain and send these signals to the EEG device. It records the signals as wavy lines, projected on a computer screen or printed on paper.
“This simple but effective memory training system works by encouraging subjects to increase cognitive performance through better concentration,” explains Dr Guan. “Much like creating ‘pathways’ within the brain, it paves the way for a personalised treatment device for elderly with ARCD and MCI.”
It is an efficient way to retrain the brain and the results have been so promising, it has been tested in day-care centres and even in homes.
“Such a successful partnership would never have seen light of day had there been no doctor-engineer chemistry cum collaboration,” says Dr Guan. “In the past, doctors and medical engineers worked separately with different goals, but today’s medtech industry is all geared to change this model. Today’s medtech doctors provide valuable information for engineers to work on and design complex algorithms.”
Caring for seniors and the critically ill is made more efficient with Dr Chan Zhihao’s vital signs monitoring technology.
Fighting the Silver Tsunami
Recent government statistics revealed that by 2030, one in five people in Singapore will be 65 years or older. The government predicts that senior citizens of the future will be more educated, savvy and resourceful, and therefore demand a better quality of life.
One of the latest medtech inventions funded through A*STAR’s Biomedical Engineering Programme (BEP) is a Non-intrusive Vital Signs Monitoring Technology that allows doctors to keep track of a patient’s vital signs to gauge his personal health and manage chronic diseases. They have developed an innovative sensor that looks like a seat pad. The act of sitting on this seat pad immediately triggers real-time monitoring of a patient’s vital signs through a multi-mode optical fibre system. There is no need to attach any sensors to the patient’s body.
Funded by BEP and led by researchers Dr Chen Zhihao from the Institute of Infocomm Research and Dr Kei Pin Lin, consultant, Department of Diagnostic Radiology, Singapore General Hospital, this invention is currently licensed to two companies and is being considered for commercial development.
“The key success of this invention is the highly sensitive multi-mode optical fibre that is able to monitor vital signs and generate accurate data without being intrusive to the patient,” explains Dr Chen. “Best of all, its robust wireless transmission is also ‘cloud’ deployable — meaning the data can be sent via wi-fi networks to a central cloud system where such data is stored and managed to provide a knowledge base for physicians and researchers.”
Not limited to geriatrics, the technology can be deployed in a sleep monitoring device to observe sleep disorders or track sleeping behaviours. Its low-cost application and ease of use also allows it to be a baby monitoring system. It can even be used to assist caregivers through an alert system that is triggered when an elderly patient moves out of a safe zone.
“We are also exploring ways to incorporate the taking of blood pressure measurements without the cuff,” says Dr Chen, making this pad even more practical and indispensible in everyday hospital use.
“Our med tech industry is now so vibrant that it is attracting a lot of interest from external communities from the United States and Japan.”
— Associate Professor Tan Sze Wee, A*STAR
Helping in preventive eye deterioration care with early screening is Dr Damon Wong’s THALIA Ocular Machine.
Eye for an Eye
One of the characteristics of a country with a rising number of senior citizens is a corresponding rise in age-related macular degeneration (AMD). After cataracts and glaucoma, this is the third leading cause of blindness worldwide, accounting for 5% of global blindness. Patients with AMD experience difficulty in driving, reading or even recognising people. While there is no cure for AMD, treatments are available to slow down the disease. Currently, the lack of symptoms in people with early stages of AMD is the biggest obstacle in managing the disease, as they are unaware of their condition and therefore do not seek medical help.
“Early-stage AMD is characterised by the presence of drusen,” explains Dr Damon Wong from the Institute of Infocomm Research. “Drusen are tiny yellow or white fatty deposits in the membrane of the retina. Drusen can be naturally removed by the eye in those below 45 years of age. But in the elderly, the body becomes less efficient in disposing drusen from the eye, which results in the build-up of fatty deposits that impair vision.”
“Doctors and medical professionals can now be alerted to those in the very early stages of AMD and send them to appropriate speciaists for treatment.”
— Dr Damon Wong, Institute of Infocomm Research
Dr Wong and Professor Wong Tien Yin from the Singapore Eye Research Institute have devised the THALIA system that allows doctors to detect AMD in its early stages in order to avert disease aggression.
“Most clinics and GPs already have fundus cameras,” elaborates Dr Wong. “We have basically created software for these fundus cameras to capture retinal images with the drusen. The fundus machine is used to obtain images of the retinal fundus, which is the interior lining of the eyeball. Doctors and medical professionals can now be alerted to those who are in the very early stages of the disease and can send them to the appropriate specialists for treatment.”
“The next phase of this technology is to make it cloud-based,” says Dr Wong. “This offers wider accessibility and potential for extending the range of services available to the patient.”
Looking into the future, the THALIA system could be the perfect tool for mass screening for early AMD. The medtech invention is touted ‘firstin-class’ in the ophthalmology world and plans are underway to get it commercialised.
Getting to the Brain of the Matter
While not quite on the same scale as government-funded A*Star, another specialist is quietly making interesting inroads in the realm of neurofeedback technology that optimises brain function for better health.
Neurofeedback works on the understanding that the brain is malleable enough to adapt to influences from the environment, injury or new information and memories. Neurofeedback trains the brain by providing feedback on one’s brainwave activity through sound, images and touch.
Over a period of training, the individual can experience a change in brain functions that could range from enhanced mental ability to focus and faster, more accurate responses; to physical improvements such as the easing of migraines or seizures; to emotional states like managing anger to cravings in addictions. The effects endured after this learned process is internalised over a sustained period of regular training. Subsequently, the patient will be able to produce or maintain the desirable brainwave behaviour without further input from neurofeedback.
Local company Spectrum Learning was the first to offer neurofeedback services in Asia in 1995, specialising in alleviating attention deficit disorder (ADD), autism, dyslexia and other learning disabilities besides stress and anxiety. It is part of a pioneering cohort of neurofeedback clinicians that emerged in the USA, Australia and Europe, where brain exercises using neurofeedback were introduced to the public around the same time.
“We are also into research and development of new protocols and equipment to enhance the efficacy of our programmes,” says Dr Kenneth Kang, Founder and Principal Consultant of Spectrum Learning. “We have a scholar’s programme or protocol and a Speed Reading protocol. In our next stage of equipment development, we will interface our brain exercise system to XBOX games and also to a reading.” Dr Kang started off as a teacher and was dismayed to see hardworking students failing miserably in their studies, and was certain that “something was going on in their brains”.
Dr Kenneth Kang pioneered the use of neurofeedback services in Asia
“The ’90s was the decade of the brain,” explains Kang. “Numerous studies were published in journals about what was emerging as a fascinating new component of science — neurofeedback. Back then, the primary focus was about prolonging attention spans. I brought the system back to Singapore in 1993, and started working on some of my thenstudents, and the results were indeed encouraging enough to spur me on to further research and a desire to do more with neurofeedback in Singapore.”
Dr Kang went on to pioneer a brain mapping, which is a set of neuroscience techniques that studies the anatomy and function of the brain and spinal cord through the use of imaging. This technique allows the therapist to analyse how a person uses his brain while engaged in a specific task. It also reveals regions of the brain which remain inactive or fatigued — which can happen when reading or solving a mathematical problem.
“The knowledge gained from this kind of brain mapping is invaluable in understanding the learning characteristics of a person in relation to the innate talent he may already have,” explains Dr Kang. “This technique provides a road map for designing an individualised brain exercise programme using neurofeedback.”
Though still in the relatively early stage of development, neurofeedback is fast gaining traction in an environment where science and creativity are happy partners, thus continuing to strengthen the basis upon which medtech industries can continue to thrive and grow.
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