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Products and Technologies

Our busy labs and workshops are feeding a pipeline of new commercial products, including patient lifting devices and an array of rehabilitation and home care tools. Some examples:

  • ApneaDx™: the world’s only cordless sleep apnea diagnostic device
  • Stimulation therapy
  • HandyAudit®: Toronto Rehab’s hand hygiene audit tool
  • BalancePro: enhance balance instantly
  • Sonneta
  • Prescribing opioids for pain: guidance for doctors
  • Caring for caregivers
  • An ‘intelligent’ emergency response and fall detection system
  • SensiMAT
  • Age-CAP app
  • Robotic arm for stroke therapy
  • RoboNurse
  • StandEasy™ Adjustable Pole System

ApneaDx™: the world’s only cordless sleep apnea diagnostic device

Obstructive sleep apnea (OSA) is a common yet underdiagnosed condition linked to a range of serious problems from accidents caused by daytime drowsiness to increased risk of cardiovascular disease. Currently, people must spend a night in a sleep lab to be tested for sleep apnea. Long wait lists are common. Now, Toronto Rehab scientists have come up with an easier, less costly way to detect OSA. Called ApneaDx™, it’s a portable detection device that analyzes breathing sounds while a person sleeps at home.

Recent tests show the device is remarkably accurate, says Dr. Hisham Alshaer, a University of Toronto Ph.D. candidate who is collaborating on ApneaDx with Toronto Rehab senior scientists Drs. Douglas Bradley and Geoff Fernie. The device is lightweight and wireless ― key features developed by a Toronto Rehab engineer and an industrial designer.

A spin-off company called ApneaDx, owned by Toronto Rehab-UHN and MaRS Innovation, has been launched to commercialize the detection device. Partners include the Ontario Centres of Excellence and Johnson and Johnson Inc. There is also support from MaRS EXCITE and FedDev Ontario. ApneaDx should be available in 2014, says Dr. Ashaer. For more, please watch our video on Youtube.

Stimulation therapy

A Toronto Rehab-University of Toronto start-up company called MyndTec Inc. is commercializing a stimulator used to reawaken paralyzed muscles. The device was developed by senior scientist Dr. Milos R. Popovic and colleagues to help people paralyzed from stroke and spinal cord injury to regain the ability to reach, grasp and walk.

Functional electrical stimulation (FES) uses low-intensity electrical pulses, generated by a pocket-sized stimulator. Unlike permanent FES systems, the one designed by Dr. Popovic is for short-term treatment. The therapist uses the stimulator to make muscles move in a patient’s limb. The idea is that, after many repetitions, the nervous system can ‘relearn’ the motion and eventually activate the muscles on its own, without the device.

In a recent study, Dr. Popovic and colleagues reported that FES “significantly” reduced disability and improved grasping in people with incomplete spinal cord injuries, beyond the effects of standard therapy. “This has real implications for people’s quality of life and independence,” says Dr. Popovic.

The team is working to put its approach into widespread use at hospitals, physiotherapy clinics and in people’s homes. MyndTec secured $2 million in funding in 2012, and the company is moving forward with the product development. Already tested in randomized controlled trials, the device will be available for initial testing in third quarter of 2013.

Also in 2012, MyndTec was awarded the TieQuest 2012, which attracted entries from over 225 entrepreneurs in Canada and the U.S. The company also won a TieQuest for Best Intellectual Property in 2012.

For more, please watch our video on Youtube.

HandyAudit®: Toronto Rehab’s hand hygiene audit tool

Toronto Rehab scientists have developed an easy-to-use electronic tool that healthcare facilities can use to help prevent the spread of potentially deadly hospital-acquired infections. Every year in Canada, about 10,000 patients die from infections they acquire while in hospital. Toronto Rehab’s HandyAudit® system helps to provide objective, accurate and consistent hand hygiene measurements.

The current paper-based observation system requires one hand hygiene auditor to simultaneously monitor the hand washing practices of several health care workers, and decide if they’ve made a mistake. This can be a complicated task, and relies on subjective judgments. “The potential for error is high,” says senior scientist Dr. Geoff Fernie, who invented the new audit tool with Dr. César Márquez Chin and Mike Tsang.

How HandyAudit works: auditors simply record actions of health care providers using the touch screen. They can record a range of typical activities such as touching a patient, cleaning open wounds, and using an alcohol gel hand sanitizer. Software analyzes these actions and automatically calculates compliance rates; there’s no need to transcribe information from paper to computer.

Today, more than 100 hospital sites in Canada and abroad are using HandyAudit, including a majority of Ontario’s academic hospitals. A Toronto Rehab start-up company, HandyMetrics Corporation, is steadily advancing sales. “Data can be used to compare compliance with other units or institutions in a consistent way, and to introduce corrective measures, if necessary,” explains Tsang, now managing director of HandyMetrics. “It’s all about helping hospitals to meet the infection-control challenge.”

HandyAudit turns out to be a research tool too. At Toronto Rehab, scientists are using data generated by the device to answer important questions, such as what causes health practitioners to wash their hands.

In 2010, HandyAudit was selected by the Council of Academic Hospitals of Ontario (CAHO) for rapid implementation. Reporting on hand hygiene compliance has been mandatory in Ontario since 2008.

For more on HandyAudit, please visit www.handyaudit.com.

BalancePro: enhance balance instantly

Roughly one in three people aged 65 or older falls at least once a year, and falls are the cause of almost 95% of hip fractures in older people. Of the seniors who suffer a hip fracture, 20% die within a year of the accident. Fall-related injuries in Canada have been estimated to cost the economy $2.8 billion a year.

Dr. Perry, an Associate Professor at Wilfrid Laurier University, and Dr. Fernie, Toronto Rehab Institute’s Director of Research, have conducted research showing that a person’s balance is affected by their ability to feel pressure on the soles of their feet. As a person ages, they loses this ability feel pressure on the soles of the feet, and became more prone to falling.

The BalancePro insole features a specially designed ridge around its perimeter to stimulate and enhance foot planter sensation and therefore, enhance one’s balance and reduce possibility of falls. A small study with 40 subjects showed that the BalancePro insole reduced falls by 44%. A spin-off company has recently been launched, and is now commercializing the BalancePro insoles.

More information can be found at www.balancepro.ca.

Sonneta

Many people suffer from voice disorders (dysphonia), which can have a dramatic impact on their ability to make themselves heard and understood. Voice problems can be associated with age, neurological conditions such as Parkinson's disease, structural problems, and voice strain among people in professions like teaching, acting, law and politics. A challenge for clinicians and researchers is the lack of an easy to use and objective measurement tool for assessing a person's voice quality. The technology that does exist is limited and complicated to use.

Now, researchers at Toronto Rehab and the University of Toronto have developed new software that makes voice assessment easier, faster and more evidence-based. Called Sonneta, the software records, analyzes and archives a person's speech. It uses 'norms' derived from an extensive literature database so that an individual sample can be compared to a larger group. Changes in an individual's voice can be tracked over time.

Sonneta was launched in October 2012 as beta software. It is currently available for evaluation and testing in Canada and the U.S. "We plan to launch Sonneta as a commercial product within the next few months, and are seeking input from clinicians, researchers and educators," says Dr. Dave Fernandes, who invented the prototype for Sonneta while on a postdoctoral fellowship at Toronto Rehab. He founded MintLeaf software to commercialize Sonneta. University of Toronto speech scientist Dr. Pascal van Lieshout helped to develop the ideas behind Sonneta.

For more on Sonneta, please visit www.mintleafsoftware.com.

Prescribing opioids for pain: guidance for doctors

Canada is one of the world’s largest per capita consumers of opioid painkillers. These medications, such as morphine, codeine and oxycodone, help people deal with chronic non-cancer pain. But there’s an alarming misuse of these pain drugs. Dr. Andrea Furlan, a Toronto Rehab scientist and clinician, has played a big role in developing a new Guideline to help doctors when they are considering whether to prescribe opioids for their patients.

“The goal is to reduce abuse and addiction problems with these medications, and ensure that the right people are getting them,” says Dr. Furlan, a lead author of the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. The Guideline includes 24 practice recommendations for doctors.

To encourage widespread use of the Guideline, Dr. Furlan created a new app for iPhone and iPad that helps doctors decide whether to prescribe opioids and makes it easier to monitor patients taking these drugs for non-cancer pain, such as osteoarthritis and low back pain. Called Opioid Manager, the app launched in September 2012.

The new app captures key information from the Guideline, and is a technology-based interactive version of a paper tool, also called the Opioid Manager, developed by Dr. Furlan in 2010, with the Centre for Effective Practice. The paper tool has been translated into French, Portuguese, Spanish and Farsi and can be downloaded from the National Pain Centre website. There’s also an Opioid Manager video. The Opioid Manager is currently being adapted for physicians using Electronic Medical Records.

Dr. Furlan is a member of the National Faculty, a group that is implementing and evaluating the Guideline. She is also an associate scientist at the Institute for Work and Health and a University of Toronto assistant professor of physiatry.

For more information, please visit www.opioidmanager.com.

Caring for caregivers

Despite the introduction of mechanical patient lifts several decades ago, nurses continue to experience high rates of back injury. Many injuries occur during the transfer, lifting or repositioning of a patient. Enter Toronto Rehab, where research is pointing to ways to reduce these injuries.

“The problem of back injuries among nurses is huge,” says Dr. Tilak Dutta, a Toronto Rehab scientist. Why do injury rates persist? Because of time pressures, nurses may not always use overhead or floor lifts, says Dr. Dutta. More patients are obese, and that’s also putting a load on nurses’ spines.

Recent studies by Dr. Dutta and colleagues show that overhead lifts are significantly safer for staff than floor lifts. In fact, spinal load is lower when one caregiver uses an overhead lift than when two use a floor lift.

Concern about injuries on the job has prompted Toronto Rehab researchers to invent several high-tech lifting tools. Take SlingSerter™, a revolutionary new device that uses compressed air to insert a lifting strap under a patient, with no effort. There’s a special strap that allows for easy removal after the lifting task has been completed.

A commercial partner, Andrew J Hart Enterprises Limited, is onboard and SlingSerter is expected to be commercially available soon. Also coming: RoboNurse, a patient-lifting robot for areas lacking overhead lifts.

An ‘intelligent’ emergency response and fall detection system

Toronto Rehab scientist Dr. Alex Mihailidis and colleagues at Toronto Rehab and the University of Toronto have developed a high-tech emergency response and fall detection system. The technology is designed to help older adults live longer and more safely at home, while easing the concerns of family and friends.

Now at the final stage of development, the system is awaiting an industrial partner to commercialize it. At a cost of about $100, it includes a simple camera mounted on the ceiling in the user’s home that wirelessly relays images to a computer. The system uses artificial intelligence to “learn” and track the actions and patterns of the user. If the system senses that the user has fallen or stopped moving, it automatically calls out a series of questions with yes/no answers. If the person says that help is needed or no response is heard, the system can alert relatives or dial an emergency number.

Falls are the most common cause of injury for the elderly, and one-third of older adults fall every year, according to Dr. Mihailidis.

SensiMAT

It’s hard to believe sitting can be hazardous to your health. But as wheelchair users know, pressure sores can be caused by sitting improperly or forgetting to regularly change position. These sores can have serious, even fatal, consequences. “Many wheelchair users have them, and some get sores more frequently than others,” says Dr. Milos R. Popovic, a Toronto Rehab senior scientist, adding that treatment and hospitalization for one pressure sore can cost tens of thousands of dollars. Dr. Popovic has come up with a high-tech, low-cost way to prevent these sores. It’s called SensiMat. Developed in collaboration with Elmedex, a Toronto-based company, SensiMAT is a thin cushion that goes underneath the wheelchair cushion. Sensors inside can detect if pressure is building.

“If the person is not sitting properly or forgets to regularly rearrange their sitting position, the system tells them,” Dr. Popovic explains. “It can do this in several ways, such as calling their cell phone to say: “This is your behind calling. I’m sorry, but you’re not sitting properly.’” The team is seeking funding to conduct clinical trials.

For more on SensiMAT, please visit www.sensimatsystems.com.

Age-CAP app

A new app lets seniors rate the ‘age-friendliness’ of restaurants, community centres, libraries, crosswalks, shopping centres and public transit in their city ― and share their ratings with others. The free Age-CAP app uses GPS to pinpoint the user’s location, no matter which city they live in worldwide.

Available for iPhone, iPad and Android devices, users rate locations on things like general accessibility, availability of seating, lighting levels, staff attitudes and background music levels. The app then produces an overall rating, based on the World Health Organization’s age-friendly cities guidelines. People can also simply browse the database to see which locations and services in a neighbourhood are considered ‘age-friendly’ and why.

The Age-CAP (Age-friendly Communities Assessment ApP) was developed by researchers at Toronto Rehab and the University of Toronto (U of T). “It empowers older adults to evaluate what’s senior-friendly and what’s not,” says one of the creators, Dr. Alex Mihailidis, a Toronto Rehab senior scientist and U of T professor.

The team hopes Age-CAP will promote ‘active’ aging, encouraging seniors to get out and about in the community. Social isolation in the elderly can lead to depression and physical problems. “People are also using the app to warn others about dangerous crosswalks, and subway stops that don’t have elevators,” says Dr. Mihailidis. As the app’s database grows, it can be used to advocate for improvements that make cities more senior-friendly, he says.

Dr. Mihailidis developed Age-CAP with Dr. Barry Trentham, an assistant professor in U of T’s Department of Occupational Science and Occupational Therapy, and U of T students Manas Bhatnagar and Jennifer Jimmo. Dr. Mihailidis is an associate professor of occupational science and occupational therapy and a core faculty member in the Institute of Biomaterials and Biomedical Engineering at U of T, with a cross appointment to the Department of Computer Science.

Robotic arm for stroke therapy

A robotic device to help stroke patients rebuild upper-body strength has been developed by scientist Dr. Alex Mihailidis and others at Toronto Rehab and the University of Toronto in collaboration with Quanser Inc. Stroke patients require extensive practice and assistance to regain motor skills, and therapists spend a lot of time guiding patients through exercises. Using the new robotic device, patients will be able to do these exercises unsupervised at any time of day. The device uses haptic technology so users actually “feel” resistance when they push on a robotic arm. Thanks to artificial intelligence, the system also adapts to users’ needs, adjusting exercises when necessary. Stroke inpatients at Toronto Rehab will begin using the robot very soon. It will initially be used in rehabilitation settings, but will eventually be available for home use.

Because the robot is small and easy to operate, people can use it on their own almost anywhere – at home, by the bedside while in hospital – and at any time. The idea is to encourage them to exercise more often. Studies involving people who have had strokes suggest that the more intensity, the better the outcome.

RoboNurse

Toronto Rehab scientists are part of a Canadian government-sponsored joint venture with China to produce a sophisticated patient lifting robot, known as RoboNurse. The ride-on machine is designed to take a load off the backs of caregivers who are dealing with a growing population of obese patients. Guided by a trained nurse, the robot can lift very heavy patients out of bed and move them to a chair or down the hall for tests.

A prototype of the robot was developed and tested at Toronto Rehab. Now, with matching grants of $1-million from the Canadian and Chinese governments, the institution has teamed up with Canadian and Chinese manufacturers to bring the ambitious concept to fruition. The goal is to produce a device that could one day become ubiquitous in healthcare facilities and homes around the world―a market potentially worth hundreds of millions of dollars. Under the deal, the Canadian partners will get the European and North American markets, while the Chinese will get the Asian markets.

“We are able to succeed by combining the advantages of both countries, and potentially, by combining the markets in China and Canada,” says Dr. Geoff Fernie, Institute Director, Research, at Toronto Rehab-UHN. “Our strategy is to do the development and engineering in Ontario and to own the technology. Then, to remain competitive, we’ll do some selected manufacturing through our own network in China. Wherever possible, we will manufacture components and systems using highly automated low-cost manufacturing methods in Canada.”

StandEasy™ adjustable pole system

Being able to independently get out of bed is fundamental to maintaining good health and enhancing recovery following illness or injury. Being left in bed for prolonged periods leads to complications such as incontinence and rapid loss of muscle needed for strength, balance and general function. For instance, we know that older adults lose 12% of muscle mass after each week spent in bed.

For many of these patients, a simple bedside pole would allow them to get out of bed independently. Unfortunately in most hospitals, the pressure-fit safety poles that are available for home use cannot be securely installed because false ceilings are present.

Enter StandEasyTM Pole System, which is specially-designed for hospitals and long-term care facilities. This safety pole system is secured to a pair of tracks on the wall. It can be easily removed from the wall tracks to swap the installation from one side of the bed to the other, or moved to support patients in other beds.

Working with industry partner EasyRange, we have turned StandEasy into a commercial product that is now in production. StandEasy units have recently been installed at Toronto Rehab – University Centre, both in patient rooms to support safer and more frequent bed transfers, as well as in common areas to allow patients to practice their transfers with a pole before they return home from the hospital. The response so far has been enthusiastic.

StandEasy is available for purchase. Please visit www.easy-range.com for more information.