Every step 17-year-old Rinesh takes is accompanied by the distinct whirring of robotic limbs. Rinesh was diagnosed with Leukaemia in November 2020, and lost his ability to walk when the disease spread to his spinal cord. But today, he is once again taking steps with the help of Ekso, a wearable exoskeleton.

Ekso is just one of the many robots helping with patient rehabilitation in the Clinic for Advanced Rehabilitation Therapeutics (CART) within Tan Tock Seng Hospital (TTSH) in Singapore. CART uses cutting-edge tech like robotics to rehabilitate patients suffering from stroke or spinal cord injuries, as well as amputees or those suffering from neurodegenerative disorders like Parkinson’s disease.

In April this year, the clinic went through an extensive revamp, expanding to four times its previous size and bringing in more robots to better support patient rehabilitation. GovInsider speaks with patients and doctors to learn more about how this revamped clinic is revolutionising healthcare in Singapore.

Fast-tracking the road to recovery

Robotic rehabilitation technology is helping patients at CART to recover faster while reducing the burden on physiotherapists. For instance, Ekso helps patients by moving weak legs in a normal physiological pattern. This strengthens their legs and allows them to achieve assisted walking with minimal help.

Without Ekso, a few therapists would have to manually support Rinesh and assist with his walking. Ekso has helped patients to walk for a longer distance and improved productivity in the clinic, according to TTSH.

Another assistive walking technology is the Lokomat, where patients can practise walking on a treadmill that supports their body weight. This device allows patients to take up to 1,000 steps in 30 minutes, a whopping 10 times increase from conventional therapy with a physiotherapist.

Like Ekso, the Lokomat also reduces the burden on therapists. Without the Lokomat, two to three therapists may need to be present to assist a patient with walking. But now, only one therapist is needed, says Dr Loh Yong Joo, Head and Senior Consultant at the Department of Rehabilitation Medicine at TTSH.

This reduces the chances of physiotherapists injuring themselves while physically assisting patients as well, Dr Loh adds.

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The Lokomat supports a patient’s body weight while they practice walking. 

While Rinesh was previously wheelchair-bound, he is now able to stand for longer periods of time and walk more freely after using Ekso and Lokomat for just two months. “I am also less afraid of falling, and can walk more steadily with a walking frame,” he says.

Additionally, many of CART’s technologies are presented in the form of video games, with the games being modelled after real-life simulated environments. This gamified format can help patients commit to otherwise repetitive exercises, keeping them motivated.

“Initially, it was a little frustrating as I was not able to get the scores because my arm was weak. But because the games had scores, it pushed me to better my previous scores,” shares 55-year old stroke patient, Fabian Yeo.

Bringing healthcare closer to communities 

Singapore is facing a rapidly ageing population, increasing the prevalence of chronic diseases, said Minister of Health Ong Ye Kung at the launch of the revamped clinic. “Rehab must be made more accessible for a wider group of patients,” he added.

CART is filling this gap with portable robotic devices, which patients can use to continue their rehabilitation training at home. Yeo, for instance, uses a portable AI robot called the H-Man, which helps stroke patients improve their arm and hand function.

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A patient using the H-Man, a portable AI robot which helps stroke patients improve their arm and hand function.

Home-based rehabilitation speeds up the recovery process for rehab patients, says Kuah Wee Keong, Senior Principal Occupational Therapist at TTSH. Patients can now participate in their rehabilitation programmes in the comforts of their own homes and at their own convenience.

A lot of training is required for the brain to recover after a stroke, shares Kuah. The intensity, engagement and frequency of how often a patient puts his brain and body through repetitive motions will all help the brain recover, he adds.

With a portable robot, Yeo is able to practice the same motions every day. Without the tool, he would have to travel to the clinic for this treatment, which may only be possible once a week. Today, Yeo has regained the ability to write, and is in the process of returning to driving.

Measuring patient progress with accuracy

Robots are also helping therapists better track patient progress to improve their rehabilitation programmes. Traditionally, therapists would measure patients’ progress through visual observation. This process is both time consuming and prone to errors.

“A lot of it is based on what we feel and how we interpret the patient’s performance,” says Kuah. But robots are able to accurately measure a patient’s range of motion or even judge the quality of their movements (like whether it is smooth or jerky), he explains.

For example, therapists used to evaluate a patient’s ability to balance and their fall risk manually. But CART now has a robot that can digitally track the fall risk of patients while they are standing on it.

Having robots digitally measure patient progress is helpful for telerehabilitation as well. As patients perform rehabilitation exercises at home, anything they do will be reflected on the computer systems at the clinic, Kuah shares.

“This will give a more objective understanding of a patient’s recovery journey while we undergo a patient’s outpatient rehab treatment,” says Dr Loh.

Within the four walls of the clinic and beyond, robotics are helping Singaporean patients get back on their feet, recover, and reintegrate back into society. CART’s technologies have touched the lives of over 75,000 patients in the last decade. With the aid of these cutting-edge medtech, the number will only increase.

All photos courtesy of Clinic for Advanced Rehabilitation Therapeutics (CART), Tan Tock Seng Hospital.