Hans Bussmann: "Projects in which different experts work together deliver the best result"

Dr. Hans Bussmann from Erasmus MC is one of the scientific leaders of Medical Delta eHealth & self management for a healthy society. Last November he received a grant of almost € 800,000 from ZonMw, NWO and the Hartstichting for his project ArmCoach4Stroke. For the next four years, this grant will be used to research technology to enable patients who have had a stroke, to use and train their arm at home.

How did this research come about?

The wish for this research came directly from discussions and interviews with practitioners and patients. Around 40,000 people a year get a brain hemorrhage. This is followed by rehabilitation, but a large group continues to have problems with their arm function. It is true that there are many more bodily functions that are no longer fully recovered even after a rehabilitation process, but a poorly functioning arm experiences a lot of discomfort in daily life.

We know that a lot of use and exercise are very important for the recovery of the arm function, but in practice that does not happen. One reason is that it takes a lot of time and money to go to the physical therapist again and again. Moreover, there is not always enough staff available. In addition, people do not like it at all to do those exercises at home. Our goal is to develop a technology that overcomes these problems. We want to encourage patients to use and exercise the arm more, without leading to higher costs.

And what does that technology look like?

We are developing a set of two "watches" that resemble pedometers and other commercial health meters. They have motion sensors that measure how much the arm is used and whether that is sufficient. This can be set per patient. The watches indicate when the patient needs to move more and give a signal when it is time to do exercises. It also measures whether the exercises are performed properly. They are linked to a tablet on which the patient can see what he should do.

Partly because the device provides feedback, the exercises are challenging and stimulating. Furthermore, the data that the watches collect is shared with the practitioner. As a result, he/she remains informed of the patient's progress. He or she can instruct the patient if necessary, but can also change the settings of the program. The patient and practitioner have as much contact as is needed inside and outside the consultation room, but much less than is currently the case.

To what extent does this innovation resemble products that are already on the market?

Many systems that are now on the market are not made for people with disabilities, but for healthy people. The users mainly monitor for themselves whether they are moving enough and are sleeping well. The technology that we develop is intended as part of a treatment and focuses specifically on arm function. It has the same building blocks as the ‘lifestyle’ products, but from there it gets a completely different purpose.

In itself it does not take very long to come to a first prototype. The further development is optimization. Experiences and feedback from end users must lead to adjustments, so that it actually does what it has to do and fits within the wishes and requirements of the end users.

The development of this product fits in with a trend of eHealth and blended care. How do you view that trend?

The healthcare costs are increasing and there is less staff available. To keep healthcare sustainable, technology can offer results. In addition, there is a greater need for patients to remain in control.

You can try to make something that hopefully is just as good as the healthcare that is currently under pressure, but that offers no added value. I want us to develop something that makes treatment better. This project should therefore not be about self-management or cheaper care, but about the best treatment after a brain hemorrhage.

What makes you so happy about that treatment?

I have always been fascinated by movement, since I was a child, and I initially studied physiotherapy. I also worked as a physiotherapist for a while, but I was always facing questions about how it worked. In a movement sciences study I was able to express my curiosity. After that I was lucky to get a research position at the rehabilitation department of the Erasmus MC. There I did research into measuring the movement of people with a chronic disorder using technology, which later also led to a research direction. I’ve kept that curiosity and in this project the knowledge and the treatment come together. I have a background in healthcare. With a project like this we can improve that care.

If we later have a properly working product, the technology can be adapted to all kinds of other moving issues. Congenital brain disorders and MS for example. And not only on arms, but also when walking, for example.

The project has yet to start, but it is not completely an early start.

No, it isn’t. A number of other studies and techniques come together in this project. There has already been research with motion sensors and also feedback of data to the patient and practitioner, in which we collaborate a lot with Rijndam Rehabilitation. The innovation is to bring everything together and let different disciplines work together. For example, I work together with Dr. Valentijn Visch from TU Delft. We know each other through Medical Delta and he is into design. He thinks of completely different things than me.

You are a scientific leader within Medical Delta. How does that relate to this project?

The ArmCoach4Stroke project brings together people from Erasmus MC, Rijndam Rehabilitation, Amsterdam UMC, Delft University of Technology and the University of Twente, as well as two private parties (2M Engineering and Lode – ed.). Many people already know each other a bit from previous projects and from Medical Delta. Because you meet each other more often, there is a greater chance that a cooperation project will actually succeed. I am always very collaborative. Bringing knowledge together to achieve more, challenging each other... Projects in which different people all work together with their own expertise are the best and ultimately deliver the best result.