Translator: Jacob Mukand Reviewer: Marta Pinto
Good Morning.
I would like to talk to you today
about how past events define who we are in the present
and who we will become in the future
And since the best way of approaching this idea
is by telling a story,
I am going to tell you my personal story
The event that defines me
has a defined date,
and that date is June 8th, 1994.
On that day, my 12-year-old brother, Pedro,
was hit by a car on a sidewalk
coming back from a day at school.
On that same day,
he was brought to the University Hospital of Coimbra
presenting with multiple fractures and injuries
in the most important parts of the brain.
With a highly reserved prognosis,
he stayed in a coma for 3 months.
After his vital signs had stabilized,
he was transferred to a rehab center in Alcoitão
and ever since that moment
when the focus shifted from survival
to recovery,
my parents gave up their lives,
their careers and their social networks
to bring back, not what my brother was before,
but to bring back his independence.
They realized something very important, right from the beginning.
As a way to have my brother recover above expectations,
which were very conservative,
due to the injuries he had,
they had to maximize the intensity of the treatment.
This was done by dovetailing the work of the therapists in their absence,
And that was my parents' mission for 10 years,
dovetailing the work of the physical therapists,
and the occupational therapists in their absence.
And they became really good at it.
One year later,
my brother had been in Aloitão, showing clear progress,
which was defined as a miracle, in terms of recovery.
He was brought back into a school setting in the Guard
and after 2 to 3 years, without the network of therapists of Alcoitão,
he continued to progress, more slowly, but surely.
Do you now that cliché,
"life is made of small victories"?
Nothing is more true in the rehab process,
because these small victories make up
for all the pain that you've suffered up to that point.
After three years, my brother's independence assured,
my parents thought that it was still possible to take it up a notch.
And that's why the four of us went to Cuba,
to probably one of the best rehab centers in the world, the CIREN
where I was able to witness firsthand
that the CIREN is one of the best rehab centers in the world,
not for having the most innovative techniques,
or even more sophisticated than the ones we have here in Portugal.
Their secret is quite simpler than this,
and much easier to explain.
They assign a physical therapist to one patient.
In other words, that physical therapist has no distractions.
Imagine how good we would be, doing just one thing,
if, out of hundreds of things we have to do, we were told:
"You are going to do only this."
It's a very good method.
And this enabled my brother, for example,
to have access to 5 hours of motor rehab every day while he was in Cuba.
And this enabled him, for example, to have access to 400 hours of motor rehab
over the 3 months he was in Cuba.
Without a doubt, practice makes perfect.
Now, my brother is an active member of society,
completely independent,
with his own job and social networks separate from his family.
And this is a success story.
But, beyond being a success story,
it is an inspiration for me.
Because it's made me clearly understand
the paradox that exists today in clinical services,
which is the need for more intense rehab,
whether cognitive or motor,
is accepted by all those involved in the healthcare field.
However, the costs that these services incur,
since rehab is done essentially
through human resources,
make it impossible to provide more rehab hours.
I clearly understood, from very early on,
that if there was a solution to this problem,
that solution would be through the use of technology.
That's why, when I was 18, I enrolled here, in the Electronic Engineering course,
already with my vision of trying,
in a rather naive way, to solve this problem
and this problem of mine
came to be my doctoral thesis in 2008,
when I met Victor Tedim Cruz,
a neurologist at Santa Maria da Feira Hospital,
who, with different motivations
-- his motivations came from the patients that he saw everyday --
starting with different motivations, we had the same vision,
which was to use technology as a tool to change
the traditional methodologies of rehab.
And we knew
that we were going to tackle the biggest problem
in terms of motor rehab.
Because we were ambitious and naive and a bit innocent,
we decided that we would go after the biggest problem,
and the biggest problem, maybe not the most complex problem,
but the biggest problem at the motor rehab level,
is the motor rehab of stroke patients.
Why?
Well, the numbers are easy to understand.
Every year, 16 million strokes occur around the world.
16 million.
Statistically, one in every six people will have a stroke.
In other words, out of this audience of 500 people,
90 of us will have a stroke at some point in our life.
But more interesting than that
is that 70% of the 16 million strokes occurring every year,
will require motor rehab.
11.2 million people need motor rehab,
but can't get it with the desired intensity,
because there simply aren't enough human resources
for so much need.
Very well, Victor and I decided then
to start to develop our system.
And so that our system would be efficient,
we decided to look immediately
for what the success in traditional rehab methodologies was.
And all of the state of the art reports say the same thing:
"There are three golden rules for efficient rehab in stroke patients:
therapy based on repeating specific tasks,
high intensity and feedback on performance."
In other words, if the patient
moves well enough,
we applaud that,
if he moves poorly,
we say that it was not good enough and tell him/her how to do better.
And we knew that,
in order for our system to be successful,
it would have to incorporate this technology.
That is how SWORD came about.
SWORD is a system
that has two components:
a component that quantifies movement,
and a vibrating interface component,
that allows you to give feedback to the patient
if the movement was well done, or poorly done,
and establish the intensity of rehab.
But this system, beyond having these characteristics,
would have an added advantage.
It had to be easy, simple and intuitive to use at home,
because it's at home that the patient's rehab must occur.
You guys know Moore's Law, right?
Trying to do very complex things
in a simple way causes problems.
The best way to resolve problems
is through talent.
And that is exactly why we included on our team
David Ribeiro and Márcio Colunas,
two brilliant engineers
that made up for my failings at the technological level,
and we began developing SWORD.
SWORD was an ecosystem made up of three elements:
this gadget on my wrist,
that quantifies the movement I have done,
that vibrates for me when the movement is well done or poorly done
or when I need to make a new movement.
But since we believe
that rehab can't be done at home as if it were an island,
it must occur on the pivot of house-clinic or house-hospital.
And that's why we introduced that second element which is the smartphone
The SWORD devices communicate with the smartphone,
which, in turn, communicates with the clinician's web interface.
In other words, the entire evaluation
of the patient's in-home rehabilitation
is documented by the smartphone
and the clinician, in his office, can have access
to all the measurements of the patient's evolution.
This causes the rehab ecosystem to be centered on the patient.
The patient comes to be an active part of the rehab
and, as we say,
we empower the patient through his rehab.
"Use it or lose it."
In other words,
just like when we give a prescription for a drug
and we know that, for the patient to get better,
he/she has to take that drug,
here we have a digital drug.
For the patient to recover, "use it or lose it."
And this, SWORD,
which we think will be on the market
within a year and a half
--- we do not think, no,
we are sure that it will be on the market a year and a half from now ---
is the beginning of a larger project,
And that project is the Endeavor Lab,
the start-up which is made up of the four creators of SWORD,
and has its founders' vision in its DNA,
which is to shake up the market of traditional rehab,
whether it be motor or cognitive rehab, through technology.
And our first product is SWORD.
And SWORD has a global market, without borders,
that can be used democratically.
It can be used democratically because of the fourth factor of SWORD,
which is its cost.
SWORD was designed
to have a cost a hundred times lower
than its tech competitor of robotic systems.
Why?
Because a robotic system,
which is the solution that some people present for rehab through technology,
can only exist in a hospital environment,
and costs 50,000 euros.
That's not democratic.
SWORD allows for democratization
because it allows for not one, not two, but millions of people
to have access to patient rehab.
And Endeavor Lab envisions a direct interconnection
between science, technology, the clinical field
and real-world applications.
And one of our secrets
is in the multidisciplinary nature of our founders.
My vision
is the same as Victor's, is the same as Márcio's, is the same as David's.
But not our motivation.
Vitor's motivation
comes for the hundreds of patients he has seen
and the hundreds of needs that he witnessed over his years as a doctor.
My motivation clearly comes
from the years that I witnessed my brother's rehab,
Because that rehab
gave me a very important feedback
about the needs that families face.
And the families need to be active in the rehab process.
And that's why, if I hadn't witnessed
my brother's on-site rehab for 10 years,
if I hadn't felt the pain, in such a direct way,
that comes from the feeling of impotence,
of not being able to do anything
and wait for the next hour of rehab
while nothing happens,
and the problem is that
rehab needs to be started right after the first minute.
But, particularly, if I hadn't witnessed
my parent's dedication and selflessness,
without expectations, without hope -- because there were none ---
sacrificing, purely out of love, their social networks,
their careers and their lives
in order to maximize the intensity of my brother's rehab,
hoping, just hoping, to give him back his independence...
If I hadn't witnessed all of that, I wouldn't have the determination
or the clairvoyance to say
that SWORD, without a doubt, will be a real solution, without two years.
And that Endeavor Lab, without a doubt, within five years, will be
the company that defines technological rehab in patients' homes,
because
my future defines my past,
and because, just like Newton said,
"If I have seen further, it was by standing on the shoulders of giants."
Thank you very much.
(Applause)