Populations in industrialised countries are getting older and older, posing major challenges for healthcare systems: as demand for services rises, the existing infrastructure and resources are increasingly struggling to meet this demand. In many European countries, hospitals and clinics are already having difficulty finding suitable staff. The burden on doctors and nursing staff is also increasing. Waiting lists for rehabilitation centres are getting longer, and healthcare costs are rising. So what can be done to ensure that healthcare systems continue to function in the future?
“We will not be able to avoid examining, treating and caring for an increeasing number of patients in their homes,” explains Rea Lehner. The 32-year-old Swiss scientist has been a programme manager and researcher at the Singapore-ETH Centre since March 2020. Together with ETH professor Nicole Wenderoth, she is responsible for setting up the new Future Health Technologies research programme. Its aim is to develop the scientific basis for the urgently needed transformation of the healthcare system through mobile, digital technologies.
Breaking new ground in Singapore
When it comes to healthcare, Singapore is a laboratory for the future. “The level of digitalisation is very high, and apps are already being used for many services. This is why we can run projects here that wouldn’t yet be possible elsewhere,” says Lehner about the healthcare system in the city-state. For example, a study of 3,000 people in Singapore is currently under way to investigate how falls and fractures can be detected and prevented at an early stage. Mobile sensors and algorithms are being used to determine whether a person is particularly susceptible to falling and has a high risk of sustaining a fracture. Based on these findings, tailor-made cognitive and physical exercises are then developed in the interests of prevention.
“A project of this scale is only possible through very close collaboration with the health authorities and local partners,” explains the ETH researcher. Singapore offers excellent conditions for this. Whether clinics, universities, or the authorities, those involved in healthcare work intensively to exchange information on a continuous basis. “There is a highly collaborative culture here, and on the government side, we have a well-connected partner in the Office for Healthcare Transformation, which always opens doors for us,” says Lehner. In addition, older residents of Singapore tend to be generally more tech-savvy and are not afraid to use digital mobile applications.
How movement is controlled by the brain
As an enthusiastic volleyball player, Rea Lehner was keen to know even at a young age how movements are controlled by the brain and decided to complete a degree in sport and biology at the University of Bern in order to study this topic in greater depth. Rea, originally from St Gallen, moved to ETH Zurich for her Master’s degree, where she studied movement sciences and became increasingly involved in neuroscience. Following a period of research at Trinity College in Dublin, Lehner ultimately began her doctorate in Nicole Wenderoth’s Neural Control of Movement Lab in April 2014.
It has been four exciting and informative years for Lehner. In her dissertation, she investigated the influence of rewards on human behaviour. One of the things she demonstrated was that reward in the form of money significantly reduces motor slowing in a movement such as tapping the index and middle fingers.
This is relevant, for example, for rehabilitating stroke patients who are required to perform highly repetitive movements in their training and tire quickly. “The reward encourages patients to do the exercises longer, which in turn has a positive effect on their rehabilitation,” says Lehner. This effect can be explained by altered neuronal activity in the motor system of the brain, which is triggered by the reward.
The Cybathlon as a formative experience
In her doctoral thesis, Lehner repeatedly applied neuroscientific methodologies such as magnetic resonance tomography (MRI) and electroencephalography (EEG). She also used the latter in a project that had a strong influence on her, and to which she still feels attached: the Cybathlon. This is an event where people with physical disabilities compete against each other using modern technologies. Since 2018, Lehner’s team has been working together with Samuel Kunz, who is quadriplegic and dependent on a wheelchair for his mobility.
“Our goal was for Samuel to drive a car in a computer game using only his thoughts. We measured his brain’s electrical activity, looked for patterns and translated these into specific commands,” explains Lehner. Although she and her team achieved considerable success with this method, the result is ultimately sobering: “A non-invasive method like an EEG simply provides signals that are too weak and inaccurate. A lot of development is still needed before we can send a person with impaired mobility like Samuel out onto the street with a wheelchair he can control using his thoughts alone,” says Lehner.
Nevertheless, Lehner’s enthusiasm prevailed, and thinking back to the Cybathlon 2020, she says: “In addition to the technical knowledge we gained about brain-computer interfaces, we learned a great deal about how to involve end users in technology development right from the onset. This is crucial to my work here in Singapore.”
From researcher to manager
At the Singapore-ETH Centre, Lehner’s research focuses on customised rehabilitation procedures for stroke patients. This only accounts for a small part of her work, however, because as programme manager, she is no longer only responsible for her own research: “At the moment, I have very little time for research myself – setting up our research programme is taking up most of my time.”
In addition to recruiting new staff, which proved to be very difficult during the coronavirus pandemic, this includes leading an international research team. There are currently 23 employees working on the Future Health Technologies programme, with a further 12 researchers from ETH and 22 local partners involved. “Our team is made up of physicians, therapists, engineers, psychologists, software developers, biologists and social scientists. Despite our different perspectives, we’re all working towards the same goal: to develop new health technologies and help as many people as possible,” comments Lehner proudly.
The biggest challenge for Rea Lehner at the moment, however, is not in her own research or personnel management, but in dealing with health data and the question of how sensitive data from the projects can be stored and processed securely. How can this data be made available to the right people without compromising patient data privacy? This is precisely the kind of question we will inevitably face in the context of the advancing digitalisation of Western healthcare systems. And one that Rea Lehner will be extremely well prepared to provide a response to.