By ROBERTO ASCIANO                     PARTNER CONTENT

We are living in an age where thousands upon thousands of individuals and companies are trying to find faster, better and cheaper ways to get things done leveraging the latest digital technologies. We are so completely surrounded by efforts to innovate, disrupt and accelerate, that it may come as a surprise to find out that “innovation” has been around ever since our earliest ancestors shed their body hair and started walking upright.

Since those early days, our ancestors have sought solutions to their everyday problems and the “technology” they leveraged was whatever the environment around them gave them to use. These early humans started to make tools and weapons out of stone and thus came up with a clever solution to help them hunt, grind grains, start fires and build shelters. It may however come as a surprise to find out that, even in the stone age, our earliest ancestors applied their latest innovation to also find solutions to their health problems!

The first evidence of healthcare innovation technique at that time, which leveraged the use of sharp stone tools, was the prehistoric surgical technique known as Trephination, which dates back to the stone age. Trephination involved the drilling of a hole in the skull of a person suffering from blood build up after trauma, and there is evidence that it was also used to treat patients suffering from epileptic seizures, migraines and possibly mental illness. At a prehistoric burial site in France dated from 6500 BC, a staggering forty out of 120 skulls found had evidence of trepanation holes.  “Many prehistoric pre-modern patients had signs of their skull structure healing, suggesting that many of those subjected to the surgery survived.” [1]

Ever since those early days, humans have consistently applied whatever innovation and discovery they had at their fingertips to try to improve healthcare, to varying degrees of success. Electricity brought on electroshock therapy (long since abandoned), advances in physics brought along the field of radiology (both for diagnostic as well as treatment), and advances in space travel have allowed for research in zero gravity where new compounds could be better studied and understood.

The cross road we are at today, at the intersection of digital technologies and life sciences, is already seeing some very interesting results with digital health companies creating non-traditional therapeutic solutions such as TinniTracks which has revolutionized the treatment of Tinnitus (ringing of the year) by tricking the brain into filtering out the very same frequency that the ringing manifests itself at, all of this by listening to the music people already have in their smartphones!

Research at Northeastern University in the US is changing the practice of physical therapy with the use of Virtual Reality scenarios. The VR in this setting combines the visualization common real life situations (for example being able to walk up a steep staircase) help patients achieve their physical rehabilitation goals more quickly by being able to visualize the results virtually albeit taking much smaller physical steps than the ones they are visualizing climbing in the VR goggles. The visualization activates a reward mechanism in their brain which encourages them to keep going rather than giving up. [3] And a combination of physical therapy, rehabilitation and robotics assistance has led to a completely unexpected results. Paraplegic patients who were outfitted with robotic exoskeleton and a Virtual Reality program that would train them move their own legs and arms not only regained some physical movement on their own, but physical sensation as well, which suggests that the brain can retrain itself and exploit other nerve pathways in the body to regain control of lost functions such as touch and motor control. [4]
More interestingly is also the evidence that Virtual Reality is also powerful enough to trick the brain into other physiological responses that can influence sensory functions not associated with sight. In this latest example of VR applied to healthcare, severe burn victims hospitalized during treatment and recovery had a significantly lower need for pain medication and faster recovery when they were shown Virtual Reality films of winter scenes such as snow covered mountains, frozen riverbeds and the like. These immersive visual experiences were enough to trick the brain into thinking it was really there, triggering the same sensory response as if the patient was exposed to cold air, thus relieving them of the pain from their burns. [5]

As these last examples illustrate, we have definitely entered an area where we are beginning to understand that certain technologies and quite rudimentary techniques (a video clip shown at 360 degrees) can have a significant impact on the mind and the body.  Where things will become infinitely more interesting is when other human behavioral traits are also targeted with the ultimate goal of changing behavior and improving health and wellness overall. In the case of behavioral health, we now face the possibility that even mental health issues can be addressed by technology.  There are two technology areas that come into play in the future of mental health care, and more specifically in the areas of cognitive language analysis machine learning.

Some of the more vexing and difficult mental health conditions to treat go beyond depression and anxiety (which in many cases can be managed by medication) and they require constant coaching and support by behavioral specialists. Difficult to treat conditions such as Borderline Personality Disorder have only one effective intervention known as DBT, dialectic behavioral therapy. DBT is a cognitive behavioral treatment that was developed to treat chronically suicidal individuals and it is recognized as the gold standard psychological treatment for this population. DBT specialists work in teams with individuals and a large part of the therapy is in having the patient, through sequential reasoning, explore the different possible reactions to every day stresses, and eventually come to methodically understand from the range of possible reactions to those stresses, which ones would be the more appropriate ones for any particular situation. These could go from accepting that other people make unintended mistakes not to be taken as deliberate slights (and thus react forcefully against this situation) to developing reasoning patterns that encourage empathy, forgiveness and problem solving rather than an extreme emotional reaction and seething anger.

Needless to say, when confronted with treating a patient who may also misinterpret the words and actions of the therapies as a confrontation, this can become an extremely exhausting caregiving exercise, so much so that DBT practices that specialize in treating Borderline patients work in teams and are themselves often prescribed psychotherapy on a regular basis to be able to retain the doctor-patient relationship and try to maintain the emotional boundaries into their own personal lives that such type a patient can easily tear down by their behavior.

In this case, having a real-time artificial intelligence system that can “converse” with the patient through all the possible scenarios on the ways to handle stressful life situations could be of great help as a virtual assistant to a Therapist. Such a system would help the patient analyze the problem until both the system and patient arrive to an acceptable reaction to a situation that the patient will learn to use the next time he or she is confronted with it.

The logic flow of the conversation could unfold in the following way:

Patient describes a problem and the reaction they had to it.

• Customer (patient) goes into a coffee shop and orders a coffee to go, with milk and sugar.
• The barista prepares the coffee and hands it to the customer.
• The customer takes a sip while walking towards the exit door, and realizes that there is no sugar in the coffee. (this type of situation precipitates an over-reaction on the part of borderline patients)

The reaction to this event from a borderline patient’s point of view is that the barista completely disregarded their request, does not value them as a customer and person, and most likely purposely did not put sugar in the coffee as a spite to them. 

A likely outcome to this stress scenario could be the borderline patient throwing the cup of coffee on the floor of the shop and storming out in anger (but usually without confronting the object of their anger). This might be followed by hours of ruminating in anger over the event, directing a lot of mental anger at the barista (who meanwhile has no idea why one of his customers threw a coffee on the floor of the shop and stormed out)

In a scenario like the above, an artificial intelligence system trained in problem solving scenarios as well as conflict resolution scenarios would first walk the patient through a set of alternative reasons as to why the sugar might not have been in the coffee.

The System Provided Problem Analysis and Reasoning 

1. Perhaps the shop was really busy and they were handed someone else’s coffee by mistake
2. Perhaps the barista had a very bad personal situation that morning (a pet’s death, an argument with their spouse, etc) and they were simply distracted and had their own mental anguish they were dealing with
   1. Have you ever had a sad situation that made it difficult to do your job
   2. Is it possible that maybe this is what the barista was going through
   3. What would you tell the barista if you found out that their pet had just died that morning
3. … and so on.

In each one of these cases the intelligent system would “train” the patient’s cognitive patterns into choosing solutions that rely on empathy first, rather than assume that the problem is a deliberate action against them. Secondly the system would provide the tools to how to solve the problem (rather than throwing the cup on the floor and storming out).

Potential Problem Solutions (avoiding conflict as the first choice)

1. Most coffee shops have a sugar and milk self-service station. After realizing the barista might be having a tough day, just go and add sugar to the coffee.
2. If the coffee was to be brought back to the office where there might already be sugar, wait until arriving to the office and then add the sugar at that point.
3. If no sugar will be available, ask the barista if they could add sugar to the coffee (trying not to engage the in an argument, or berating them for their lack of concern to the order)

The digital technologies available to us today are almost ready for this type of interactions with a mental health patient, and can also be of support to a physician or surgeon to discuss from potential medical cases to help diagnose a puzzling disease or in identifying the best potential treatment or procedure given a myriad of factors to consider. We believe that artificial intelligence and machine learning technology is arguably one of the most exciting areas of innovation today, and as the technology becomes better with time it will, in the near future, become another essential tool in the delivery of healthcare.

Profile
Roberto Ascione is a serial entrepreneur and global thought leader in digital health. With 20 years of experience, he has been focusing on marketing and communications, business transformation and innovation in health and wellness.

He is currently CEO at Healthware International, a next-generation healthcare consultancy, combining a unique blend of marketing and creative services with innovation and technology capabilities, able to deliver value to existing and emerging healthcare stakeholders.

He is also very active in the digital health start-up ecosystem in various advisor capacities both in Europe and in USA.

Roberto Ascione was recognized as Best Industry Leader at The Health 2.0 10 Year Global Retrospective Awards.

Passionate for medicine, computer science, and human-technology interactions he believes strongly that digital innovations and technologies will be the most impactful drivers of change in the healthcare industry. He nurtures this vision by speaking at a number of conferences, as well as contributing to several research organizations and start-up accelerators.

Sources:

1. https://en.wikipedia.org/wiki/Trepanning
2. By Rama (talk · contribs) (Self-photographed) [CeCILL (http://www.cecill.info/licences/Licence_CeCILL_V2-en.html) or CC BY-SA 2.0 fr (http://creativecommons.org/licenses/by-sa/2.0/fr/deed.en)], via Wikimedia Commons
3. http://www.pivotphysicaltherapy.com/blog/future-virtual-reality-physical-therapy/
4. https://www.theguardian.com/science/2016/aug/11/brain-training-technique-restores-feeling-and-movement-to-paraplegics-virtual-reality
5. http://www.firsthand.com/creations/pain-control.html

Roberto Asciano is the CEO of Healthware International.