What Do You Know about Alzheimer’s Disease? Find Out from a Geriatrician!

WORDS LIM TECK CHOON

FEATURED EXPERT
DR TEH HOON LANG
Consultant Geriatrician
Sunway Medical Centre

21 September is World Alzheimer’s Day. We’re pleased and really appreciative of the fact that, in conjunction with this day, Dr Teh Hoon Lang has graciously shared her insight on Alzheimer’s disease with us.

IS DEMENTIA THE SAME THING AS ALZHEIMER’S DISEASE?

Dr Teh explains that:

  • Dementia is a complex brain function impairment set that interferes with daily life.
  • Alzheimer’s disease is a common type of dementia.
  • It is a progressive brain disorder characterized by the buildup of abnormal proteins in the brain.
  • This buildup will lead to a gradual decline of memory, thinking, and reasoning skills.
  • This condition will get worse over time.
An overview of Alzheimer’s disease. Click on the image to view a larger, clearer version.
  • According to some studies, over 8.5% of Malaysians aged 60 and above have dementia, with a higher prevalence among women.
  • However, note that Alzheimer’s disease and other forms of dementia can also occur to people at a younger age. They should not be considered as merely ‘old people’s disease’.
WE SHOULD BE VIGILANT & KEEP AN EYE OUT FOR EARLY SIGNS

According to Dr Teh, symptoms of dementia can be mild and hence overlooked.

“Many people may assume these symptoms as part of the normal ageing process,” she adds.

COMMON EARLY SIGNS OF DEMENTIA (OF WHICH ALZHEIMER’S DISEASE IS ONE TYPE)
  • Recent memory loss, such as being unable to recall recent events or appointments.
  • Difficulties in planning and carrying out tasks or solving problems such as following a recipe, managing their finances, or managing their own medicines.
  • Difficulty in completing familiar tasks such as cooking, driving or using appliances.
  • Confusion about time and/or place—they may lose track of the date, time, or where they are. They may also get lost in familiar places.
  • Trouble understanding visual images and spatial relationships. This can manifest as difficulties in understanding maps, following directions, judging distances, determining the size of objects, etc.
  • Problems with languages, such as difficulty finding the right words or using the wrong words during a conversation.
  • Frequently misplacing things and losing the ability to retrace steps.
  • Decreased or poor judgement. They may make poor decisions, such as giving away large sums of money or insisting on driving when they are no longer fit to drive.
  • Withdrawal from work or social activities that they used to enjoy. They may also become isolated and avoid interacting with others.
  • Changes in mood or personality such as becoming depressed, anxious, or irritable. They may also experience personality changes, such as becoming more passive or withdrawn.
CERTAIN FACTORS CAN INCREASE ONE’S RISK OF DEVELOPING ALZHEIMER’S DISEASE & OTHER FORMS OF DEMENTIA

Dr Teh shares that common risk factors include:

  • Sedentary living—not getting regular physical activity.
  • Smoking and/or excessive alcohol consumption.
  • History of head injuries.
  • Infrequent social contact and isolation. This can lead to depression, a risk factor. Thus, we, especially the elderly, are encouraged to stay socially active no matter our age.
  • Less or low levels of education in early life, as this can affect cognitive reserve—the ability of the brain to maintain our cognitive function and withstand deterioration and damage.
  • Obesity, especially during one’s mid-life.
  • High blood pressure or hypertension.
  • Diabetes, primarily type 2 diabetes.
  • Hearing impairment or individuals with hearing loss. Hearing aids may help reduce this risk.
WHY EARLY DETECTION IS CRUCIAL

Any damage to the brain is irreversible; there is no way to treat or undo the damage.

“It is important to see a doctor for an assessment as soon as possible, as early diagnosis and treatment can help to prevent or delay irreversible brain damage,” Dr Teh states.

HOW ABOUT SCREENING FOR ALZHEIMER’S DISEASE?

“According to guidelines, routine cognitive screening isn’t recommended for everyone, it’s only recommended to screen people at risk,” Dr Teh shares.

She adds, “However cognitive screening is not 100% accurate, hence, it’s crucial to educate the public about the early warning signs of dementia.”

Furthermore, some conditions may resemble dementia, such as vitamin B12 deficiency and hypothyroidism, and these can be reversed by early treatment.

INNOVATIONS OF THE PHARMACEUTICAL INDUSTRY IN DEVELOPING A TREATMENT FOR ALZHEIMER’S DISEASE

In other news, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) has released a video highlighting the challenges and advances made by the pharmaceutical industry in finding means to slow the progression of Alzheimer’s disease. Have a look!

For more information, visit the IFMPA (link opens in a new tab).

A Consultant Urologist Talks about Kidney Stones & How They Affect Children & Younger Adults

WORDS DR GOH ENG HONG

FEATURED EXPERT
DR GOH ENG HONG
Consultant Urologist
Prince Court Medical Centre

Kidney stones are formations that develop in the kidney.

The process of stone formation often begins with a blood flow issue. Such issue causes a small crystal to start to grow and eventually transforms into a stone—a kidney stone.

Kidney stones. Click on the image for a larger, clearer version.

There are typically a few types of kidney stones, with calcium stones being the most prevalent.

NOW, HOW DO THESE STONES FORM IN THE URINARY TRACT?

There are several factors contributing to their formation.

  • Structural abnormalities along the kidney tract.
  • A malfunction in the body, leading to a higher risk of stone formation in the urine.
  • Lifestyle choices.
  • It’s essential to consider the presence of other concurrent medical conditions. For instance, diabetes and cholesterol can contribute to stone formation as well.
KIDNEY STONES ARE INCREASINGLY MORE COMMONLY DIAGNOSED AMONG YOUNGER PEOPLE?

I can’t provide an exact prevalence, but it’s evident that kidney stones are becoming more frequently diagnosed in young people, especially young women.

There are several reasons contributing to this trend.

  • Improved medical care leads to more regular check-ups that detect the presence of kidney stones.
  • Modern lifestyle, characterized by the consumption of fast and convenient foods. Such processed foods tend to be high in salt content, a known risk factor for stone formation. Moreover, sugary beverages, processed drinks, and excessive sugar consumption also contribute to the risk of stone formation.

In the case of young women, several additional factors may play a role.

  • Many of them desire to maintain a lower body weight, which leads them to adopt special diets that may lack proper balance. This imbalanced diet can contribute to stone formation.
  • Their busy lifestyles and work commitments may result in reduced water intake and holding in of urine for extended period of time (finding a restroom can become inconvenient). This inadequate hydration can also lead to stone formation.
OTHER INTERESTING POSSIBLE RISK FACTORS OF KIDNEY STONES AMONG YOUNGER PEOPLE
  • Climate change. Rising temperatures lead to increased dehydration. While outdoor activities and games are encouraged, inadequate water intake during these activities can contribute to stone formation.
  • Antibiotic misuse. The direct role of antibiotics in the formation of kidney stones remain uncertain. They may affect the formation of kidney stones indirectly, probably by causing issues related to nutritional absorption in the gut.
SYMPTOMS OF KIDNEY STONES

Kidney stones can present in various scenarios. For instance, some patients may exhibit symptoms like pain, bleeding, or fever when the stone obstructs the urinary tract, causing an infection.

Alternatively, kidney stones may be detected early in some fortunate cases, while these stones are still small, and hence there are no significant issues.

So, the manifestations of symptoms of kidney stones can vary.

POTENTIAL CONSEQUENCES AND COMPLICATIONS OF UNTREATED KIDNEY STONES

The stone might not cause any significant issues to the person’s quality of life if it is quite small.

However, the kidney stone may block the ureter—the passage in which urine is expelled from the body—creating a ‘traffic jam’ that leads to kidney swelling.

If left untreated, this blockage can lead to pain, infections and even kidney failure.

KIDNEY STONES MAY COME BACK OR RECUR IF ONE’S DIET IS NOT PROPERLY MANAGED

While water intake is often emphasized in relation to kidney stones, it is essential to consider other factors as well, such as salt and sugar intake.

Without proper diet management, there is a high chance of recurrence of 50% in 5 years, with some patients experiencing kidney stone formation again only 5 years after their initial operation.

This is also true for children. There is always a risk of kidney stone recurrence, especially if their diet is not properly managed.

Additionally, if a child has any structural or functional body issues that have not been adequately addressed by the doctor, it can also contribute to recurrent kidney stones.

HENCE, SPECIAL ATTENTION IS NEEDED FOR CHILDREN THAT HAVE EXPERIENCED KIDNEY STONES

They should undergo thorough medical assessments to rule out any body structural defects or functional problems that could lead to stone formation.

Proper management and monitoring are also essential.

TIPS TO REDUCE THE RISK OF KIDNEY STONE FORMATION
  • Adopt a healthy lifestyle. This is crucial. It involves maintaining a balanced diet, controlling one’s body weight, engaging in regular exercise, and managing blood sugar and cholesterol levels.
  • Drink an adequate amount of water daily as it helps in both hydrating the body and flushing out stones.
  • Avoid or limit foods that are high in sugars and salt.

The Haze Is Back, and Here’s How You Can Protect Your Lungs

WORDS LIM TECK CHOON

FEATURED EXPERT
DR KOW KEN SIONG
Respiratory, Internal Medicine, and Interventional Pulmonology Consultant
Sunway Medical Centre
WHAT, THE HAZE IS BACK?
  • The API readings for September 2023 showed alarming levels of fine particulate matter.
  • Experts predicted that the haze would persist until October.
  • Dry and monsoon seasons will further increase the risk of forest fires and haze during this period.
WHY SHOULD YOU BE CONCERNED?

Dr Kow Ken Siong tells us: “Fine particulate matters in the haze less than 2.5 microns in diameter, though often short-term, can leave a lasting impact, especially when inhaled.”

  • Short-term exposure can result in acute bronchitis symptoms like cough, phlegm, chest tightness, breathlessness, and lethargy.
  • Long term or chronic exposure can lead to respiratory diseases like asthma, chronic obstructive pulmonary disease (COPD), pneumonia, and lung cancer.
  • Air pollution, including haze, is linked to premature deaths, infections and various diseases, with chronic respiratory illnesses ranked the third-leading cause of death globally in 2019.
  • In Malaysia, nearly 20% of hospitalizations in government hospitals and over 12% in private hospitals are due to the abovementioned respiratory diseases!

He adds that:

  • Vulnerable groups such as children, the elderly, and those with pre-existing conditions (such as asthma and cardiovascular diseases) face higher risks of worsening pre-existing chronic lung conditions, increased the risk of lung cancer, and frequent bronchitis episodes.
  • Individuals without prior health issues may develop upper respiratory symptoms and become more susceptible to viral infections.
DR KOW’S TIPS TO PROTECT YOURSELF AGAINST THE HAZE
  • Staying indoors as much as possible, especially in areas where the air pollution index is unhealthy.
  • Keep doors and windows closed to prevent indoor air pollution.
  • Use high-quality air purifiers with high efficiency particulate air (HEPA) filters, especially when natural ventilation is limited.
  • Use N95 masks for prolonged outdoor exposure, to filter out potentially harmful fine particulate matter that may be harmful.
  • Stay hydrated throughout the day.
  • Stay informed and seek medical advice. Monitor air quality through official sources, limit outdoor activities during the haze, and seek professional medical advice if experiencing lung or heart symptoms.
  • Self-medication, particularly with inhalers, is discouraged as it may lead to unwanted side effects.

Can the World Truly Be Free of Fear of Cancer in the Next 25 Years? Experts Believe So

WORDS LIM TECK CHOON

On 5 September 2023, Siemens Healthineers hosted Creating a World Without Fear of Cancer: A Critical Dialogue, a panel discussion for local healthcare experts and leaders to share their thoughts on whether the world can indeed be free of fear of cancer within the next 25 years.

This may seem odd at the surface as cancer cases continue to rise—indeed, the number of cases in Malaysia is projected to double by 2040!

However, we are also seeing a rise in technological innovations that allow for more precise and earlier detection of cancer, as well as more effective forms of treatment through customized therapy that capitalizes on recent breakthroughs in genetics, immunotherapy, and more.

Hence, it is possible that, over the next 2 decades, we will see a shift from cancer as a ‘death sentence’ to a manageable long-term or chronic disease with higher survival rates. In other words, a world without fear of cancer.

We managed to get a front row seat at this panel discussion, and we’re pleased to share the highlights with you.

WHO’S AT THE PANEL DISCUSSION?
  • Fabrice Leguet, Managing Director of Siemens Healthineers Southeast Asia
  • YB Dr Kelvin Yii, Special Advisor to the Health Minister
  • Serena Yong, CEO of Regency Specialist Hospital
  • Professor Ricky Sharma, Global Head of Clinical Affairs at Varian
  • Ranjit Kaur, former President and current board member of Reach to Recovery International (RRI)
HIGHLIGHTS OF THE PANEL DISCUSSION
FEATURED EXPERT
YB DR KELVIN YII LEE WUEN
Special Advisor to the Minister of Health
  • “The National Strategic Plan for Cancer Control aims to make cancer prevention, management, and control accessible and affordable through partnerships with stakeholders,” says YB Dr Kelvin Yii. “The goal is to reduce the cancer burden, promote understanding of cancer, encourage prevention and early diagnosis to alleviate patient fears.”
  • The backbone to this effort is the Public Private Partnerships (PPPs) that involve strategic partnerships between government and private hospitals.
  • Current, most of the medical innovations for cancer diagnosis and management are centred around private hospitals, thus putting them out of reach of many Malaysians, especially those in the B40 group.
  • Through PPP, efforts such as government hospital patients getting follow-up treatments at private hospitals can be made possible while still at a reasonable cost partly funded by the Ministry of Health Malaysia.
  • Dr Kelvin admits that funding is a significant challenge at the moment.
FEATURED EXPERT
PROFESSOR RICKY SHARMA
Global Head of Clinical Affairs
Varian Medical Systems
  • “Cancer is a disease that can evolve and mutate to evade treatments,” Professor Ricky Sharma states. “The importance of patient data cannot be understated, as well as patient experiences of treatment from country to country.”
  • He underscores the importance of using patient data to deliver a personalized patient experience. “It has to be from a holistic point of view,” he elaborates. “We need to be asking important questions from the patients’ perspective: ‘Is treatment accessible? Are patients being treated with the respect they deserve? How and where are clinical decisions being made and the treatments being administered?'”
  • In light of the objectives set by the Ministry of Health Malaysia, such as the digitalization of all their healthcare facilities by 2030, Professor Ricky Sharma believes that this would allow for more accessible healthcare to people of all economic status, regardless of location.
  • For example, he cites the use of a virtual cockpit, which allows a healthcare professional to deploy customized treatment plans, analyze and provide results of imaging tests, etc to multiple hospitals without having to physically travel to those places. This would save time and improve productivity and efficiency.
  • Furthermore, digitalization of the medical workplace would allow for more flexible work hours for the staff, which is an effective way to reduce burnout. He and Ranjit Kaur bring out the fact that the medical profession has one of the highest suicide rates in the world, and this move to digitalization would help reduce the prevalence of burnout and mental issues that could help reduce such tragedy.
FEATURED EXPERT
FABRICE LEGUET
Managing Director
Siemens Healthineers Southeast Asia
  • Fabrice Leguet believes the next step in comprehensive cancer care will be to move beyond today’s fragmented cancer care landscape towards a more integrated approach.
  • He cites the shift of cancer screening from tertiary hospitals to general practitioners’ clinic as an example of such an approach. Having screening services available to clinics, especially at more rural areas of Malaysia, would go a long way in increasing the number of cancer cases detected at an early stage and, hence, the chances of better treatment outcomes and fewer deaths.
  • “By partnering with healthcare providers, we accelerate the transfer of knowledge in oncology across clinical, technical and managerial fields and fast-track the adoption of integrated innovative technologies across the continuum of cancer care,” he says.
  • “While we leverage our access to global best practices and the latest technological innovations, we take a ‘fit for purpose’ approach, where solutions are adapted to the local context in close collaboration with our partners in the region,” he adds.
  • He further says, “Every strategic partnership, every technological innovation, and every collaboration with policy makers will bring us one step closer to creating a world without fear of cancer.”
FEATURED EXPERT
SERENA YONG
Chief Executive Officer
Regency Specialist Hospital
  • Serena Yong shares that the private medical healthcare sector welcomes the partnership with the Ministry of Health via PPP programmes.
  • “By integrating insights from different fields, we can achieve more diverse and effective outcomes,” she states.
  • “Patient well-being at the heart of our mission,” she goes on to add, “so this partnership expedites the integration of connected health solutions, ensuring swifter access to care. Moreover, it facilitates the expansion of teleconsultation services and the implementation of predictive analytics on a broader scale, ultimately contributing significantly to our patients’ journey toward improved health outcomes.”
FEATURED EXPERT
RANJIT KAUR
Former President and Current Board Member
Reach to Recovery International (RRI)
  • In spite of technological advances, Ranjit Kaur reiterates the importance of community support and holistic approaches that emphasizes the patient’s emotional well-being alongside their medical treatments.
  • “In a world where technology drives improvement in various aspects of our lives, we must also prioritize empathy, timely care access and comprehensive support systems for patients, not only in Malaysia but worldwide,” she says. “Each patient journey is often daunting and worrisome, but by paying greater attention to these details, we can help individuals look beyond their diagnosis and find confidence in their ability to overcome cancer.”
  • Given that the oncologists in Malaysia are still concentrated in urban areas such as the Klang Valley, Ranjit highlights the efforts of the Ministry of Women, Family and Community Development to provide very affordable lodging for families that have to travel to these urban areas for a family member’s cancer treatments. She calls for the Malaysian government to look into providing more similar assistance and services to enable Malaysians from outside of urban areas that are traveling long distances for cancer treatments.
  • She and YB Dr Kelvin Yii agree that the government of Malaysia should prioritize the Ministry of Health in the yearly budget. Ideally, the Ministry of Health should be getting the most, if not the lion’s share of, the annual budget to allow PPP programmes to make healthcare treatments, especially for cancer, accessible to all Malaysians regardless of race, gender, and socioeconomic status.

Pancreatic Cancer 101: How Early Detection Can Make a Crucial Difference

WORDS LIM TECK CHOON

FEATURED EXPERT
DR TAN CHIH KIANG
Consultant Clinical Oncologist
Thomson Hospital Kota Damansara
PANCREATIC CANCER AT A GLANCE
An overview of pancreatic cancer. Click for a clearer, larger image.
  • “Pancreatic cancer is a type of cancer that originates from the pancreas, a vital organ located between the stomach and liver,” Dr Tan Chih Kiang tells us. “It occurs when abnormal cells in the pancreas multiply uncontrollably, forming a tumour.”
  • It’s the 12th most common cancers diagnosed worldwide.
  • It’s one of the deadliest cancers, with a 5-year survival rate of just 5–10%.
  • According to Dr Tan, this low survival rate is mainly the result of many pancreatic cancer cases being detected and diagnosed only when the cancer has reached an advanced stage. “At this stage, treatment options are limited, and surgery is no longer an option,” he says.
YOU ARE MORE LIKELY AT RISK OF PANCREATIC CANCER IF YOU…
  • Are obese. People with body mass index or BMI of 30 and higher face up to 20% increased risk.
  • Smoke. 25% of pancreatic cancer cases involve tobacco smokers.
  • Have diabetes. The link between diabetes and pancreatic cancer is still unclear, however.
  • Have chronic pancreatitis or long-term inflammation of the pancreas. Heavy smoking and drinking of alcohol can lead to chronic pancreatitis.
  • Have a genetic mutation that leaves you more likely to develop this cancer.
  • Are older. Dr Tan shares that the average age of the people diagnosed with this cancer is 70.

Aside for the last 2 risk factors, the other risk factors can be managed through lifestyle modifications—losing weight through healthy, balanced diet and regular physical activity, for example—and good control of existing health conditions. You can consult your doctor for more information.

HOW TO TELL THAT YOU MAY HAVE PANCREATIC CANCER
  • Upper abdominal pain and discomfort. The pain may radiate to the back.
  • Jaundice, which is the yellowing of the skin and the white of the eyes, and/or very itchy skin.
  • Indigestion that does not respond to conventional medications.
  • Fatigue—feeling exhausted all the time.
  • Unexplained weight loss.

Most of these symptoms often go undetected, or are assumed to be trivial, hence the cancer is allowed to progress to an advanced stage unchecked.

Dr Tan advises us to see a doctor should we experience these symptoms. Better safe than sorry, as early detection allows for a higher chance of better treatment outcome!

IFPMA Launches New Video to Share How Innovative Ideas Are Changing Cancer Care for the Better

WORDS LIM TECK CHOON

#AlwaysInnovating is an initiative by the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), which aims to share with the world the expertise, collaboration, and perseverance involved in transforming ideas and innovations into real-world medicines and vaccines.

We’re pleased to share with you the latest film and expert insight from #AlwaysInnovating, in which an animated guide called Sparky will explain how decades of dedicated cancer research and innovation have paved the way for a reimagined approach to cancer care bringing fresh hope to people with cancer as well as their carers.

HERE’S THE VIDEO

FOR MORE INFORMATION

Click here to access the IFPMA webpage to learn the sobering statistics of the cost of cancer of our lives and how, driven by this cost, the pharmaceutical industry is driving innovation across all areas of medicine to delivering new medicines to those in need. Link opens in a new tab.

How Robotics Can Help a Stroke Survivor’s Brain to Relearn How to Walk at a Faster Rate

WORDS LIM TECK CHOON

FEATURED EXPERT
DR KOK CHIN YONG
Consultant Neurologist and Internal Medicine Physician
Sunway Medical Centre Velocity
FIRST, LET’S TAKE A LOOK AT STROKE

Stroke is a medical emergency caused by the disruption of blood flow to your brain.

Without enough oxygen, your brain will stop working properly. This is why stroke is often considered the brain’s version of a heart attack.

 

Ischaemic stroke

This occurs when there is blood flow disruption to the brain. This can occur when the blood vessels in your brain are blocked by blood clots or other substances.

This is the most common type of stroke and is often linked to poorly controlled type 2 diabetes, high blood pressure, and/or high blood cholesterol levels.

Haemorrhagic stroke

This type of stroke occurs when there is internal bleeding in the brain. Accumulated blood in certain areas of the brain can exert pressure to brain tissues in these areas and damage these tissues.

While not as common as ischaemic stroke, this type of stroke is especially dangerous because the affected person’s symptoms can get worse very quickly and urgent medical attention is needed to prevent permanent brain damage and even death.

MOST STROKE SURVIVORS EXPERIENCE GAIT DISABILITY

Stroke is one of the main causes of disability.

2005 statistics from the American Heart Association revealed that more than 80% of stroke survivors suffer from gait disability—the loss of mobility due to impaired ability to walk normally.

Gait disability can affect the survivor’s quality of life.

However, there are also other repercussions of this disability on the person: the person’s confidence and sense of independence can be compromised.

Furthermore, gait disability is linked to increased risks of cardiovascular diseases and death in people approaching 80.

Because of this, gait therapy is an important aspect of rehabilitation for a stroke survivor.

ALL IS NOT LOST, AS THE BRAIN HAS A CHANCE TO ADAPT & RECOVER

The brain is an amazing organ. The network of nerves and other tissues involved in brain function can adapt to changes by reorganizing themselves, or ‘rewire’ in response to these changes.

“This can happen after a stroke,” Dr Kok explains, “as the brain begins to compensate for the damage caused by the stroke.”

This process, called brain neuroplasticity, can involve the formation of new connections between remaining healthy nerves and ‘recruiting’ other parts of the brain to take over the functions that were handled by the now-damaged part of the brain.

Much research is being done on the neuroplasticity of the brain to explore possible ways to improve the rehabilitation process of people that had a stroke or other brain injuries that affect their normal day-to-day function.

Currently, research data increasingly suggests that techniques that can stimulate the part of the brain affected by stroke can help improve the rehabilitation of the lost function linked to that part of the brain.

HENCE, GAIT THERAPY IS AN ESSENTIAL COMPONENT OF A STROKE SURVIVOR’S REHABILITATION

Dr Kok Chin Yong mentions that the restoration of a stroke survivor’s ability to walk can be a complex process.

The stroke survivor’s inability to walk normally is usually due to the stroke disrupting the function of the nerve pathways in the region of the brain that plans and controls movement called the motor cortex.

Furthermore, the stroke survivor also often suffers from other debilitations that make it harder for them to walk, such as changes in their muscle tone and strength as well as impaired heart function.

Additionally, the more gait therapy is delayed, the harder it is to achieve a good outcome because the organs involved in walking will further weaken and waste away due to lack of use.

Hence, gait therapy should be prioritized as soon as it is feasible to do so.

ROBOTICS-ASSISTED GAIT THERAPY CAN BENEFIT STROKE SURVIVORS CONSIDERABLY
If you have not read Dr Foong Chee Chong’s explanation of what robotic-assisted gait therapy is, you can do so by clicking here. Have a read, and then hit the back button to come back here and continue reading—it will help you better understand the rest of this article!

Dr Kok explains that the first line of rehabilitation is conventional physiotherapy.

“During this stage, we will assess the patient’s suitability for robotics-assisted gait therapy,” he explains, adding that the criteria for suitability are similar to those explained by his colleague Dr Foong is the above-linked article.

“The main benefit of the use of robotics is that many patients can regain their normal physiological walking at a faster rate than conventional physiotherapy,” he shares.

He elaborates that this is due to the robotic exoskeleton stimulating the neuroplasticity of the patient’s brain, helping it to relearn how to order and control the movement of the patient’s lower limbs at a much faster rate.

He reiterates that such outcome is more likely achieved when the robotics-assisted gait therapy is initiated as early as it is feasible to do so.

Hence, he encourages stroke survivors to consult their doctors further on whether such a therapy is suitable for them.

THIS IS THE SECOND PART OF THE SERIES LEARNING TO WALK AGAIN

Below are the articles in this series:

  1. A Rehab Specialist Explains How a Robot Can Help You to Learn Safely & Successfully to Walk Again
  2. How Robotics Can Help a Stroke Survivor’s Brain to Relearn How to Walk at a Faster Rate (you’re reading this article now)

References:

  1. Duncan, P. W., Zorowitz, R., Bates, B., Choi, J. Y., Glasberg, J. J., Graham, G. D., Katz, R. C., Lamberty, K., & Reker, D. (2005). Management of adult stroke rehabilitation care: A clinical practice guideline. Stroke, 36(9), e100–e143. https://doi.org/10.1161/01.STR.0000180861.54180.FF
  2. Newman, A. B., Simonsick, E. M., Naydeck, B. L., Boudreau, R. M., Kritchevsky, S. B., Nevitt, M. C., Pahor, M., Satterfield, S., Brach, J. S., Studenski, S. A., & Harris, T. B. (2006). Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA, 295(17), 2018–2026. https://doi.org/10.1001/jama.295.17.2018
  3. Su, F., & Xu, W. (2020). Enhancing brain plasticity to promote stroke recovery. Frontiers in neurology, 11, 554089. https://doi.org/10.3389/fneur.2020.554089
  4. Selves, C., Stoquart, G., & Lejeune, T. (2020). Gait rehabilitation after stroke: review of the evidence of predictors, clinical outcomes and timing for interventions. Acta neurologica Belgica, 120(4), 783–790. https://doi.org/10.1007/s13760-020-01320-7

Seeking the Light at the End of a Cancer Treatment Journey

WORDS LIM TECK CHOON

Khariza Abdul Khalid has a blessed life. At 47, she is the Executive Director of Gamuda Land and a mother of 3 precious children.

However, it was not always rosy for Khariza, for in 2012, the discovery of an unusual bulging on her left stomach led to a diagnosis of stage 3 non-Hodgkin’s lymphoma.

Non-Hodgkin’s lymphoma is a type of cancer that starts in the lymphatic system—a network comprising our lymphatic vessels, lymph nodes, lymphoid organs, lymphoid tissues, and lymph fluid. When one develops this cancer, their white blood cells grow in an abnormal manner, forming tumours throughout the body.
A SHOCK, THEN COMES DETERMINATION

“I was scared, worried, nervous,” recalls Khariza, “but I was informed that I would have to go through chemotherapy.”

Fortunately, her husband and parents were very supportive, acting as the rock for her to stay strong and supported throughout her cancer treatment journey.

Her parents even stepped in to care for her children during the period.

A LONG JOURNEY

“I had to go for 6 cycles of chemotherapy and a bone marrow transplant,” Khariza shares with us.

Each cycle took place in a month, and she would, depending on her health condition, have 2 weeks of rest or staying in the ward for 3 to 4 days.

During this period, she took a year leave from work.

“I’m grateful for the support from not only my family, but also my employer and colleagues,” she tells us.

Additionally, she is also grateful for the compassionate care, understanding, and support she received from the doctors, nurses, and other hospital staff during her treatment journey.

“Don’t worry too much,” Khariza advises others that are embarking on their cancer treatment journey. “It is not an easy road, but you will get through this!”

A HOPEFUL FUTURE

By the end of the 6th cycle, Khariza received the news that she had been hoping to hear: her cancer cells had been eliminated.

She would undergo immediate bone marrow transplant, to replace bone marrow damaged during chemotherapy and to regenerate her immune system.

These days, Khariza is feeling more like her old self.

“I am blessed,” she says. “I am feeling heathier and more energetic too, as I have added exercises and workouts into my daily routine.

Not taking life for granted anymore, she also devotes more time to bond with her family and friends.

Michelle Yeoh Joins Local Healthcare NGOs in Rallying Malaysians Against COVID-19

WORDS LIM TECK CHOON

On 17 August 2023, the Malaysian Society of Infection Control and Infectious Disease (MyICID), the National Cancer Society of Malaysia (NCSM), and the Malaysian Red Crescent (MRCS), in collaboration with Pfizer Malaysia, launched the MyPELINDUNG campaign.

WHAT’S MyPELINDUNG?

It’s a public educational campaign aimed at mitigating the threat of COVID-19 in Malaysia by increasing the awareness levels of Malaysians on the importance of up-to-date vaccination and seeking of prompt COVID-19-specific treatment.

Among the luminaries gracing the launch were:

  • Her Highness Dato’ Seri DiRaja Tan Sri Tunku Puteri Intan Safinaz binti Almarhum Sultan Abdul Halim Mu’adzam Shah, Tunku Temenggong Kedah, who is the National Chairperson of the Malaysian Red Crescent
  • Datuk Dr Norhayati Rusli, Deputy Director-General of Public Health, Ministry of Health
  • Yang Berbahagia Tan Sri Dato’ Seri Michelle Yeoh, Oscar-winning actress
  • Dr Shaharudeen Bin Kamaludeen, the President of MyICID
  • Dato Dr. Saunthari Somasundaram, the President of NCSM
  • Professor Datuk Dr Zulkifli Ismail, the Chairman of Immunise4Life
  • Madam Luksanawan Thangpaibool, the Country Cluster Lead of Pfizer Malaysia, Pakistan and Brunei
A PRINCESS’S WORD OF WISDOM

“Just as it takes many drops to form an ocean, our shared actions—however small they may seem —can create significant impact in the fight against COVID-19,” says Yang Teramat Mulia Dato’ Seri Diraja Tan Sri Tunku Puteri Intan Safinaz.

She adds: “It’s through initiatives like MyPELINDUNG that we can harness our collective strength to navigate this health issue. Together, with the strength of unity and shared responsibility, we can contribute to a healthier, safer nation for all Malaysians.”

WAIT, ISN’T COVID-19 OLD NEWS?

Not so! Yes, Malaysia has made significant strides but the virus responsible for COVID-19 continues to circulate in our communities and can still lead to hospitalizations and even death, especially among high-risk groups.

Hence, the experts driving MyPELINDUNG advocates constant vigilance, updating of COVID-19 vaccinations, adherence to recommended health measures, and prompt seeking of COVID-19-specific treatment if one is tested positive.

VACCINATION IS KEY, EXPERTS SAY

MyPELINDUNG aims to reduce public hesitancy around the COVID-19 booster doses by disseminating scientifically-accurate information and addressing common concerns held by Malaysians about these boosters.

The campaign’s efforts will particularly focus on high-risk groups, as up-to-date vaccination (including booster doses) can reduce their risk of severe illness, hospitalization, and death.

Dr Shaharudeen Kamaludeen, President of MyICID, tells us: “It’s paramount that we understand the critical role vaccinations play in mitigating the severity of COVID-19. Vaccinations, including recommended booster doses, are our primary line of defence against this virus.”

He also adds that prompt medical consultation and treatment after a positive test for COVID-19 are equally vital.

Professor Datuk Dr Zulkifli Ismail, the Chairman of Immunise4Life, further emphasizes the importance of maintaining one’s up-to-date vaccination status.

“Full vaccination significantly reduces the risk of severe disease outcomes,” he says. “We urge everyone, particularly those in high-risk groups, to consider vaccinations as their personal shield against the virus, and to remember that this shield is most robust when all recommended doses, including boosters, have been administered.”

THE ACTRESS ADVOCATES

Tan Sri Dato’ Seri Michelle Yeoh concurs with the experts, adding that she herself had 2 brushes with the COVID-19 vaccine.

She participated in an educational video for MyPELINDUNG, a video that she is very proud of, and will continue to commit to encouraging Malaysians to remain vigilant and take the appropriate protective steps against COVID-19.

“Trust the science,” she urges.

PROMPT & QUICK TREATMENT CAN SAVE LIVES

“The most important thing to remember about treatment for COVID-19 is that it should be started as soon as possible after diagnosis to be effective,” states Dato Dr Saunthari Somasundram. “If you test positive for COVID-19, treatments are available that can reduce the likelihood of severe illness, hospitalization, and death. Please don’t delay because COVID-19 specific treatment must be started within days after you first develop symptoms to be effective.”

Tan Sri Michelle Yeoh concurs. “On screen, I’ve navigated flying stunts and leapt off moving vehicles, but life isn’t an action film, and we can’t afford to wait for the dramatic last-minute rescue. If you’re showing any symptoms, act fast, seek help at once.”

For more information about the MyPELINDUNG initiative and its efforts to combat COVID-19, please visit https://www.facebook.com/MyPELINDUNG (link opens in a new tab).

A Rehab Specialist Explains How a Robot Can Help You to Learn Safely & Successfully to Walk Again

WORDS LIM TECK CHOON

FEATURED EXPERT
DR FOONG CHEE CHOONG
Consultant Rehabilitation Medicine Specialist
Sunway Medical Centre Velocity
FIRST, LET’S TAKE A LOOK AT GAIT THERAPY

Gait therapy is a form of physical therapy to help improve one’s ability to walk.

COMMON HEALTH ISSUES THAT LEAVE ONE WITH DIFFICULTIES IN WALKING
Stroke
Osteoarthritis
Cerebral palsy
Parkinson’s disease
Joint replacement surgery
Lower limb paralysis
Multiple sclerosis
Traumatic brain injury
Muscle weakness due to long periods of inactivity or immobilization

Gait therapy is typically conducted by a rehabilitation medicine specialist together with a physiotherapist and assisting personnel such as nurses.

If the affected person needs counselling or experiences mental issues such as depression due to their inability to walk normally, a counselor or psychiatrist will also be involved.

INTRODUCING ROBOTIC-ASSISTED GAIT THERAPY

Consultant rehabilitation medicine specialist Dr Foong Chee Chong reveals that this technology has been around for the last decade or so, and it is increasingly adopted in Malaysia as part of gait therapy.

It’s a bit like Tony Stark and the Iron Man suit!

Dr Foong shares that in robotic-assisted gait therapy, the robotic device used is a wearable robotic exoskeleton.

There are a few different types of robotic exoskeletons available, and the specific way each works may vary from other types.

However, they generally work in the following manner:

  1.  There is a control panel, placed usually at the back of the exoskeleton, that allows the physiotherapist to adjust the settings to the level of assistance needed by the patient. Such adjustment is based on the patient’s current abilities and needs.
  2. The robotic exoskeleton is a lightweight frame that will be strapped onto the patient’s torso and legs.
  3. Once activated, the robotic exoskeleton will provide powered assistance to the patient’s hips and knees, assisting the patient in performing walking and standing motions.
  4. The entire session will be supervised closely by the physiotherapist and their assistant, who will always remain close to the patient.
  5. Should the patient do something wrong, the robotic exoskeleton will emit a sound that will alert the supervising physiotherapist, so that they can tend to the patient and provide necessary advice and assistance.
What’s the benefit of using a robotic exoskeleton?

Improved rehabilitation. Studies have found that robotic-assisted gait therapy can lead to clinically significant improvements in lower-limb movements among stroke survivors and people with spinal cord injuries, when compared to conventional gait therapy.

Shorter rehabilitation period. Dr Foong points out that, unlike the human eye, the robotic exoskeleton is more precise in detecting issues faced by the patient as they try to walk during gait therapy.

Furthermore, data from each session is tracked to allow the physiotherapist and rehabilitation medicine specialist to review the patient’s progress and identity areas for improvement.

As a result, the patient’s gait recovery from their robotic-assisted gait therapy is usually faster than those that do not use this technology.

Less resources are needed. Conventional gait therapy requires more personnel to assist the patient. For example, Dr Foong mentions that an assistant may be needed to support each of the patient’s arms, while another will guide the movement of the patient’s legs.

With the use of the robotic exoskeleton, fewer personnel are needed.

CAN I SIGN UP FOR ROBOTIC-ASSISTED GAIT THERAPY?

Dr Foong points out that a person will need to meet certain criteria to be considered for such therapy.

The person can sit upright and stand without experiencing dizziness and other issues. “They need to be able to do these actions at least 30 to 45 minutes without experiencing dizziness and other issues,” Dr Fong explains.

The person’s joints and bones are supple and strong enough to move without experiencing fractures. Dr Foong says that, typically, medical examination and muscle strength assessment will be conducted first to determine whether a patient is suitable to put on the robotic exoskeleton.

The person’s mind is sharp enough. They need to have a sound mind and be able to follow instructions from the physiotherapist.

The person is within the stipulated height and weight limit. A robotic exoskeleton can only support a person up to a certain weight and is within the recommended height range.

For the Ekso machine, for example, it can fit patients under 100 kg and between 1.5 m and 1.9 m.

HOW LONG IS EACH SESSION?

“Each session is usually between 30 and 45 minutes,” Dr Foong says.

The number of sessions is determined on a case-by-case basis.

WILL I BE ABLE TO WALK LIKE I USED TO?

“It will depend on a few factors,” Dr Foong says.  “The most important factor is the severity of the stroke. However, majority of stroke survivors will regain some form of movement or ambulation after undergoing robotic rehabilitation.”

He adds that one’s walking ability typically declines over time due to age-related issues such as loss of muscle strength. Hence, it’s possible that one may need to undergo periodic gait training to improve their walking ability.

Additionally, Dr Foong recommends staying active to ensure that the improvements developed after gait therapy will persist for as long as example. For example, one can go for walks around the neighbourhood in the evenings.

THIS IS THE FIRST PART OF THE SERIES LEARNING TO WALK AGAIN

Below are the articles in this series:

  1. A Rehab Specialist Explains How a Robot Can Help You to Learn Safely & Successfully to Walk Again (this is the article you are reading now)
  2. How Robotics Can Help a Stroke Survivor’s Brain to Relearn How to Walk at a Faster Rate