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How digital is at the heart of rehab goal-setting

Through the pre-pandemic creation of Goal Manager, rehab professionals and clients alike are benefitting from the power of digital tech



Back in late 2018, Dr Penny Trayner launched Goal Manager® into a healthcare and rehab world which had yet to fully appreciate the need to adopt digital technology into its ways of working. 

As a platform which made use of the gold standards in goal setting and software, Goal Manager created, for the first time, the means to set targets, monitor progress and generate meaningful outcome data around a client’s ongoing recovery. 

Crucially, through digitalising the process, clinicians were able to save significant amounts of time spend on admin – Goal Manager statistics show goal setting time is reduced by 43 per cent – through the paperless system, and avoid hours of travel for a meeting which could now be held virtually. 

Even in a pre-COVID healthcare world – and despite the scepticism and often reluctance from the sector to adopt digitalisation – Goal Manager’s offering was warmly welcomed. Although created for Dr Trayner’s own business, Clinical Neuropsychology Services, its commercialisation and expansion into a host of other businesses was demand-led. 

Now, given the seismic shift in attitudes towards digital and remote technology from healthcare as a result of the pandemic, Goal Manager is on a path of significant growth, and is even set to secure its first public sector commission later this year – a process which, pre-COVID, was known to take many years. 

And for Dr Trayner, who recognised the need for technology and the role it could play years before it became a necessity, the huge shift in adoption and attitudes are factors she believes are crucial to the future of healthcare. 

“I think, during the pandemic, two things have happened,” paediatric clinical neuropsychologist Dr Trayner tells NR Times. 

“One, people no longer necessarily see technology as a lesser option. I think there was a public perception that perhaps if you were not seeing someone face to face, you weren’t getting the same quality of service. 

“But I think what’s also happened is we have recognised there are some things that are not best delivered remotely, and we’ve got a lot better at delineating what things should we be doing remotely, and when we should be dedicating in-person clinical time.”

Both of those factors were crucial in the foundation of Goal Manager. Dr Trayner recalls a period where she was travelling up to 1,000 miles each week to attend meetings across England and Wales – something that remained ‘the norm’ for many practitioners until March 2020.  

“We’ve seen there’s no reason to do that anymore, and we can be far more effective and more efficient,” she says. 

“Zoom allows us to share our screens so we don’t have to come with documents, everyone’s got everything available in their own workspace, if people can’t attend because of the weather or whatever else, the meeting still goes ahead. 

“It’s very costly in terms of expense and time to meet face to face, but we don’t always need to meet that way anymore. There will be times for some teams where it’s appropriate; but for a lot of teams, it won’t be. I think we’ve got much better getting this working – people are accepting it, embracing it and seeing it as an acceptable offer.”

And as well as the travelling time – and its additional carbon-cutting benefits – Goal Manager also frees up significant amounts of time spent traditionally on paper-based data collection and analysis, compiling information from multiple sources and having to assess it manually. 

“My view was that there has got to be a better way to do this,” says Dr Trayner, who hails from a family of engineers. 

Goal Manager team members Dr Penny Trayner (left) and Merryn Dowson

“Having such a family background makes you see that actually, if we can harness technology in the right way, we can make it help us make our lives more efficient. 

“Goal Manager is an administrative tool which is there to speed up something that takes a long time to do in a manual way. But the idea of it is to create more clinical space, so you can then dedicate the time you have free to doing the good stuff, actually seeing your patients and doing the important clinical work, whatever it may be.

“And I think people can reflect on that in our everyday lives. I don’t think there’s many of us that don’t use our smartphone. And if we actually apply that to our workplace setting, ‘where can tech can make my job better?’, then that’s going to improve our working practice.”

One issue Dr Trayner was quick to identify on rolling out Goal Manager in late 2018/early 2019 was the need to train people properly in using the system, particularly those who aren’t adept in using technology, to avoid it being something they feared. That is something which still hasn’t been tackled more widely within healthcare and wider society since the onset of the pandemic, she says. 

“It wasn’t a stepwise progression when the pandemic came, it was a giant leap, we made years of progress extremely quickly. But with such rapid change, some people will need support to catch up,” says Dr Trayner. 

“We identified early the importance of not just giving people technology, it’s actually the training and support that goes with it that really makes a difference. If people feel confident and competent, and can get on with it themselves, then they’ll get on board with it and use the tech with maximum benefit.

“Alongside Goal Manager, we have designed CPD-accredited training courses that look at goal setting and how to embed the gold standard techniques in your routine practice by using the software, so they’re getting the training and learning opportunity alongside being able to use it. In general we find that people know the principles, it’s really just learning what buttons to click. 

“But I think, more widely, that’s where a lot of tech gets let down. Proper support isn’t there, and then the fear factor comes in. If you’re going to introduce something into a team, what training do they need to help them? How confident do they feel in using it? What are you doing to support them? That is crucial in this.”

But as well as appropriate training and support, a crucial factor for Dr Trayner is that the platform is fit-for-purpose for the healthcare sector and those working within it – and highlighted the roles healthcare professionals have in enabling that. 

“The problem with a lot of technology is, particularly in healthcare, it is often made by external companies, sometimes really top IT companies, but ones that that have absolutely no experience within healthcare on the frontline,” she says. 

“People get tired of the tech. Tthey try it but it doesn’t work and it doesn’t do what they want it to do. So, they move on, and that’s a real shame and a missed opportunity. 

“I think what we need to do as healthcare professionals is to be the driver of technology that works for us. We need to say what are our needs, what do our services and our service users need, and work in partnership with technology companies to design those solutions, rather than it being the other way around – them designing a ‘solution’ which we then shoehorn into our services. 

“Goal Manager was supposed to be internal, to manage a challenge we had, and it just organically grew from there. We identified a healthcare app developer and worked very closely with him, and still work with him now on the continuous roll-out of updates to the system. We really hit gold there, as it can be very challenging to find a developer with that level of expertise to work with. Once you start and you can see the process taking shape, it becomes a lot easier. 

“It was an idea I had, and I’ve got a load more, but I can’t be the only person with them – there are loads of ideas out there. We’ve got staff teams out there with buckets of ideas, and tapping into those really could mean positive change for your service and many others.

“I think that is a really important part of this journey we are all on. Things have been accelerated massively and the infrastructure is now there, people have access to laptops, computers, tablets, whatever they need to be able to do this. We’re much better resourced now from an IT perspective, and the ideas are there. 

“It’s there to be done. We’re not in a place now where you have an idea and it sits on the shelf, you can make it happen if you want to. That’s what I did with Goal Manager and it has been incredibly effective for us, and also for others.

“Clearly there are structural limitations and it all costs, but I think this is such a great time for ideas. No longer do these things take ten to 15 years to come to into use – the world has changed and we can all help to play a role in the future.”

  • Dr Penny Trayner is among the speakers at Virtually Successful, a five-day conference which runs throughout this week which looks at the contribution and potential of digital tech to the world of neuro rehab. To access the presentations, which are available online, at an NR Times discounted rate, visit here


Fourier Intelligence continues international collaboration

The rehab robotics pioneer has signed a MoU with Centro Europeo de Neurosciencias



Rehab robotics unicorn Fourier Intelligence is continuing its work in advancing the fast-growing sector by forming a new partnership with Centro Europeo de Neurosciencias (CEN). 

The signing of the Memorandum of Understanding (MoU) will focus on the testing of new and existing rehabilitation robotic devices created by Fourier Intelligence. 

Fourier Intelligence robotics are already in use around the world, with testing and feedback undertaken continually to ensure they are best equipped to improve patients’ lives and deliver the highest standards of rehabilitation. 

With a track record of healthcare excellence and research, working alongside international partners, CEN already makes an important contribution on a global scale and will be a key partner in the further development of Fourier Intelligence’s portfolio of life-changing devices. 

The MoU is the latest to be signed by Fourier Intelligence with key global partners, as part of its commitment to working in collaboration with experts around the world to create world-leading rehab robotics. 

“The agreement of this MoU is another significant step in the ongoing development of rehabilitation robotics, which will improve patients’ lives,” says Zen Koh, co-founder and group deputy CEO of Fourier Intelligence. 

“CEN has an excellent international reputation and track record in healthcare and research, and we are delighted to partner with them in this way. The testing of new and existing Fourier Intelligence devices is critical to maximising patient outcomes, so this will be very important in achieving that.

“We believe collaboration is at the heart of developing this sector and making a difference in the lives of those who need this technology, and are very proud to have key partners around the world. Together, we will take this forward and make the positive change that is needed.”

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The patience of patients

Stroke survivor Lisa Beaumont reflects on her ongoing rehabilitation and the vital role NeuroProactive can play



Rehabilitation cannot be rushed. Each patient needs to develop techniques to build the patience they need.

In Spring 2022, I faced the biggest setback in my rehabilitation journey so far. A problem with my leg splint meant that I was unable to walk for two to three months.

I learned plenty about myself during this interlude. While my orthotic was being replaced, I watched from my window while Spring became early Summer.  I could not leave my bedroom for several weeks. Most importantly, I learned about my techniques for managing my frustration with my situation.

I had plenty of time to reflect upon my situation and to consider ways that might avoid this situation happening for others. Access to digital solutions such as from the outset will offer solutions for the patients of the future. 

For the last eleven years I have focussed my energy on learning to walk again. Therefore, it took a substantial adjustment physically and mentally for me to adapt to being confined to one room without any possibility of walking anywhere. I chose to focus on two activities which were possible for me to do.

Firstly, I could still develop my cognitive rehabilitation through game-playing. I found several games I could play on my phone, including Wordle, Words with Friends and Solitaire. 

I realised that Solitaire, also known as the English card game Patience, makes a good analogy for any rehabilitation journey. There is only one player in the game, and you can win or lose depending on your actions and choices. You cannot speed up the pace of the game, but you at least know where you are.  

Likewise, in rehabilitation. offers features that would have avoided some of my frustration this Spring. It enables speedy communication between clinicians and patients. I would have had an opportunity to track the progress of my replacement splint. And it would have been a single place for the orthotist, physiotherapist and district nurses to discuss my case.

I realised that a strength of is that it recognises the central role that a patient has in their rehabilitation journey.  Consequently, the platform validates the patient’s experiences by giving them the ability so see and to help manage the input they need from their team of clinicians.

The other second activity was that part of the physiotherapy that I could still do – exercises in bed and upper limb work.  My carers supported me by helping me to count and record my repetitions and by monitoring the quality of my movements.

How could have helped to improve my situation? My situation could potentially have been avoided through better
communication between my orthotist, physiotherapist, GP and my team of carers. can act as a single shared space for each person to share updates and photos.  

As more practitioners gain access to, and familiarity with, and its features, new and exciting ways to use it will emerge.

We’re in the process of rolling out Neuro ProActive to 31 NHS Trusts.

You can find out more online or connect with us on Twitter @NeuroProActive.

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ONWARD – making the impossible possible

CEO Dave Marver discusses its pioneering work in spinal cord injury and the new hope for people living with paralysis



Professor Gregoire Courtine, Dr Jocelyne Bloch, Dave Marver

The concept of three people living with complete paralysis regaining the ability to walk independently is something that, in the very recent past, would have been dismissed as being impossible – but through the work of ONWARD, this one-time ‘impossibility’ is now becoming reality. 

For years, spinal cord injury has been regarded by many as the ‘graveyard of neuroscience’, where hope was in short supply and the outlook for those daring to dream of the day that may change was bleak. 

But now, through the efforts of pioneers who have led the research breakthroughs that are now shaping reality, the ability of technology to change lives is being seen by the whole world, with people watching in amazement as paralysed patients rediscover the ability to move. 

After being implanted with spinal stimulation technology developed by ONWARD – the first time its epidural electrical stimulation (EES) had been trialled in humans – all three participants who were part of the STIMO-BRIDGE trial were able to take steps independently within a single day.

After five months of rehabilitation, they were also able to use their legs to stand, walk, swim, and/or cycle. They also regained control of their trunk muscles. 

Such colossal steps forward in SCI are now giving new hope to people living with paralysis – and are helping to show, rather than being impossible, what could become the new possible for the future. 

“We were very pleased with the results of STIMO-BRIDGE, although we as a company are not going to be pleased with just impacting subjects in a clinical trial,” Dave Marver, CEO of ONWARD, tells NR Times. 

“Our job and our unique role is to scale these therapies so they can provide benefit to hundreds of thousands of people with spinal cord injury around the world. 

“These results show great promise, but we still have a tremendous amount of work to do to achieve our vision.” 

And for ONWARD, that vision is to change the lives of people living with SCI globally, to enable them to enjoy and live their lives in the ways that matter most to them. 

Established in 2014 to focus specifically on SCI, the venture has led truly groundbreaking research into this long-underserved area. 

Founded by neurosurgeon Dr Jocelyne Bloch and Professor Gregoire Courtine, Swiss-based ONWARD has taken decades of research and translational science to bring to fruition two viable commercial solutions. 

With its ARC EX and ARC IM devices, ONWARD – backed by many of the leading European life sciences venture capital investors – has led the charge on redefining the outlook for SCI patients. 

Its ARC IM, recently subject to the STIMO-BRIDGE trial, consists of an implantable pulse generator and lead that is placed near the spinal cord, controlled by wearable components and a smartwatch. A pivotal trial is set to begin within the next 12 to 18 months. 

The ARC EX is an external, non-invasive wearable stimulator and wireless programmer, which targets the rediscovery of upper body movement. Currently subject to the international Up-LIFT trial – the largest SCI trial of its kind – it completed enrolment of 65 participants ahead of schedule, despite the many challenges presented by the COVID-19 pandemic.

Currently being trialled at sites across the world – including in the NHS Greater Glasgow and Clyde (NHSGGC), as well as Neurokinex sites in England – the aim, pending necessary approvals, is for a commercial launch in the first half of 2023. 

But while the excitement at the potential of ONWARD is palpable, with the first introduction of its technology into rehabilitation centres across the United States, UK, France, Germany and the Netherlands potentially barely a year away, Dave is keen to ensure expectations remain realistic.  

“Certainly this will give hope to people, and I think the fact we enrolled all 65 subjects in Up-LIFT ahead of schedule, despite all the challenges of clinics closing and difficulties with quarantines and so forth, speaks to the enthusiasm that the clinical community has for this therapy,” he says.

“They have really embraced it, as the participants did in STIMO-BRIDGE. We, and they, are showing what is possible. 

“But I do think it’s important to not overstate it, I don’t want to create false hope, because these subjects really committed themselves to the therapy and to the rehabilitation process. 

“I think there is great potential that many people with paralysis will be able to stand again with the benefit of our therapies, maybe take some steps. But then it really depends on their particular circumstances and their overall level of health, their willingness to commit to rehabilitation, whether they can go further than that. 

“And, of course, not everyone with spinal cord injury, desires necessarily to walk again, they may have other priorities. And that’s why ONWARD is also committed to addressing other challenges that affect the quality of daily life, such as blood pressure and trunk control and use of better use of the upper extremities. 

“And then in the future, we’ll be looking at incontinence and restoration of sexual function, the whole battery of things that people with SCI have to contend with.”

Through its longstanding and deep-rooted commitment to the SCI community, ONWARD has secured relationships with of some of the world’s leading organisations in this area, including the International Spinal Research Trust and the Christopher & Dana Reeve Foundation. The latter has even become ONWARD shareholders, to help further its pioneering work. 

For Dave, while the word ‘pioneering’ is well-used, for ONWARD, it is also well-earned. 

“I think we are seen as pioneers in this area because we’ve chosen to focus on serving the spinal cord injury community,” he says. 

“It’s a smaller population than other populations with movement-related challenges, like stroke and Parkinson’s, for example. Most businesses orientate toward the largest potential markets, whereas our founders really had a passion for helping people with spinal cord injury. 

“And that remains the core vision, that was their raison d’être, and it’s with that commitment and determination that we have achieved such progress. 

“We haven’t partnered with existing spinal cord stimulation companies, we’ve developed our own technology platform that is built for the specific purpose of not stimulating the spinal cord for pain management, but stimulating the spinal cord to restore strength and function.

“But I think the progress we have made also reflects the close collaboration that we enjoy and value with our scientific partners. We have a group of people so committed and driven by our mission, which I think is why we make the progress we have done. 

“We develop that lead together in a very rigorous way, with our vision at the heart of that.”

Constantly looking to the next innovation and how its technologies can be even more beneficial to those who need them, ONWARD is also considering how, post-commercial launch, its ARC EX could be used remotely. 

“Later, we’ll be seeking approval for it to be used in people’s homes, so they can conduct periodic sessions maybe once or twice a week in their homes to continue gains that they have observed in the clinic, and build on those gains,” says Dave. 

“We’ll be looking at a successor study to Up-LIFT which would look at safety and performance when used in the home. 

“Without question, it’s important with spinal cord injury to be able to operate this technology, which is why we were keen to incorporate voice activation into the system. Both of our platforms can be programmed by the clinician, but in the future may be operated by and used by the injured with their voices. 

“But very importantly, we do our best to connect as frequently as possible with people with injury to inform the design of our product platforms, and inform our future direction as a company. 

“We consider ourselves part of the community, so that feedback to ensure the design of our technologies is really usable and accessible, in my view, is vitally important.”

And with such huge advances and new-found hope for the future, many conversations have turned to whether SCI may be curable. 

“I wouldn’t rule anything out, with human ingenuity and so forth, but what I would say is more realistic at this point is to have optimism – quite a bit of optimism – that movement and strength and function can improve, and in some cases, be restored with the benefit of therapies like ours,” says Dave. 

“Perhaps other therapies and technologies will emerge, if you look at how far we have come. But for us, our vision is to support the SCI community around the world through our therapies, and we’ll continue to do that. 

“We’re making steady progress across all areas of our plan, and while what we’re doing is difficult and complex, I’m confident we will come through.”

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