Vision of Future of PT part 2 - reply to comments and thoughts on tech

Hi everyone, and thanks to all who have reached out with their thoughts and comments, whether here on this site, on YouTube, Twitter, or personally.  On balance the comments have been fruitful and constructive, and I’m quite pleased to see engagement from the broader community.  I just wanted to take a moment to reply to some of them here on this site as the ability to have meaningful conversation through Twitter or YouTube is limited.

For those who haven’t yet seen my YouTube follow-up post (linked above), please view it for a bit more context.  In short, in none of these predictions have I tried to make value judgments about whether they’re good or bad.   I’ll leave that to the broader professional community – these are predictions based on trends I’m seeing, the purpose of sharing those to be to stimulate thought on where we’re going, whether we’re happy with where we’re going, and if not, what we can be doing now to control where we’re going.

Glenn Ruscoe raises an important point in his comment below – that the future will not only affect PT in isolation, every other professional group should be, or ought to be, planning for a very different practice in the not distant future.  Many futurists believe we are currently living in the midst of a third industrial revolution, a ‘digital revolution’ you might say, that probably dates back to the widespread accessibility of the internet (late 1980’s-early 1990’s) through to now and likely for another decade or two to come before progress flattens slightly for a while until the next one.  If that’s in fact true, then every profession will feel the impact.  Think of what the internet and automation has already done to librarians (I can’t remember the last time I’ve actually been to the physical libraries on campus to get a book), accountants (thanks to products like TurboTax, I do my own taxes), auditors, paralegals and the like.  Lawyers, teachers, doctors, dentists, physios, engineers, all should be planning for a future where we are no longer the gatekeepers of a highly specialized and private pool of knowledge.  If I’m being quite frank, I actually think teachers and doctors are probably the next ones to be affected in a big way.  Like it or not, much of medical practice has been reduced to checklists and algorithms now – the kind of routinized activities that machines are far better suited to perform, and which they should be.  Offloading/downloading of those tasks should not only make things like medication errors or misdiagnoses less common, but should free up the professionals themselves to more completely perform up to their mandates.  So, good call Glenn, let’s recognize that we’re just a small cog in a much larger machine – but by jumping ahead of the curve we may be able to manage challenges and seize opportunities before others are able to mobilize.

Another question from YouTube came from an ex-student named Praneeth Ellanti who asks “how do you think rise of machines and automation of labour jobs will affect our practice/caseload?” – which makes me realize that I probably didn’t do a great job of describing some of the tech that I see changing PT practice in the near future (will try to avoid getting too far into the distant future as that becomes a far more nebulous exercise):

1.            Big data, machine learning, and artificial / mixed intelligence: Probably the best example of this that springs immediately to mind are the online data collection and interpretation platforms, with the good folks over at Focus on Therapeutic Outcomes (FOTO) leading the way in PT right now.  Using machine learning algorithms applied to a very large and growing database of clinical encounters, the FOTO platform is now able to predict things like an individual patient’s most likely outcome, how long they will take to achieve it, and how many visits will need to happen over that timeframe with freakish accuracy.  Whether it be FOTO or another provider, think of what will happen when they get into things like screening and differential diagnoses – now the patient will answer a computer’s questions in the waiting room (or at home more likely) and before you even see the person you will have an indication of most likely diagnosis, prognosis, duration and number of treatments, and eventually (as it grows) treatment recommendations.  In fact, if you can buy this vision, then it shouldn’t be a stretch to imagine that consumers can also get this information, and make their own decisions about whether they even need to come see you.  Again, I’m avoiding value judgments on this, if you want to know my personal views on whether this sort of thing is good or bad you’ll have to contact me directly for now.

2.            Human-machine interfaces: We’re already seeing the rapid growth of a new field of ‘neuroprosthetics’, where artificial limbs are being connected directly to the brain.  Whether it be bionics, exoskeletons, injectable nanobots that repair damaged nerves and tissues, the fact is that recipients of these technologies will require some form of physical rehabilitation.  It’s an interesting question isn’t it?  Who are the stewards of rehabilitation for augmented humans?  There’s again a broader ethical question at play in many of these, but I’ll leave those for now.  Of interest, if you watch the video on artificial limbs that can also feel (linked above), you’ll see the patients using an adapted version of a Myo armband, which has been developed in Waterloo Ontario (45 mins down the road from me) and can be purchased for about $100 – I have one sitting on my desk.

3.            Virtual, Augmented, and Mixed reality:  There is a pile of potential with these technologies, in terms of improving accessibility to care providers, creating more engaging and more effective interventions, and optimizing patient evaluation and diagnosis.  I feel like a blog post on potential uses of VR in rehab is forthcoming.  For now though, get your creative juices flowing with this video on holoportation.  And then blow your mind farther by this story of a conversation I had with a researcher from Alberta a couple of months back who has created a system whereby he can where a glove with haptic feedback, and his target (‘patient’) wears a suit with similar haptics built in, and he can actually reach out and touch a patient who is thousands of miles away, and on the other end the patient feels the touch.  Don’t stop dreaming folks.

4.            3D printing: As a clinician I spent hours creating customized hand splints for patients with various upper limb disorders, usually by starting with a big sheet of thermoreactive plastic, trimming, shaping, and retrimming until I hit on a splint that felt comfortable for the patient to wear.  This is just one example of where 3D scanning and printing could make those processes not only easier (and eventually cheaper), but something that a consumer can do themselves, from home.  As 3D printing technology improves, we’ll see use of different materials (already people are printing metal, concrete, and food) that could allow consumers to create many of the custom orthotic-type products for which they currently rely on professionals.

5.            Gaming systems:  For several years now, I’ve had an unbelievably advanced piece of 3D full-body motion tracking hardware sitting on top of my living room television in the form of a Microsoft Kinect camera.  Prior to that, I had an accurate, wireless, battery powered force platform connected to a Nintendo Wii.  Now, newer systems (Xbox One, Playstation 4) are including virtual reality peripherals which, in addition to body capture cameras, are now turning the average living room into what a lab-based researcher even 10 years ago would have been thrilled to boast in a high-end laboratory.  As games are becoming more realistic and engaging, and connected to the ‘cloud’, it should be no stretch (has already been occurring) to think about how rehab providers will be prescribing video games to their patients, and can receive feedback on performance metrics in a way not previously seen.  This begs a rather interesting question again: Who among us are ready to prescribe games?  Do we know anything about the correct parameters to prescribe?  What game (and do we now have to include knowledge of available video games as part of our education)?  For how long?  At what intensity?  These are actually rather important questions – when the Nintendo Wii first came out it was seen as a boon for rehab providers, and I know of several clinics who quite excitedly bought one and had it connected to a TV in the exercise area.  And there it sat, because while the concept was right, it turned out none of us had any clue as to how to properly prescribe a video game for rehab.  This feels like a field ripe for exploration by an enterprising clinician or graduate student.

6.            The quantified human:  While the fitness tracking wearables market seems to be cooling, and smartwatches have yet to really catch on, this has not stopped progress towards the development of new technologies to quantify all aspects of human health, including physical activity, cardiovascular health, blood sugar, diet and nutrition, and sleep patterns among others.  My take on this market is that it’s still trying to figure itself out, and that no one’s really hit on the right form factor yet (for what it’s worth, I’ve now gone through 3 fitbits – lost one and washed two), but eventually we’ll get to a point where we can reliably and continuously track several aspects of our health, and then provide those when asked to our healthcare providers.  This might even be in the form of injectable accelerometers or other sensors that live under our skin.  Regardless, think of the potential that this constant, real-time monitoring of health could have on your interactions with patients.  Have you been doing your exercise?  Oh yes, I see you have.  And your sleep has improved, and your resting heart rate is down.  But oh, what was this blip? 

These are just simple examples of course, the real interesting questions come into play when we think about connecting all of these technologies I’ve described (and several more yet to come): Your injected health sensor sends information to a deepmind-type machine learning algorithm, that provides you with real-time feedback about your health on the heads-up display from your AR contact lens, and when something seems amiss provides you with likely diagnoses, suggested actions to take, and maybe suggests you get off the couch and play some games or go out for a walk.  All of this tech currently exists but is in various stages of development.  If Moore’s law continues, then 10-15 years is not a stretch for many of these.

One final note here – often times when people here about ‘the rise of the machines’, they (depending on their age) immediately conjure images of genocidal robots as shown in mass media – HAL 9000, Skynet, or Ultron.  I won’t say I’m not concerned at all about AI getting out of hand – and people far more clever than I are currently working to put important boundaries on how it gets developed.  Rather, I’m far more optimistic of a future where humans and machines work together to solve problems faster, better, and more effectively than we ever could before.  If I nerd out a moment and draw an analogy from one of my favourite movie franchises: I envision a future where I’m less concerned about Ultron and more excited about J.A.R.V.I.S.