Israeli technology is finding a home in the Canadian health system

Capt. Trevor Greene using the ReWalk, assisted by his wife, Debbie, and Jay Courant, training director at ReWalk Robotics.

Back in 2006, Capt. Trevor Greene was serving with the Princess Patricia’s Canadian Light Infantry in Afghanistan when he suffered a nearly fatal blow.

A 16-year-old Afghan, whom he later came to know as Abdul, plunged an axe into the back of his head at a meeting with local tribal elders.

He was transported to an American medical hospital in Germany where life-saving surgery was performed. However, the attack left him unable to walk – until a B.C.-based neuroscientist, Ryan D’Arcy, connected him with an Israeli-made wearable exoskeleton that does the walking for him.

D’Arcy hooked him up with ReWalk, a futuristic contraption at the frontier where science and science fiction meet.

ReWalk was designed and developed by Dr. Amit Goffer, an alumnus of the Technion University in Israel who became a quadriplegic after an accident in 1997.

As the company describes it, “ReWalk Robotics is an innovative medical device company that designs, develops and commercializes powered solutions which provide gait training and mobility for individuals with lower limb disabilities.”

Greene’s use of the ReWalk apparatus may well be one of the first of several Israeli-designed medical devices that will become employed in British Columbia, said Rowena​ Rizzotti, vice-president of Healthcare & Innovation for the Health and Technology District in Surrey, B.C.

“ReWalk was used by Capt. Greene as a very important part of his therapy and the first time for use with a client with traumatic brain injury, which continues to be used here in clinical research,” particularly in areas where motor function and brain functions are involved, she said.

ReWalk was introduced to Canadians and supporters of the Technion at a demonstration in Toronto in 2014. At the time, retired U.S. Army Sgt. Terry Hannigan Vereline wore the device before a crowd of Technion supporters, physicians and representatives of rehab hospitals. She’s still wearing the contraption, becoming the first paralyzed American to successfully complete a marathon – the 2019 New York City Marathon, though it took her three days.

Israel is known for its large number of innovative companies, including in the area of medical technology. Several Israeli innovations are in use in Canada, helping people walk, cope with loneliness and aiding physicians diagnose ailments that improve Canadians’ well-being.

In British Columbia, the results of Greene’s use of ReWalk have been encouraging across the brain injury community.  Where once it was thought that patients make little progress beyond six months after their injury, “Greene has continuously demonstrated that is not the case.” He continues to show improvements years later, Rizzotti said.

ReWalk may be only the first of several Israeli-designed medical innovations to be used in British Columbia’s south mainland. There is an ongoing relationship between Israel and British Columbia in which both sides exchange research and communicate best practices. What’s more, a medical mission to Israel is scheduled for May, Rizzotti said.

The formal relationship arises out of a 2017 memorandum of understanding between the Surrey Health and Tech District with the Centre for Digital Innovation (CDI) in Beersheva, Israel. That built on pre-existing “longstanding scientific collaboration” between the two countries, she said.

For participants in British Columbia, the reason for the relationship is clear: “We recognize that strong innovation and technology is emerging out of Israel, some of it out of the CDI,” Rizzotti said.

In addition, Surrey has an ongoing relationship with Ben-Gurion University of the Negev (BGU) as well as Hebrew University in Jerusalem.

“Our focus is to work with Israel’s innovation authority to identify areas of research and collaboration,” Rizzotti said.

When Canadians attend the medical mission in May, “We will be looking at emerging technology. We recognize that Israel is well advanced around health-related technology. That is where we look for the greatest emerging science and technology.”

Even beyond that, Rizzotti continued, Canadians can learn how Israelis commercialize their technology and get it in use where it can help people, sooner rather than later.

David Berson, executive director of British Columbia and the Alberta region of Canadian Associates of BGU, points to a second Israeli medical innovation being tested in B.C.

Nanoscale Artificial Nose (NA-NOSE) promises to give medical practitioners an early non-invasive means to determine whether there are chemicals in a person’s breath that are markers of cancer.

NA-NOSE was developed by Technion Prof. Hossam Haick, a Palestinian-Israeli and alumnus of BGU. In 2016, Breathtec BioMedical, Inc. a company traded on the Canadian Securities Exchange and which is now known as Algernon Pharmaceuticals, announced it had acquired non-exclusive licenses to the NA-NOSE technology patents to enable commercial development of the technology.

Technion Research and Development Foundation Ltd., an Israeli private company and wholly-owned subsidiary of the Technion, owns shares in Algernon.

Berson said “they’ve been trying to attract people to do clinical trials,” and found a partner at the Health and Tech District located across the street from Surrey Memorial Hospital.

The connections between the City of Surrey and Israeli tech go back at least to a 2013 trade mission led by then mayor of Surrey, Dianne Watts, which spent a day at BGU, “looking at cyber security, artificial intelligence, health care and other areas in the health sciences,” Berson said.

“CIJA Pacific Region (the Centre for Israel and Jewish Affairs) put together the trade mission,” he added.

It’s not just medical technologies and devices that brings the two countries together. There’s an academic, research and scientific nexus as well.

In Toronto, Mount Sinai Hospital, in partnership with the Azrieli Fellows Program, has created a two-year fellowship program for Israeli physicians that focuses on knowledge sharing and providing specialized training in Toronto for disciplines that are under-served in Israel, including psychiatry, emergency medicine and neurology.

Beyond that, the flow of doctors and researchers between the two countries remains substantial.

Yuval Shachar, a BGU professor, has lectured in B.C.’s lower mainland about the use of artificial intelligence to extract information from data sets.

Alon Friedman, the past head of BGU’s neuroscience department, is currently at Dalhousie University in Halifax, studying brain trauma.

Friedman, founder and CEO of Emagix, said the Israeli company employs “diagnostic software, developed at Ben Gurion University, which takes images of the retina captured by conventional medical cameras and quantifies leakage, flow and volume in retinal blood vessels. This provides an accurate and quantitative view of vascular health and integrity of the retina, eliminating the subjective element of a retinal examination.”

That software is under development in Canada, he added.

And David Meiri, who  now heads the Laboratory of Cancer Biology and Cannabinoid Research at the Technion‘s faculty of biology in Israel, worked in Toronto from 2009-13 where he conducted post- doctorate research at the Ontario Cancer Institute, which is associated with the Princess Margaret Hospital.

One of the Canadian doctors who has taken an interest in Israeli medical technology is Barry Rubin, chair and CEO of the Mount Sinai Hospital UHN Academic Medical Organization and Medical Director of the Peter Munk Cardiac Centre at UHN in Toronto.

He’s also a vascular surgeon who is excited about a medical device he has been testing for about a year.

Developed by RealView Imaging, an Israeli startup, it’s a 3D imaging device that generates holographic images that doctors can “touch” and manipulate in real time.

Until now, doctors relied on two-dimensional images created by ultrasound devices or CT scans, he said.

“This is different. This is projecting elements of light called pixels into space. You can actually have depth perception. It’s sort of like looking at the real thing. It’s amazing, really.”

When you put on the device, with its sunglasses-like lens, you look a little like the Terminator, Rubin quipped. But when you do so, the computer in the device takes data from two-dimensional imaging machines and turns them into a three-dimensional holographic image.

You can look inside the heart and examine the valves, check for clots or trauma.

“We think that by seeing better inside the heart, we have more accurate procedures and have better outcomes,” he said.

So far, tests of the device have been encouraging, but it’s new technology, so “we’re going slowly,” Rubin said.

When Rubin first learned of the device from a colleague a few years ago, he couldn’t believe what he was hearing.

“I said, what are you talking about?”
Intrigued by its potential, he cold-called the company in Israel, and set up a meeting with RealView.

That was about four or five years ago, and in the interim Rubin has visited there three times, while company representatives have come to Toronto as well.

The technology was unveiled at the Peter Munk Cardiac Centre in April 2019 by Israeli President Reuven Rivlin, who was making his first trip to Canada as president.

Sunnybrook Hospital, one of the main trauma facilities in Toronto, is also riding the Israeli tech train using a Non Invasive Cardiac System (NiCas).

“Over the last two years we have been conducting a prospective study on maternal cardiovascular characteristics in complicated and uncomplicated pregnancies using a device (NiCas) developed by a company based in Israel,” the hospital said in an email.

“We have been pioneering work in a procedure called focused ultrasound which uses sound waves instead of scalpels to treat issues such as brain cancer, Alzheimer’s, ALS and others. The machine we use for this procedure is developed in part by an Israeli company called Insightech.”

Igor Granov, the chief operating officer of NI Medical, said NiCas is being used both at Sunnybrook and in hospitals in Alberta.

It provides information to doctors about the heart – how well it is beating, how well it is pumping blood through the body, while monitoring blood pressure.

It can replace more invasive procedures, such as inserting a catheter, which “is not a very pleasant procedure,” he said.

With NiCas, patients sit in a chair while disposable sensors are placed on the wrist and ankle.

“It’s as simple as that. There is no need to undress,” Granov said.

Granov said the connection between doctors at Sunnybrook and Israel helped establish the relationship that led to the import of NiCas to Toronto.

“One of the Israeli doctors came in for a fellowship and told the doctors in Canada about the wonders of the machine,” he said.

The device can run from US $12,000 to $24,000 depending on its configuration.

To date, the company has made only minor inroads into Canada. The United States is a much more lucrative market because of its size and the greater number of doctors. What’s more Canada imposes greater regulatory burdens, he said.

The Technion is the source of yet another medical marvel in use in Canadian hospitals – a snake-like robot that can be inserted into an orifice and which is guided to an area needing treatment. The “snakehead” contains sensors and a camera that provides a 3D image, while surgical instruments are inserted through the snake. Cardiac cauterization and removal of tumours are among the procedures that the snake can accomplish, all while minimizing trauma and the risk of infection.

Baycrest, one of Canada’s leading gerontology institutions, likewise makes use of Israeli medical innovations:  ElliQ, a proactive mini robot that relies on artificial intelligence and a device developed by Brainmarc that  measures brain engagement when patients perform various tasks.

Baycrest and the Jewish Senior Living Group in San Francisco are currently evaluating ElliQ and its potential impact on alleviating loneliness, social isolation, mood and improving the quality of life.

In addition, Baycrest is evaluating Brainmarc’s brain engagement index (BEI), which senses brain waves. The hospital has five units and is ordering two more.

Allison Sekuler, managing director for  the Centre for Aging and Brain Health Innovation (CABHI) at Baycrest, said the facility has entered into special arrangements with Israeli firms to test innovative products for Canadian seniors.

Israel is a “hothouse for medical innovations,” particularly when it comes to brain health and aging patients. CABHI has partnered with the Israel Innovation Authority to invite Israeli companies to test their technologies in Canada, Sekuler stated.

CABHI will bring innovators, clinicians and scientists to Israel in March to further foster cooperation, she added.

Israel isn’t the only producer of innovative medical devices that Baycrest looks to. CABHI also maintains relationships with Silicon Valley and with collaborators in the Netherlands and Norway,  but given its modest stature, “Israel punches above its size,” Sekuler said.

The Brainmarc device reads brainwaves as patients engage in tasks. It can help clinicians determine the extent to which a patient’s brain is being engaged, and design activities to better keep the brain active. That can lead to more effective therapy, Sekuler said.

Given the potential of the product and the reputation of Baycrest, other hospitals and geriatric centres are following the trials closely, Sekuler said.

ElliQ, designed by Intuition Robotics, sits on a desk or table and has a tablet connected to it.

Resembling a smooth white “Groot” that can bob its “head” and answer questions with a human voice, it is designed to serve as a companion to elderly patients.

“She’s very cute,” Sekuler said. “She doesn’t look like a human, but she has a female voice.”

About 50 ElliQs are in use at Baycrest and associated seniors facilities and it has proven so popular that “people get upset if the power goes out,” Sekuler said. “People get really attached to the robot, even though it doesn’t have a face.”

“There’s a companionship element” to ElliQ, she continued. “It uses cognitive artificial intelligence. It learns about you. It’s sort of like a roommate.”

ElliQ can play music at a patient’s request, it will let you know if you’ve received new email, it can display photographs on its tablet, it can connect you to loved ones through Skype and it can play games, like bridge. Once it gets to know you, it can suggest you get up and take a walk or it can remind you to put on a sweater.

Right now, Baycrest is testing ElliQ to see if it decreases loneliness, which is thought to be a factor in cognitive decline, Sekuler said.

From pregnant women at one end of the spectrum to seniors at the other, the benefits of Israeli medical innovations are finding their way to Canada.