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Jean-Francois Roy, Hexoskin chief technology officer, in the company's Montreal offices, on July 7, 2021.Christinne Muschi/The Globe and Mail

The founders of Montreal-based Carré Technologies Inc. set out to use artificial intelligence to improve health care for an aging population. The journey has taken a few unexpected turns, including a foray into cutting-edge wearable technology and even into space.

“When we started the company, it was to automate data processing and to see how we could do personalized medicine using AI algorithms,” says Jean-François Roy, who created the company in 2006 with Pierre-Alexandre Fournier.

The founders believed that AI could offer some relief to a stretched health care system. For example, monitoring patients at home would free up resources and provide a better picture of a person’s health.

“It wouldn’t be possible to monitor all patients at the same time, but using AI, it is possible,” says Mr. Roy, the company’s chief technology officer.

“We could save a lot of time, we could prevent diseases, and we could keep the people at home for a longer time,” adds Mr. Fournier, the company’s chief executive officer.

The idea was to develop non-invasive sensors that would remotely monitor health metrics such as cardiac and respiratory activity. It would allow patients and their health care providers to measure these biometric indicators outside of the hospital, freeing up precious health care resources and staff. It would also give a broader view of a patient’s biometrics in their normal environment, such as in their home or driving, to mix it up.

“It’s much more interesting to look at when you walk in the street, for example, than when you’re watching TV, sitting on the couch,” Mr. Fournier says.

Traditionally, electrocardiogram and other sensors are strapped to a patient and hooked up to obtrusive – and expensive – equipment in a clinical setting.

“We thought, well, this is not natural. It should be as easy as getting dressed in the morning; it should be part of the things you already carry with you,” he says.

That’s when it became a garment – and the Hexoskin and Astroskin smart clothing brands were born.

By 2013, the founders released the first version of their Hexoskin smart shirt equipped with lightweight sensors to monitor primarily for cardiac and respiratory activity.

Unfortunately, Hexoskin may have been ready, but the health care industry wasn’t.

“We decided to launch it in a way that was open, meaning anybody could use it to collect information and export data, and then to see who would adopt it,” Mr. Fournier says.

Among the earliest adopters were clinical researchers worldwide, who flocked to Hexoskin to collect data for more than 120 scientific papers and counting.

The form-fitting sleeveless tank top-style shirt, which has a built-in bra for women, is used in a range of research in areas such as cardiology, behavioural psychology, sleep patterns and physical conditioning, to name a few. The sensors weigh less than 90 grams and the data are synced to local and remote servers, which allows real-time monitoring by the person wearing it and remote health data management and analysis.

In 2011, recognizing that the health care system would need to catch up, Carré Technologies put in a bid on a request for proposals from the Canadian Space Agency. Today, its Astroskin platform is worn by astronauts on the International Space Station (ISS). It will also be worn aboard the first commercial space flight expected next year by Virgin Galactic, the space-tourism company whose CEO Richard Branson recently made his inaugural trip.

Built on the same principle as Hexoskin, the Astroskin contains substantially more sensors and is designed for prolonged remote use.

Kellie Gerardi, a bioastronautics researcher with the International Institute of Astronautical Sciences, will wear Astroskin on that suborbital space flight. The suit will monitor the biological effects of the launch, weightlessness, re-entry and landing on space-flight participants.

“I’ll also be able to see my stats in real-time, which is information I can use to adjust my behaviour,” Ms. Gerardi says.

She tested the Astroskin in 2018 during parabolic flight campaigns with the National Research Council of Canada, right before the experiment made its way to the ISS. During her flight next year, the Astroskin will help track the effects of space flight on astronauts.

“My space flight will be the first time we’ll be able to collect data during launch, re-entry, and landing though, so I’m excited to contribute to that novel data collection,” she says.

Carré Technologies has grown to 30 employees today, not including the network of researchers, university research and development partners, supply chain and distribution partners around the world. Its clients include defence and aerospace agencies, such as the U.S. Navy medicine corps, the Australian Army, Royal Canadian Mounted Police, the Canadian Space Agency and NASA, in addition to hundreds of health researchers and professionals in more than 15 countries.

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Mr. Roy discusses heat transfer with Marc Paquin, vice president, strategic development, in their prototype room.Christinne Muschi/the globe and mail

It’s all been a bit surprising for the founders.

“We really started this so that we could prevent acute disease and we would do something about the aging of our population,” Mr. Fournier says. “That was the first idea. And then we ended up doing all these crazy things, you know.”

Astroskin has been worn to unexplored regions of Antarctica and measured the effects of high-altitude hypoxia during a “lightning” ascent of Mount Everest.

“We’ve had people in space. We have users who have won gold medals in the Olympics. We’ve worked with Cirque du Soleil in Las Vegas. We’ve worked with NBA players,” Mr. Fournier says. “I think we’re very creative, and we have a lot of imagination, but that was just beyond what we could imagine about the technology.”

About five years ago, the health care technology environment began to catch up. Carré Technologies returned to its original focus, to bring the benefits of AI to improving health care outcomes.

The company has developed a new Hexoskin product currently under review for approval by the U.S. Food and Drug Administration.

Ultimately, the goal is to use AI to detect and prevent disease, Mr. Roy says.

“What we want and what we’re working really hard on is to deploy this for real patients,” Mr. Roy says. “With that data, we will be able to really attack bigger issues that were not accessible before. This should unlock some projects that we were waiting for.”

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An app monitors data including heart rate from Hexoskin smart clothing.Christinne Muschi/The Globe and Mail

Using AI to help people with epilepsy

Epilepsy is the most common neurological disorder affecting all age groups. An estimated 300,000 Canadians have the disorder that produces abnormal bursts of electrical activity in the brain and, left uncontrolled, seizures of varying forms and severity.

Every day, 54 new cases are diagnosed. For the one-third of patients whose seizures are not controlled, the consequences can be dire.

“It has a high prevalence and around 30 to 35 per cent of patients do not respond to anti-epileptic treatment, which is the first line of treatment,” says Élie Bou Assi, an assistant professor in the Department of Neuroscience at the University of Montreal and a principal scientist at the Centre Hospitalier de l’Université de Montréal (CHUM).

Dr. Bou Assi is part of CHUM’s Epilepsy Research Group where he and Dr. Dang Khoa Nguyen, Canada Research Chair in epilepsy and functional anatomy of the brain, are leading one of the hundreds of teams around the world using Hexoskin, and other smart devices, to monitor patients and detect seizures. It’s considered the first step toward developing algorithms that will generate alarms to alert caregivers.

Typically, epilepsy monitoring is done using electroencephalography (EEG), in which electrodes are stuck to the skull.

“The problem is that it’s not wearable and it’s not good for every day,” he says. “The advantage of using the Hexoskin smart wear is it’s comfortable compared to what we use now. [Patients] wear it 24-7 and they’re able to sleep with it.”

The smart shirts provide quality data and stable recordings, he says, and the next phase – once the AI algorithms are developed – will involve monitoring patients in their normal environments outside the controlled setting of the epilepsy monitoring unit.

“Our objective is to see if we can monitor other signals, namely the signals recorded by the Hexoskin – the respiration, the electrocardiography, so the heart’s electrical activity and movement – to detect seizures,” Dr. Bou Assi says.

To date, the researchers have recorded nearly 300 seizures among more than 60 patients.

The data gathered using Hexoskin and other smart devices will help the researchers develop an automated seizure diary that will support treatment. For instance, it will alert caregivers in the event of a debilitating seizure and could eventually even lead to predictive algorithms that would warn a patient of a coming episode.

“This is an avenue, I think, to explore,” he says.

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