People in rich, developed countries are increasingly disillusioned, and realising that politicians are short on long-term answers
These nations need to agree on a new approach to managing the future and a fresh compact with their society and the rest of the planet
The idea that those living successful, advanced countries can look forward to perpetual advancement is no longer a given after Covid-19 .
I thought the end of the world would look different. There are no horsemen, no mushroom cloud, no alien spacecraft. Just sweatpants and Zoom. As it turns out, rumours of our demise have been exaggerated.
If you live in the developed world, the first 20 years of this century might have resembled the apocalypse in slow motion – from September 11 to Sars, the war on terror, the global financial crisis, technological disruption and Islamic State, to Trumpian anxiety and now Covid-19. Are we reliving the Crusades or fast-forwarding to the dystopian world of Blade Runner?
And yet, for many others, the 21st century has also been a revelation. Money to spend, real-time connections with the world, the Babylonian wonders of urban life and much more.
THE (DEVELOPED) WORLD IN CRISIS
Time and again, data and insights have supported this dichotomy. For years now, polling and analysis have pointed to growing levels of dissatisfaction and malaise in a number of rich countries. This is against the backdrop of people who are not only living better lives, but empowered with opportunities thanks to greater mobility and education, which have transformed their existence.
Our study by Blackbox Research, “World in Crisis”, measured the sentiments of citizens from 23 countries toward their governments’ Covid-19 crisis management efforts. While news coverage has focused predominantly on the study’s political findings and how leaders performed, these results are in many ways less interesting and largely predictable. What really stood out to us at Blackbox were the wider perceptions of how business, media and communities were seen to have responded.
The results of our study, which have been reported in nearly 30 countries to date, show that most countries were rated poorly across the board. The major revelation for us was how people in the majority of the world’s most advanced countries – in both the East and the West – were not only shocked and surprised by how quickly the crisis overran their daily lives, but also expressed a wider feeling of being let down, giving the impression that they had expected more.
Performance ratings for business leaders and healthcare systems, even local communities and neighbourhoods, all scored more poorly in advanced nations.
Our findings, from the United States to Italy and to Japan, all point to one thing: People living in wealthier nations feel isolated and vulnerable in a way they have not felt for generations. Of the 11 developed countries and territories covered in the study, only New Zealand scored above average in our index. Who knew the Kiwis were living in the last well-appointed bungalow in a run-down neighbourhood?
A REJECTION OF THE TRUTH
Despite the long-standing evidence from even before our study, we are witnessing a level of denialism, with some commentators suggesting that the scores do not reflect the best route ahead. The wealthier nations, they argue, just need the time to organise their resources in response to such an unprecedented event. Once this happens, they claim, public opinion will soon shift. Yet the most recent polling in nearly all of these countries indicates that perceptions have actually deteriorated further.
Japan and France, for example, scored the lowest in our study, and public opinion in both countries remains anaemic. Yet the responses from these countries hardly feel like outliers. South Korea, which scored fourth lowest in our study, even voted overwhelmingly to reelect a president during the crisis. So in all likelihood, the scores reflect more than simple antagonism towards political leaders. Something else is going on.
Flaws laid bare: South Korea, which scored fourth lowest in the study that measured citizen sentiments, even voted overwhelmingly to reelect a president in the middle of the Covid-19 crisis. —
On the other end, some argue that the countries that scored well are often authoritarian and have leaned on state-controlled media to the extent that their people tell pollsters everything is hunky-dory. While their media diet can have some influence in what people tell pollsters, it does not tell the full picture. Singapore, Thailand and even Iran are all dominated by state media, yet none of them recorded stellar results in our study. Barking up the propaganda tree only gets you so far.
Two months on, the vulnerability expressed in our study by people in advanced countries largely remains. It also appears to fit a continuum that has been developing for some time now: the belief and confidence that unravelled after World War II and peaked with the collapse of the Berlin Wall in 1989, but was rock solid by the end of the 20th century.
TIME TO SET THINGS RIGHT
The rich global disillusionment reflected so obviously in our poll, as well as in others conducted during the current crisis, has not arisen out of nowhere. It demonstrates a real sense that all is not right. The emotional mindset also goes well beyond anger. There is a growing realisation that political and business leaders are short on long-term answers, and “community” is now a term more likely associated with social media than social cohesion.
What this crisis has done more than anything else is expose the real flaws and weaknesses that have been emergent in advanced countries for many years. The scab has been peeled off, and the wound is worse than we thought.
The findings of our study reveals something pertinent: It is time for developed nations to truly reflect on the way forward. The idea that those living in successful, advanced countries can look forward to perpetual advancement is no longer a given. More and more people are coming to comprehend this. The present crisis, more than all the other recent ones, has laid this bare.
With that, confidence can only be regained through new ideas and action. Developed countries need to agree on a new approach to managing the future and a fresh compact with the rest of the world. As with a major war, Covid-19 has left everyone with heavy losses, and now is the time to acknowledge that simply trying to paper over long-standing flaws (that are much worse than most have been prepared to concede) is not going to offer either stability or hope
These could include rethinking the global institutional framework – whether it is for trade, health, finance or even technology. Countries also need to reconstitute and develop new forums to include a more diverse representation of key global stakeholders. In the same way leaders have been forced to address changing attitudes and demands on race and gender in recent years, they now need to expand this change of approach to society itself.
So, it turns out once again that the apocalypse is not nigh. People too often confuse end times with a reshuffling of the order. Those who have enjoyed sitting in the premium seats for a long time will have to pay more for them or give them up altogether.
By David Black, the founder of Blackbox Research, a Singapore-based research agency and data content specialist, mainly covering national and regional opinion across Asia. David has lived in Singapore for the past 20 years
As R.E.M.’s Michael Stipe sang, “It’s the end of the world as we know it and I feel fine.” – The Jakarta Post/Asia News NetworkThe writer is founder and CEO of Blackbox Research, a data-driven content and research agency based in Singapore that primarily covers national and regional public opinion. The views expressed here are solely the writer’s own.
The dollar is central to the global monetary system – used worldwide as a unit of account, store of value and medium of exchange. Most commodity and forex contracts are denominated in it. It represents more than one-half of all cross-border interbank claims (a proxy for international payments). That’s five times US share of world goods imports, and three times its share of exports. About two-thirds of world reserves is held in US dollars.
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The yuan’s stability is partly by design, and by good luck; backed by foreign exchange reserves held steady at US$3.1 trillion since mid-2016.
TODAY, the world’s financial rhythm remains American. The US dollar assumed the role of the world’s dominant reserve, payment and settlement currency after WWII. The country’s position as the sole financial superpower gives it extraordinary influence over the destinies of nations.
For 70 years, the United States has used this power rather routinely, as a matter of reality. Of late, however, it has been engaged in “financial warfare” in the service of its foreign policy. This has prompted nations to “break free” of US dollar hegemony, including preventing “US sanctioned nations” free access to US dollar-based financial system with devastating impact.
The dollar is central to the global monetary system – used worldwide as a unit of account, store of value and medium of exchange. Most commodity and forex contracts are denominated in it. It represents more than one-half of all cross-border interbank claims (a proxy for international payments). That’s five times US share of world goods imports, and three times its share of exports. About two-thirds of world reserves is held in US dollars.
It is the preferred currency of central banks and capital markets (accounting for 65% of global securities issuance). The irony is people rushed to buy dollars during the subprime crash, even though Wall Street caused it. They did so again in March this year despite US bungled response to Covid19. The global finance plumbing is US dolarbased – most international transactions are ultimately cleared in US dollars through SWIFT (banks’ main cross-border messaging system) and CHIPS (Us-centric clearing house network) through New York by US “correspondent banks.”Denied access to this infrastructure, the institution is isolated and financially crippled. The United States began flexing its financial muscles (including imposing hefty penalties) after the terrorist attacks of September 2001.
Trump has since “weaponised” it to a new level – to-date, it has over 30 active financial and trade-sanctions programs. Early this year, it used this dominance to cut-off support to the Iran and Iraq regimes, adversely affecting their use of oil revenues.
This use of the dollar to extend its policy reach is “an abuse of power,” i.e. bullying; Russia refers to its use, a “political weapon.” Even allies (EU, Japan, UK) are concerned Trump is undermining US role in maintaining orderliness in global commerce and finance. There is already widespread talk to “dethrone” the US dollar, through the dedollarisation of assets; more use of domestic currencies in its trade workarounds and swaps; and new banking payments mechanisms and digital currencies.
Also, nations have expanded settlement of bilateral trade in their own currencies, or gold; even barter. Russia has gone the furthest, including dedollarising parts of its financial system; reducing US dollar share of its foreign reserves (40% to 24%); cutting its bank’s holdings of US dollar Treasuries to under Us$10bil from Us$100bil; bringing down its exports denominated in US dollar to 62%; and shifting US dollar trade with China and India to non-us dollar settlements; and denominating over 40% of its crude oil tenders in euros.
Like Russia, China has begun to set-up “building blocks” to become more autonomous, including a yuan-denominated crude oil futures contract (“petroyuan”) on the Shanghai exchange. US allies are flirting with it, too. But, EU first has to reform the inner workings of the euro and complete work on banking union, fiscal integration, etc., before it is ready to create a global electronic invoicing euro currency.
Reserves option
US dollar’s role as a reserve currency point to three distinct benefits: (i) lower transactions cost; (ii) macroeconomic policy flexibility, including foreign financing of its deficits; and (iii) leverage to benefit allies. Of course, it carries costs: (a) tends to hurt exports by being strong and stable; (b) overhang of debt overseas opens domestic economy as hostage to sudden capital movements; and (c) needs to bail-out the system.
That’s why the UK, Japan and Germany shied away. However, because the world has changed, EU has since started to push for a stronger international role for the euro. But becoming a serious reserve currency requires: (a) large, deep and liquid capital markets; (b) a secure bonds infrastructure, especially in government bonds; (c) wide use in world trade; and (d) a big economy that’s integrated into global markets.
Without fiscal union, EU lacks a supranational, liquid euro bond; its capital markets are not robust enough – a real banking union would help. Euro’s share of global reserves is down to 20%. Russia also tried – cuts US dollar share of its reserves to 24%. Issues most debt in roubles and euro; only 60% of its exports is settled in US dollars, and 40% of its oil sales contracts is denominated in euros. It has still a long way to go.
China had longed wish to internationalise. But, its capital controls remain a serious problem: it limits how much outsiders can access its currency. In 2017, Bond Connect was launched – allowing foreigners to invest in offshore bonds through Hong Kong, and scrapped investment quotas.
China has since made good progress: (i) offshore yuan deposits are rapidly rising; (ii) issues of yuan “dim-sum” bonds are getting popular; (iii) boom in forex transactions suggests growing usage, especially in hubs like Hong Kong, London, New York and Paris; (iv) more offshore investment products are denominated in yuan; and (v) Hong Kong today lists ETFS, gold futures and property investment trusts in addition to Chinese equity. China’s advances are global: it has a vast global trade and investment network; Chinese FDI is mainly in yuan; it settles 15% of its foreign trade in yuan. Today, more globally yuan payments are processed by banks.
One-fifth of European trade with China is settled in yuan, as is 55% of payments among them. Since 2018, yuan-denominated oil futures were launched in Shanghai, as are margin deposits on iron ore futures in Dalian. China’s commodity exchange is emerging. Most of all, central banks are warming up to the yuan – since inclusion in IMF’S SDR (a basket of five elite currencies), its share of global reserves has risen to 2.1%;
China has already signed currency swap arrangements with over 60 nations. Today, the “yuan bloc” accounts for 30% of global GDP – second only to US dollar (at 40%). China opened up its US$13 trillion bond market (world’s second largest), which accounts for 51% of all bonds issued by EMES.
Foreigners now hold 3% of this market and 9% of its government bonds. Its main attraction: good yields and diversification benefits. Further, the yuan has been among the most stable currencies in the world since mid-2016. Its real effective exchange rate – against the basket of currencies of its trading partners, adjusted for inflation – has risen by just 0.2% over the past four years. The yuan’s stability is partly by design, and by good luck; backed by foreign exchange reserves held steady at US$3.1 trillion since mid-2016.
New initiatives
US geopolitical rivals’ desire to escape the dollar dominance is real. In designing its new e-yuan, China wants a head start on the dollar; it is reported to be considering creating a common cryptocurrency with other BRICS nations (Brazil, Russia, India and South Africa). Similarly, on its part, EU is determined to encourage its members to eliminate “undue reference” to US dollars in payments and trade invoicing.
EU’S main initiative has involved Iran. It tried to create a way for its banks and firms to trade with it through Instex (a clearing house created for this purpose by Britain, France and Germany, with European Commission’s support) by-passing US dollars or SWIFT.
The stuttering performance of Instex reflects the sheer scope of the dollar reach: US claims jurisdiction if a transaction has any American “nexus,” even though not denominated in dollars. Despite this, more EU states are determined to join Instex. It’s EU’S intention to expand its financial reach – through a network of global electronic central bank digital monies that serves as a global invoicing currency, excluding US dollars. Also, its capital market needs greater depth and liquidity, key factors in choosing a currency for commerce. As Trump continues to use sanctions aggressively, efforts to circumvent them will accelerate. The reality is that US does not have a monopoly on financial ingenuity.
What then are we to do
There’s no question the world urgently needs a multinational currency reserve regime. The dollar is being weaponised to bully. This won’t do. Nations, including US allies, are looking for and working on an effective but viable and sustainable option. This will take time. The search is still very much work-in-progress. Euro and e-yuan look promising. But they have a way to go. Like it or not, any e-currency has to be central bank-backed to be credible, and where the public can readily access it.
Still, central banks face hurdles in offering dedicated digital currencies and related accounts to the public. Understandably, many central banks have been hesitant in creating digital currencies. As I see it, they remain worried on how to monitor transactions to prevent fraud and hacking, and whether digital currencies should be linked to interest rates. It’s a responsibility, I think, central banks really don’t want to take-up.
By Lin See Yan, Kuala Lumpur, June 22, 2020
Former banker, Harvard educated economist and British chartered scientist, Prof Lin of Sunway University is the author of “Trying Troubled Times Amid Trauma &Tumult, 2017–2019” (Pearson, 2019). Feedback is most welcome.
(Front row, from left) Cheong, Lim and Hoo at the MOU signing to implement AI development training.
A PARTNERSHIP has been formed between a global information and communications technology (ICT) solutions provider, an Internet solutions provider and a secondary school in Malaysia to implement artificial intelligence (AI) development training. (Front row, from left) Cheong, Lim and Hoo at the MOU signing to implement AI development training.
Huawei Malaysia is the first company in the Asia Pacific to sign a memorandum of understanding (MOU) with Jenexus Holding Sdn Bhd and Chong Hwa Independent High School, the first independent secondary school in Malaysia to be a part of the Huawei Atlas AI Talent Development ecosystem programme.
The partnership sets a milestone in the Malaysian education landscape as the programme is expected to nurture a pool of savvy young talents who are proficient in developing AI technologies.
This will ensure that Malaysian talents remain relevant for future employability.
Chong Hwa Independent High School principal Cheong Moey Lian said, “We are proud to be the first independent high school in the country chosen for this programme.
“As technology becomes a necessity in our daily lives today, it provides vast possibilities for those who master it.
“We are excited to experience how this series of coursework with the Atlas 200 Developer kit and Huawei Cloud AI Modelarts can empower our students to be expert AI developers.”
According to Huawei, the AI industry is expected to grow rapidly in the coming years and demand for AI specialists has never been greater.
Globally, Huawei has been playing an important role in nurturing AI talents and is committed to grow these talents in the market where it has a presence.
Huawei Malaysia is harnessing its expertise to grow Ai-related roles as a catalyst to spur economic growth in the country.
Collaborative engagements with partners and learning institutions is a vital component to grow the AI industry in Malaysia.
Together with the tools and case studies available in the Huawei Ascend Developer ecosystem, the programme aims to bring immersive AI experience and knowledge to all its users.
Huawei Malaysia Cloud and AI vice-president Lim Chee Siong said:
“Huawei is committed to nurturing young digital talents to equip them with skill sets that are highly sought after, as they forge the future of Malaysia’s Industrial Revolution 4.0.
“As a leader in ICT solutions, Huawei continues to be committed to developing creative solutions to fulfil the technology gaps in the country and be a catalyst for Malaysia’s economic growth,” said Lim.
With the emphasis on developing quality AI talents, Huawei Malaysia and Jenexus Holding Sdn Bhd will be providing their expertise, resources and technical support to the coursework deliverables to ensure that they are on par with global standards.
Jenexus Holding Sdn Bhd managing director Desmond Hoo said: “As a leading company in providing business network services, business IT development, business cloud as well as business software development and business digital segment, we are thrilled to be Huawei’s chosen partner for the Atlas AI Talent Development programme, which will benefit both students and teachers.”
Leveraging on cloud expertise from Huawei Malaysia’s collaborative partner, Jenexus Holding will assist Huawei in providing cutting edge AI technology training to Chong Hwa’s teachers and teaching assistants.
This includes providing and updating of teaching aids and courseware support, such as Huawei Atlas-related literature, AI basic theories, Atlas-series product innovation, hands-on experiments as well as relevant industry case studies.
Rational voices have been calling for China-US cooperation in AI, an area where they have overlapping interests. Instead of viewing AI with a zero-sum mind-set, the US should embrace healthy competition with China for the good of the world.
China launches last piece of BeiDou Navigation Satellite system into orbit
China’s final BeiDou-3 satellite for its global navigation system was launched on June 23, 2020, at 9.43am, from the Xichang Satellite Launch Centre in the southwest province of Sichuan. A Long March 3B rocket carried the satellite into geostationary orbit, completing the third-generation network for the BeiDou Navigation Satellite System (BDS). BDS is the fourth major global satellite navigation system, following GPS built by the US, Russia's Glosnass and the European Union's Galileo.
"Ten, nine, eight…three, two, one. Launch," the calm voice of 01 Commander Yin Xiangyuan in the valley of Liangshan mountain in Southwest China's Sichuan Province, was soon overwhelmed by the thunderous boom of the rocket taking off on Tuesday.
Carrying the last satellite of China's domestically developed BeiDou Navigation Satellite System, or BDS, the Long March-3B launch vehicle blasted off from the Xichang Satellite Launch Center on Tuesday morning.
And after a flight of around 30 minutes, the spacecraft, the third geostationary Earth orbit (GEO) satellite and 30th of the third-generation series of the BeiDou system, or BDS-3, successfully entered its planned orbit, marking the completion of the global geolocation network, which is also China's largest space-based system and one of the four global navigation networks, along with the US' GPS, Russia's GLONASS and the European Galileo.
The launch of the final satellite of China's indigenous BeiDou system had been previously scheduled on June 16, but was delayed after technical problems were found with the Long March-3B rocket in pre-launch tests.
Space launches have always been full of challenges and sometimes faced with high risks of failure. The postponement of the final BeiDou launch and resumption after resolving the problems once again demonstrated that Chinese space scientists uphold the scientific spirit, allowing zero errors at any stage of the mission, insiders said.
Photo: Hu Xujie
World-class performance
The latest GEO satellite is the 55th BDS system, and will work with other members of the network, allowing global users to access high-accuracy navigation, positioning and timing as well as communication services.
Compared to previous generation series, the constellation of BDS-3 with an array of 30 satellites flying on three different orbit planes - three at the GEO, three at the inclined geosynchronous orbits, and 24 at the medium Earth orbit, have higher bandwidth, enabling enhanced communication capability and carrying more accurate and stable atomic clocks to improve the precision of timing and navigation services, according to the project contractor China Academy of Space Technology under the state owned space giant China Aerospace Science and Technology Corporation (CASC).
The BDS-3 also possesses better messaging capability, increasing its unique short message service capacity from 120 Chinese characters to 1,200 per message, and the higher communication bandwidth also expands the user capacity from 500,000 to 5 million users.
BDS-3 is also capable of providing precise point positioning service (PPP) with a decimeter-level dynamic accuracy and centimeter-level static accuracy, meaning it can support applications such as auto-pilot for vehicles and precision docking of ships.
Yang Changfeng, the chief architect of the BDS, told the Global Times on Monday that China's BDS is compatible with the US' GPS, Russia's GLONASS and Europe's Galileo, and users worldwide can freely choose any four satellites with the best signals from the global navigation satellite systems with over 100 satellites.
According to the chief architect, the BDS has satellites on three orbit planes in the Asia-Pacific region, which makes it more capable of resisting disturbances from occlusion even in such environments with multi-layer surfaces in the urban areas as well as in forests.
Users in low latitude areas in the Asia-Pacific region can enjoy non-stop navigation services from the BDS in these circumstances, and the accuracy of the BDS service is just as good as that of the US' GPS, and of world-class quality globally, Yang noted.
According to the China Satellite Navigation Office on Tuesday, the majority of the world have started using the BDS.
Photo: Hu Xujie
Hardwork of generations
China began research and development into the country's indigenous satellite system in 1994, aiming to reduce its reliance on foreign networks, especially under the complicated external environment.
The first BeiDou satellite entered orbit in 2,000, and started providing positioning, navigation, timing and messaging services to domestic users in China and users in the Asia-Pacific region in December 2012.
The BDS system started providing global services at the end of 2018, when construction of the BDS-3 primary system had been completed.
BeiDou has been supporting dozens of businesses and public sectors in China, ranging from transportation and agriculture to electric power transmission and fisheries, and tens of millions of BeiDou-enabled terminal devices have been sold and are in use.
In the field of transportation, BDS has been widely used in the monitoring and management of priority transportation, highway infrastructure safety, port scheduling, and real-time high-precision positioning.
By the end of 2019, more than 6.5 million road operating vehicles, 40,000 postal and express delivery vehicles, 80,000 buses in 36 central cities, 3,200 inland navigation facilities, and 2,900 marine navigation facilities have adopted BDS, forming the world's largest dynamic monitoring system for road operating vehicles.
More than 70,000 fisheries and law-enforcement vessels have installed BeiDou terminals and more than 10,000 people have been rescued thanks to the BeiDou application.
Time reference for public security networks has been synchronized based on the BDS timing services. BDS has played an important role in ensuring security at major events, such as the Asia-Pacific Economic Cooperation (APEC) Meeting and the G20 Summit.
In the field of smart phones, mainstream chip manufacturers both at home and abroad have introduced integrated chips that are compatible with BDS. By the third quarter of 2019, more than 400 smartphone models sold in China supported positioning functions, of which about 300 models supported BDS.
The scale of navigation satellite positioning and navigation industry in China has reached 345 billion yuan ($48.6 billion) by 2019, up 14.4 percent from the previous year, according to an annual industry report.
Cao Chong, a Beijing-based senior expert on satellite navigation industry, told the Global Times the industry scale is expected to exceed 400 billion by the end of 2020.
Cao said the next step to further promote the BDS system in market both at home and abroad lies in the research and development of terminal capabilities, which should keep up with the enhanced power of BDS-3. "There are huge market potentials to be released."
The Tuesday mission marked the 44th BeiDou satellite-launching flight for the Long March-3A rocket series since October 31, 2000, which the Long March-3B rocket belongs to. The rockets have sent 59 BeiDou satellites, including four experimental ones, into orbit, with a 100 percent success rate.
As the BDS system continues to develop, the Long March-3A rocket series have also started to use three-mode receptors which are compatible with the BDS, GPS and GLONASS networks, Jiang Jie, chief engineer of the rocket series, with the China Academy of Launch Vehicle, also under the CASC, told the Global Times.
As the three modes all complement each other, they work together to improve the orbiting accuracy of rockets and reduce consumption of propellants, Jiang noted.
APA model of the BeiDou Navigation System is displayed during the 12th China International Aviation and Aerospace Exhibition in Zhuhai earlier this month
China's homegrown BeiDou Navigation Satellite System is going global
https://youtu.be/yPAiR71rIxs
BeiDou, China’s homegrown navigation satellite system, is to cover the world by 2020. Watch a video to see how it differs from GPS and can help you in life. - China Daily
Physiotherapy for stroke patients is not just about exercises and movement, but also incorporates technology such as functional electrical stimulation and virtual reality. — Photos: SUNWAY MEDICAL CENTRE VELOCITY
There you are, walking around the house, maybe on your way to get something to eat or to the living room to watch some TV.
All of a sudden, one side of your body goes numb and weak, and you lose your balance, causing you to collapse on the floor.
When you try to call for help, you find that you can’t speak properly with your speech sounding slurred.
You realise that you can’t see properly either, as your vision has become blurry.
And when you look at your face in the mirror, you realise that one side is drooping down, but not the other.
You are most likely experiencing a stroke, the third most common cause of death in Malaysia.
This emergency condition occurs when the brain is deprived of vital oxygen supply, either when a blood clot blocks off a blood vessel supplying the brain (ischaemic stroke) or when one of these blood vessels ruptures and starts bleeding (haemorrhagic stroke).
According to consultant neurologist Dr Kok Chin Yong. your brain cells will start to die within minutes after the stroke hits you – about 2,000,000 cells every minute.
Therefore, you need to get help and go to the nearest hospital’s emergency department as soon as possible.
The good news is that there are immediate treatments that can not only save your life, but also minimise any disability you might have from the stroke.
Ischaemic strokes are the most common type of stroke, comprising three-quarters of all cases.
For this type of stroke, the first and most immediate treatment is the administration of tissue plasminogen activators (tPAs), which help break down blood clots.
Says Dr Kok: “For an ischaemic stroke, the target is to unblock the blood clot as soon as possible.
“We can do this with an intravenous (IV) clot-busting agent called alteplase.
“The current guidelines state a cut-off point of 4.5 hours from the onset of symptoms in order to derive benefit from this treatment.
“Hence, time is brain.”
He notes that alteplase is the only US Food and Drug Administration-approved tPA for acute ischaemic stroke at the moment.
Another treatment available in certain hospitals, he adds, is a clot-removal procedure called mechanical thrombectomy, which is done by an interventional radiologist.
Meanwhile, haemorrhagic strokes are usually treated by the neurosurgeon or interventional radiologist.
Explains consultant neurosurgeon Dr Gerard Arvind Martin: “Choosing whether to take the patient to the operating room or not can depend on various factors, such as age and condition of the patient, the level of consciousness and extent of bleeding, all of which the surgeon takes into consideration before performing surgery.
“In those cases where a subarachnoid haemorrhage has occurred due to a suspected aneurysmal rupture, a further scan called an angiogram will be required to determine precisely the site of bleeding.
“Angiograms can be either via computed tomography (CT) scan or a catheter, which is typically carried out by a radiologist in an angiogram suite.
“Depending on the findings, the surgeon can then elect to operate and clip the ruptured aneurysm, or consider endovascular techniques, which are performed by an interventional radiologist.”
If you are lucky, you would have survived your stroke with no or minor complications and have a quick recovery.
However, many stroke survivors will face long-term disability, which can be physical or cognitive.
For example, patients may experience paralysis of the side affected by the stroke; weak coordination; difficulty in speaking, understanding, reading and writing; and difficulty concentrating.
This is where rehabilitation comes in.
A stroke patient exercises his muscles with the help of a machine, supervised by a physiotherapist.
A stroke patient exercises his muscles with the help of a machine, supervised by a physiotherapist.
Physiotherapy Treatment in Malaysia https://youtu.be/PYQO3SDe8_w ”
Dr Wong Yee Choon - Mix FM Doctor On Call
How much you know about Stroke? Stroke is an emergency, every minute counts – Act F.A.S.T.
Listen to Dr Wong Yee Choon, consultant Neurologist being interviewed by Mix FM - Doctor On Call.
Topic: Stroke - Act F.A.S.T
Says Dr Kok: “This is an area that is often given less attention, when in fact, to me, it is equally important as the acute treatment for stroke.
“A good rehabilitation programme improves disability and prevents complications.”
According to Sunway Medical Centre Velocity Rehabilitation Centre head Maxim Chea, stroke rehabilitation has to be individualised to the patient as it depends on the part of the body or type of ability affected by the stroke.
He explains that there are three main types of rehabilitation therapy: physical therapy, technology-assisted physical therapy (e.g. functional electrical stimulation and virtual reality), and cognitive and emotional therapy.
Visual rehabilitation is also available for those whose vision is affected by stroke.
For example, consultant neuro-ophthalmologist Dr Lakana Kumar shares that “Double vision and peripheral loss of vision can be treated with prisms incorporated into glasses for patients to wear.”
Rehabilitation is usually carried out by a team consisting of physiotherapists, occupational therapists, speech therapists, and dieticians/nutritionists, among others.
In addition to physical and cognitive problems, patients might easily become depressed, overly anxious and panic easily.
Says consultant psychiatrist Dr Lim Wai Jenn: “Stroke survivors are at significantly higher risk for neuropsychiatric conditions such as post-stroke depression (one in three patients), anxiety (one in four patients), and other changes in personality and behaviour.
“These conditions impede the rehabilitation process and degree of recovery in post-stroke patients.
“They also significantly impact the patients’ long-term functioning and quality of life, and can even lead to higher mortality rates.
“Early psychiatric assessment and intervention is essential.”
She notes that caregivers also need support and psychoeducation on how best to support patients in regaining function.
While being affected by a stroke is a frightening event, rest assured that there are treatments and therapies available to help you manage this condition – just remember that you need to seek medical help as soon as possible.
By TAN SHIOW CHIN This article is courtesy of Velocity Neurocentre, Sunway Medical Centre Velocity.
A CT scan of a stroke patient’s brain, showing the affected area of their brain (in violet). The affected area will determine the type and extent of disabilities the patient will have. — Schering AG
By Matthew Teo Yong Chang
Stroke or a cerebral vascular accident (CVA) was the third leading cause of death in Malaysia in 2018, according to the Department of Statistics. The department reported that stroke caused 7.1% of all deaths in the country. However, two-thirds of those who have a stroke actually survive and will require rehabilitation.
The objectives of rehabilitation are to help survivors become as independent as possible and to attain the best possible quality of life. It is crucial as stroke survivors can lose the function of their affected limbs without rehabilitation, something we have observed in real life.
Even though the function of a stroke survivor’s affected limbs may seem lost after the stroke, our brain possesses a trait called neuroplasticity that can help the survivor regain the limb’s function.
Neuroplasticity enables the unaffected nerve cells (neurons) around the affected area of the brain to rewire and create new pathways around the affected area through repetition of physical and mental training, as well as regulated emotional feedback.
However, the extent for neuroplasticity varies in each individual. So, even though rehabilitation does not “cure” the effects of stroke, in that it does not reverse brain damage, rehabilitation can considerably help survivors achieve the best possible outcome in the long run.
Levels of disability
Rehabilitation, rehab, stroke, physiotherapy, activities of daily living, occupational therapy, Star2.com Rehabilitation is aimed at regaining practical function for the patient, like opening a door latch, turning a tap or pushing a switch.
Strokes happen when a blood clot or bleeding (haemorrhage) restricts the blood supply to the brain, resulting in the brain being deprived of oxygen, which leads to the death of brain cells.
Usually, it is only one part of the brain that is damaged and this affects the type and degree of disability the survivor will experience. This also influences how much rehabilitation can help the survivor.
Generally, stroke can cause five types of disabilities:
• Paralysis, or problems controlling voluntary movement
• Disturbance of the senses, including pain
• Problems using or understanding language
• Problems with thinking and memory
• Emotional disturbances
It is also imperative to know the severity of the stroke before deciding on the rehabilitation plan. There are seven recognised stages of stroke recovery through which most survivors progress through:
• Stage 1 – Flaccidity: No voluntary movement is observed.
• Stage 2 – Spasticity appears: Spasticity refers to the continuous contraction of muscles, which interferes with normal movement, speech and gait, and causes the arm or leg to make small involuntary jerky movements.
• Stage 3 – Increased spasticity: The e arm or leg becomes more spastic, and the muscles feel stiff and tight against external resistance.
• Stage 4– Decreased spasticity: Spasticity of the arm or leg decreases and the limb begins to move more easily.
• Stage 5 – Complex movement combinations: The movement of the limbs start becoming more coordinated and full movement begins to return.
• Stage 6 – Spasticity disappears: Muscle spasticity disappears and isolated joint movements are voluntary; however, spasticity may return if the patient is tired.
• Stage 7 – Normal function returns: Movements return to normal.
Each stage requires different types of approaches and exercises for rehabilitation.
Home rehab
Rehabilitation, rehab, stroke, physiotherapy, activities of daily living, stretching, Star2.com A volunteer helps a stroke patient with her exercises during a therapy session. Stroke survivors are recommended to do flexibility exercises two to three times a week for the rest of their life.
The rehabilitation programme for stroke survivors involves a multidisciplinary healthcare team consisting of a rehabilitation physician, nurses, occupational therapist, physiotherapist, speech therapist, dietitian and clinical psychologist.
However, the most important members of the team are the patient and their caregivers. This is as rehabilitation should be done daily at home, not just during therapy appointments.
Battling stroke disabilities is not as simple a remedy as taking a pill from the doctor or attending a session with the therapist for an hour a week. It requires compliance to medication and the continuous effort to practice the therapies repetitively with strong determination!
Contrary to common belief, stroke rehabilitation can be offered in any setting without sophisticated equipment or technology.
The American Heart Association recommends that stroke survivors perform aerobic exercises three to seven days per week, as well as strengthening, flexibility and neuromuscular exercises two to three days a week, for the rest of their life.
Training at home, in a familiar environment, by adapting and using utensils or tools at home is more meaningful than the therapeutic remedial therapy received at institutionalised centres.
For instance, toilet training at a hospital ward is not as useful as toilet training in your own home, as you will eventually be going home and using that toilet, rather than the hospital’s toilet.
After all, the ultimate goal of rehabilitation is to promote optimal functional independence in the survivor’s own living environment.
Besides, providing therapy in the home environment supports continuity of care, provides a relevant environment for daily function, and encourages patients to develop problem-solving skills.
Some of the other benefits of home rehabilitation for stroke include:
• Early discharge from the hospital to return to the comfort of your own home.
• Avoiding hospital-acquired pneumonia and other illnesses due to a shorter stay.
• Reducing the cost of care.
• Preventing deterioration and promoting health through physical activity.
• Preventing falls, which are common among older patients and can cause additional long-term disability.
Barriers to home rehab
The main barriers towards rehabilitation in stroke are a lack of motivation and apathy towards recovery. Most stroke survivors stop coming for their treatment regime after a period of rehabilitation because they do not see any significant improvement.
Over a period of time, they will begin to learn helplessness and compensate themselves – mostly incorrectly – for their abnormal postures and movement, leading to non-compliance in rehabilitation.
Poor awareness among the public about the different roles of the different therapists in stroke rehabilitation could also be another barrier in rehabilitation.
In addition, the lack of trained therapists in Malaysia for stroke rehabilitation is also another factor, as it contributes to increased cost of hiring in-house therapists for home rehabilitation due to their scarcity.
Matthew Teo Yong Chang is a lecturer in the School of Occupational Therapy at the Perdana University Graduate School of Medicine. This article is courtesy of Perdana University. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
Stroke Hand Exercises: For every stage of recovery
A physiotherapist explains safe lower limb exercises for stroke patients This video is brought to you by Singapore General Hospital.
https://youtu.be/3GbpbuwcWDk
Post-Stroke Exercises (Part 2: Lower Limb)
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Stroke Exercises for Arm & Hand with Little to No Strength-for Home
"Famous" Physical Therapists Bob Schrupp & Brad Heineck demonstrate stroke exercises you can do in your own home for the arm and hand that has little to no strength.
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Stretches For Hand Spasticity - Best Stroke Recovery Hand Exercises
DAEHAN Rehabilitation Hospital Putrajaya offers customised rehabilitation services that focus on intensity and discipline to give patients with neurological and orthopaedic disabilities optimal results.
Strokes and other neurological disabilities often leave individuals with lasting and damaging effects that can greatly impede their daily functions.
This brings to light the need to raise awareness on the crucial and beneficial role rehabilitation can play in the lives of such patients.
According to Dr Fazah Akhtar, studies have shown that early and high-intensity rehabilitation has given patients better outcomes.
“Certain neurological conditions such as strokes and traumatic brain injury have a window period of best recovery after the event,” said Dr Fazah.
“If an individual were to undergo high-intensity inpatient rehabilitation in a specialised hospital or unit, the recovery and functional outcomes of the patient have shown to be better than those who do not receive such treatment.”
Understanding this approach, Daehan Rehabilitation Hospital Putrajaya offers South Koreanstyled rehabilitation services in which they are on a one-on-one basis and are personalised to specifically match the needs of the individual.
Besides stroke patients, they also manage cases of traumatic brain injuries, hypoxic brain injuries, brain tumours, spinal cord injuries, musculoskeletal conditions and other complex conditions that require multidisciplinary rehabilitation.
With an emphasis on intensity and discipline, the inpatient rehabilitation programmes are planned and targeted for a duration of three months with extensions as needed.
A programme’s daily schedule usually features several rehabilitation sessions, starting at 9am and end at 5pm.
In addition, parts of the programme are practised in open and spacious therapy areas such as the gymnasium to enhance engagement and social interactions between patients.
This forms a support group system and such peer encouragement has seen a positive impact on the programme, says Dr Fazah.
All this is further augmented by technological advancements such as gait robotics, computerbased therapy, individualised hydrotherapy, and anti-gravity treadmills.
Their full list of therapy programmes includes physiotherapy, occupational therapy, functional electrical stimulation (FES), pain therapy, speech therapy, dysphagia rehabilitation, computerised cognitive function therapy, activities for daily living (ADL) training, return to work training, pulmonary rehabilitation, machine treatment, gait training with special equipment, robot-assisted gait trainer, hydrotherapy treadmill, and anti-gravity treadmill.
Meanwhile, their facilities and services include an emergency department, room and board, imaging department, specialist clinic, daycare service, inpatient and outpatient services, and outdoor therapy.
While Daehan Rehabilitation Hospital Putrajaya only offers its services to adults at this point, there are plans to expand to paediatrics rehabilitation soon.
Certain neurological conditions such as strokes and traumatic brain injury have a window period of best recovery after the event.
-Dr Fazah Akhtar
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SBS - Sure Boh Singapore ·Founding Father Lee Kuan Yew's famous quote:
Founding Father Lee Kuan Yew's famous quote. I'm surprised it took them 65 minutes. I would have apologised straight away after he says "STOP IT!
Flaws laid bare: South Korea, which scored fourth lowest in the study that measured citizen sentiments, even voted overwhelmingly to reelect a president in the middle of the Covid-19 crisis. — On the other end, some argue that the countries that scored well are often authoritarian and have leaned on state-controlled media to the extent that their people tell pollsters everything is hunky-dory. While their media diet can have some influence in what people tell pollsters, it does not tell the full picture. Singapore, Thailand and even Iran are all dominated by state media, yet none of them recorded stellar results in our study. Barking up the propaganda tree only gets you so far.
