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Fusion Series

How World Class Innovators Create the Unexpected

The Autism Ear Test

Age 0–4 Intervention for 70 Million People (While Our Brains Are Speed-Developing)




Raffi Rembrand fused:
- autism diagnostics & audiology (SensPD)
- touch & technology (BioHug)

Through the blur, I wondered if I was alone or if other parents felt the same way I did—that everything involving our children was painful in some way. The emotions, whether they were joy, sorrow, love or pride, were so deep and sharp that in the end they left you raw, exposed and yes, in pain. The human heart was not designed to beat outside the human body and yet, each child represented just that—a parent's heart bared, beating forever outside its chest.” 
- Debra Ginsberg, author and parent of an autistic child

Autism Spectrum Disorder (ASD) is a range of conditions characterized by sensory-perception, social-skill, repetitive-behaviour, and communication challenges, as well as positive differences/strengths. The challenges make it difficult to integrate with others at school, work, and social settings, and parenting an autistic child can involve difficulties not only in parenting the child with ASD but also the siblings, as well as managing work, marriage, and health.

Finances also become a challenge. Special education and healthcare costs total over USD 17,000 per child per year. Average lifetime cost of having ASD is USD 1.4 million. Twenty per cent of those diagnosed with ASD also have intellectual disability, which increases the average lifetime cost to USD 2.3 million. In the US alone, ASD costs are estimated at USD 11.5 billion a year.


source: SensPD Summary, May 30, 2016

Diagnoses have risen exponentially, from 1 in 2000 people in the 1970's to 1 in 45 today (CDC, 2016). The current diagnostic procedure is based on subjective observation of behaviour, beginning as early as 18 months, but only finalizing as early as 4 years old. Most children are diagnosed at age 5 and above.

Unfortunately, this delay in diagnosis dooms most interventions to failure. Social-skills interventions before age 2 are over 90% successful. After the age of 5, the rate drops to 11%.

The importance of applying interventions as early as possible cannot be overestimated. It can make the difference between a meaningful life integrated in the community or an isolated life.” 
- SensPD Introduction & Summary, 2016

Learn & Collect

Isolation and the daily struggle of raising a child who has ASD—with no cure and few effective interventions—led one parent on a cross-disciplinary, international journey of discovery and invention. One of his inventions could help millions of children (whole families, in fact) and could become a standard test for all new-borns. The other could provide comfort and calmness to those with ASD, as well as other conditions, such as PTSD, hypertension, hyperactivity, etc.

The journey began with the same imperative all ASD parents face: learning. Every parent learns what characterizes ASD, what the implications are, possible interventions, and how to track the impact of the therapies they sample. However, Raffi Rembrand tracked something more.

For years, he tracked (and collected thousands of) ASD research studies. He was stunned by the lack of understanding of ASD's underlying mechanisms, the absence of early diagnosis, and the scarcity of effective therapeutic interventions. He kept tracking the studies and even moved with his wife and son to the US, where he would find better support for his child's condition and a more active community of parents and researchers.


Engineer-Thinking and ThinkWalking

With a background in chemical engineering and extensive experience in signal processing, Raffi delved into medicine, physiology, and the physics of wavelengths. As an engineer, his default approach to any problem is to break it apart, find the problem(s), fix, and re-connect. He has to find (or define) a problem before he can fix it.

In fact, while he's pondering a problem, he has a particular method for mulling it over and connecting with his creative inner environment—he takes a walk. When he was in his master's program, he walked extensively, and one day his supervisor stopped him, asking why he wasn't working—he was just walking around.

Raffi explained that his most creative thoughts came when he was walking (alone), thinking about a problem or about nothing in particular. There is even psychology research to support the practice,* and “incubating” ideas sub-consciously over time is a well-known creative technique.

He explained what he'd thought about and the advances he'd made in his research beyond the current frameworks (and time-schedule) while he was walking. The supervisor went back to his desk.


Breaking Assumptions: Cause or Effect?

Raffi's new research would require some creative thinking. Currently, no one knows what causes Autism (or at least, no one agrees). Only the effects—the difficulties—are known, one of which is sensory perception.

Researchers knew sensory-perception issues typify ASD, and their unconscious assumption was that it's an effect. Breaking this assumption was my breakthrough. I believe sensory perception is the cause of autism.

He also believes that recognising and breaking assumptions is a key tool for creative advances:

Usually people understand creativity as unhampered by conventions, and that's just pure nonsense. Being creative means understanding what are those hidden assumptions that bog you down, and then crossing over them. You need to understand everything at a deeper level to find the assumptions—the barriers, the boundaries—and then break through those.

Treating an effect as a cause opened a whole new avenue of inquiry—one he would pursue with his own time and his own funding—and one that began with an ASD difficulty: speech-in-noise discrimination.


How Ears Perceive—and Make—Sound

Most people can have a conversation with someone in a noisy room. The brain filters out the general room noise (e.g. at a party) using Oto-Acoustic Emissions (OAE), which are naturally-synthesized stochastic signals (sounds), generated in the cochlea (inner ear). These are the sounds you hear when you hold a seashell to your ear or when you're in a silent room and realise it isn't actually silent.

Our ears don't just perceive sound—they generate it.

Like spilling coins onto a table before you can pick out, say, the 10-cent pieces, the OAE is used sub-cognitively by the brain to filter out background noise so we can focus on particular sounds we want to attend to. In fact, OAE also facilitates tactile, visual, and proprioceptive sensations.

No wonder people with ASD withdraw into themselves and are often sensitive to sound, touch, and body position & movement. They can't effectively filter them out.


Raffi needed to test some of his ideas, so he crafted a headset device to measure the OAE response to auditory stimulus, expecting that people with ASD would show delayed response and random response patterns.

With two earphones and two microphones adjacent to each ear, the earphones emit a sound, and the microphones capture both the stimulus and the response OAE emitted from the ear. The stimulus is subtracted from the recording, in order to isolate the OAE. A 3D spectrogram is then produced, showing a frequency, time, amplitude signature.


source: SensPD Study Report, August 4, 2016, p. 6.

As expected, in response to a given sound profile (top spectrogram), the average listener's response roughly mimicked the original sound and did so within a narrow band of response variations (bottom left spectrogram). Listeners already diagnosed with ASD, however (bottom right spectrogram), did not fall within normal range and did not mimic the original sound.

In fact, the more severe the sensory dysfunction, the more severe the ASD symptoms.

They also tested the timing of the OAE (see below). Once again, results were as predicted. The OFA of typically-developing listeners (“TD”) were quickly produced, while ASD OFA's were delayed.


The device has shown itself to be an objective, early-stage, non-invasive way to diagnose ASD and can be administered within a few days of birth. The test results even act as a biomarker of other sensory-perception disorders, such as dyslexia and hyperactivity.

This is a life-changer. Early, objective diagnosis enables early, effective intervention.



Raffi filed a patent for the technology and co-founded a company called SensPD (for Sensory-Perception Diagnostics). In 2017, he won first prize at the Merage Institute's 45+ Entrepreneurs' competition. He partnered with 7 hospitals in Israel and the US that have agreed to finance and conduct clinical tests. He plans to offer the diagnostic tests world-wide, using a cloud-based big-data approach that should enable constantly-improving analytics and further research.

Such research will undoubtedly include causality and interventions such as oxygen pressure cells, auditory training, behavior modification, Transcranial Magnetic Stimulation, and more. Whether OAE dysfunction is an effect or a cause (sole or conjoint), an intervention to directly correct perception-disorder has not yet been created. More research is needed.

Further, although the SensPD device can detect the severity of a perception disorder, it cannot distinguish between ASD, dyslexia, and hyperactivity. Again, further research is needed.

Nonetheless, SensPD's diagnostic value is clear. With further testing (only preliminary tests are complete), the device should enable both early intervention and measurement of intervention effectiveness—leading to better interventions.


BioHug “Touch Technology”

While researching the SensPD device, Raffi needed help to calm some of the participants. Parents and professionals working with ASD often do so by applying therapeutic pressure via weighted garments or blankets; enveloping them with cushions, mattresses, or wet linens; rolling them in gym mats; or applying rollers or physiotherapy balls. Unfortunately, some of the methods require training to implement, and the receiver cannot self-regulate.

So, Raffi created the Bio-Hug vest to deliver (technologically) Deep Pressure Treatment, a technique that helps patients calm themselves and process sensory stimuli. It uses the same type of surface pressure exerted in most types of firm touching, holding, stroking, animal petting, and swaddling.

The battery-operated, washable, cloth vest offers stress relief and arousal control via inflatable air cells and an electronic controller. It delivers pressure of varying strength and duration (in both automatic and manual modes), in order to avoid habituation. It has been used with positive effect for ASD, ADHD, PTSD, and even hypertension:

I tried the vest, and it worked marvelously. We checked my blood pressure, and it went down immediately.” 
- Jonah Gavrieli, Patent Attorney, office-mate, and neighbor

So, Raffi also has another company—BioHug—with a mission “to improve the lives of people with stress or anxiety issues.”


Outwardly Open

Not surprisingly, Raffi is described as highly compassionate, persistent, and mission-driven:

Raffi has a life mission concerning his son and is seeking a solution to his son's problem. His son's grown up, now, but in Raffi's head, the problem is still there. Now, after so many years of hard work, he's found the solution.” 
- Kobi Cohen, Incubation/Innovation Mentor and friend

Surprisingly (or not, given his auditory focus), Raffi is extremely musical. He plays piano, sings in the choir, and is described as a good listener. He's also a good noticer, empathic, creative, systematic, and spiritually disciplined.

He's a citizen of the world (as well as Israel) and describes himself as a modern Renaissance man, interested in a broad array of topics and activities, collecting ideas as he goes, which he may connect with another idea later. He talks to everyone he can, in order to learn more (broadly or deeply).

First of all I'm generally an open person, and second, I've had to be, since I'm doing research without funding or a big organization. In Israel, we've a very close-knit society. Relationships are very informal. So, it's easy to pick up the phone and say, “Hi, can I ask you a question?

Once he's identified a problem or topic, he's extremely focused and reads everything he can on it, in order to deeply understand.

Innovation comes from intimate knowledge. It's not something you wake up with one morning and say, ‘I have this great idea in a field I'm unfamiliar with, and I know it'll revolutionize the world!'” 
- Jonah Gavrieli, Patent Attorney, office-mate, and neighbor

Raffi knows what he doesn't know and is open to partnering, believing we do not achieve things alone. He's the first to say he's not a businessman, so he sought a partner for each of his companies. We cannot manage breadth and depth alone.

Inwardly Open

Caring deeply about another's problem, investigating, collecting, and connecting with others are all outwardly-open activities. They give us a reason to create and help us create, but creating something radically new can only happen when we're open inwardly. It requires deeply feeling, deeply understanding, and deeply questioning, followed by inwardly-motivated, persistent action.

Raffi did that by learning, searching, reading, walking, thinking, and experimenting, across years of time. He created something to help alleviate the isolation of autism, in the process becoming isolated in a world of autism detection—and hope.

Does your heart beat outside your chest?

Will you take it with you on a journey of discovery and invention?

Do you understand deeply enough to turn an effect into a cause?

What or whom will that cause affect?



 1. one who innovates across domains of industry, field, country, social class, etc.
 ◦ s radical innovator, interdisciplinary creator, T-shaped person, borderless freethinker, boundary-crossing integrator, oddball;

Raffi Rembrand is Chief Technology Officer of BioHug Technologies and SensPD. He invented an electronic calming jacket for autism, as well as an autism diagnosis device that can be administered at birth, thus enabling early intervention. He is “from” Israel and the USA (lived 6 months+, countries listed in alphabetical order). For more information on his work, see: LinkedIn, SensPD.com, and BioHug.com.

*Marily Oppezzo & Daniel Schwartz, “Give Your Ideas Some Legs: The Positive Effect of Walking on Creative Thinking,” Journal of Experimental Psychology: Learning, Memory, and Cognition, American Psychological Association, 2014, Vol. 40, №4, 1142–1152.

I thank the participants in this study (Fusioneers and Friends) for your insights, sharing, help, and patience. You inspire me, and I am honoured to know you. Special thanks go to Gladys Lee for her marketing excellence and video- and podcast-production brilliance, as well as the host of creative professionals involved in producing the videos and podcasts (you're all listed on YouTube, iTunes, etc.). I extend a warm thanks to Fusion Research Assistant Dr. Lee Poh Chin for her continually-wise and dedicated contribution to this research, as well as i2i Executive Shareff Uthuman for managing the rats-nest of global research travel and budgets. I thank Nitish Jain and the S P Jain School of Global Management for supporting this research—you're the foundation that enables the whole project. You are all God-sends. It takes a village to write a paper.

Photo/video cuts courtesy of Raffi Rembrand, Depositphotos, and our own creative team.

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