PRoGS (Puppetry Robotic Glove System) - A Cost-Effective Rehabilitation Device for Stroke Patients
Institute of Technical Education

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Stroke is a significant cause of human death and disability globally. Annually, 15 million people suffer a stroke. Of these, 5 million die and another 5 million are left permanently disabled (WHO, 2014). The number of people affected by stroke is expected to rise to 61 million in 2020. According to a WHO research in 2012, stroke is the second leading cause of death in the world, and two-thirds of stroke deaths occur in less developed countries (Stroke Association, 2013). In Singapore, stroke was the fourth highest cause of death, accounting for 8.4% of total deaths in 2010. Besides physical after-effects of ischemic or haemorrhagic strokes such as numbness and weakness of a limb, many stroke survivors also experience feelings of anxiety, sadness, frustration, fear and hopelessness. These negative feelings, if not treated or managed properly, can slow down recovery. Additionally, the health conditions of these stroke patients place emotional and financial burdens on their families and surrounding caregiving communities. These burdens of stroke therefore render the provision of and accessibility to effective treatment for stroke patients extremely crucial. The cost of stroke treatment and rehabilitation remains high. To improve the quality of lives of stroke patients physically and emotionally, healthcare organisations and practitioners are constantly innovating to discover efficient and efficacious physiotherapy methods. One such method is the Constraint Induced Movement Therapy (CIMT) developed by St. Luke’s Hospital (SLH) in Singapore. The Hospital has been developing a Neuro Hand Orthosis Rehabilitation Program (NHOP) based on the principle that stroke patient who could do voluntary, intense exercises for their limbs would help ‘re-wire’ their brains and ‘reconnect back’ to improve their muscle control and coordination greatly. After 10 weeks, NHOP results showed that many of their patients could use their stroke-affected arm to grab objects. However, this NHOP solution was still very costly, and not well adopted in this region.

B. Strategic Approach

 2. What was the solution?
The Institute of Technical Education College West (ITE-CW), a technical college under the Ministry of Education decided to offer their services to partner SLH to develop a more cost-effective rehabilitation solution to stroke patients in Singapore. Under the Public-Private partnership scheme, and in collaboration with SLH, ITE-CW developed the Puppetry Robotic Glove System (PRoGS). This rehabilitation project consists of an Electromyography (EMG) Reader, a Robotic Glove, PC EMG display and feedback software. A stroke patient’s affected arm has remaining muscle neurons firing. These muscle neurons, which produce signals in micro voltages, could be read from the surface of the skin. PRoGS uses the Electromyography (EMG) reader to read these signals, amplify it more than hundreds of times, clean up the electrical noise and wirelessly transmit them to the computer application. This allows the patient to see a visual representation of their muscle signals. The signal is also transmitted to the robotic glove, controlling it to open or close proportionally to the muscle signal’s gradient. With the ability to see their muscle signals and use their affected hand to handle objects via the robotic glove, the patients were motivated to continue with the rehabilitative treatment which helped their brains to ‘re-wire’, eventually gained greater use of the affected hand.

 3. How did the initiative solve the problem and improve people’s lives?
A. Highly Advanced Technology Unlike existing solutions, PRoGS provides real-time wireless feedback to therapists on the patient’s progress. It also provides patients visual motivation via computer during therapy. The PRoGS technology allows the glove to sense the intent of the patient in the use of his fingers through reading signals produced by the patient’s affected arm. It then controls the movement of the fingers as intended, allowing the patient to hold objects (e.g. a cup). Furthermore, the PRoGS components were entirely designed and developed by the ITE-CW team. B. Highly Functional Design PRoGS was designed to be easily managed by users. It is low cost (less than S$1,000), portable and easy to use. A patient can perform rehabilitation without therapist supervision. Furthermore, PRoGS is powered by rechargeable batteries lasting operationally for at least 6 hours. This duration is substantially longer than current solutions. The portion of PRoGS in contact with the patient’s skin is made up of antimicrobial cloth easily sterilised by alcohol swipe. The glove is also detachable for further sterilisation by machine wash. Most importantly, the gloves are safe in usage as it has built-in safety checks to prevent over strain and fulfil healthcare safety regulation standards.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
A. Strategic Methodology The team adopted “The Lean Startup” strategy when implementing PRoGS. It is a principled approach to new product development. The strategy steps taken were: 1. Create a prototype rapidly (minimum viable product) 2. Obtain ground feedback (from St. Luke’s Hospital (SLH) Physiotherapists) and understand the feedback 3. Apply the feedback and create the next prototype 4. Go back to step 1 Such design iterations enabled the team to gather results quickly and direct them to the right design direction. It also allowed them to develop a simple, workable design. B. Stages of Project Implementation Stage 1: Specification Drafting a) Collaborated with SLH to derive the product specification. b) SLH was selected based on its close proximity to ITE – College West. Both are located in the western part of Singapore. They are well-known for Stroke Rehabilitation. Stage 2: Prototype Development a) The technical team created a prototype rapidly (Minimum Viable Product) for SLH’s testing and feedback. b) Upon receiving the test results and feedback, the team designed and developed the next prototype. c) Steps a) and b) were repeated till the product was accepted by SLH and ready for the User Acceptance Test. Stage 3: User Acceptance Test (UAT) a) ITE conducted internal UATs, allowing the team to re-design and work on areas for improvement. b) Once PRoGS passed the ITE internal UATs, SLH conducted their own UATs on the product. c) When the product passed all UATs, the results were submitted to SLH's Medical Board for their approval to proceed with the Medical Trial. d) Each UAT included the following procedures: i. Functional test on each sub-modules: EMG reader, PC program and Glove. ii. Stress test for 4 hours ensuring no bruises and abrasion on the tester's hand. Stage 4: Medical Board Approval Stage 5: Medical Trial It took the team two years to complete stages one to four, after which the medical trial was conducted in 2012. More than 5 SLH stroke patients participated in the pilot medical trial, and three patients (after attrition) participated in the full 10 weeks of the medical trial. Stage 6: Patenting The patent rights allowed the team to obtain licensing agreements with commercial companies, like Xentiq Pte Ltd, to produce PRoGS. C. Strategic Collaboration with SLH The team engaged SLH’s physiotherapists as they had expert knowledge in stroke rehabilitation and first-hand experience working with stroke patients. By combining SLH’s physiotherapists’ knowledge, and the team’s expertise in Engineering, innovative solutions were quickly derived. To connect with relevant stakeholders and develop a product best suited to the needs of the stroke patients, the team held frequent discussions with the SLH team and physiotherapists. Such meetings facilitated “The Lean Startup” strategy adopted by the team, allowing them to gather feedback on their prototype quickly, refine their design and progress to the next prototype. D. Involving ITE Students and Interns As ITE lecturers, the team believed that it was important for them to ‘walk the talk’ when teaching their students and provide them a learning environment as authentic to real-life circumstances as possible. As such, students are involved in the prototype design of PRoGS with the aim to strengthen their skills in the following: a) Schematic Capture and PCB routing b) Lead-free Microsoldering c) PCB Rapid Prototyping d) Troubleshooting e) Firmware development and testing

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
A. Public Agencies and Health Care Institutions 1. St. Luke’s Hospital (SLH) SLH supplied the target audience - stroke patients, to participate in the PRoGS medical trials, and its physiotherapists also played the role of experts to the team. The physiotherapists not only had knowledge on stroke rehabilitation, but also experience working with stroke patients. They could therefore understand difficulties faced by stroke patients and what would benefit them. By engaging these partners, it helped team members who had no first-hand experience working with stroke patients, develop a PRoGS design best catered to their needs. 2. SingHealth and Singapore General Hospital (SGH) SingHealth and SGH, two national healthcare groups, provided a source of backing, credibility and support to this project. SingHealth expressed interest to participate in PRoGS medical trials, allowing more stroke patients and caregivers to benefit from this innovation. In addition, there were plans to collaborate with SGH to enhance PRoGS. The enhanced application can be scaled up to a wider range of limb disabilities, thus meeting the needs of more stroke patients. 3. Ministry of Education (MOE) The ‘MOE Translational R&D and Innovation Fund’ helped launch this project. With its success, the project also received more funds to further improve PRoGS, facilitating its commercialisation and wider medical trials with SLH and SGH. 4. Institute of Technical Education (ITE) To train ITE students in technical skills, they were involved in the PRoGS’ design. ITE’s Senior Management also assisted the team with procurement and employing medical trial physiotherapist and interns. B. Private Sector 1. Xentiq Pte Ltd. Xentiq Pte Ltd. had a licensed agreement to mass-produce PRoGS in the market. As a commercial company, they also provided insights to PRoGS’ design, ensuring that it will be as close as possible to the commercialised version at the end of the project.
 6. How was the strategy implemented and what resources were mobilized?
A. Costs Associated with Initiative 1. Technical / Equipment Resources The total budget estimated for ‘Equipment’ for the duration of 3 Fiscal Years (FYs), from FY2009 to FY2011, was $33,400. The items consisted of: a. Computers b. Force & Torque Meter c. EMG System d. Biokinetic Analysis System e. Body Medical Models f. Miscellaneous 2. Human Resources The total budget estimated for ‘Expenditure of Manpower’ (EOM) for the duration of 3 Fiscal Years (FYs), from FY2009 to FY2011, was $338,920. Manpower category consisted of: a. Visiting Collaborators b. Student Allowance c. Project Engineers d. Project Officers e. Interns f. ITE Student (Final Year Project) g. Therapist salary h. Research staff i. Project Manager 3. Other Operating Expenses The total budget estimated for Other Operating Expenses (OOE) for the duration of 3 Fiscal Years (FY), from FY2009 to FY2011, was $68,800. B. Project Funds The project was funded by the ‘Ministry of Education (MOE) Translational R&D and Innovation Fund’, which aims to: a. Enable new innovations which will improve or develop new products, processes and systems that generate economic payoffs; b. Enable self-initiated applied research ideas to be developed to the point which demonstrates potential for product development or improvement that could attract industry funding; c. Support the Polytechnics in building up capabilities beyond the few selected niche areas of Centres of Innovation (COIs); d. Support the Polytechnics' and ITE's partnership with the industry, especially local SMEs, to augment technological capabilities; e. Improve the overall quality of Polytechnic and ITE education by updating and developing staff expertise and providing realistic project work opportunities for students; and f. Enhance the Polytechnics’ and ITE’s standing as innovative and world-class education institutions. The MOE Translational R&D and Innovation Fund was the only source of funding for the PRoGS project.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
1. Shorter and Quicker Rehabilitation Time Results from PRoGS medical trials showed that by the 4th week of treatment, patients demonstrated better recovery than conventional therapy. A positive effect on the upper limb recovery post-stroke in the sub-acute rehabilitation was also found. Based on Motricity Index (MI) scores, the patient who used PRoGS had a higher improvement score (11.1%) as compared to a patient who received conventional therapy (9.2%). The Motricity Index test scores are used for measuring strength of upper and lower extremities (i.e. fingers and toes). Similarly, there was a 10.6% improvement in the Fugl-Meyer Assessment (FMA) scores of the patient who used PRoGS as compared to a patient receiving conventional therapy (3.18%). The Fugl-Meyer Assessment scores are used for measuring motor recovery – assesses five domains namely Motor function, Sensory function, Balance, Joint Range and Joint Pain. 2. Increased Confidence and Psychological Well-Being The burdens experienced by stroke patients can diminish their psychological well-being and impair recovery. The favourable PRoGS treatment results received by the patients in turn gave them greater confidence to continue with the treatment and live a better quality life. It gave stroke patients greater hopes of recovery amidst their difficulties. Increased confidence also help patients establish self-efficacy, which has been proven to be crucial for recovery as patients believe that they have control and are able to attain their goals. 3. Cost-Effectiveness With the team’s innovative technology and design, PRoGS is successful in shortening rehabilitation time at a very low cost (less than S$1,000). As stroke patients are often burdened by rising healthcare costs and expensive treatment procedures, the affordable PRoGS treatment becomes a viable and attractive rehabilitation option for Singaporeans, especially those from low-income groups. 4. High Functionality Design PRoGS was designed to be portable and easily managed by the users so that patients and caregivers can undergo rehabilitation at their own conveniences, without the supervision of a therapist. Beyond these, the team made efforts to design the gloves in such a way that it is safe and can be easily managed (i.e. use of rechargeable batteries, antimicrobial grade cloth easily sterilised by alcohol swipe and detachable cloth gloves which could be machine washed).

 8. What were the most successful outputs and why was the initiative effective?
The ITE-CW team started out developing the PRoGS prototype from scratch. However, the initial phase of development proved challenging as they had no first-hand experience working with stroke patients. Considering the importance of having a user-centric design, the PRoGS team decided to engage SLH’s physiotherapists, who have the knowledge and experience working with stroke patients, to obtain feedback at various stages of the development of their prototype. The numerous refinements took up significant amount of time. However, with the guidance and feedback received, the team developed a rehabilitation tool which caters to the needs of many stroke patients, and helped make a difference to their lives. To ensure that PRoGS is best designed for the users, the team also held regular meetings with stakeholders to discuss progress issues and make changes to PRoGS. As a result, the team members who are full-time teaching staff, had to find time outside the classroom to work on the project. To address this, the team established close communication ties between ITE’s Senior Management and collaborators, and in turn, gained their trust. The team secured financial support and approval from Senior Management and collaborators to push the research forward, which saved them a lot of time and resources. With strong support given by ITE Management, the team was also able to expand the project to partner SGH to enhance PRoGS. Particularly, the team’s collaborative partnership with therapists in SLH played a key part in effectively evaluating the progress of PRoGS in assisting stroke patients and allow for refinements to the rehabilitative programme. PRoGs medical trials were conducted. In 2012, 5 patients participated in the pilot trial. Subsequently, 10 patients volunteered for the programme, with 3 SLH stroke patients completing the full 10 weeks. These patients were closely monitored by the physiotherapists for limb strength and motor recovery. A positive effect on the upper limb recovery post-stroke in the sub-acute rehabilitation was also found. The feedback attained from these trials were then used to inform refinements and redevelopments of PRoGS.

 9. What were the main obstacles encountered and how were they overcome?
1. Overcoming the Lack of Relevant Expert Knowledge The team only possessed the technical know-how and not the tacit knowledge, including detailed understanding of stroke patients’ care and rehabilitative needs, which comes with being a direct caregiver. Without the experience of working directly with stroke patients, the team had difficulties understanding the daily challenges that patients’ face. Therefore, the team initially struggled with designing the PRoGs prototype on their own. To better design a product which connects closely to the user, and best suits his/her needs, the team instead partnered healthcare experts in the field, effectively bringing together the knowledge of an engineer and a practitioner. As stroke patients rely heavily on their physiotherapists, they have acute and insightful knowledge of patients’ needs. Thus, this partnership allowed the project to move forward and directly cater to specific functional needs. 2. Overcoming High Attrition Rates In the beginning of the PRoGS medical trial, more than 10 patients volunteered. However, attrition rate was high, and only 3 patients underwent the full 10 weeks. This challenge was overcome by taking time to understand the difficulties experienced by patients themselves and to anticipate issues which might surface when they participate in such medical trials : a. While treatment was free, patients were not reimbursed for transportation. For low-income stroke patients who are in greatest need of this low-cost rehabilitation solution, this incidence of high transportation costs undermines the project’s fundamental intended beneficiaries. b. Stroke patients are easily affected by (i) depression; (ii) family or career changes; (iii) other illness complications; and (iv) misinformed alternative treatments It was essential for the team to ensure sufficient administrative preparations (e.g. transport or meal reimbursements etc.) and consider their physical and emotional stability, to prevent too many drop-outs before and during the trial, and yield more fruitful results.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
A. To Patients and their Carers As elaborated in Section 7, PRoGS has effectively allowed for shorter and quicker stroke rehabilitation time, measured on the Motricity Index. Nonetheless, recovery from stroke is more complex than just regaining use of the affected limbs. It is also important to consider patients’ psychological needs and their social environment. PRoGS excels precisely in this area. Stroke patients are easily affected by negative emotions, depression, family or career changes, and other illness complexities. Sometimes, they are misinformed of alternative treatments which further complicate the management of their circumstances. These conditions, if not well-managed, can affect the efficacy of treatment and the patients’ recovery. This also has knock-on effects on caregivers who experience stress from sources such as financial worries, the labour-intensity of caregiving, anxiety and depression. Therefore, the benefits of PRoGS extend beyond the tangibles e.g. cost savings. As the ITE-CW team shared, “putting a smile on the faces of stroke patients and their caregivers when they regain the ability to use their stroke affected hand and fingers were priceless”. The favourable results received by the patients give them more confidence to continue with the treatment. It gave stroke patients greater hopes of recovery and quality of life amidst difficulties. Increased confidence also help patients establish self-efficacy, which has been proven to be crucial for recovery as patients believe that they have control and are able to attain their goals. Therefore, the lasting impact of PRoGS is demonstrated in that it targets both patients’ and carers’ physical, financial as well as social needs. B. To the wider Education Sector and Public Service It is easy to forget that this medical project incubated in a school for teenagers. To the team members who are all teachers, one key benefit of undertaking this project is to be able to walk the talk, and model for their students the reality and positive impacts of correctly applied knowledge for society. Additionally, the team engaged interns from the local polytechnics, National University of Singapore (NUS) and Hong Kong Poly University who worked with the ITE-CW team during the development of PRoGS. By doing so, it helped provide an authentic learning environment for both interns and ITE students. The interns and students were able to see the fruits of their labour and how their work created a real and tangible impact. This inspires and provides meaning to education. The team was proud to know that one of the NUS interns, using skills learnt during a 3-month internship, performed very well in his final year project. With his NUS team mates, the intern also started a company dealing in assistive technologies for autistic children. In recent years, Singapore has experienced a significant manpower crunch in the healthcare sector. In 2012, Singapore’s Health Minister Mr Gan Kim Yong announced that around 20,000 more healthcare professionals are needed in Singapore. PRoGS is particularly useful in meeting this need. Designed to be portable and user-friendly, even to the elderly, stroke patients could perform the rehabilitation process without supervision. This implies that less manpower are required for patients to engage in rehabilitation therapy. They can do so at any day and any time. This could also in the long-term help patients, caregivers and hospitals save cost from engaging a therapist for each rehabilitation session. Therefore, PRoGS has been able to provide rehabilitative care to stroke patients more efficiently and effectively, at a lower cost, allowing them and their loved ones to regain a new lease on life. For the many (potential) benefits that PRoGS has contributed to the Singapore medical landscape, it received a Gold Award in the 2014 Public Service ExCEL Convention Awards. PRoGS was only one of three projects, among many other government agencies and Statutory Boards submissions, to win gold this year at this prestigious top-tier innovation award which celebrates the public service’s most innovative yet feasible and sustainable ideas. In his recent posting in the Government Intranet, Mr Peter Ong, Head of Civil Service, shared on his ‘hands-on’ experience with the PRoGS robotic glove – “portable easy to use, and cost-effective”. He commended the ITE team for creating an ‘out-of-the-box’ innovation “that brings hope and cheer to patients and caregivers”.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
Sustainability PRoGS has attained recognition from patent examiners for its innovativeness (the team is currently completing the patent filing process). With the team finalising licensing agreements with Xentiq Pte Ltd to produce PRoGS, and also receiving SingHealth’s interest to participate in PRoGS medical trials, more stroke patients and caregivers will benefit from this innovation. Healthcare organisations and practitioners can also engage the team to implement this treatment with their patients. As the cost of the PRoGS treatment is affordable, this would be a viable and attractive rehabilitation option for stroke patients. PRoGS also opened doors to new possibilities and addressed issues which today’s healthcare organisations and specialists have difficulty resolving. For instance, PRoGS proved that with effective use of technology and good partnerships, developing a highly efficient and cost-effective stroke rehabilitation tool in the hospital is achievable. The success of PRoGS and its potential for scaling up, have gained the attention of organisations from the Public Service’s healthcare sector which have approached the team for collaboration. We see this from Singhealth’s interest to participate in PRoGS’ medical trials, and a partnership with SGH to enhance PRoGS for a wider range of limb disabilities. In time, we foresee greater collaboration opportunities between the PRoGS team and other Public Service healthcare agencies to develop solutions which will better serve the needs of stroke patients. Transferability In conventional stroke limb rehabilitation, recovery is slow, labour-intensive, strenuous and stressful on both patient and caregiver. If non-conventional methods are desired, high cost is usually an inhibiting factor. While there is no comparable rehabilitation equipment in the market, similar ones (for elbow therapy) can cost upwards from S$9,000. Many stroke patients are either not able to afford these treatments, or the financial burden on the patients and their family are increased. Costing only $1000, and requiring minimal manpower and technical know-how for operation, PRoGS can be a potential knowledge and technology that can benefit poor countries and poor-income groups worldwide who are also in need of affordable stroke rehabilitation. PRoGS has also displayed great potential for scaling up to benefit even more stakeholders. Because of its great potential, the project has received the MOE Translational R&D Innovation Funds (TIF) to further improve PRoGS, facilitating its commercialisation and wider medical trials with SLH and the Singapore General Hospital (SGH). Collaborative efforts with SGH to enhance PRoGS are already in discussion. The PRoGS2 application can be extended to a wider range of limb disabilities and meet the needs of more stroke patients. Currently, the team is also exploring with Singapore’s Ministry of Health Holdings, Agency for Integrated Care and other related industries to conduct PRoGS sharing sessions. Moving forward, there is potential for larger groups of students and external organisations in Singapore to learn and benefit from the PRoGS project. With the entire project designed and completed in-house, it would be a rare exposure to learn from the team, not just the mechanics and technicalities, but also lessons learnt from developing the project.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
Importance of Being Customer-Centric The team learnt after its initial ‘failed’ trials and experimentation, the importance of understanding customer needs and circumstances. The team was humbled by the knowledge and expertise that the medical healthcare practitioners had, and tapping on each other’s strengths, this led to the successful development of PRoGS. The PRoGS was designed with the user in mind for all stroke patients, regardless of income groups, their caregivers and rehabilitation therapists. With the team’s innovative technology, patients and therapists are now provided with an innovative technological solution that shortens rehabilitation time at a very low cost. The team also ensured that the gloves were portable and user-friendly, so that patients can undergo rehabilitation at their own conveniences, without the supervision of a therapist. Beyond these, the team made efforts to design the gloves in such a way that it is safe and easily maintained. The PRoGS is lightweight (lighter than iPad) and aesthetically acceptable (using softer robotics via puppetry means), these made PRoGS very welcome and acceptable to elderly patients. Furthermore, the meticulous attention behind designing PRoGS demonstrated that the ITE-CW team not only focused on addressing the physical aspects of stroke rehabilitation, but also the soft aspects and difficult experiences affecting stroke patients and their caregivers. This shows their keen understanding of and empathy for the complex issues surrounding stroke rehabilitation. They understood that patients not only have to face their disabilities on a daily basis, but also the burdens that come along with it e.g. financial burdens from expensive treatment procedures; distress caused by complicated rehabilitation procedures. These can easily diminish the psychological well-being of the patients and their caregivers, and in turn impair recovery. From the PRoGS medical trials, we not only see the successful effects of the rehabilitation (positive results shown by the 4th week), but also how the favourable results gave hope to the patients and their caregivers, and increased their confidence in the treatment. Importance of Partnerships ITE, being in the education fraternity, went beyond education and into the healthcare sector to develop an innovation that benefited not only students (in terms of creating an authentic learning environment), but also healthcare organisations, practitioners, stroke patients and their caregivers. The team worked with practitioners from outside their field of work, to design a user-centric equipment that greatly benefited various groups of stakeholders beyond the classrooms. The ITE team’s collaboration with SLH was key to the project’s success. Their partnership created a deep synergy of talents and also led to mutual exchange of ideas and knowledge. For example Mr Gribson Chan, Deputy Director for Rehabilitation Division in SLH shared that they learnt the journey of developing a medical invention. PRoGS also opened doors to new possibilities and addressed issues which today’s healthcare organisations and specialists have difficulty resolving. ITE is now working with a host of organisations including SingHealth and SGH to further develop the effectiveness of this technology to meet the needs of a larger group of stroke patients.

Contact Information

Institution Name:   Institute of Technical Education
Institution Type:   Government Agency  
Contact Person:   Chun Kee Ng
Title:   Section Head, Electronics Engineering,College West  
Telephone/ Fax:   64641673
Institution's / Project's Website:  
Address:   2 Ang Mo Kio Drive
Postal Code:   567720
City:   Singapore
State/Province:   Singapore

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