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Pratikara

January 30, 2020

A gamification-based affordable & assisted physiotherapy to help stroke recover safely and reliably post stroke surgery.

Helping stroke patients recover safely and lead a normal life

What would you do if your family-member is struggling with loss of limb movements (motor skills) due to poor recovery and rehabilitation after the stroke (cerebral or brain) surgery? Even worse what if near or dear ones succumb fatally to recurrence of stroke caused by lack of access to physiotherapy because it wasn’t affordable.

For Deepika & Krishna — recent engineering graduates with a degree in BioMedical engineering, coming up with an innovative solution to help patients recover safely and reliably post stroke surgery became a passionate quest. To them it was unacceptable that despite a successful surgery post the incidence of stroke, patients were losing limbs or even lives due to lack of affordable physiotherapy.

“Despite improvements in mortality and morbidity, there is a serious lack of rehabilitation therapies for stroke survivors especially in developing countries like India. It is important that we make them feel normal and well at home, and not remain housebound or bedridden patients at the hospital for months”, say Deepika & Krishna, the co-innovators of GloveiT — a smart glove for assisted physiotherapy, which uses playing games on a smartphone/tablet as the means to aid the rehabilitation and recovery of limbs as well as regularly monitor the progress of the recovery process post surgery.


Delivering Social Impact powered by Assistive Technology

Deepika’s uncle had survived a stroke in 2012 and joined the several million Indians undergoing rehabilitation of their limbs to gain back the semblance of normalcy with the hope to become independent once again. After losing his right hand permanently due to poor recovery after surgery his inability to use his dominant hand to perform daily activities took a toll on his life. The therapy was both expensive and time-consuming.

No family is ever prepared for the realities after the incidence of stroke and its consequences. Inpatient physiotherapy is effective but costly with limited access given the gross shortage of professionally qualified practitioners. While Outpatient or Home based recovery is cost-effective, the treatment has only a minuscule effect on the recovery, with a higher risk of limb impairments. Because stroke causes a wide range of motor impairments, caring for survivors presents multiple challenges.

“During the second year of engineering, while preparing for an internal exam, I saw my Uncle sitting right next to me struggle to balance himself and I was shocked to see his mouth turned to one side. To watch him feel powerless, unable to move the right hand was frightening and what followed was a very prolonged period of gradual recovery that cost a lot of money and despite that he never regained normalcy”.

Typically stroke patients are discharged after a few weeks of recovery therapy being admitted in the hospital, but even then carry disabilities for a much longer period. Home based exercises are taught at the time of discharge along with intermittent physiotherapy sessions at a minimum of Rs. 600/day. Even for those who can afford the results are never guaranteed.

Presently there are very expensive and complex AR/VR based solutions with head-mounted displays and expensive gloves with embedded electro-mechanical movement enablers to aid in the process of self-rehabilitation — imagine getting stroke patients to use very complicated devices and gadgets to play games to help them recover from their motor impairments. Very few can afford them and the cost and complexity is not justified against the incremental benefits offered. In addition there are monitoring devices (Goniometer) used by therapists to monitor the recovery progress only when patients come for therapy sessions.

Innovation Mantra — “Right PROTOTYPE, Prototype RIGHT”

“After taking the opinions of the medical doctors and physiotherapists, and upon closely observing the way patients performed their exercises, it was quite evident to us that improving the recovery process lies in helping them do the limb exercises more regularly and properly, and also each patient’s progress has to be monitored regularly. Early detection of poor recovery can certainly ensure that the right intervention is offered and thereby prevent permanent impairment or even recurrence”, says Krishna, who came up with the idea of replacing the boring exercises with playing video games on a smartphone that will keep them engaged for a longer duration and also make it possible to ensure that desired movements of the fingers, wrist, palm, forearm and elbow parts are all appropriately performed.

The first step in the prototyping process was to design games such that the patients when engaged in playing those games with a standard handheld device will make the requisite movement of each finger, and other parts of the arms. However it was quite clear to them that while designing games, adding more features, testing them and putting all the time and effort into it will become meaningless without ensuring that this game-mediated method of recovery was indeed effective in terms of achieving the desired progress and results, and they were acceptable to the doctors and the therapists. Unless this acceptance and approval from the doctors was achieved it was going to remain a toy and never become a commercially viable and a successful product in the market.

“Prototyping to test value and not features, was an important lesson we learned through examples shared with us my our mentors and that the smartest thing to do at the very beginning is to test the most critical risk in our innovation. The risk is not so much in our ability to design the games and the glove itself in a manner that will be easy to use. But the real risk is whether the doctors and therapists will recommend this to the patients. If they do gain the confidence, we were also quite sure that at least the physiotherapists would be more willing to recommend the product to the patients, as there is the possibility of earning additional revenues”, tells Deepika who along with Krishna pitched this innovation in the HealthTech hackathon organised in Vizag, Andhra Pradesh by the AMTZ (AP MedTech Zone) and won the second prize with cash award of Rs. 50,000 from CM Mr. Naidu in June, 2018. They did an encore act by also winning the first prize in the hackathon organised by IIT Patna, a cash award of Rs. 25,000.

Innovation for Education & Employability leads to Innovation for Entrepreneurship

In FORGE, we guide and support innovators to undertake a rigorous process of problem validation and customer discovery, with the aid of iTOOLs — a set of tools and techniques to learn and apply the principles of design thinking to come up with compelling value propositions for their innovative technology enabled solutions. Ultimately the success of innovations as widely adopted products in the market depends on there being a market with a large number of customers willing to pay a price to purchase and use the product. To validate this potential, it is important for the innovator to rapidly design and develop a prototype that allows the customer to test and experience the value proposition and express the willingness to pay a certain price for the innovative solution. We call this the MUP — Minimum Usable Prototype, and we coach innovators to define the most effective MUP concept to rapidly test the target value proposition and assess the customer’s willingness-to-pay.

During their final semester in Feb’ 2018, they came to know about the Hardware Hackathon organised by FORGE as part of the Tamil Nadu Innovation Grand Challenge program sponsored by the Govt. of Tamil Nadu. They applied with the idea of designing a smart glove to aid in the limb recovery process of stroke patients post surgery, and thanks to their strong performance during the hackathon, they were offered a fully sponsored admission to the ProtoSem program, a 20-week curriculum integrated course to help student innovators learn and apply the tools of technology to design, develop and build prototypes for innovative solutions to real-world problems.

During the ProtoSem course — a comprehensive skills and competency development program offered as a pre-incubation program to create a pipeline of innovative tech startups for the incubation and investment programs of FORGE, Deepika and Krishna working under the guidance of medical doctors, tech experts and with the support if the in-house technical operations team of FORGE, were able to achieve rapid progress in converting their idea into their target MUP.

On the one hand they are moving forward with the design and development of 3D games, which seem the most effective in managing the complete range of hand movements necessary to achieve full motor recovery of the hands. The other track is identifying the right set of sensors and the design of their position in the glove to measure the set of bio-mechanical parameters in order to accurately monitor the progress of the recovery process. In the HWjunction, the suite of innovation labs covering Electronics, IoT, LoRaWAN, 3D FabLab, Drones, Robotics, Computing, and AR/VR domains, they are offered the necessary equipment, resources and services to fast-track their progress towards achieving manufacturing ready prototypes.

In the first version they made a fabric glove with flexi-force sensors and accelerometer sensors, to capture the motion of hand and wrist movements simulated using labVIEW tool, and they interfaced with a 1D game to test movements caused by playing the game. Now they are designing a 3D game developed on the Unity (VR) platform and have replaced the accelerometer with the IMU 9 axis sensor.

Overcoming Adoption Barriers, to fast-track Testing & Validation of Value Proposition

Why do most Product Innovations fail? Because they don’t get tested enough by the target customers (end-users). As a result the innovator doesn’t get a strong validation that the target customer is willing to pay a certain price for the set of benefits, gains or outcomes that the innovation claims to offer.

Why? In almost all cases its not the the features/functionality offered is not attractive enough for the target customer to give it a try but just the customer felt challenged to adopt the solution due to there being the dreaded Adoption Barriers.

“To us it was quite evident that to get even a few patient to try our gloves, play the games, and for us to monitor the bio-mechanical parameters, we need either the doctor or the therapist to be fully convinced before they recommend patients to try out the gloves. Unless the doctor or the therapist is able to assess the quality/reliability of the solution, we will end up with insufficient validation. To overcome this barrier, we were guided by Tech Operations Team in FORGE to design a 3D printed prosthetic arm that is able to simulate the exact same movements made wearing the glove for each finger (or parts of fingers), the palm or the wrist”, says Deepika summing up their intent to get a MUP in the hands of the patients as soon as possible and convince doctors, therapists and patients so that they feel confident about co-creating the innovation.

Innovation in Product + Business Model = DISRUPTION

“We heard Vish, CEO of FORGE talk about the concept of Device-as-a-Service as a business model innovation that is most necessary to make product innovations both affordable for the masses as well as commercially profitable. He spoke about how almost 90% of mobile connections in the country is on pre-paid model, which makes it more affordable and low-risk for the low-income consumers. He encouraged innovators to go away from the ‘purchase’ oriented approach of selling hardware products and to execute a ‘usage’ based model of selling device-as-a-platform, in which revenues can come from rentals, value-added-services delivered over the device, monetizing content or ads, and from derivative revenues from the aggregation and analysis of data”, say Deepika and Krishna, who believe that their pre-incubation experience in FORGE has given them the confidence as well as the roadmap to convert their product innovation into an enterprise. As a result they decided to pursue this as a startup right after after graduation in June 2018, and are now working towards raising funds through grants.