Option 1: Small-Business ERC Collaborative Opportunity for the Virtual Coach for Home-Based Therapy

Myomo, Burlington MA

Investigators

Abstract

Stroke occurs in 2.9% of the US adult population and there are nearly 800,000 new or recurring cases annually. Neuromuscular impairment is a common consequence, though one from which recovery is possible with appropriate therapy. Though most healthcare plans cover post-stroke therapy, insurance reimbursement caps typically limit it to a few weeks, despite a growing body of evidence that therapeutic gains are possible months and even years after a stroke. Adding the fact that patients generally prefer out-of-clinic care, there is a compelling case for delivery of physical therapy in the home setting. The new product that will result from this project will increase dosing of meaningful exercises that promote recovery and minimize co-morbidities such as pain, swelling, spasticity and (shoulder) subluxation. This project?s outputs respond to other trends in the US healthcare system, including the dwindling supply of qualified care providers, the movement toward evidence based medicine and the economic requirement for increased self-care. The ultimate goal of our Virtual Coach technology is to leverage scarce human-based care with computer based solutions at substantially lower cost. The self-adjusting goal-setting capability developed in the proposed research will enable professional therapists to extend their reach to patients. One significant challenge in computer-based coaching is devising algorithms that affect human behavior in an intended way. It is difficult to predict how people will react to commands, instructions, prompts and rewards. Some respond well to a nurturing "atta boy!" while others respond better to a drill sergeant?s "that?s not good enough!" Moreover, not only is there variability among people, but also within a particular individual from day-to-day. To be a viable, pervasive solution, Virtual Coaches will need to be responsive to the psychology of the people they serve. Pursuit of our objectives, especially the exploratory research objective, addresses this challenge in the context of motivating people to adhere to an exercise regimen. A second challenge is designing exercise software factoring in the heterogeneous presentation of individuals with neuromuscular impairments. Such patients have varying levels of motor control, cognitive ability and co-morbidities associated with their impairments. Off the shelf exercise packages do not account for their limitations. Our translational research objective is to overcome this challenge by leveraging research conducted on impaired patients and an already developed software architecture for coaching them through movements that promote long term recovery.