Taking the Guesswork out of Device Management in Neurorehabilitation with Rowan Armstrong, the CEO of Bioliberty

[00:00:00] Hey everyone, super excited that you're joining us for this thought leadership series, Tech Rx,

[00:00:08] your prescription for tomorrow's healthcare device challenges. We're diving into DevOps

[00:00:13] for devices, helping innovators at companies in healthcare have a guide to enterprise fleet

[00:00:20] transformation. I'm so excited to this step-by-step guide with these interviews that we're doing

[00:00:26] in partnership with Esper so you could transform your devices and fleet. For more resources on how

[00:00:33] you could do this and make it happen for your organization, go to outcomesrocket.health.esper.

[00:00:37] That's ESPER, Outcomes Rocket.Health.Esper. Hope you enjoy the series. Today I have the privilege

[00:00:49] of hosting Rowan Armstrong on this podcast. He is the CEO of Bio Liberty. Rowan has an incredible

[00:00:59] background in engineering, in entrepreneurship and is doing strong work in the area of stroke

[00:01:05] and robotics. I'm excited to host him as part of this series. Rowan, such a pleasure to have you

[00:01:10] here on the podcast today. Thanks for joining us. Rowan Armstrong

[00:01:13] Pleasure to be here. Saul, thanks for the introduction.

[00:01:17] Absolutely. Look, you've done super interesting things, including funding your way through college

[00:01:22] with photography business. Now, you're doing such incredible things with your company,

[00:01:27] Bio Liberty. Tell us about yourself and tell us about Bio Liberty.

[00:01:32] Of course, to start off from the beginning, I was born and raised in Ireland. Then I moved

[00:01:38] over to Scotland to study, which is actually where I met my good friend and co-founder,

[00:01:45] Ross O'Hanlon, who supported me with that photography career and is not supporting me with

[00:01:51] this stroke rehabilitation technology career that I find myself in now. The story of Bio Liberty

[00:01:57] actually kicked off in the first COVID-19 lockdown when Ross gave me a phone call.

[00:02:03] We started talking about his current situation at home and unfortunately Ross's auntie has MS

[00:02:11] and it's reached a stage where it was severely impacting her ability to complete day-to-day tasks.

[00:02:17] And that's where Ross pitched his idea of creating technology, which empowers people to move again

[00:02:25] using soft robots. And with not a lot else to do during COVID-19 lockdowns, I'm sure everyone

[00:02:32] can relate to that. We started building these rough and ready prototypes,

[00:02:37] mailing to them each other remotely. And the aim of these prototypes was to encourage movement.

[00:02:44] And it was in those early days actually talking to patients that we found this huge problem

[00:02:49] that we could start with solving. And that problem was that neuro rehabilitation doses

[00:02:55] are typically too low and they're often delivered too late to allow maximum recovery

[00:03:02] potential. So three years later, we're here now and with support from an amazing network of patients

[00:03:09] and leading clinicians and our fantastic team, we're getting ready to launch LifeGlove,

[00:03:15] which is what we call our soft robotic glove and our virtual therapy environment. And as you said,

[00:03:21] we're now focused on upper limb rehabilitation for stroke patients.

[00:03:25] That's brilliant. I really appreciate you sharing the background, your inspiration to

[00:03:30] healthcare, which sounds like it was your partner, Ross's aunt and this need. It's a big need that

[00:03:37] people need to act faster if they're going to have the proper rehabilitation.

[00:03:43] How is what you guys do different than what's available today? And is there anything like

[00:03:48] this available in the market today? That's a good question. And there's

[00:03:54] lots of neuro rehabilitation technology available on the market and that includes robotic solutions.

[00:04:02] And we had to work really closely with providers and thought leaders in this space

[00:04:09] to find a few reasons why a lot of this technology does sit in cupboards and doesn't get used

[00:04:16] anywhere near enough. We kept walking into these clinics and seeing all this

[00:04:21] amazing technology that's like 10 years of development behind it just sitting locked away

[00:04:27] and we were really just trying to figure out why. And it really is a lack of focus for that

[00:04:33] technology and the integration of it into clinical workflows. So that's where we put

[00:04:39] all our resource. And when it comes to stroke rehabilitation, the technology needs to get

[00:04:44] so seamlessly into their day to day operations in order to really deliver a higher rehabilitation

[00:04:51] dose at that earlier stage. And what does that actually mean when it comes to product development?

[00:04:58] The first thing that we looked at was a really seamless process of using the glove,

[00:05:03] taking it all and off, dawning and dawping is what we call it behind closed doors. And

[00:05:09] the second one is for the virtual therapy environment, it needs to be extremely intuitive to use.

[00:05:16] This includes setting up a therapy program for a patient, exporting reports for those to be used

[00:05:21] to show progress for reimbursement purposes, whatever that looks like, it needs to be

[00:05:27] really integrated I think in their operability as a huge topic right now within healthcare.

[00:05:33] And that's something we've really seen. If they require to hire two extra staff members

[00:05:40] in order to use technology, that's just not going to happen, especially when you're trying

[00:05:44] to paint a picture where this technology is going to reduce costs. And that's, yeah,

[00:05:50] that's just not going to work. So I think that's where we do fundamentally differ in

[00:05:55] our attitude towards other players. Love that. Thank you for that, Rowan. Sounds like

[00:06:01] you guys are obsessed with the user experience and also the workflows, which is oftentimes where a

[00:06:09] lot of technologies fall off or sit on the shelf, collect us, become door stops.

[00:06:14] And many occasions your glove is innovative and these types of technologies don't happen

[00:06:20] by themselves. Partnerships are a key thing. Have you had any exciting partnerships develop

[00:06:26] in your journey so far? Absolutely loads. It's hard to think to pull out a few,

[00:06:34] but at this point we're very proud to have engaged with over, I'd say over half of the top 30 stroke

[00:06:40] rehabilitation clinics in the US. Those relationships come in lots of different flavors.

[00:06:45] Some of these clinics have become early adopters, research partners for clinical

[00:06:51] validation studies that are currently ongoing. Even just clinics who've offered us feedback and

[00:06:56] support in developing our product, if we find a provider that's willing to give us some really

[00:07:02] tough feedback and really get stuck into the technology in a productive way that we always

[00:07:09] try to stay in touch with them when we walk in and people say, oh yeah, this is nice. This is

[00:07:14] really good. That's not what we're looking for at this stage because we do have the tools to

[00:07:19] make this even better. So that's what those partnerships with providers might look like.

[00:07:23] When it comes to partnerships for deploying the technology, I think well Esper is a really good

[00:07:29] example there of a company that has been great to partner with because we specialize in providing

[00:07:35] the next generation of neuro rehabilitation technology to clinics when it comes to things

[00:07:41] like device fleet management and other elements like that. There are companies out there who've

[00:07:47] really nailed it and we can rely on them to tick that box for us and then we can stick to the thing

[00:07:55] that we're really good at in the neuro rehabilitation front. And then with this type of product, an

[00:08:01] exoskeleton robotic glove which can affect grip strength. We've also had some wacky conversations

[00:08:08] with people trying to combat hand fatigue. I'll never forget when the providers of beef

[00:08:14] for McDonald's approached us and asked for a version of their glove for their workers who have

[00:08:19] to chop up so much beef that their hands were getting really tired. And from a company vision

[00:08:26] perspective, it was unexpected. Those conversations happen all the time but it's that type of

[00:08:34] technology where people hear about it and they think oh you could use it to do that. You could

[00:08:38] use it for my tennis. In fact, Princess Anne wanted to use it for her horse fighting when we spoke

[00:08:45] to her and that wasn't the in terms of a beachhead market. I'm not sure if Princess Anne is that

[00:08:51] but yeah. I'd say pretty cool though. And so I remember it was like eight, nine years ago

[00:09:00] we started hearing the beginnings of exoskeletons. It's a very innovative technology that I

[00:09:06] think it's time has come. Your innovative product here uses robotics. Could you share more about

[00:09:14] how it works? Of course, yeah. So when we were designing Life Glove and the virtual therapy environment

[00:09:21] the first protocol for us was trying to cover as much of the rehabilitation continuum as possible.

[00:09:28] Rehabilitation continuum being the journey from day one through to full recovery hopefully.

[00:09:35] And what I mean by that is the therapies that we've integrated into the technology

[00:09:41] are tailored the stage and specific needs for the patient. And this helps me describe how

[00:09:47] the technology works because I can take out one of our therapy modes which is our active therapy

[00:09:52] mode. That can support patients at a very early stage of rehabilitation for moderate to severe

[00:09:59] strokes. Essentially what happened is a patient will be wearing the glove and it will sense

[00:10:04] a very small movement from the patient and then it will complete that movement for them.

[00:10:10] And we call that early stage mobilization and that process can help avoid the development of tone

[00:10:17] and specificity by opening up the hand fully and completing their passive range of motion.

[00:10:24] And the clever part is that the algorithms we've developed track all of this. The robot can tell

[00:10:31] how much assistance the assistance it had to provide to complete the movement and compare that

[00:10:36] to the level of input from the patient. And this paints a really nice picture of how patients

[00:10:44] are progressing in their rehab journey which is good for motivation. We've seen patients look at

[00:10:49] these graphs whether it's maybe slightly platoeing or maybe it's exponential and it's

[00:10:54] growing really quickly and that could be a big motivating factor. And it can also help

[00:10:58] clinicians make really good decisions around the next steps of therapy.

[00:11:03] And so that's just the last thing around how you talked about exoskeletons and I think when we

[00:11:08] say the word exoskeleton we think like stiff, hard, plastic, metal based. And I think that's

[00:11:17] maybe you've seen like Terminator for example. That's how we picture traditional robots.

[00:11:23] But one thing that we noticed in the early days was that the human body is made of soft

[00:11:27] tissue and why don't we make our robots soft too? And that's why all our robots are textile based,

[00:11:35] air driven, all pneumatic which makes them much more compliant with the human body.

[00:11:41] And it makes a lot less intimidating I think if you were to compare Terminator to Big Hero 6

[00:11:46] I don't know if you've seen Big Hero 6. Yeah, I have. I got a seven year old.

[00:11:51] Of course. Great movie, by the way. But it actually depicts soft robots really well compared to

[00:12:00] traditional ones and we've seen that similar attitude in clinics where a patient is presented with

[00:12:05] a soft robot versus a traditional one. And yeah, that's one of the big priorities for us is to

[00:12:11] make it more comfortable. That's fantastic. Yeah, Baymax is fantastic.

[00:12:17] And for those of you that haven't seen the movie he is the fluffy nursing robot that Rowan

[00:12:24] referred to and I think it's a great parallel. And speaking about how users interact with the

[00:12:29] device, tell us a little bit about it. Do they just put it on or how does that work?

[00:12:33] That is a good question because I think some of the assumptions in the beginning were yes,

[00:12:38] someone would just put it on but the process of putting on has become a huge priority for us

[00:12:45] and that's due to tone and specificity because even putting on a basic glove is a huge challenge for

[00:12:52] stroke patients. We've really had to think outside the box so that the glove can be assembled around

[00:12:57] the hand easily so that we don't eat into the already limited therapy time that clinicians have with

[00:13:03] patients and we see this sort of high tone high specificity where the muscles are contracted

[00:13:08] and pulling the fingers in pulling the wrist in and and that makes for quite a difficult

[00:13:14] starting position for assembling that glove. So that has been a huge design challenge for us.

[00:13:20] Now in terms of how the user interacts with it, one thing I haven't mentioned yet is

[00:13:24] Life Hub which is a pretty key component to our solution and it's a box that sits in front

[00:13:29] of the patient with a screen on it and allows the patient to engage with games and other

[00:13:34] interactive experiences to make everything more engaging so Life Hub can sit in front

[00:13:41] of the patient and allow clinicians to have potentially multiple patients carrying out therapy

[00:13:46] at the same time so you're starting to increase the efficiency of these flows within clinics.

[00:13:51] And then one of our other therapy modes is actually giving clinicians complete control over

[00:13:55] the glove so Life Hub now faces them and they can control the opening and closing of the glove

[00:14:01] so that the patient can complete functional tasks in the industry known as EDLs which are

[00:14:07] activities of daily living and those are so key to getting patients back to independent living.

[00:14:13] They're trying to simulate these day-to-day tasks that they'd be completing in the home for example.

[00:14:20] Yeah that's really great. No thanks for sharing that with us and really when you think about

[00:14:24] the data side there's a lot of interesting ways that devices can do processing on site versus

[00:14:30] the cloud. Can you share a little bit more about what you're doing here?

[00:14:34] Of course yeah so we actually do a mix of the two. A lot of our algorithms are embedded locally on

[00:14:41] the device and that means we can give that real-time feedback to the patient and the clinician whilst

[00:14:47] the therapy is going on but then we send all this process data to the cloud and this is where we can

[00:14:53] start summarizing it into reports and maybe even start looking for trends in that data

[00:15:01] and that's why I think it's really important to have a really neat and tidy cloud infrastructure.

[00:15:07] If we ever want to do some predictive analysis therapy recommendations in the future

[00:15:12] we need to make sure the data has been stored securely and then an anonymized manner

[00:15:20] and then we can start thinking big about how that data can be used and I've seen just on

[00:15:26] the topic of the cloud infrastructure when it comes to building a portal that's driven off that

[00:15:31] data and those insights. We've seen so many clinician portals from companies and it's

[00:15:38] actually gotten to a point where we mentioned the word clinician portal and the clinician looks

[00:15:43] startled and feared at the thought of having to remember another login and that's where the

[00:15:50] whole integration and interoperability is key when it comes to these sorts of platforms and

[00:15:56] giving people access to everything that you have within your cloud infrastructure but in a way that

[00:16:02] doesn't mean that they have to remember another password and have another step in their workflows.

[00:16:08] Yeah for sure that's a great call and back to the obsession on the experience of the

[00:16:12] clinician and the patient right being super or super keen on making that smooth as vital.

[00:16:18] We're talking devices we're talking software both of them integrated deployments in the hospital

[00:16:26] possibly in the home. How do you see devices playing a role in your future roadmap and how

[00:16:31] are you thinking about your device strategy because this could get complicated.

[00:16:36] Yeah it absolutely could and it does it does I said there's only so much I can reveal here

[00:16:42] I'd not future roadmap but it's safe to say that life hub and life glove are only a starting point

[00:16:49] in our roadmap. The cool thing about soft robotics is that when they get larger they

[00:16:56] generate larger levels of force and what that means for us is that the technology lands itself

[00:17:02] while being skilled up to other parts of the body and as I mentioned before we want to cover

[00:17:08] as much of that rehabilitation continuum as possible so integrating as much of the human

[00:17:14] body as possible makes complete sense and then when it comes to life hub in the virtual therapy

[00:17:19] environment we're currently focused on inpatient and outpatient settings but this is very much a

[00:17:25] stepping stone towards moving our technology into the home. We hear a lot of conversation about

[00:17:31] hospitals at home based care it's been a huge talking point over the last few years and I

[00:17:37] suppose our goal is to generate enough evidence in that clinical setting to justify the deployment

[00:17:43] of our technology in the home setting and we want to get the backing of providers insurers and all

[00:17:49] the other stakeholders before we make that move and you can imagine how the number of devices

[00:17:56] and it would be deployed in that situation where we actually managed to send it home with

[00:18:01] patients every stroke patient so they can continue that rehabilitation continuum into the home

[00:18:07] and I do love a bit of blue sky thinking and for our devices for our technology I think that physical

[00:18:14] therapy is only really one part of the puzzle and if you're thinking about making a full recovery

[00:18:20] post-stroke clinicians have to consider cognitive therapy speech therapy and so many other elements

[00:18:27] of recovery and our goal as a company is to support those clinicians as much as we can to

[00:18:33] increase that rehabilitation dose much earlier and I think we can't really ignore those other

[00:18:39] elements of therapy forever and then we have to build all these other elements into our future

[00:18:45] roadmap. That's great now thank you for that Rowan and there are a lot of listeners here

[00:18:51] also developing technologies solutions looking for ways to scale any any ideas that you'd like

[00:18:57] to share on thinking about that device strategy best way to go about it. Oh I think big to start with

[00:19:05] and then bring it back to the clinicians the customers the really the people who have helped

[00:19:13] you so far in identifying that first product you'd be so surprised when you ask someone to just

[00:19:20] draw out their dream device for their dream platform and after all their experiences

[00:19:26] within an occupational therapist for example and we've actually got into rehabilitation clinics before

[00:19:33] and asked a junior clinician to do this and some of the ideas that they come up with are amazing

[00:19:40] absolutely amazing because those are the people that are doing it like we're not in that stroke

[00:19:44] rehabilitation clinic every day and it's so important and yeah although you get some

[00:19:50] yk ideas there as well yeah I'm sure but no that's what I'd recommend yeah some great recommendations

[00:19:58] there Rowan thank you look phenomenal tech love everything that you've shared from the

[00:20:04] inspiration to why you guys are doing this the partnerships and the nuances around workflow

[00:20:11] is there anything else you'd like to share here before we conclude not much so just thank you

[00:20:16] very much for having me and anyone who wants to reach out any of those innovators that you're talking

[00:20:22] about any providers who want to have a conversation or anyone who's interested please reach out on our

[00:20:28] website and yeah thank you very much for the great questions it's been an absolute pleasure

[00:20:33] it's a pleasure to have you here Rowan and for everybody listening thanks for jumping in again

[00:20:38] on this series tech rsx there's so many challenges that you could be faced with as you look to evolve

[00:20:47] healthcare for all of us think about the recommendations Rowan left us with and stay

[00:20:52] tuned for the rest of our series you're going to have a blast learning and listening Rowan thanks

[00:20:58] again thank you