Find out how FlintRehab became the number one global leader in gamified neuro rehab devices as our host Dr. Mary Goldberg talks to Drs. Dan Zondervan (VP) and Dr. David Reikensmeyer (Clinical Advisor) of FlintRehab. Listen to how they leveraged resources from academia and small business to attract funding, what products they have developed and what the data they have obtained is suggesting about the thresholds of practicing movement after stroke.
Host: Dr. Mary Goldberg, Co-Director of the IMPACT Center at the University of Pittsburgh
Guests: Dr. Dan Zondervan (VP) and Dr. David Reikensmeyer (Clinical Advisor) of FlintRehab
FlintRehab | Website, Facebook, YouTube, Twitter
Products | FitMi, MusicGlove,
IMPACT Center | Website, Facebook, LinkedIn, Twitter
Full Episode Transcript | PDF
Timestamps:
1:22 FlintRehab's Backstory.
7:56 SBIR Funding Mechanism got them started.
8:39 Their Products.
10:09 What the data is suggesting.
14:53 Why neuro-rehabilitation.
16:37 Straddling the university and small business role.
20:51 Wearing many hats.
SPEAKERS
Mary Goldberg, Dan Zondervan, Dave Reinkensmeyer
Mary Goldberg 00:05
The IMPACT Center at the University of Pittsburgh supported by the National Institute of Disability, Independent Living, and Rehabilitation Research proudly present ImpacTech. Today's episode is Tools to Spark Recovery with our guests, doctors, Dan Zondervan, and David Reinkensmeyer, CEO and Clinical Advisor of FlintRehab, the number one global leader in gamified neuro rehab devices. Recorded remotely from my soundproof bedroom closet in Pittsburgh, PA, this is your host, Dr. Mary Goldberg, and welcome to our seventh episode of the ImpacTech podcast series. We are so excited to have you Dan and Dave, could you please introduce yourselves?
Dan Zondervan 00:56
Sure. I'm Dan Zondervan. I'm the CEO and co founder of FlintRehab. We're a company that makes consumer stroke technology. So devices to help people with stroke or spinalcord injury, do exercises at home.
Mary Goldberg 01:07
Thanks, Dan. How about you, Dave?
Dave Reinkensmeyer 01:09
Yeah, I'm Dave Reinkensmeyer. I'm a professor of mechanical and aerospace engineering and also of anatomy and neurobiology at University of California, Irvine, and I'm a co founder of Flint as well.
Mary Goldberg 01:22
Just based on your introductions, I can tell how your skill sets may complement each other. And I'm so excited to learn about the backstory of FlintRehab and how your team came together. Would you like to start Dave?
Dave Reinkensmeyer 01:36
Sure, yeah. I've been a professor at UC Irvine for about 20 years. And we've been building robotic devices and sensor based technologies to try to help and stroke rehabilitation focused on mainly the upper extremity. And I had two awesome grad students, Dan Zondervan here. And then Nizan Friedman, and they were both working on their PhDs. So we developed a couple of devices. One of them is a glove that can be used for training finger dexterity. It's called MusicGlove. And this was developed as part of a research project an NIH grant to test a scientific hypothesis about what would be the optimal way to train your hand movement. And so this is Nizan's project. And we tried to gamify, the movement training. And he had the idea of like, hey, let's use one of the really popular video game we liked, we were making our own video game. So I like to say, there were like a two on a scale of 10. But he said, Let's, let's use a popular game. So we use Guitar Hero, which is like the third most popular video game. And so he worked really hard to have like, whole drawers full of gloves that he sewed with sensors into them and things like that. And we did our scientific study. But we found that the users both people with stroke that were using it, and also the rehabilitation therapists, they really loved it and saw a lot of potential on it, like, Hey, can I can I keep using this. And so I think that was really the impetus is, hey, let's let's start a company to see if we could commercialize this, and there's kind of a pull for it. Let's see, how would we get it out? So that more people can actually use it.
Mary Goldberg 03:15
So Dan, what were your plans at the time? And and what made you decide to join forces or jump on the ship?
Dan Zondervan 03:23
Sure. So it was kind of an interesting journey that that led me here. So I remember when I was first made the decision that I wanted to go to grad school, you know, I was scouring the internet looking at different programs. And I saw these awesome videos from Dave's lab of these really cool rehab robots that were you know, helping people walk and move their ankles, and it looked, you know, very high tech and, you know, robotic and I was very interested in that so I reached out I was able to connect and started at UCI and I get there, and all of a sudden he's like, Oh yeah, we're not gonna do that stuff anymore. We're gonna try and focus on lower tech things that we could scale things that people could use at home. And so really, the was kind of thrown early on. So across the lab, a lot of the work was was more on this at home type of rehab stuff. So it wasn't exactly what I expected to go into. But it ended up being very interesting, because as he mentioned, once we started getting these devices in the patient's hands, it was something that they respond to very, very strongly. And we could see that it was something that could scale out in a in a business. And so a nice thing about the lab was very collaborative, as Dave mentioned the MusicGlove was was Nizan's project. But he and I have worked on some of the projects together a lot of my, my background was more on the software side of things, right. So he was making all the gloves and then he needed to hook it up into basically an open source version of Guitar Hero. And so he you know, just asked me on the side, if I could spend some time connecting the two together so that they could use it. It felt very organic and just kind of a simple side project at the time. But then anytime an update needed to happen to the software, we just kind of would keep working on it together. And so it just ended up becoming very organic as it was obvious that people liked the product that, you know, we had been working on it together to just say, alright, well, let's just take this to the next level, and try and start a company and actually spin this out. And kind of, we didn't see all the steps, but we could see enough of how this was a product that could actually be sold in scale. And in our environment.
Mary Goldberg 05:19
Did you envision yourself in a industry role versus traditional academic role? Or was it more the impact that you saw that the MusicGlove could have on the end users that drove you to make that decision?
Dan Zondervan 05:34
Yeah, I think it was, it was more of the opportunity. I don't know. I think if Nizan was here, he would definitely say he envisioned himself going into the industry role. But for me, it was more the opportunity presented itself, it seems an interesting and helpful problem to address. And, you know, the door open towards the industry through is actually we were able to secure an NIH SBIR grant early on. And I was actually while I was still working on my PhD. So by time, it got to the point where I had to decide what was next we had funding to take this and turn it into a company. So yeah.
Mary Goldberg 06:07
And so this was your dissertation project?
Dan Zondervan 06:10
It was actually it was not No, my dissertation project, it was for a device that hooks onto a wheelchair to basically converts a wheelchair into an exercise device for individuals early after stroke. And it's funny, because if you go back and look at our early pitch decks for FlintRehab, we had kind of put both products, you know, together that we are going to have this music product and the we had we call it Ray at the time. And it just didn't quite come together in the way that music club did. We also didn't get funding for it quite as quickly. But we eventually did. And the funny thing now is that that product, you know, MusicGlent out it was a success pretty pretty quickly on. And the other product is just kind of stayed sort of in the lab in the company trying to work on it. And I think it's finally going to come out that as a new product called Boost, which which we could fill a whole nother conversation about, it's a really exciting product took a while for it to kind of come into its own, so to speak.
Mary Goldberg 07:05
So the fruits of your labor anyhow, are paying off. Yeah, hopefully. And so in what year was the company found?
Dan Zondervan 07:14
We founded it in 2011. And actually in quite a hurry, because so Dave had identified and I'm not even sure Dave where you had come across the SBIR program. I don't know if you've worked on it before. But Nizan and I had kind of come to him saying that we wanted to start a company. And he mentioned the SBIR mechanism as a way to go out and get some funding to do the initial technology transfer. And so we started looking at I think the due date was December five, and it was October five, we had two months to come up with a company form a company, you may have to go through all these different registrations and everything to apply. And so yeah, in a weekend, we just kind of got our all our stuff together and formed the company.
Mary Goldberg 07:56
And the fair information for our listeners, this small business innovative research program is offered by the majority, if not all of the federal agencies. You pursued the NIH mechanism. The SBIR program has two levels a phase one and phase a two. Did you pursue both of those levels in the formation of Flint rehab?
Dan Zondervan 08:20
We started with the phase one, we did two, so that that first admission, we did a phase one submission for the MusicGlove and a phase one for the Ray project. And I think we ended up getting the MusicGlove and then we actually got another set through the Department of Education. Yeah, we kind of cast a wide net early on.
Mary Goldberg 08:39
Great. And so at this time, how many commercially available products does FlintRehab have? And do you offer any additional services? Or is it just those products?
Dan Zondervan 08:49
So yeah, our two flagship products are the Music,Glove. And then we have another product that came out in 2016, I believe, which is the FitMi. It's the same concept. It's about sensing movement, and and hooking that up with software to motivate and monitor exercise. But whereas with MusicGlove, it's really about fine motor. So you're doing exercises, really just touching your thumb to the your fingertips, for me uses these two pucks that have accelerometers and other sensors inside of it so that you can do like a bicep curl. You can hold it to your chest and do a crunch. You can put it on the ground and you can step on it. So it really opens up exercises for the full body. And then we have a kind of a virtual gym software application that connects into.
Mary Goldberg 09:30
Great and how many sales has FlintRehab had and are there any other interesting statistics that you would like to share with the audience?
Dan Zondervan 09:38
Sure, yeah. So we've sold about 10,000 of our at home stroke rehab products. Yeah. And a really cool stat is that we've been collecting de identified data from the people that use these devices. So you know, we just get to know what exercise they do and how much did they do but we don't know who did it. But we've been able to add all that up and I think we are now over 100 million repetitions of exercise performed with with our products, which is a little overwhelming to think about sometimes, but, but a pretty cool number.
Mary Goldberg 10:09
So what is that data suggesting to you? What have you learned from it? And has that then resulted in any product enhancements or future plans?
Dan Zondervan 10:18
Yeah, I'll let Dave start on this one. Because as you're just been doing a lot of looking at the data in recent months.
Mary Goldberg 10:24
So interesting. Yeah, please go ahead, Dave.
Dave Reinkensmeyer 10:26
Yeah, so there was this large data set. And so we don't know anything about the people using it except sort of the usage patterns from the device. And so we looked at that to test three different ideas about what might encourage people to practice a lot, because one thing we know, is, after a stroke, he did a practice a lot. Most people aren't getting enough movement, practice, and some of the data says that the relationship between your amount of practice and the amount that you benefit from kind of looks like a hockey stick kind of thing. So you can practice, practice, practice, you're not going to get much benefit until you get up to a threshold. And then after that, it goes up like the shaft of the hockey stick and starts starts ramping up. So you really have to get above a threshold. So what we find is that people who are, this is for FitMi, that we're looking at right now. But people have like a wide variety of amount of practice, some people are doing tons of practice, a lot of people don't do that much practice. And so one thing we looked at is your experience of success and the gaming aspect. So the FitMi pucks are connected to a game, it asks you to exercise fairly intensely, as you know, as music is playing, and you have to get up to a certain number of reps in order to them level up and you get more exercises unlocked. And you go up the higher challenge levels. So we looked at the first week of practice. And we said, you know, let's look at success on whether or not you've leveled up in that first week. And what we found is that there's an optimal success point. So people who have low success, they seem to get frustrated, and they don't practice as much, ultimately over a two month period. And you might expect that, but then the kind of surprising thing is people who had 100%, success really fell off too. They didn't, they didn't do very much, either. So the optimal success was about 80, or 90%. And to your question about them using this to improve the system, so the Danny, as we're working on this, this research project together, he's able to look at that and say, it looks like we've made our game a bit too aggressively challenging. So we're going to back off of that a little bit. And so they did, made another software release about probably, what, six or eight months ago. And so now what's really cool is we can get data from that and then compare it to see if that change kind of helped people to practice more and more.
Mary Goldberg 12:48
What do you think it is that makes people want to engage or want to practice is this also a data driven decision that you have made?
Dave Reinkensmeyer 12:58
We just have the Olympics, right? And people watch that and you watch all those are same DNA structure as me, you know, look at the possibility of the human nervous system and the human body. So I think that desire to exercise and get better, and you've had people with a stroke have had a traumatic neural event. And they know, if I work hard, I can improve. Almost everyone who has a stroke improves. And unfortunately, right now, there's like a huge variability in the amount of improvement that people see. So the science is really about trying to understand that variability. Some people will go and fully recover, or some people will kind of get recovered a little and get stuck. We know that the amount of practice really matters. So and that's conveyed by therapists and rehab is kind of common sense as well. So I think that's ultimately I think that's what's driving Flint products, I think is it's the first company that did a consumer priced consumer style, high tech stroke rehabilitation product, if not the first one of the first. So people have a stroke that they're in the hospital for a week to three weeks and then might get some inpatient rehab might might just go home, I might go to a skilled nursing facility. But eventually, you know, the therapy, the reimbursed therapy is going to run out. And what you see is just a lot of people who would like to continue getting better and want tools to keep that motivating. monitor your progress. I think what the MusicGlove demo was, I think, in the first year when we launched that, you know, a lot of people are calling the company, only about one out of six people had enough hand dexterity. That was really the impetus for the FitMi pucks which I'm holding it up now a little blue puck. So this can have much more diversity of exercises, as Dan was saying, and then the pricing at a level that people can buy it out of pocket. In some cases can't get reimbursed for insurance, but it's affordable enough that people can just buy it and then figure out a whole how do you then let people know all over the country in the world that this thing is available and that they could buy it out of pocket?
Mary Goldberg 14:53
Thanks so much. It seems like both the pricing model but also this strive to get better is why people engage would need products in this area, but it seems fairly common across different areas of rehabilitation. So I'm curious and interested, if you could please talk a little bit more about why neuro rehabilitation, why did you decide to research it? Why did you decide to develop products in this domain? So a little bit, perhaps about the importance of it, but maybe also some challenges that are specific to this area?
Dave Reinkensmeyer 15:23
Well, I guess I'll start on then, Dan you can jump into. On the personal side, it was when I was I was interested in robotics and neuroscience. And when I was in grad school, I had a friend who had cerebral palsy, and was exploring using robots to do like assistive tasks like eating or cooking or things like that, and kind of stumbled on this, there's a lot of science going on, at the time that the brain is more plastic than we thought there were not very many technological tools to help in that. So that's how I got into the robotics part of it. And then, you know, as far as the need, it's amazing, about one in four people around the world are gonna have a stroke in their lifetime. It's a huge group of people. So it's about 80 million people per year around the world, and the estimated cost of rehab services, about 9 billion each year in the US, there's a huge need. And you have these kind of two forces colliding with each other where the science and the neuroscience was saying, hey, wait, your brain is way more plastic than we thought all not just the brain, the spinal cord, all aspects of your nervous system. And at the same time, the health healthcare system was saying, we got to limit the amount of therapy people can you know, amount of time that you get for therapy, and we'll put some constraints on that. So yeah, these two kind of forces battling so technology is one possible way to help address that.
Mary Goldberg 16:37
And did you feel that in terms of your role of straddling the university and the small business role, that the small business was necessary to get the products out? Where were you limited in the university environment in doing so?
Dave Reinkensmeyer 16:54
Yeah, I realized pretty early on in my career, you know, you can do research, and you can have an impact that way. But if you find something that's actually useful for people, then commercialization is how it gets out to a lot of people. Like if you really want something to be used by people, you got to find that commercialization route. And it's interesting in academia, sometimes there can be a little bit like condescending or looking down at that sometimes it depends on it, I think it's changed recently. But you definitely will hear that, like, it's not pure science, or pure research, or whatever, I don't view that way. I think it's, it's the way that you know, again, if you have something useful, the only way it's going to get out to many, many people is the commercialization. And that means that there's got to be a company that's putting in the work to get it done. And those people have to be able to feed the families making a living. And so that's the way that it gets set up. And my university University of California, Irvine has been very supportive of it, the whole process really has had a focus, especially I would say, in the last 10 years or so to promote entrepreneurs. And it just been so forced out to work with Dan and Nizan, who were not only really great engineers, but red had a really great entrepreneurial kind of spirit and, and work ethic and able to wear many hats.
Dan Zondervan 18:06
Yeah, and from my perspective, it's actually almost the opposite, I would say that, it's hard for me to imagine FlintRehab being successful had it not started in a university environment, simply because that that gave us one, you know, a sense of security, it was, we had a lot of time to do it. We had funding through a research grant, we had the resources of the university, a lot of help, you know, both through Dave and other professors that were advising us. But you know, there's also entrepreneurial networking groups and different things like that. And it basically gave us a, I guess, a safe environment, to iterate and really find the right product market fit. As Dave mentioned, there, there was clearly a need. But it wasn't clear what the market solution to that need was. We knew that that people needed to be doing more exercise, but people that have had a stroke also are often not working or on limited incomes. And so if if there's not an insurance mechanism that's going to pay for them to do this, can we actually have a consumer model that works and can we have a product, if somebody is going to just buy this, to take it home and use it, it has to be super easy to use, they have to be able to not talk to a therapist, it shows up on their on their door and with a motor impairment and take it out of the box and you know, interact with it and use it. And so the amount of human interface design that had to go into it was was quite alot. You might not think if you look at the final product, since it looks simple, but a lot of that was actually driven by user feedback, where we were pulling features out and simplifying things, making it easier and easier to use. And we were able to do that because we were in a university environment where we would have people come in for clinical studies, use the product right in front of us and get their feedback right away and then we could take the time to iterate on it. Whereas I think if we were out and you know, had venture capital money, and they were saying you need to release a product next week. We want to just put something out. And people, you know, might have been overly complicated, and it might not have had the success that we ended up having.
Mary Goldberg 20:08
So you've really been able to leverage the resources, the best of both worlds attract funding. But I can also imagine with all of the different aspects of the product development, the resources within the university system that allow you to bounce ideas and validate ideas off of others, instead of having to go down a consultant route would also be really cost effective.
Dan Zondervan 20:31
Yeah, definitely. Yeah, it was, it was very, you know, we weren't in the garage. We were in a research lab, but I had that same kind of spirit where it would just be somebody would come by and help you with something and bounce ideas off different things like that. So
Mary Goldberg 20:43
Yeah, Steve Jobs on a larger scale at the University.
Dan Zondervan 20:49
The didn't drop out, right.
Mary Goldberg 20:51
Right. Right. Exactly. And so, Dave, it seems certainly mutually beneficial for the company and for your career within UCI, but I'm curious for you, in particular, what it's like for you personally, to wear these different hats, I'd guess sometimes, simultaneously. You must have a very busy schedule.
Dave Reinkensmeyer 21:12
Yeah. Yeah. Running in a lot of different directions. No, it's been a great, great experience. I've been involved in several commercialization attempts in the past, like, several of them didn't work out, one of them worked out, which is the ArmeoSpring is an exoskeleton that came from our lab that a Swiss company license that's in about 1000 hospitals now that this was a different model. And yeah, it's been really fun. I mean, I just have to say, again, that it really wouldn't be possible except for for Dan and Nizan and, and just the type of people that they are and the skill and the enthusiasm that they've had. And again, willingness to learn all aspects of business. So you know, I've been able to play more of an advisor role. It's been great, because we've been able to get other SBIR grants, and those are research grants. So we have great conversations about like, what what hypothesis are we testing, you know, when we're when we're putting this grant and, and it's been a way to fund my lab and do some really interesting science. I'll mention too, it's because it's interesting, you know, I've got a one aspect of as to as I get to manage the conflict of interest, part of it. So the university has set up an office and there's a committee and basically, the idea is that I need to disclose all my financial interest, and then have a plan of management. So that sort of, if we're doing, say, a clinical trial, we always have like someone else involved in the safety management, or in doing analysis of the data or final check on everything. So you just want to set it up. So you've had safeguards so that the conflict wouldn't cause you to do things that are inappropriate way. So that's been great, too, because it's pulled more people into the research. You know, Dr. Steve Kramer's been involved a lot with us and Dr. Rondo and we have Vicki Chan's are a research physical therapist, he has done amazing work with us. So it adds a level of another level of paperwork and sort of checks and safeguards, but in a way it's been, it's been fine as well. And even positive. So
Mary Goldberg 23:21
I can definitely see how several of those skills would be transferable because in academia, you already know and have to frequently bridge these collaborations across disciplines. You also have to execute, I think, a lot of entrepreneurial behaviors to have a career with some longevity in academia. So you've you've been able to do that fabulously well. And I've really enjoyed this conversation. Can one of you please provide the website for our listeners to learn more about FlintRehab?
Dan Zondervan 23:56
Sure. That's Flintrehab.com. That's as in Frank Li n T. rehab, com. There's a contact us there's a newsletter you can sign up for. And yeah, a lot of information there.
Mary Goldberg 24:08
All right, perfect. So to our listeners, please join us next time as we continue our conversation with Dan and David will delve into their clinical trials dealing with the FDA and the approaches they took for the various products to get them to market. Thank you and we'll see you next time. If you like ImpacTech, please review us on Apple podcasts or wherever you listen to podcasts. Thank you again for tuning in and continue to make an impact in whatever you do. A quick note from our sponsors. IMPACT initiatives are being developed under a grant from the National Institute on Disability independent living and rehabilitation research. NIDILRR is a center within the Administration for Community Living Department of Health and Human Services. IMPACT initiatives do not necessarily represent the policy of NIDILRR, ACL or HHS and you should not assume endorsement by the federal government and the same goes for the University of Pittsburgh. We would like to thank our ImpacTech guests and our production team led by Dr. Michelle Zorrilla at the University of Pittsburgh Department of Rehabilitation Science and Technology.