Remote Monitoring of Rehabilitation after Total Knee Replacement:

The StepRite System

Carolee Winstein, Christopher Powers, Helen Bacon

Industry Sponsor: MedHab, Johnny Ross, Co-founder and CEO

A few facts, definitions, and the future:• Exponential advances across myriad technological fields are

conspiring to usher in an era of profound change

• Never underestimate an exponential. --Carl Sagan

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Background and Motivation• More than 400,000 TKAs are performed per

year. More are expected with aging baby boomers reaching 65 yr of age.

• The operation typically involves substantial postoperative pain, and includes vigorous physical rehabilitation.

• Healthcare dollars allotted to rehabilitation declining.

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Need to develop remote monitoring of rehabilitation after TKA

• To enable better adherence with exercise protocols

• Optimize self-management of recovery• Variation in patient’s independent exercise

and activity after TKA surgery may contribute to variable functional gains (Franklin et al., 2006)

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StepRite System• Developed by MedHab (http://www.medhab.com/)

• Allows the physical therapist to monitor physical

activity and exercise remotely

• StepRite provides a pressure sensing dashboard for

the physical therapist and physician.

• It provides 3D tracking, pressure sensing, real-time

wireless communication and a HIPAA secured user

interface website.

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StepRite System

• Provides quantitative feedback about

exercise compliance comparing the surgical

side with the non-surgical side

• Real time feedback during exercise and

weight-bearing activities

• It is a developing remote, interactive

monitoring system

Development of a Smart Insole Tracking System for

Physical Therapy and Athletics

Johnny Ross Jr.CEO

MedHab LLCPETRA ‘14

Motivation for the Industry Partner• Johnny Ross - Knee surgery in 2008• Poor results with traditional rehab

methods• Enhance rehabilitation with quantitative

data

Design Goals• Wireless, remote monitoring, force sensing

device• Monitor patient rehabilitation• Enhance athletic training

Insole Hardware• Force sensors• 9-axis sensor (gyroscope)

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Pressure Sensor insole (earlier version)

Based on pressure sensing and accelerometry technology

Algorithm Development• Custom algorithms needed

– Translate raw sensor data into various information• Gait Analysis• Range-of-Motion analysis• Power Meter

Quality Assurance• Hardware challenges

– Calibration– Validation

System Architecture• Two versions – Medical & Athletic

Mobile Applications• StepRite (Medical)

– Simple interface– Collect data from insoles– Sends data to web service

• Log in screen shot

Medical version: Web-basedClinician Interface – enter protocol, review recorded patient data, adjust protocol

Patient Interface – review progress

• Protocol page with showing standing pressure

• Protocol page showing icons of from which to choose

• Gait screen shot • Cycling screen shot

• Range of motion here • Pressure here

• Provider compliance dashboard

• Patient compliance dashboard

• Provider and Patient Compliance Reports

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Stage of Research• Intervention development• Intervention efficacy

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Project Objective:• We will test the hypothesis that patients who use

the device post-surgery will demonstrate

superior short-term improvements (i.e., 6 months

post TKA)—two outcome measures:– Self-reported functional outcomes (WOMAC)

– Gait parameters (GaitRite system)

• Compared to a control group who does not use the

device (standard care with log book).

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Specific Aims:• To compare the short-term changes in gait

parameters after TKA between those who use the StepRite device and those who follow a standard therapy program with out the device.

• To compare the short-term self-reported functional outcomes after TKA between those who use the StepRite device and those who follow a standard therapy program without the device.

Work in progress

• Exercise protocol will be programmed into the device.

• IRB and development of industry partner contract.

• Development of protocol including the number of HH

(home health) and OP (out-patient) visits (in-person

and remote) for each group.

• N= 25/group for the efficacy study

• Proposed time line (~1-1.5 yr project)

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Acknowledgements• Deaton Engineering

• TECH Fort Worth Technical Incubator

• Angelo State, Lamar Universities, & Texas A&M, Corpus Christi

• Texas Manufacturers Assistance Center

Questions