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
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.
6
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
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Johnny Ross Jr.
CEO
MedHab LLC
PETRA ‘14
Development of a Smart
Insole Tracking System for
Physical Therapy and
Athletics
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)
Pressure Sensor insole (earlier version)
Based on pressure sensing
and accelerometry
technology
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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-based
Clinician Interface – enter protocol, review recorded patient data, adjust
Protocol page with showing
• Protocol page showing icons of
protocol
standing pressure
from which to choose
Patient Interface – review progress
• Gait screen shot
• Cycling screen shot
• Range of motion here
• Pressure here
• Provider compliance
dashboard
• Patient compliance
dashboard
• Provider and Patient Compliance
Reports
Stage of Research
• Intervention development
• Intervention efficacy
25
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.
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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)
)28
Acknowledgements
• Deaton Engineering
• TECH Fort Worth Technical Incubator
• Angelo State, Lamar Universities, &
Texas A&M, Corpus Christi
• Texas Manufacturers Assistance Center
Questions