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01.28.19 - Recovery Game


Nizan Friedman first demonstrated entrepreneurial skill in the fourth grade. After learning origami from his grandfather, the young Friedman shared his enthusiasm for the Japanese art by selling folding papers at 50 cents each to his classmates.

Today, Friedman and his partner Danny Zondervan, both UC Irvine engineering alumni and former CALIT2 TechPortal occupants, are proud owners of Flint Rehab, a 15-employee device company that makes products to help survivors recover from stroke. Flint’s “tools that spark recovery” are the next generation of physical therapy equipment, light years ahead of traditional exercise balls and resistance bands. The two engineers, both musicians, use technology and music to gamify the process and motivate people to exercise.

Friedman and Zondervan were doctoral students in 2011 when they founded Flint. They designed, created and tested their first product, the MusicGlove, in CALIT2’s eHealth Collaboratory under the guidance of engineering professors Mark Bachman and David Reinkensmeyer. The MusicGlove helps stroke patients with hand paralysis regain function; it can be used at home or in a clinic to augment traditional physical therapy. The fledgling company has sold about 6,000 devices so far, mostly to individuals.

Its success inspired Friedman and Zondervan to develop new products based on the MusicGlove model. They wanted to take “the essence of why people enjoy the MusicGlove − the connection between music, the brain and the addictive qualities of game playing − and distill that, then convert it into a way that can be used on other parts of the body,” explains Friedman. That determination led to their next offerings and to their growth. Flint hired fellow biomedical engineering alumnus, Justin Rowe, to serve as lead engineer on the new products.

After several years of research and development − Flint develops custom hardware, firmware and software for its products – they launched FitMi in 2017. The full-body home-therapy tool helps patients retrain their brains and improve movement through repetitive exercises set to music. It includes two wireless pucks and a therapy software app (Rehab Studio), which guides patients through workouts to improve strength and dexterity for various parts of the body: arm raises, toe taps, torso twists, etc. It offers 40 different exercises specifically for people with a neurologic injury. The pucks contain multiple sensors and algorithms, and movements are tailored to a patient’s stage of recovery. As they improve, the FitMi exercises and difficulty levels increase to enhance recovery. FitMi comes with a customized tablet called the Flint station; or patients also can use it with their own personal computers.
Tina Orkin, 62, suffered a stroke two years ago, and she has been using the FitMi once a day for about six months. She really likes it. “It’s an extremely easy product to use. You don’t have to be tech savvy, and it’s very compact. You can use it anywhere; I can take it with me to my grandkids’ house.”

Orkin lets her grandson in on the fun. She says therapy can be boring, but this system is self-rewarding, making dinging noises and releasing balloons on screen when a goal is reached. “It’s like a game, and I really like that it gives you feedback. My grandson will say, ‘push harder!’”

The former nurse practitioner practices multiple forms of therapy, including the FitMi. She is expecting two more grandchildren soon and wants to be able to bend, twist and lift things easily. All those movements translate into living a better life after stroke. “It’s been very helpful in getting me closer to my end goal, which is to have more use of my arm and more balance in my life,” says Orkin. She has plenty of incentive, including encouragement from the 4-year-old grandson. “Grandma, when do you think you’ll be using that arm? I’d like to hold your hand,” he told her.

With active Facebook support groups for stroke patients and a popular blog, Flint is not short on endorsements. FitMi is selling three times as well as the MusicGlove. This has inspired the two founders to develop even more products.  “Our first two products gave people the ability to quantify their movement and engage in a more fun way to do therapy,” explains Friedman. “With our next two products – Cycli and MiGo -- we are making rehab more social, by allowing people to join groups and compete.”
Flint held a Kickstarter campaign in June 2016, raising more than $130,000 to manufacture and sell Cycli, an under-the-desk, Bluetooth-enabled portable cycle. The high-tech, low-profile cycle tracks reps and calories burned, sending data to an app for the iPhone or Android. In addition to tracking exercise, it allows users to compete against each other in public or private groups.
Flint’s fourth product, MiGo, is a wristband activity tracker designed specifically for rehab. Flint has sold about 100 pilot units. Unlike most activity trackers, MiGo counts more than just steps, an important factor for people with disabilities who may be using a wheelchair, walker or cane, or just have a unique gait pattern. The MiGo tracks every move a patient makes, including arm, trunk and leg movements. It is also smart enough to rule out unintentional movements, like a tremor.

Knowing the “rep count” is incredibly important in rehab, but unfortunately, most stroke survivors are not aware of their daily movements. Research shows that if patients receive feedback on how much they are moving, they have a much better chance at recovery.

Intricate algorithms are built in to MiGo, and every day, users see a new smart goal right at the top of the screen, based on their history. It pushes patients to do more and more exercise by upping the goal, and it offers encouragement in the form of text messages. MiGo has 50 different programed messages, and when users reach 100 percent, fireworks explode on screen.
Friedman and Zondervan have been successful at securing small business government grants to fund their innovations, raising about $8 million so far for research and development. And they’re working with Kaiser Permanente to try to get their products covered by insurance so these tools can become part of the continuum of care. They’re also branching out into other areas, such as orthopedic rehabilitation, for post- hip and knee replacement, as well as cognitive rehabilitation for those with Alzheimer’s Disease.

Reinkensmeyer, professor of mechanical and aerospace engineering and biomedical engineering, can’t wait to see what his former students do next. He says that after 20 years of research showing that robotics, computer gaming and sensing technologies can enhance movement recovery by facilitating intensive movement practice, only a handful of companies have been successful making clinic-based robotics technologies. Most of these devices remain expensive and are mainly used by a relatively small number of flagship rehabilitation facilities.

“Flint is driving a new model, which is to produce technologies that can be purchased out-of-pocket directly by consumers who have had a stroke,” Reinkensmeyer says. “These technologies are simple, yet engaging and effective.”

Friedman’s advice to other entrepreneurs, which probably goes back to fourth grade, is to “do something you really believe in rather than just something that will make you money. Starting a company requires an incredible amount of dedication and work.”
He adds: “It’s been an amazing experience. I feel really fortunate.”

— Lori Brandt