Okay. Hi, everyone. I am Sally Evans. I've met a lot of you all, and I am currently the chief of the Division of Rehabilitation Medicine at the Children's Hospital of Philadelphia. I'm speaking today with my colleague, Kevin Cleary, who is the scientific director at the Sheikh Zayed Institute at Children's National Medical Center, and we're going to talk to you today about a project that we're working on together called PEDBOT, which is a rehabilitation robot that we've been working on for the last several years. But in general, we wanted to talk about rehabilitation robotics for children, and get started on the conversation of how we can be incorporating more and more rehabilitation robots into the practice of pediatric rehab. Thank you. The investigational robots that we'll be discussing today were developed at Children's National in the laboratories in the Sheikh Zayed Institute. We were supported by several grants that you can see listed there, but neither Dr. Cleary nor I have any relevant disclosures related to this presentation. The learning objectives are also listed there, but basically what we want to do is again talk about rehabilitation robotics and make sure that people are understanding some things about that and then talk again about what we've learned as we've been building this robot about how we can start to use more robots in our practice in pediatric rehab medicine. So when we talk about robots, it's important that we all understand what we're talking about. So what really is a robot? Robots have by definition several different characteristics that are common to all robots. They all have a structure, so they're not anything virtual. They actually have a structure to them. They have a power source. They have some ability to sense what is happening in the world that you create for them. They have actuation, which means that they can move. They have manipulation, which means that they can move something other than themselves. And then some of them can move themselves or move other things in relationship to a base. The other thing that they have is that they all work based somehow on computers and therefore have some artificial intelligence. They don't all look the same. And, you know, again, when you hear robot, you may be thinking about danger to Will Robinson or a freaked out C-3PO, but all robots look different, and most of the ones that we'll use in rehabilitation look nothing like these two. In terms of pediatric rehabilitation and rehabilitation robots, robots are designed to restore functionality in people with physical disabilities and can frequently also help patients with self-care or ADLs, all of the things that we're trying to accomplish as we're working in pediatric rehab or in rehab medicine in general. When we talk about robot-assisted rehabilitation therapy, we're talking about a system that consists of a mechatronic or a combination of a machine and something electronic that's a device that provides highly repetitive task-specific guided movements that allow people to be able to learn. The benefits of using robots in rehab is that it can provide more practice than any therapist ever could by working manually, especially with a child. Because the robot is doing the work in terms of providing the practice, when patients are practicing certain tasks repetitively, this can lead to reduced effort for therapists during that exercise, which is a good thing for the therapist who's involved. It can also help to increase independence for a child with mobility or with whatever the child is actually doing, because if the therapist doesn't have hands on the child but only the robot does, while the child may still not be putting in any more effort, because the child is free of another person, there's increased independence. And then the robots themselves, by collecting data, can provide some quantitative assessment of what's actually happening during the therapy that can be difficult to obtain otherwise without using the robot. Robots can measure strength and force production with each repetition and can develop some really nice graphs that show us what's happening to the patient while undergoing the therapy provided in conjunction with the robot. There are several different forms of robots that are used in rehab, but they fall into categories that basically include exoskeletons, which are wearable machines. And I think all of us have seen some examples of those sorts of things, but we show a couple here. One is an exoskeleton that can allow for adults who otherwise could not walk to be able to get up and walk with the use of the exoskeleton. And then the Myomo, which many of you all may have also seen, this is a commercially available robot, is an exoskeleton that's worn on the arm that can allow assistance with different movements of all the joints in the arm so that tasks can be completed that otherwise would not be able to. The other group of robots are end effector, which are robots that attach to a patient and then cause movement to happen at all the joints by just small movements, perhaps in the distal end of the limit attached to. The thing that's great about end effector robots is that it can generate forces that otherwise wouldn't be capable, the patient wouldn't be capable of generating on his or her own. And they're used in a certain pattern that makes sense with regards to movement. These are fairly easy to adapt to different patients and certainly much easier to adapt than any exoskeleton, which must be fitted particularly to an individual patient. But they also sometimes end up creating movements that are less complicated and they can't lead as easily to isolated joint movements for patients who are wearing them. So what about application of rehabilitation robots in pediatrics? Is that going to do what we want to for our patients, no or yes? Well, certainly I think the answer to some of these questions is yes, because we can with rehabilitation robots, again, go into practicing a skill over and over again for multiple times. And we know from work that's been done with athletes and with artists that there's a pretty strong theory that you need to repeat a new task 10,000 times before you really get it right. So this is really easily accomplished by a robot who can help with precision of a particular task, doing it multiple times. Robots help with this repetition. They can also collect data that we wouldn't be able to collect otherwise. And analysis of that data can make a huge difference in terms of continued planning for rehabilitation of our patients. Association with the use of rehab robots with video games, gamification, makes therapy much more interesting for children. And for those of you who were recently at the ACPDM, if you attended the conference on the camp that's working on motor control in L.A., you know that what they said was that the choice of the video robot was the thing that children liked the most and they looked most forward to in the day of their camp. So we're still on target there saying that video games are popular with children. Completion of a home program for one hour a week, and there's really good evidence that shows this, adds valuable practice for a child who's participating in therapy. So if there's anything that we could do that would increase what's happening in a home program, that would help children be able to improve faster. And this is something that can be done with robots that are then placed in the home. We know from studies that have been done recently that self-directed robots are better at getting children to learn new tasks. So anything that's self-directed is more likely to be successful in both the child choosing to use that robot or to do those tasks. And also in terms of accomplishing whatever the child was trying to do with the robot. And finally, what we know is that the ideal robot would be one that could be with the child at all times. It's one that could help the child accomplish a task in exactly the way that we would want him to accomplish it. And that while he was accomplishing that task with the assistance of the robot, he would actually improve his ability to be able to accomplish that task and thereby need less help from the robot itself. So that it would be a robot that will put itself out of business by doing such a good job. Recently, there was a review of 206 publications that talked about 58 new robots that had just come online in the last few years. And the analysis of these different publications showed that weight, safety, operability and motivation are the crucial factors of successful design of devices that are going to be used by children. And again, there is a trend of developing exoskeletons that can work with self-direction for helping to improve gait in children who need that. So our question was, could we build a robot that in any way would increase the efficiency of gait in children with cerebral palsy? We decided that we would build on evidence. So we looked at the constraint induced therapy that's been done for children who are hemiplegic in terms of increasing the use of the hemiparetic arm. And constraint induced therapy has shown to be effective. We all know that. We've been hearing about that for years. And we know that with the repetition and with the intensity of therapy that happens with constraint induced therapy, the children show an increased use of the hemiparetic arm. It does rely on that repetition of tasks over and over again for multiple times a day. And it makes a difference, although there's not any research yet that shows definitively that the effects are sustainable for more than six months. We also know, looking at evidence, that improving range of motion and strength across the ankle will improve foot placement in space during swing phase and will improve the position of the ankle during stance phase to improve proximal kinematics during gait. We know, again, to repeat, that participation in a home exercise program adds multiple hours of practice and repetition of tasks, which is critical when we're trying to provide the appropriate amount of therapy for children who need it, especially at particular times. And we also know that virtual therapy is effective. It was necessary during the pandemic, and it provides therapy in remote settings, which has been shown before the pandemic, especially in Australia, where there's some pretty vast distances that need to be covered and can't be by therapists in person. Other kinds of evidence. We know from General Mills since 1961 that serials are better when they're kid tested and parent approved. So by relying on that evidence, we can assume that if therapy and home therapy were kid tested or kid enjoyed and parent approved, that we might have children begging to do their therapy and parents directing children to go play video games. We looked at some of the information that was available in the literature and realized that Zhang had said that too much assistance with any sort of a device, including robots, is detrimental and that platform-based ankle robots are needed to provide effective movement. The other thing that Mio found out in 2018 with a review is that the device should function with alignment at the axis of the ankle, that multiple degrees of freedom at the ankle are the most ideal sort of robot, and that adjustable robot posture can reach a larger population with varying needs. We also looked at what was commercially available and found that the thing that seemed to work the best was the robot that Larry Zhang and Deb Gabler developed, or the stretch and move, but that it didn't have all the degrees of freedom for the movement around the ankle. And in fact, nothing that was commercially available could check all the degrees of freedom. So then we started on the journey to develop PEDBOT, and I'm going to turn the program over to Kevin Cleary. Okay, thank you, Sally. I hope you can hear me okay. It's always hard to tell with Zoom, but I will now talk about the different families of robots that we built and try not to give too much engineering jargon, but you can see from these slides, here's some of the different iterations we went through, and it was an iterative process. Next slide, please. So the idea was to create a platform that could mimic the movements of a therapist passively flexing and extending the ankle. This device here on the right is like a mini flight simulator. If you've ever been in, for example, the Air and Space Museum on the National Mall, they have some nice flight simulators, but here we've attached a footplate to it, and this device could move the footplate in all directions, and that was the start of PEDBOT. Next slide, please. So when we design things as engineers, we want to get the minimal viable product here, and Sally, I don't know if you can click and play the video. That would be great. These videos are all used with permission of the family and the therapist, but this girl here, her foot is being manipulated by the therapist, and then the device has learned that pattern and is replaying it. And if you play again, maybe, Sally, too, when it ends, it's about 10, you'll see how bored she looks. So we learned that children needed to be actively involved in order to make a useful device. This one did have what we call six degrees of freedom, and in our language, it means it could both rotate about three axis as well as translate about three directions. Later, we only worked on devices that rotate about axis right here. Next slide, please. So this is what we call the minimal viable product. So when you do innovation, we say you want to build the MVP, which is the minimal viable product, so you can very quickly have a discussion. The engineering and the clinical world usually talk different languages, and the viable product gives them a common platform to talk about. The cons of this was that it was basically inconsistent, difficult to move from a mechanical point of view, but mainly it was limited engagement of the patient. But it did open the dialogue between clinicians and engineers. Next slide, please. So then we came up, we called PBOT Lab, and this looks much sleeker here. You see it on the right here, and this is what we call three degrees of freedom. We use the ship analogy, which is kind of pitch up and down, yaw left and right, and roll is a rotation. You know, you would use different language in the physical therapy world. But this device also included motors, so the motors could be used in two ways. One, if the patient could not make the motion, the motors could be used in assisting like power steering. But if they could make the motion, it could be made to resist so that they would also increase force as well as flexibility. And then this footplate was later a gaming platform, which we hooked up to an airplane video game that we'll show, so that the child could become a pilot for the airplane video game and using their foot to control the plane. Next slide, please. So here we go with the PBOT Lab feasibility study, and these are always fun to watch. This was one of our early patients pre-pandemic right here. And you can see for one how focused he is, and his foot, his right foot here is in the device, and his right foot as he moves up and down, the plane will go up and down, left and right, left and right, and then roll as well. And then we gave him a little bit of assistance as showing him the plane that he would try to match to go through. If he could not quite make it, we could use the assist mode to pull him in. Once he got good at it, we could change to resist mode, and this could all be controlled by the computer. Plus now we have quantitative data as to how well the child is doing and how many repetitions he's doing. So this was really the start of the PBOT test at our institution. Next slide, please. And it was a lot of fun. When the kids came up, we always liked the fact that all the engineers would come to see. So this was our first one. So lab meant that we actually did it in our lab or in the, quote, clinic environment, although it was our research lab at the top floor of the hospital. We had 11 patients enrolled. Then the trial got suspended by a little thing called COVID. We had eight complete all 20 sessions in the evaluation. The goal was 20 sessions over 10 weeks and lasted 20 to 40 minutes. So the physical therapists were present to run the session and set the system in the planes of motion, but it was really, of course, the patient involvement that carried out the trial, and this has been documented in a publication. Next slide, please. So here's some of the different things that we covered. And I don't know, Sally, if you wanted to point out anything in particular. You know these values better than me. It seemed the patient improved. I don't know the statistical significance, but what were your observations, Sally, from this one here? Just basically patients improved significantly with regards to range of motion and strength. And then we also found that we didn't have as good of ways to measure control to see if they improved, but the fact that their gaming got better implied that they improved with regards to control. And everybody got better with everything. Some things were more significant than others. Okay, I think we can go to the next slide then. Thank you. So what did we learn? You know, we learned a little bit about the device first that three degrees of freedom, which to us means all the rotations. Again, from a biomechanics standpoint, I don't know that the ankle is strictly what we call a spherical joint, but again, I think there's enough play in it. We're actually hooking it to a mechanical three degree of freedom system, does give you all the range of movement that you need. The motors do give a lot of feedback to the patient. So having it motorized and being able to do that does allow for gains in range of motion and fluidity. Gaming, the child did get bored after a while here playing the same airplane game right here. So we needed more options in the ability to modify games. And finally, the seating right here, seating is always an issue. We were using a commercial rehab chair, but the seating needed to be adjustable to patient's size and provide enough support so that they would not compensate. Next slide, please. So here's, we decided let's go to a home version because if we make a home version, we can reach a lot more patients. And our hospital is in the middle of Washington DC and with traffic can be quite difficult to reach. And then of course, park. So this home version, we said, let's make it low cost using three degrees of, sorry, 3D printed components, still three degrees of freedom, still motors for each plane of motion, but we used a straight back chair and a self-contained computer right here. And then we had an auto progression algorithm. So that's the picture of the device here. One of the issues was it was not that robust. 3D printing does not stand up too well, particularly 3D printed gears to heavy use. But if you go to the next slide now, Sally, you can see the algorithm and some of the idea of the same gameplay right here too, right? So the same airplane video game, but this time we designed an algorithm where the computer would advance the patient through the various stages. So they could start with active practice and see how they did and see what their quote, maybe natural range of motion was, and then go into assist or resist, depending upon how they did. And this was determined by a series of numerical values that could be set by the computer. So you can imagine in the longterm, I hate to throw out the AI and machine learning buzzwords that are so popular nowadays. But again, if you had enough data, the system could eventually learn how the child's doing and could be maybe taught what rehab patterns would be most effective. Next slide, please. So here's the pilot study with BeatBot Home. I actually still remember this young lady. She was so excited playing the device here. So in this case, we placed in the home for 20 days and the goal, really the main goal was just, would they use it? Okay, so 20 of 28 days, 30 minutes of play with three sets of exercises. We had eight participants complete the trial. And I can't remember in this first version, if we had remote monitoring, we do have it in the current system. Next slide, please. So here again, I think Sally, I'll turn this one over to you to comment, but it looks like to me improvements in most of the parameters measured. Yeah, so that's exactly right. And what we found was that we did get improvement with, again, with everything, range of motion definitely significantly improves. Some things improve more than others, which you can certainly see by the bar graphs and more for some patients than others, which we haven't really been able to tease out who yet with looking at the data, how we can predict who will do better with what. But we did have, again, that this is a feasible robot. It was a feasible idea, even though with this version, we kept having problems with the lack of robustness and the machine breaking down. But even with that, the children would play with it and did get better. Okay, great. And so here's some more of the results here, and you can particularly, some of the highlighted results here, showing right here how some of the children improved. Anything else, Sally, you wanted to add about this one here? I think you've circled a few ones. Okay, all right, let's go to the next slide. So again, what we're getting here is quantitative data. So I think that's very valuable right here for evaluation. For this one, what did we learn? Again, more game variability. The algorithm was still too restrictive right here. We did need an easier way to monitor and modify exercises. Again, the device was not robust enough, and the footplate movement was not so smooth. So that was the goal to improve in the next version. So if we could have the next slide. So here we have PEDBOT home version two. So I call this the industrial shrink version. This was built by our engineer, Tyler. And I said, okay, the first one didn't quite hold up to, can you build me one that will hold up? And he certainly did. Again, from an engineering standpoint, this extruded aluminum rails we use is something called 8020 system right here, which is almost like an erector set for those who remember that from the old days. But this device had the same functionality, but was larger, did have a larger footprint, but was robust. So this device now we've started to put into home trials for a 90 day home trial. So next slide, please. So in this one, we had four motors to give us a little more power, all metal gears right here, an inclined and adjustable base, an adaptable chair, and finally game autonomy. So we'd have a menu of games right here so that the child would have more variety. And we also decided that we wanted to have it for a longer period of time in the home too. So we changed the home trial from 28 days to 90 days. Next slide, please. So here we have the pilot study. This is great, Sally, because this is the one we just went out last Friday right here. And I don't think I can give away the location because of HIPAA right here, but this is a five-year-old boy. And here he's using his right foot again, his left foot is up, but his right foot is down in the device and he's flying the game. And I don't think we'll be able to hear the sound, but he's quite excited when he goes through the hoops right here and he does things as well. His father was monitoring and helping. And of course, everyone signed the informed consent as they did for the other ones right here. But this to me shows kind of the promise right here because these people are more than an hour from the hospital so it would not be practical for them to get down for therapy on a regular basis. So now we have something that's remote. The footprint's a little large. We did kind of tuck it into the corner of their living room here. And then it was able to, we can monitor remotely. So we have had four patients complete this trial now. This is just the fifth home right here and we're continuing to gather data and refine the devices right here. And again, it's just a lot of fun. When we saw this, we were able to post to social media and everybody really was excited to see all this. So, okay, let's go to the next slide, please, Sally. Yeah, just to say, we got this because the dad posted it on social media. He was that excited about what was going on. So we didn't take this video and then post it on social media without consent, but the dad was so excited that he posted it himself. Yeah, yeah. Thank you for keeping me compliant, Sally. Okay. All right. We're recorded. Okay. Right. I think of this one, am I turning it back to you at this point, Sally? Yeah, yeah. So what we're looking at is whether or not this, and what we have been looking at with different approaches is to see whether or not this is acceptable. And one of the things that we've done with our group is that we also have included people who work on human factors and work with the patients who are involved with using PEDBOT and their parents. And then we also have been working with therapists who can help us with regards to letting us know what they think about the device. And we've done that with structured interviews with them. So when we talk to therapists, they want one. Therapists do want this in their clinic, even though we thought that this would be something that's more likely to be used in the home. But therapists, there are a lot of therapists who can think of ways that they might want to use this in their clinic. And again, it relieves them of the need to do repetitive tasks for patients. And we've talked to therapists also who take care of adults who are interested in using something like this for their patients as well, who need to do repetitive tasks of moving the foot across the ankle. As we've talked about, this has the potential to mitigate some of the barriers to home exercise compliance that were identified in prior studies. What things that have been shown in prior studies and things that we also found in our interviews was that parents have reported they were much more comfortable with their children participating in this home program because they felt as though the therapist had set everything up for them and that the therapist was still involved because the therapists are monitoring what's happening with the home program, with Peabody anyway, on a weekly basis to change the algorithms as necessary so that patients can work on different skills as they attain skills that were programmed from the week before. The parents also felt that this decreased the family burden as far as having to be directly involved necessarily with any of the home programs, such as manually stretching children, but also it decreased the burden of having to nag their children to participate in doing this because even though it did take some parent reminders for some patients to continue to participate, mostly we just wanted to see how this unfolded, and definitely it decreased therapist time when children were involved in using this rather than coming in for center-based therapy. As with anything that we say, with any sort of small studies, more studies indicated, and we want to look particularly at whether or not this is going to be viable or useful for children who are younger, building on the evidence that the earlier that you intervene with, especially with gross motor patterns, the more likely you are to make a difference. And then we also learned from talking to the children that one of the themes that you've been hearing throughout this presentation is that kids want more video games. And so we did develop some more video games on our own, but we also learned that while we can develop video games, and we meaning the engineers, not me, because I have no idea how to do it, but that there are people who do this better than we do, and that an opportunity to partner with anybody who commercially did video games might be something that would enhance the desire for children to participate more. We've looked with our device at the 5Fs of the ICF, and we feel like it does meet the goals of the 5Fs with regards to fitness. We've shown that there's increased strength, range of motion and control. We have no real idea yet whether or not this will improve gait despite the evidence and the theories behind what we're doing, but we do know that the task of, that it is necessary and incorporated into all therapy programs of which we're aware to be able to get the foot in a better position in order to approach improving gait. And definitely we have shown improved compliance with a home exercise program. The function that would come out of this is if there is an improved gait, and what we did see was that children could have a more typical looking gait on a visual analysis of gait, but we have not been able to test our theories in a gait lab. And what we were hoping to find after one month of using the device was an increased efficiency in gait as evidenced by increased speed on either the 10 meter walk or the six meter walk, that there would be, or the six minute walk, that there would be increased distance. And we did not find that after 30 days of use of P5. But perhaps, again, based on evidence that it takes hundreds of hours of practice, we didn't actually allow for enough practice time in order to see that improvement. So we'll have to see what happens with that. This is something that people can play with their friends and what we hope to see down the line with the improvement in the gaming part of the device is that we could have children playing with each other or perhaps even playing commercially available games with their friends while they're using their foot as the controller for at least some components of the game. And for those of you who are gamers, you know that with just having the foot in the driving position, that won't do all the things that need to happen. So this would probably have to be some sort of combination controller. With family, it solved a lot of the problems that we learned about and that have also been reported in the literature with regards to family's involvement with home exercise programs and families were universally accepting of this. And then for the fun part, this is fun. It's lots of fun. So we see this as being something that may be part of the future. And we think there are endless possibilities, especially for rehabilitation robotics being incorporated into the tools that we use in pediatric rehabilitation. For our device alone, we've listed some of the places where we think that this device itself could be useful in the future. But we certainly think that really for the future, the thing that's important is that we all continue to pay attention to the potential benefits of rehabilitation robotics, especially in pediatric rehabilitation. And that is the end of our presentation. This is the team of people who are working with us. We, as you can see, are working with a combination of clinicians and engineers, and we have several physical therapists on our team as well as several engineers. We also have a computer specialist who has been helping us with the development of the games. And we'd also really like to thank our patients because they absolutely have been involved in the iterative process that has led us to be able to go forward with the design of P-BOT. And I'm going to stop there, I think, I hope. Let me see. I cannot figure out how to stop sharing my screen. I apologize. Well, I think we can wrap it up there, Sally, and take any questions or comments even. We're not averse to having comments, pro or con. Absolutely. It seems like maybe a shy group, so I'll start it off if that's okay. Thank you so much for the presentation. And I can't even imagine all the work that went into all the iterations of this and the creativity and funding to make this come to fruition. I'm wondering, it seemed like there were a lot of young kids that were involved in the design of P-BOT. And I'm wondering if you could talk a little bit about how you were able to do that and how you were able to get young kids that were involved in this or kids maybe more so with hemiplegic cerebral palsy, I'm assuming. Is there intention of looking at doing this for kids that have like a footplate where they can use both feet and working on, I guess, is it bipedal? Kind of like the bimanual therapy, but bipedal therapy and maybe expanding it to older kids or is there trouble with that too? Actually, the span of patients who have been involved in this, they've sort of been two different groups. And we have several patients who are closer to the latency age. The five-year-old is the youngest who's been involved, but we have a few children who are in the seven or eight-year-old range. We did try in P-BOT Lab, we had a child who was three and a half, but she really needed the therapist right there with her the whole time that she was doing it. And she improved, but she was not a good candidate for having it in her home because she had a brother slightly older than her and another brother slightly younger. And they frequently came to therapy and were crawling all over everything. So we could just see that not working particularly well for their family. But we have had teenagers involved as well. And we have, our protocol only allowed us to go up to the age of 18 to start using this. And we had two 18-year-old twins who finished finally with our version two and were able to get that into the home. But as they headed off to college, they weren't really interested in doing much more of that. But one of our first patients who's gone through all the iterations with us is a teenager and actually got so interested in all of this that she requested and was granted the opportunity to be an intern in Kevin Cleary's lab and was helping with the idea of, what will she be inventing for the future? And to answer your question about the patients, most of them are hemiplegic. And I think this appeals a lot to people who are hemiplegic, but we did have at least one guy who is diplegic and he switched feet. He actually used one foot primarily for the first 30 days and then went a second 30 days with using the other foot to see how he would go. And that worked okay. He perhaps was not as compliant with using the devices frequently, but also very particular in noting things that were going wrong. So he gave us his pages in his notebook of how we could improve things. And again, we've really appreciated that from our patients, but we do have a range of ages and to look at mimicking bimanual therapy. No, we haven't really done that yet, although we never kept children out of looking at this device who were diplegic and who might need help with both feet. And we certainly, it can switch from either foot, but there is not an opportunity at this point to use both feet at the same time. Other questions, comments, criticisms? Why don't we start with the criticisms? That's always a good one. How can we make this better? Yeah, I think one of the things we'd been struggling with, you know, is how do we make a low cost version that's also robust enough to stand up to repeated use? We would love to make a lower cost version and have more in trial, but then they do take quite a bit of use. So I don't know. I don't know, Laura, if you had a comment or not, but we would love to hear from you if you're willing. Oh, I was just thinking about the footprint. You know, I think about my patients who don't have a lot of space and already have a lot of assistive devices and equipment and standers and skate trainers and wheelchairs and whatnot. So I guess I was thinking about that, particularly those that live in small apartments and other types of places. Yeah, yeah. We did try to make that first home version, and the idea was it would fit on a two by four piece of plywood. To give you the idea of the footprint. I think the problem was it just wasn't that robust. And then the chair, you know, it's hard if you don't use a commercially therapy chair to have a chair that's adjustable enough and then make your own chair was past itself. I think it's a trade-off between robustness and comfort and adaptability of the system and size. But I would certainly agree that footprint is an issue. No doubt. Yeah, and then Laura, also to your point, we've been continuing to consider that and worked with a design firm who have mocked up a design that may turn out to be something that when we can build it, we'll take care of some of that because it will look more like a very giant cam boot. And at least that's the theory behind the design. And the motors will be built into the cam boot itself, or at least some of the motors, I guess some of the actuators, Kevin, I'm going to get the words wrong, but some of the actuators will be built into the cam boot itself with the device then resting on a base that's similar in size to the initial base that we had for the lab version or that we have for the lab version. And then there would be motors that were contained in the base of that itself. And that may be lightweight enough and small enough that it could even, I mean, this is what I was hoping they would do, is make it so that when you're sitting in the backseat of the car and watching a movie or playing video games anyway, that you could actually be doing repetitive tasks on the way to see the therapist, on the way to see your grandmother. So that if you're on the way to see the therapist, you don't have to do any stretching warmup sorts of things. So it's in our minds, but we come back to the same thing about what are we going to do to prevent the compensatory movements that happen at the hip and at the knee, which is what we see with some of the commercially available gaming devices where they've really focused on gaming and the foot can still come in as the controller, but you can dance all around what the foot's supposed to be doing with the knee or the hip or the other leg in order to do that. And we paid a lot of attention to the therapist's recommendation to really try to isolate the foot. And that's where we have been unable to decrease the footprint of the entire package. That's where we run into the most trouble. But I could certainly see where within a therapy department, this could still have a lot of utilization. And when we start thinking about resources and how to get repetitions in, and can we be creative with a PTA supervising this while the PT is handling another patient or something like that, just to get more time in the therapy department and get some good results. So I think we could be creative that way as well, get them set up and then have somebody come supervising it. Yeah, absolutely. Anybody else? I really liked the idea that you guys thought about the connectivity of it too. So connecting these kids to other kids that potentially are doing it. I think that's a huge gap. And a lot of things that we do is that many of these children don't see other children or interact outside of maybe therapy or medical appointments with other children with disabilities or who are similar to them. So having a way that they can interact and be at the same level, on the same playing field and using this device and potentially even talking back and forth and sort of the pie in the sky iterations of this with doing that are incredible. Yeah, we definitely talked about, ultimately we should make this multiplayer rehab right here where you would get on and see who you could play rehab against that evening or day. Exactly. Well, thank you everybody for coming to talk with us about this today. Also wanna give a shout out to something that I think is gonna happen although I have been really unclear on how to make this stuff work but I think we have a community group for networking related to rehabilitation robotics, pediatric rehabilitation robotics on Saturday afternoon at two o'clock. So if you're hanging out with the other things that are happening relative to Peds Rehab at the meetings next week on Saturday, look for a, there's a community group about sports medicine I think at close to the noon hour and then I believe we have the time at two. So if anyone wants to get together and talk about just look going forward how we could maybe collaborate for other people that are doing other things or just send ideas out there, that would be great. And I would look forward to seeing everybody there. And again, to echo what Jolene said, I'm gonna be happy to see people in person again. It'll be really nice. Okay, thank you, Sally. Thanks Kevin. Thank you.

rehabilitation robot

PEDBOT

children

physical disabilities

self-care

exoskeletons

end-effector robots

pilot studies