A lightweight robotic telerehabilitation device with integrated blood flow restriction for patients with musculoskeletal conditions

Project Summary/Abstract There are 2.5 million patients in the United States annually who receive knee surgeries, such as knee replacements and ligament repairs and as the population rapidly ages the number of these surgeries is expected to more than triple by 2030. These procedures account for over $7 billion in spending by Medicare alone and as such, Medicare has identified knee surgery as a major target for cost reduction. While the surgery itself has a relatively high success rate, patients must undergo extensive physical therapy to fully recover. Physical therapy costs are high, usually requiring a significant number of in-person physical therapy sessions combined with daily at-home exercises. Furthermore, full recovery can be difficult to achieve as decline in muscle strength is often associated with knee injuries and surgery - patients cannot exercise with typical loads during recovery. This SBIR project will reduce the cost of recovery from lower limb orthopedic injury or surgery through the development of a telerehabilitation device that provides motorized exercise modes coupled with blood flow restriction to enhance the effectiveness of low-load exercise while recording data and sharing progress with the patient’s care team, whether the patient is in a clinic or at home. Restricting blood flow during exercise offers a promising model for recovery from orthopedic surgery as high-load weight training cannot be performed, while low-load training alone often leads to muscle atrophy. Benefits of an all-in-one device include significant reduction in clinic visits (reduction in cost, workforce burden, and patient burden), better support for patients in rural communities, reduction in risk of muscle atrophy, reduction in pain during exercise, higher at-home exercise compliance, clinician access to data and trends, and opportunities for aggregate data trending to inform optimal exercise plans. The specific aims of this project are to develop, test, and evaluate a lightweight and cost effective device that provides actuated stretching and strengthening of the user’s knee joint, while restricting the flow of blood from the leg to enhance the benefits of the exercise. Evaluation of the system will comprise two pilot usability studies, one with experienced physical therapists and one with patients recovering from ligament reconstruction. In Phase II, the system will be further refined and then evaluated with a larger, statistically significant study to determine safety and efficacy of the device. Commercialization of the technology should lead to significantly reduced costs, better outcomes, and a lower logistical burden to recovery by reducing the number of in-person physical therapy sessions for some of the most common surgical procedures in the US.