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Wireless shoe based sensor device + app

A wireless shoe based sensor device + app to monitor and improve balance and increase weight-bearing.

Photo of Joshua Cohen
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What challenges or opportunities are you trying to address within the problem? (200 characters or less)

A senior "fitness tracker" has unique demands due to the low activity of sedentary individuals who are at high risk of OP-related fractures. This device tracks, reports and incentivizes those measures

Many seniors who are at risk for osteoporotic fractures decrease their physical activity and weight-bearing (for many reasons) which creates a negative feedback cycle and increases their risk of further fractures and falls due to weakness and reduced balance.


This device (wireless sensors embedded in insoles or shoes) would aid in monitoring, tracking, and improving objective balance measures. It is able to track the center of mass (COM) over the base of support (BOS) using sensors and feed that data to a mobile app. Similar in concept to the Wii Fit balance board, this device is much more flexible and allows complete ease of movement without restriction, which allows for monitoring throughout the day as well as focused game play apps to improve balance.


As opposed to other tracking sensors (ie. accelerometers like FitBit) this sensor can objectively track time in weightbearring, track COM over BOS movement, and can even provide feedback for guided exercises.


Although this technology exists in other industries (ie running) it does not exist at all in the realm of balance control and would offer many opportunities for furthering research into fall prevention. My hope is that this device would have an open API to allow other innovators to develop novel approaches to fall prevention. It also offers new opportunities for other markets such as pediatric rehab, concussion monitoring, sports training, and the gaming market.



To truly improve balance, the patient must improve the control of their center of mass over their base of support. That is difficult for patients, caregivers, and even physical therapists to convey. Current smart sensors such as accelerometers do not collect this type of data. This device measures those parameters in a valid, low cost way and provides an entertaining game that can motivate even patients with dementia.

I am a geriatric physical therapist with degrees in biomechanics and product design. I have already tested a prototype with seniors and received positive feedback from PT and biomechanics researchers. I know that this could be a very helpful resource for many patients with OP to reduce the incidence of fractures.


This sensor technology has already been developed for other consumer fields. For example, https://www.arion.run/wearable/ uses shoe based force sensitive resistors to report and track pressure patterns while running, which suggests that such a device would be able to withstand the rigors of a senior lifestyle :)


IMPACTING SOCIAL ISOLATION

  • Loneliness and isolation can be significant issues that affect seniors' motivation for increasing activity.  This device could be used to reduce these factors by implementing some of the following ideas...
  • Multiplayer balance games with the possibility to connect with other players. I love the concept of the video game Journey (https://youtu.be/bKqeD7ojynw?t=57) that allows player interactions in a non-forced way.
  • Offering incentives and listings for local, evidence based balance classes.
  • Partnering up app users (or family/caregivers) to work towards goals.


RESEARCH

Computerized dynamic posturography, aka CDP (ie. the use of computers to quantify postural control in upright stance in either static or dynamic conditions) has a substantial evidence base showing it's validity for improving balance and reducing falls. Here are just a few of many published articles.

https://www.ncbi.nlm.nih.gov/pubmed/11568601 - CDP is sensitive for identifying people who have previously fallen. The Limits of Stability test was the most significant indicator.

https://www.ncbi.nlm.nih.gov/pubmed/21801090 - a CDP training program showed promise as a systematic, objective method to reduce fall risk with improved overground performance of balance tasks in an individual with chronic stroke.

https://www.ncbi.nlm.nih.gov/pubmed/25515202 - Balance training with a gaming system showed promise as a feasible, objective and enjoyable method to improve physical performance and reduce fall risk in an individual.




Who is your target end user and why will they be interested? (650 characters or less)

This idea excels because it is both a preventative, tracking, and rehabilitative aid. It could appeal to multiple levels of senior demographics as well as rehabilitation therapists. I could also imagine assisted living facilities using such devices to track activity levels and balance among their residents to prevent losing residents (and therefore revenue) to higher levels of care after a fall. Shoe companies may also be interested in integrating this technology to offer to their consumers. Emergency fall alert system companies may also be interested in partnering to offer an option that not only alerts to a fall, but may help in alerting before the fall even occurs by tracking trends in activity and center of mass control over time.

How is your idea scaleable? (650 characters or less)

Scaling this product should not be an issue, since it consists only of an app and hardware sensors.

What do/will you measure to know if your solution worked? (500 characters or less)

As a practicing physical therapist, I would be encouraged to suggest this device if it were able to increase patient's standing activity time by even 5% per day. Since any improvement can often open the doorway to other gains and progress. Other objective measures may include: 1. Lateral center of mass (COM) excursion measurements to track the patient's ability to control center of mass in single leg stance. 2. Number of falls based on self report. 3. Anterior/posterior COM control

What is the current stage of development of your idea?

  • Prototype: We have done some small tests or experiments with prospective users to continue developing the idea.

If you were to become a Top Idea, would you want to actively participate in piloting your idea?

  • I am flexible. I would be glad to assist in piloting, but do not need to be exclusive.

Tell us about yourself or your team (500 characters or less)

I am the owner of Mobile Rehab LLC. MobileRehabNC.com I have studied gaming/Unity/3D modeling for rehabilitation & learning. I received my baccalaureate degree in Physical Therapy from Northern Illinois University and a Master’s degree in Human Movement Science / Biomechanics from the University of North Carolina at Chapel Hill. I also completed supporting classes in the Industrial Design program at North Carolina State U. I have designed other commercially available products.

Location (50 characters)

Chapel Hill, NC

What is your legal / organizational structure?

  • We are individuals

How did you hear about the Challenge?

  • OpenIDEO announcement email

Why are you participating in this Challenge?

This is the target community that I work with and strive to improve their quality of life and improve their ability to remain independent and age in place. It's a very important question to tackle and one that is vitally important to the seniors it affects.

How does your idea help more people who have had a first fracture either 1) discover they have osteoporosis or 2) access/navigate care?

This device could help to access/navigate care by providing a method to track, improve, and maintain the patient's mobility and balance. By doing so, the patient's family, physical therapist or physician could stay updated on the patient's progress as well as intervene when necessary and prevent patients from becoming forgotten in the care journey.

How is your idea new in the world or how does it build on existing interventions?

My device combines existing technology (sensor insoles with computerized dynamic posturography (CDP)) in a novel and low cost method. My prototype demonstrates the efficacy of a low fidelity foot pressure map using only two force sensors per foot for this purpose. Insoles with sensor technology exist and can be easily replicated and manufactured for this purpose. (just one of many examples... https://www.arion.run/wearable/) CDP also already exists. (ie. the use of computers to quantify postural control in upright stance in either static or dynamic conditions.) It has strong research evidence supporting balance improvements and reduction in fall risk. These devices are currently clinic based and VERY expensive. (ex. http://balanceandmobility.academy/product-overview/smart-balance-master/) My design is inexpensive, easy to use, engaging, and clinically relevant and trackable. It has the added benefit of allow complete freedom of movement, which reduces risk of user falls.

Please upload your journey map. Be sure your journey map shows when your user is introduced to the idea and when/how they access it, and illustrates which moments in the Challenge Journey Map your journey map touches.

Who did you test your idea with, what did you learn, and how did you evolve your concept?

This device was tested on a small sample of seniors from my community with balance issues. The device and app succeeded greatly in encouraging the patient to perform balance exs properly, independently, and with greater enthusiasm. The feedback it provided also aided the patient in improving their balance by providing valuable insights into their limitations of balance. The largest barrier with the prototype was the design of the hardware and how to affix it to multiple shoe sizes with various sole designs and still get proper pressure feedback. I feel that the best design may either be an insole made to fit multiple shoe sizes, or integrate it into a stand alone shoe, sandal, or slipper design.

(Optional) Share documentation of your solution prototyping and testing, such as photos.

This video demonstrates the prototype I developed and the various clinical and game apps that I created.

Please upload your Business Model Canvas

Please upload your team video.

44 comments

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Photo of Wesley Wells
Team

There's a professor called Lisa Muratori at Stony Brook University who might already have a prototype for this. She helps patients figure out when their gait is drifting away from a stable pattern by putting sensors in their shoes. https://www.wired.com/story/sonification-era-of-aural-data/

Photo of Joshua Cohen
Team

Wesley,
Thanks for that link and input. Yes, auditory feedback is one type of use case for this design, and other foot sensor arrays exist on the market.
The difference is that my design costs exponentially less than what is currently on the market, and I was able to gamify balance activities using mobile phone technology, which greatly reduces the cost and complexity of bringing the product to the consumer.
***I would like to bring this low cost, easily accessible technology to market and create an open API so that researchers could investigate, build, and monetize terrific programs that they create (such as auditory gait feedback for patients with Parkinson's that Lisa Muratori studied) to a wide variety of patient conditions.***
I have noticed that many academic researchers tend to develop unique solutions based on expensive, complex technology, that rarely makes it to the market. I believe that, in the space of balance disorders, that may be due to the lack of low cost, effective, open API tools like what I am describing. I want to change that.
PS. I just emailed her to find out more about what, specifically, she was focused on and which sensors she used. Thanks again.

Photo of Manisha Laroia
Team

Darius Z  Was curious to see what you could shaJoshua Cohen  based on your expertise in rehabilitation of Osteoporosis patients and vice-versa.
Do have a look at each other's ideas, excited to see some collaboration spring up!
P.S.
Joshua Cohen Darius has submitted this idea:
@HaloJoint
Embrace an Active Lifestyle Again
 

Photo of Ashutosh Biltharia
Team

Hi Joshua Cohen 

I am Ashutosh Biltharia, an Innovation Coach with OpenIDEO. I have been following your idea with close attention. Thanks for submitting a detailed representation of the concept. I like your idea because:

- You have approached it through the root cause of falling which is an imbalance and addressed it through the right use of technology.
- It is empowering patients to be independent and helping them reestablishing their routines with guided exercises.
- The tangible part of your design intervention is hidden- the sensors are placed in the shoes/ footwear, and that’s great because, not all patients would prefer wearing an external aid that makes them feel sick or stands out when they are out in public.

As Manisha Laroia mentioned about collaboration with other innovators, I would also like to suggest if you would like to explore a collaboration with Kathleen Cody , Her idea link:

https://challenges.openideo.com/challenge/healthy-bones/ideas/bone-health-advocates-for-fracture-patients/comments#comments-section

What I like about the idea is:

- Human to human connect- As we know that Osteoporosis comes as a shock to the older adults as it demands lots of changes in their daily lives, and while dealing with it they go through the depression as well. Therefore, it is important to empower them emotionally. In such cases human to human connect works the best way, it is a more empathic way of dealing with the situation.

- This service helps the patients understand the required information and precautions and helps them bring informed changes to their lives to prevent future fractures.

I see your idea and ‘Post-discharge Advocate Program’ as complementary ideas. If collaborated and refined further, it can be a strong holistic solution to this problem. Also, I noticed that you both are located close to each other in NC and it is great in a way that you can help each other in the user testing of the concept.

Thanks,
Ashutosh

Photo of Joshua Cohen
Team

Ashutosh Biltharia Thank you for your input and feedback. I agree that incorporating a feature like a case management model, like Kathleen Cody describes, would definitely be helpful, if there is money for it.

Since I am not completely clear on how this OpenIdeo process works, I imagine that this device would benefit from partners who are able to help progress and refine the hardware and software design. I am sure there are many opportunities for partnering with other organizations once a basic product is completed, though.

Am I incorrect about this?

Thanks,
Josh

Photo of Ashutosh Biltharia
Team

Yes, I understand that you will need hardware/ software support.
And it would be great if you continue with some more user testings with the prototype improvements that are possible at your end. Today is the last day of idea submission/ refinement. Let's explore the collaboration possibility with any new team after today.

All the best!
Ashutosh

Photo of Manisha Laroia
Team

Hi Joshua Cohen 
I am excited to see you idea progress through the Ideas Phase. Great work!
Thank you for being super-active through the Ideas Phase of the Healthy Bones Challenge.
A reminder to make any last minute tweaks you wish to asap.
The DEADLINE for idea submission is Wednesday July 3rd, 2019 5pm PST.

A CHECKLIST to guide you.
Please make sure your idea does the following:
1) Clearly define the problem
2) Connects to at least one opportunity area
3) States how & when user accesses the solution
4) Tells the story

Let me know if you need anything.
All the best for the next phase of the challenge.

Manisha
OpenIDEO Challenge Team

Photo of Manisha Laroia
Team

Hi Joshua Cohen 
Since we were discussing about cross pollination and working with other innovators, I was hoping if you would like to connect with Ivy Chiu to collaborate.
You can see it here:
https://challenges.openideo.com/challenge/healthy-bones/ideas/risk-assessment-what-s-the-risk-of-the-bone-fracture-a-symptom-of-osteoporosis

Photo of Joshua Cohen
Team

Thank you for that link, but aren't there already many informative leaflets for osteoporosis, such as this one from the NCOA? https://www.ncoa.org/resources/fact-sheet-osteoporosis-falls-and-broken-bones/?utm_source=CHAEnews_&utm_medium=newsletter&utm_campaign=CHAEnews

Photo of Manisha Laroia
Team

Hi Joshua Cohen 
It is amazing to see how your idea has grown. The amazing visuals, videos and journey maps really help tell the story of your idea and connect it to the users.
Great going! :)

Photo of Joshua Cohen
Team

Thank you! :)

Photo of Estela Kennen
Team

Hi Josh,
I was poking around the internet for other reasons and I came to a couple of studies that, while different, might provide some justification and lessons learned for your project: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5303650/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374724/

Hope that helps!

Ella

Photo of Joshua Cohen
Team

Estela Kennen Thank you for those links. Yes, the research appears very promising. I have also seen a lot of prior research on computerized posturography (basically what this sensor device is) that also demonstrated very good results at improving balance.

I don't think this will be a complete replacement for traditional physical therapy, like your second link suggested, but it can definitely be a substantial addition to the available intervention options.

To me, this device is a "no brainer" that will eventually happen. The research is in place, and the technology is basically there. It's just a matter of who will have the funding and incentive to bring it to reality.

Photo of Chris Cochella
Team

Hi Joshua Cohen 

I am one of the Innovation Coaches at OpenIDEO.

Great idea. Clearly, improving balance in patients at all stages has benefit. Gaming devices have promise as well. Thus, the blend of the two would also seem promising.

I love that you have evidence from existing patients. Like Manisha Laroia I would like to see it in use with a small video. That would explain a lot.

I also really like that the device could feedback to the cloud and alert the community healthcare worker that balance is getting worse or the device is not being used (compliance).

You mention that compliance is big issue. Picking up your solution and doing it--compliance--might be a big hurdle to adoption. The benefit of your solution is not realized if the device is not used.

In what ways could your idea increase compliance of use which in turn increases balance?

Great work.
Thank you.
Chris

Photo of Joshua Cohen
Team

Chris,
I will try to get some video of a patient using it.

I originally designed this device with the intent that it be used as a tool to aid the therapist during a treatment session (which it does well, in my opinion). I understand why you would question compliance, though, as I have seen many great devices that simply get forgotten over time and never used by patients.

If the challenge is to design something to increase compliance, it might be better to design this integrated into insoles that the patient always wears. It could easily, passively track the amount of time that the patient spends standing during the day, and could even be trained to spot when the patient is standing bipedally to track balance / weight shifting changes, in addition to offering the video game exercises, and reporting to the family/physician.

Another idea might be to simply use computerized verbal reminders without video games (through a smart phone or smart speaker), along with the foot pressure sensors, to encourage the patient to increase weightbearing activity throughout the day. The program could verbally instruct the senior in simple exercises and use the sensors as feedback. This would avoid any concerns about the senior holding the smartphone screen, or forgetting to use the program at all. An added benefit would be the intermittent social interaction, even if it is just a smart speaker. (Isolation is a large contributor to depression among seniors)

As a reminder...I'm a physical therapist who has learned how to code a bit, not a professional coder. This idea would probably take a small team of professional programmers to implement.

Photo of Estela Kennen
Team

This is interesting. I saw your original pitch as an opportunity for patients to get feedback on their balance issues, in order to improve their balance, but here you mention a different use. I like the combination: increasing patient's awareness of their balance issues, providing games/exercises to increase their balance, providing feedback on how their balance improves, passively keeping track of their weight-bearing activity, and providing prompts for that, as well as feedback to providers. That is a pretty robust insole. ;) (This also makes me wonder about geriatric footwear preferences. My dad likes socks and slippers inside the house and orthopedic sneakers out. How might that work?)

Before I get too ahead of myself, though, I wanted to share some priceless advice the Gates Foundation recently gave as part of another IDEO: Don't jump to solutions. Spend more time on the problem. So, circling back to what Chris mentioned, what exactly are you trying to improve compliance on? And what does the literature and your experience say about the reasons for those compliance issues?

Photo of Joshua Cohen
Team

I agree that this type of device might present too many possible solutions without the needed focus to actually get anything done.

Another possible idea is to create the wireless sensor insoles as an "open platform" for crowd-sourced development of all these ideas and more. Similar to how the company https://mbientlab.com/ has created ready to use wearable sensors. That would be the best "bang for your buck" so that other creative people could continue to develop novel ideas with the device.

I have spoken with mbientlab and they are interested, but pressure sensors just haven't been their focus. Is there any chance that funding from this could be used to collaborate with a company on a project like this?

PS. You should encourage your Dad to wear well-fitting shoes inside as well. The research I've read suggests that shoes that offer a cradling heel cup, flat sole, and secure upper can improve balance more than some loose fitting slippers (if that's what he has). This is a useful site for finding such shoes... www.footsmart.com. Maybe a shoe company would consider collaborating as well on this device? (There's just too many ideas! I still don't know why hasn't anyone else done any of this already?)

Photo of Estela Kennen
Team

I *love* the idea of an open source platform to best leverage the full potential of insole sensors. I have no doubt potential partners/investors exist for an idea like that. However, I also think this challenge is very much focused on achieving the goals of ... this challenge. ;)

While thinking of the post-fracture experience of patients is narrow in scope compared to the much wider implications possible with the sensors, I think it's worth pursuing not only because it's a very worthy problem, but also because it presents you the potential opportunity to design and test a very solid use case, and gives you access to design resources that are just generally useful. If I were you, I would move on parallel tracks: one honing on on how best to leverage your idea for this particular challenge (what are the biggest problems/pain points that the sensors can address?) and the other exploring how to move forward with the broad platform idea.

PS -- Thank you for the shoe advice! I passed it on.

Photo of Estela Kennen
Team

I *love* the idea of an open source platform to best leverage the full potential of insole sensors. I have no doubt potential partners/investors exist for an idea like that. However, I also think this challenge is very much focused on achieving the goals of ... this challenge. ;)

While thinking of the post-fracture experience of patients is narrow in scope compared to the much wider implications possible with the sensors, I think it's worth pursuing not only because it's a very worthy problem, but also because it presents you the potential opportunity to design and test a very solid use case, and gives you access to design resources that are just generally useful. If I were you, I would move on parallel tracks: one honing on on how best to leverage your idea for this particular challenge (what are the biggest problems/pain points that the sensors can address?) and the other exploring how to move forward with the broad platform idea.

PS -- Thank you for the shoe advice! I passed it on.

Photo of Chris Cochella
Team

HI Joshua Cohen 

This dialogue and input from others (@estela kennan and Manisha Laroia ) is really meaningful.

Summarizing: --Device/sensor platform for assessing balance, activity with shoes or elsewhere. --Compliance and Engagement Both of these areas seem promising. Agreed with Estela that a partner for the device/sensor makes sense given this is not your specialty. The compliance, engagement and social environment is much more your specialty.There are still issues of compliance/engagement (wearing the shoes, replacing the sensor, being active, doing exercises). Assuming a device/sensor partner could be found, how would you define the problem going forward?

Best,
Chris

Photo of Joshua Cohen
Team

(By "problem" I assume you are asking what hurdles would the development of this product encounter.)
I would suggest initially focusing on creating a flexible, wireless force sensor array that could be used for testing multiple use scenarios. (ie. placed under the insole of a shoe vs used externally...) Then focus on building an app to track the total time the person used the device and the time spent on feet with reporting capabilities to a database. After that, different "interventions" (ie. video games, or other incentives) could be tested with the device to see if they improve the time spent on feet. More advanced features, such as collecting objective measures of balance, could be integrated later in order to create a minimum viable product earlier on.

I have seen other companies create similar technology for other fields, so it definitely possible. Here is one such company. https://www.arion.run/wearable/

Obviously, they are so close that they probably have most of the answers figured out already in terms of the hardware.

Photo of Estela Kennen
Team

That is a great list of priorities, which you will want to keep around. However I'm pretty sure Chris was talking one level backward when he referred to the problem: What's the thing that you can intervene on that would most help prevent secondary fragility fractures? Is it that patients don't understand their balance issues and/or need practice improving their balance? Is it that they don't spend enough time engaging in weight-bearing activities? Is it something else, or a combination of factors?

And then, what's the root of *that* problem? (For instance, if people aren't spending enough time doing weight-bearing activities, is it because of low energy, boredom, forgetting, poor environment for exercise, pain, something else, a combination?) I would rely on a combination of the literature and your personal experience in making that determination. When you have a good handle on the problem, you have a solid basis for prioritizing solutions (for instance, maybe an automated reminder system is a crucial feature; or maybe not).

Also, when you have a lot of possibilities floating around (always a good problem to have!), it can be helpful to think of things this way: https://images.app.goo.gl/eMgyQ1GVPuJWuWcz8 What's the maximum value you can get for minimum effort?

Photo of Chris Cochella
Team

Estela Kennen Yes, that is exactly what I was referring to: root of the problem. Keep climbing back up to the root cause ladder.

For what is worth, a primary care physician I interviewed a while back cited that disengagement, apathy and loneliness are major factors for all types of compliance (food, medications, activity, etc.). In this physician's opinion the increase in disengagement, apathy and loneliness "might" go up after a first fracture. I am not saying this is a/the problem, @joshua cohen you did mention compliance as a big factor. If this is the root problem, what do patients describe their world as that have (whether they know it or not) this problem? The stories that come from open-ended questions letting them describe the problem will best inform a solution. Is it company? Family not nearby? Friends? A social network/commitment? How would those ideas occur to them? As an anecdote, my mother is most excited when she gets video game instruction from my son. She would do anything for that. There is no way to know that unless she told her story.

It might involve devices or it might not. How do patients, especially first fracture patients, describe their world?

You are doing great work and thinking on this. It is tough to climb back up the root-cause ladder of inferences and do ethnographic inquiry.

I love the 2x2 diagrams for prioritizing efforts and any assumptions that need validating. There are lots of different ones that help set priority.

Ask more questions if you need direction, we can help. This is a promising line of inquiry.

Best wishes.
Chris

Photo of Joshua Cohen
Team

@Chris Cochella and @Estela Kennen 
Thank you for that input.I did some research review and found this study that cuts to the point...https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548111/ "A long-term regular exercise program designed to improve postural stability, mobility, and mechanical efficiency, alongside an increased vitamin D and dietary calcium intake, is most effective in preventing OP and reducing osteoporotic fractures."

The reasons for non-compliance are multifactorial and person specific for sure, but having "purpose" is a strong incentive for compliance... and seniors tend to value family connections a lot. There are many ways this app could be designed to reinforce meaningfulness and family connections. Is it the purpose of this challenge to drill down to the actual functionality of the app at this stage? I have spoken with many seniors about these topics, but I feel that a team would be better suited to fully developing this concept, along with feedback groups.

This device is analogous to a FitBit for seniors, but FitBit wouldn't work well for people who barely walk, so you need to measure lower levels of function to incentivize activity, which is what this device would do.

Photo of Mariah Burton Nelson
Team

Hi Joshua Cohen 

I too am intrigued and I too had the FitBit on my mind as I read through this conversation.
Research re: its success (or even popularity) would be relevant, seems to me. Other research on successful attempts to gamify physical activity might also be relevant.

After all, old people are simply people - who, yes, might be family-oriented, but also are likely to have the same interest in receiving positive feedback (e.g. 10K steps) as younger people, and the same interest in "winning" as younger people.

(Actually women in the over-60-ish demographic, who are more likely to have OP, are less likely to be attracted to competitive games than men or younger women due to lack of access to competitive sports during formative years, but that's not really what you're talking about with your games, which tend to be personal rather than interpersonal.)

I'd be interested in prototypes that test devices as part of a shoe, and also test special attachments, with the hypothesis (and hope) that the integrated-shoe design would do better. If shoes could be worn all the time, that takes care of the compliance issue.

That integrated shoe design would also parallel the FitBit user's experience: the device is worn all the time, and feedback can be at any point in the day or week, depending on individual preference or interest. It's not a game they're playing in free time (and many seniors lead very-busy lives); it's a shoe that looks like a regular shoe but is tracking and teaching balance all the time - and, I'd hope, rewarding the user with "stars" of some kind to encourage continued wearing.

As a person in your target demographic, I'd be very interested in that.

I also appreciate your advice re: the father who wears slippers around the house. (I bet he'd wear your special shoes in the house if he got some small FitBit-type feedback or reward for it!) You seem like someone who is going out of your way to be helpful in response to actual human needs, which will surely increase the human-centered-design quality of your final product.

Mariah Burton Nelson, OpenIDEO Innovation Coach

Photo of Mariah Burton Nelson
Team

PS: During a previous OpenIDEO challenge re: fall prevention in the elderly, some ideas related to sensors in shoes were proposed. I'm sorry I don't know what came of those ideas but it might be valuable to see what others have explored (or developed) along these lines.

Photo of Joshua Cohen
Team

Mariah,
Thank you for your comments. I went back and read all of the Ideas from the Fall Prevention Challenge. I am fairly confident that the use of pressure sensors in the insoles is the best method for tracking valid variables with the current technology, and it seems very doable. (https://www.arion.run/wearable/)

This idea excels because it is both a preventative, tracking, and rehabilitative aid. It could appeal to multiple levels of senior demographics. I could also imagine assisted living facilities using such devices to track activity levels and balance among their residents to prevent losing residents (and therefore revenue) to higher levels of care after a fall.

Photo of Mariah Burton Nelson
Team

Very interesting! Thanks for doing the additional research.

Photo of Chris Cochella
Team

Hi Joshua Cohen ,

This idea is progressing well. Lots of people are interested and intrigued, which is nice evidence in its own right! I am confident that a device and game app that helps (and is fun) with activity and education would be a strong component of a solution. Love your new additions to the idea which, as you know, can be updated along the way.

I continue to be interested in how you might better understand the patient’s world post first fracture in general? Specifically, around their emotions that engage and motivate them to take action?

What I am getting at is, what would motivate the patient to engage with the app? Love the Alexa/Siri voice coaching by the way.

It is a big assumption to believe that seniors will categorically adopt shoe sensors and an app. How might you validate the emotional "Why" of adopting the app. Things like fun, meaning, achievement, companionship, relationship, etc.

I am highlighting some resources are below. These resources get into specific journey maps and open-ended interviewing strategies. And there is one study on loneliness I will post soon which has similar dis-engagement behavioral problems. In fact, a physician I interviewed spoke directly to increased loneliness, apathy and disengagement after a fracture.

There is another challenge idea on PTSD for post-fracture patients that you might consider engaging with because they are coming at this from a mental health/engagement point of view.

As an example interview question you could ask:

What gets you excited or makes you happy in your day?

For my mom it is a phone call from the grandkids. She will move heaven and earth for that. It is emotional and meaningful to her. If she and my son engaged in games of balance and activity, she would do it. That is what motivates her--relationship with her grandson.

This question could also be asked in a non open-ended way like:

What would motivate you to use an app?

An answer might be an alarm reminded.

This latter answer is a transactional, superficial reply and not very informative. The former question/answer is more likely to draw out emotional responses and stories. The common patterns in those stories, directionally inform the highest priorities for a solution.

What we want as innovators are our customer stories, told in their voice while we are looking for what gets them emotionally engaged, excited and moved. Inside those stories are the directional information (emotions, empathy, energy) that inform the best path to the best solutions. I like recording those conversations because listening to a person's voice later is more informative than notes and truly brings the problem-solvers into the world of the customer or community with the problem.

If you wanted to post your high-level questions prior to conducting interviews please ask! Or maybe you have done this. If so, please share those results.

Best wishes,
Chris

Resources:

Challenge Resources Page:
https://www.openideo.com/content/healthy-bones-additional-resources

Open-Ended, Human-Centered Interviewing
https://media-openideo-rwd.oiengine.com/attachments/61f6ecf6-33d3-4952-b6e4-37d88bcd7814.pdf

Journey Map (what does the journey map of using the device/app look like?)
http://www.designkit.org/methods/63

Design Kit Produced by IDEO
http://www.designkit.org/

PTSD OpenIDEO Idea
https://challenges.openideo.com/challenge/healthy-bones/ideas/identify-and-treat-ptsd-like-symptoms-after-the-first-fall-fracture

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@Chris Cochella 
Thank you for those suggestions. I'll try to be concise, because I feel this is a huge topic that I have had extensive experience with.A little more background: I started http://mobilerehabnc.com/ which provides In-Home Out-Patient therapy for seniors in 2004 because of the obvious and enormous deficiencies in the healthcare continuum for seniors. Since then, I have helped other therapists across the country start similar, innovative business models. I have worked with many patients that fit this exact description. I always ask patients the questions that you are suggesting. If you can't find what motivates the patient, you won't get any buy in to your treatment plan and long term improvement will not happen.


Reasons why seniors are non-compliant with exercise: Depression due to isolation; Increased isolation due to injury, other illnesses and loss of mobility, Lack of purpose, Concerns of feeling like a burden on others, Prior history of sedentary behavior. Motivators for seniors: Spend more time with family; Reduce the burden on others; Maintain purpose/ value to others; Prior history of being intrinsically motivated. Can a digital device help in these domains? Many companies currently believe so and are developing products for this. One solution will not be able to improve all these issues. My invention is just one piece of a much larger puzzle. That's why I think it will be important to either make the software opensource, or at least create an API for the device. Are seniors open to adopting tech? It's impossible to generalize such a large group of people into a single class. Some of the barriers to adoption, such as tech-illiteracy, could be reduced by using integrated shoe insole sensors and smart speakers to avoid dealing with phone apps. I was very surprised that Physical Therapists were left off of the personas list. No device or even telemedicine will help detached seniors suddenly become motivated to continue life. PTs are the keystone (or at least something close to it) to getting patients moving and motivated again. I believe the interpersonal relationship is crucial to building trust, reducing fear of falling issues, and increasing motivation. This device can help support that relationship and improve outcomes, I believe.

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Hi Joshua Cohen 

Wonderful! I had a feeling this was your experience. I went to your website, got it. I am so glad you detailed that. I believe that documenting this in someway as evidence (maybe a heatmap or table or common journey maps, etc.) with a clear highlight of adoption hotspots that will likely motivate action is a big part of the criteria: Patient Centered. GIven your experience you might be taking it for granted. A 3rd party audience needs the validation. People outside your experience set will likely want to see some explicit evidence. Keep thinking about how you could reduce the risk and uncertainty for a pilot. I always like to think of this like a hurdle. If you can show evidence that lowers the hurdle height so that instead of a pilot looking to jump a 7 foot hurdle, it looks like a 3 foot hurdle. Explicitly showing how to lower that uncertainty and risk is a big deal.

Such a map would inform the most valuable features/functions to bring about in a pilot knowing, as you said above, not everything can be done. Yet, so much can be done if patient adoption/engagement is high. This is why some of us have been focused on that.

Could the app have a feature that engaged distant family in the games? Maybe even having other family members participate in a group? Or friends? Thereby busting up the isolation factor AND getting patients active. Just a thought.

Other criteria will center around: post-fracture journey (clearly you are doing this), scalable (at some point, cloud apps naturally are this way) and measurable (What is success and can it be measured?). These could fall into place given the App/Cloud nature, but paying attention to the criteria is good practice.

As you move forward with details, evidence and refinement consider "speaking" to the criteria.

Wishing you a wonderful weekend. Thank you again for taking the time to illustrate your experience and passion.

Please reach out (to me, other idea submitters, or the OpenIDEO staff) for any resources or assistance you might need. There is an active team behind this wanting to support and fuel the ideas. There is a lot of collective knowledge (prior IDEO coaches in healthcare, and so on).

Chris

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Chris Cochella 
Those are good suggestions, and great ideas for interactive family games as well!

My goal with this project is to find partners that could help bring this to fruition. I think initial funding will either need to be through grants or sponsorships. I would be glad to be a consultant/designer, but I don't have the bandwidth to start another company right now or learn how to write and manage grants. I posted this idea on OpenIdeo to get the idea out and see if partnerships are possible. After reviewing OpenIdeo's site more, however, it seems that sponsorships for this type of idea are unlikely, so I'm not sure if further refinement of the idea at this stage would be beneficial. I guess I'm just not clear on what the path forward for a product like this would look like.

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Hi @Joshua Cohen 
It is so amazing to see how your idea has grown and the interest it has generated. It is great work!!
OpenIDEO challenges are more like a marathon than a sprint and I would encourage you to hang in there because your solution seems to show promise.
As more ideas come in we will cross-pollinate you with other innovators to find the partnerships you need.
You could also feel free to write to other participants on the platform and build conversations. There will be more ideas and participants adding in soon so do keep a look out.
The 5 Top Ideas will be part of a Design sprint to refine idea with UCB and the Challenge Partner Network to help get the ideas closer to implementation readiness. Top ideas will also get a Keynote spot at an upcoming bone health event and explore fit for a pilot with a hospital in the US.
There are other opportunities of partnership that open during Refinement phase and with your experience I am sure you will find your sparkle.
We do have more webinars coming up for you to meet more people in this space.
Here is some stories from our past challenges for inspiration:
https://challenges.openideo.com/blog
If you wish to get more specific information let me know, happy to mail or hop on a quick call with you.
Manisha
OpenIDEO Community Fellow

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Manisha Laroia Thank you so much for your support and insights. I'll check out that link and continue refining my idea as I am able. I look forward to the opportunity to connect with other innovators. Everyone has been so supportive and welcoming so far...I only wish that there was the opportunity to do this work in person and meet everyone.

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Hi @Joshua Cohen 
I hope you are well. This is a link provided by @alan byrant one of the OpenIDEO coaches. It is some design work on loneliness which may have overlap with your idea and the idea proposed by @Patricia Salber  on PTSD. The strength of using a device and a cloud-connected app strongly serves 2 criteria: scalable and measurable which may come later after early prototypes and minimum-viable (lovable ;)- product phase. The other two criteria are patient-centered and seem to have evidence and post-fracture journey. As you have noted, you are strongly centered here, meaning that your "evidence" and ethnographic insight is critical to adoption, deep understanding of the problem set (activity, balance but also behavioral drive), physical constraints and patient journey.

How might you provide more details in the section on measuring if the solution worked? As you say, measuring if it improves balance is one metric. What other measures are there? Consider how often the device is used in a population that has the app/device (adoption, use rate)? How much assistance is required? Engagement? What would some of metrics look for success?

Maybe statements like:
Of those given the device, X% use it # days per week. Of those using # days per week, # hours per day, a successful balance "index" would be Y. Knowing what your key metrics might be in advance will help round out that "measureable" and illustrate how much of an impact your idea might have! I also wanted to say that we will be having office hours on specific topics in the coming weeks. There might be some on partnerships and a more expanded conversation on how to partner, roles to play so that promising ideas move forward. Please keep asking questions and expanding your idea like you have been doing. Best wishes, Chris

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Chris Cochella 
Thank you for those suggestions. I did not see any link, however.
I'll try to come up with some objective goals for testing. I don't really have any specific numbers in mind, though, for what would be a significant change. From my (vague) recollection of graduate school work, it sounds like I should be developing a null hypothesis suitable for testing from your suggestions.

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Hi Joshua Cohen 
Sorry about the link: https://lonelinesslab.org/

LOL, yes, thinking about like a set of hypotheses is a great way to do it. From there, what is current evidence, methods/metrics. The nice thing is we do not have to be quite as rigorous as scientists, but it is a good lens to look through.

In your work and business you see a lot of patients. If a solution came your way for this problem what would convince you that it would be a success? What would a sales person have to "prove" to you that would convince you?

Flip it around.

Best,
Chris

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Hi @Joshua Cohen 
I'm part of the team here for this OpenIDEO Challenge and have been following these great threads of conversation. I agree with @Chris Cochella and @Manisha Laroia re: pacing yourself and keeping at your idea. Just this morning there was another idea posted, @Post-discharge Advocate Program for Fracture Patients which is an example of a potential partner for you. It was fielded by a non-profit patient advocacy organization to connect first-fracture patients with support for post-discharge care. Their website talks about exercise and fall prevention in a traditional, yet helpful way: www.americanbonehealth.org. Partnering for increasing bandwidth and adding value are points we'll cover in an upcoming webinar - we'll be sure to let you know when. On another note, your comment about Physical Therapists not being on the Persona list was well founded. When caring for my mom, we had a PT for her who was part of a privately owned company providing the service - someone who got to know her and the environment where she spent most of her time. She, and you, are a wealth of knowledge and are boots on the ground in the care journey. So I encourage you to keep at it - we (families who care) need your insights. Susan OpenIDEO Innovation Coach

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Hi Joshua Cohen 
Your ideas is amazing. I like your opinion very much. In particular, you integrate the game and nursing, which can make the elderly people experience fun. If your game connect to VR, it would be better.

Respects
Felix

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Felix,
Thank you so much! I have tried it with a VR headset. While it was fun, and potentially another avenue for development for younger generations... I think it's too dangerous for a senior population with balance deficits. Augmented reality might hold more potential, though.

However, it is a great way to incorporate player movement into Google Cardboard, where the player would otherwise be stationary with most Cardboard apps.

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Hi Joshua. What a neat idea -- it's great to see what's possible with an Arduino, some wires, and some fancy mobile phone programming. A few questions come to mind:

1- What is the effect of having this training on a mobile phone versus a conventional screen like would be used on the Wii Fit Balance board? Seems like the act of holding and looking at the phone would have an effect on posture and balance. (This might be a possible area for study, to measure the effects of standard practice versus your system.)

2 -- If part of the problem is that people aren't being screened before falls or after, at what stage in a person's journey do you see this training being implemented? What changes can we make to the health care or community ecosystem that would increase the number of people being funneled into balance programs, etc.?

3 - What features do you have in place, or could you implement, to increase the program's "stickiness"? Are there automatic reminders? A graph to see how a person's balance is changing over time? What else?

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1. A larger tablet which is propped up somehow, probably would be helpful especially for the more frail population that might need their hands for greater support. One advantage of this design over the Wii, is that it can be wireless and allow the feet to move independently. This reduces fall risk by maintaining protective extension. (ie. the person isn't restricted to a small platform and can move their feet as needed to keep their balance.)

2. This device would be helpful as a way to assess balance deficits (at senior centers, in the home, or anywhere), prevent balance issues, and as a treatment for balance deficits. If neither the senior, nor their family, take any steps to address the issue, it would be very difficult to provide any intervention. However, since certain populations have been shown to be at higher risk of falls and fractures, primary care providers could suggest the use of these without having to get the person to admit to a fall.

I am already part of a task force (The North Carolina Falls Prevention Coalition) that tries to tackle the challenge of increasing appropriate referrals to balance programs. (It's very difficult) I believe part of the solution is to incentivize the primary care provider to do so. In the USA, Medicare requires doctors to ask about falls, but we already know that many patients do not report falls due to fear of loss of independence. Hopefully, an inexpensive, fun, smart device like this could be a much less threatening way to measure and address balance deficits.

3. I have not implemented any reporting features, yet. These features would definitely be necessary and could include:
Graphs of progress (there are many well researched variables that could be tracked)
Options to send updates to providers or family/caregivers
Gamification / socialization: Compete or work together with other players to reach goals.

I have always felt that seniors could benefit from video games if they were implemented appropriately. Video games have been shown to be very helpful with reducing chronic pain issues, depression, and anxiety... all reasons why seniors end up more sedentary and isolated. There are so many avenues for research and innovative interventions with this device that it amazes me that it doesn't exist, yet.

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Hi Joshua Cohen 
Thank you for sharing your idea in this challenge and answering the feedback questions with such detail.
It would be really interesting to see visual of how your users use the solution. you could add these to the idea above by editing it.
You could also add their feedback and you findings from testing in the above idea to make it stronger.
Let me know if you need any help.

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I tested this prototype with a few patients with balance issues. I used it with them as an adjunct to treatment during their regular PT sessions. They didn't have smart phones, so I didn't leave it with them to try independently.

Here's what I found:

Pros:
Patient reported that it really gave them insight into their "weakness". For example, as a PT, I find it obvious when I see a patient who is not weightshifting symmetrically or smoothly, but patients don't often understand this concept until they saw it on the screen. It was an "oh wow!" type of moment.

Patients were able to continue exercise with more enjoyment and longer than without the device. They were also motivated to improve.

It was great to see patients enjoying video games. I was able to tailor the games into a flying game for one patient who had been a military fighter pilot, and a rollerskater for an older woman who used to enjoy that. The idea actually came to me while working with a person with paraplegia...we were working on push-up style upper extremity weight shifting exercises and the woman reminisced about how much she used to love skiing. I told her I thought I could probably create a video game to ski while doing these weightshifting exercises.

Cons:
The prototype's wires were a bit of a hassle to set up. A commercial version would need to be sturdier and fully wireless. I have seen many viable design options and have even found a manufacturer capable of creating it.

Although the prototype can be adjusted to different foot lengths, it had some issues with different shoe designs and tread patterns creating inconsistent pressure distribution through the pressure sensitive resistors. I have seen viable design ideas to correct this issue.

I stopped testing the prototype with patients because I was concerned about it's durability. Although I have not seen any similar products, I have seen some products that integrate pressure sensitive resistors into insoles and also cork sandals (like Birkenstocks).