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Source: MusicGlove Combining Music and Games for Stroke Rehab: Interview with Dr. Nizan Friedman, CEO of Flint Rehab

by Dr. Kenan Raddawi

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Stroke is a leading cause of death and disability around the world. In the United States alone, nearly 800,00 people suffer from a stroke each year. Many of those who are lucky to survive continue to live with various long-term physical disabilities, including upper limb motor impairment.

Studies have shown that early motor rehabilitation is one of the most important factors to help minimize disability and regain function after a stroke. This rehabilitation period usually includes multiple intensive and highly repetitive exercises designed to help the brain rewire itself and reclaim function through neural plasticity.

Unfortunately, staying motivated to perform these exercises consistently, especially once a patient returns home, can be challenging. Recent data suggests that only one-third of patients post-stroke continue to perform and follow their prescribed home exercises. Therefore, a few years ago, a California-based company called Flint Rehab created MusicGlove. MusicGlove is a sensorized glove that utilizes gamified therapeutic exercises to increase patient engagement and encourages the performance of necessary exercises to regain hand dexterity after a stroke or other neurological injury.

We at Medgadget covered MusicGlove when it was first introduced to the market back in 2014. Recently, we had the chance to interview Nizan Friedman, CEO and Co-Founder of Flint Rehab, to learn more about the product and any updates it has undergone over the last few years.

Kenan Raddawi, MD, Medgadget: Can you please give our readers a brief overview of MusicGlove? For example, when is it used, how does it work, and what kind of sensors does it utilize?

Dr. Nizan Friedman, Flint Rehab: MusicGlove is an exercise tool used by anyone with impaired hand function due to stroke, spinal cord injury, traumatic brain injury, or other neurologic injuries. The device includes custom, fabric-based touch sensors that are worn on the tips of each finger, with an additional sensor on the side of the index finger. These sensors allow MusicGlove to detect when the wearer performs the gripping movements most often practiced in conventional hand therapy and frequently used in daily life (e.g. a key-pinch grip, or a pincer grasp). To exercise, users simply put on the glove and then play a therapeutic, music-based video game that cues them to perform these grips along with scrolling notes that are synchronized to a song. This transforms routine hand therapy into an engaging, motivating experience that gets users hooked on their recovery.

Medgadget: What are the different types of gloves used in stroke rehabilitation therapies, and in which category does MusicGlove fall?

Dr. Friedman: The two main categories are assistive gloves and therapeutic gloves. An assistive glove, such as a splint or brace, is a device that holds a user's hand in a static position. The goal of an assistive glove is to either prevent a user from regressing or to temporarily increase their function as long as they are wearing the device. Thus, when a user takes the assistive glove off, that user may not see any long-term benefit.

Conversely, the primary function of a therapeutic glove is to enable the user to perform hand therapy in a more effective manner. Consequentially, as with MusicGlove, the brain creates new neural connections, which in turn leads to long-term improvements in the ability to use the hand, even when the glove comes off.

Medgadget: MusicGlove's app interface appears to have a similar set up as the musical game, "GuitarHero". Why did Flint Rehab select this type of game? Are there any plans to add more variety in the future?

Dr. Friedman: This was very intentional. While medical device companies are experts in sensor design, video game companies have really been the ones who have mastered user engagement, replayability, and fun. So, rather than reinvent the wheel, we looked to the gaming industry for inspiration. Music-based games such as Rock Band or GuitarHero, are among the most popular video game franchises of all time, and have continued to sustain user interest over hundreds of hours of play. By using a similar approach, we were able to transfer that addictive gaming experience into a rehabilitation tool that users actually look forward to using. Since launching, we have continued to expand the music selection with a Pop Song Pack, and are developing classical, country, and rock packs to follow.

Medgadget: How easy is it to use MusicGlove for people who are not necessarily tech-savvy?

Dr. Friedman: Our average customer is 70 years old and often not computer literate. Our mantra from the start was to provide a high-tech therapy solution that anyone can use. MusicGlove works right out of the box. Users simply have to put the device on, open an app on their computer, and then click "begin." For those who aren't comfortable installing software on their own computer, we also offer a custom touchscreen tablet that is locked down to run only our software, so users simply have to turn the tablet on and then they can immediately start exercising.

Medgadget: Does the patient need a healthcare provider (OT, PT) to set up the device, select the right exercise program, and regularly monitor the patient's progress? Could the patient remotely communicate with a therapist via the app?

Dr. Friedman: In two randomized controlled trials funded by NIH, we found that MusicGlove significantly improves hand function both in the clinic with therapist guidance and at home without therapist guidance. Therefore, getting the help of an occupational therapist to create an optimal regimen for the patient is beneficial but not mandatory.

We are currently developing an easy-to-use remote monitoring solution that enables clinicians that monitor patient progress. The expected launch date is second quarter 2019, and will release more details around that time. In the meantime, therapists can talk to their patients on the phone or via Skype if they want to check in. The MusicGlove software provides an easy-to-use analytics suite that allows patients to easily view and communicate their progress.

Medgadget: Since MusicGlove works more on fine motor skills, what level of functionality does the patient need before he/she is able to use MusicGlove?

Dr. Friedman: MusicGlove works by encouraging users to complete exercises on their own, strengthening the neural connection between the brain and the hand over time. This means that it does not move a patient's hand for them, so some initial movement ability is required. In our clinical trials, we have seen the best results when users begin using MusicGlove once they are able to touch their thumb to either the side or tip of their index finger and release it at least once every 10 seconds. If the survivor does not have the ability to move their hand, we recommend that they use our other device, FitMi, which is more adaptable to all levels of impairment.

Medgadget: How does hand rehabilitation with MusicGlove compare to conventional therapy? Has your product been clinically tested against conventional therapy?

Dr. Friedman: The exercises that users perform with MusicGlove are essentially the same exercises that they would perform in conventional hand therapy. The difference is that the number of repetitions performed in conventional hand therapy is orders of magnitude less than what is required for maximum recovery. With MusicGlove, it is easy for users to complete thousands of repetitions without even feeling like they are doing therapy. We've completed two randomized controlled trials to compare MusicGlove to conventional therapy, one in a clinic setting and one in a home setting. In both cases, patients that used MusicGlove had significantly greater improvements in hand function than those that did conventional therapy. These functional improvements also led to significant improvement in patients' ability to perform activities of daily living, such as being able to open a door, brush their teeth, wash dishes, or use the toilet independently. Notably, in the home study, the MusicGlove users actually ended up doing even more therapy than we asked them to do as time went on, simply because they enjoyed it so much. We believe that is the main reason they had greater improvements in hand function than the other group.

: One of the closest competitors to MusicGlove is the Rapael Smart Glove by Neofect. How does MusicGlove compare to this product, and what sets it apart?

Dr. Friedman: The primary differences between MusicGlove and the Rapael Smart Glove include usability and functionality. We developed MusicGlove from the ground up to be a medical device that was truly accessible to the home market. These features include:

A lower price point for ownership at a price of $349 which is 70% lower than Rapael

Transparency in pricing and no barriers to purchasing the product. Rapael requires a signup form to just get pricing on their website whereas survivors can simply click the buy button and have the product shipped out next day.

No training required and minimal setup.

MusicGlove trains fine motor movement with multiple grip variations including a key pinch grip (one of the most commonly used grips). This grip variation is not available using the Rapael.

Finally, MusicGlove is the first product to market and has a longer track record as a successful neurorehabilitation device for the home market.

Medgadget: How much does MusicGlove cost, and do insurance companies cover it?

Dr. Friedman: MusicGlove starts at $349. This class of regenerative rehabilitation devices, MusicGlove included, is not covered by most insurance companies.

: We at Medgadget covered MusicGlove when it was first launched back in 2014. Have there been any major updates since the initial launch?

Dr. Friedman: When we first launched MusicGlove, it was only available as a full system that included the 10" touchscreen tablet for $1200. Since then, we have released a desktop version of the MusicGlove software that can run on a Mac or PC. We have substantially increased the number of devices being sold to thousands of units and therefore have therefore been able to reduce the cost of production. We have been able to pass these savings along to the end user and can offer the device at a significantly lower price point of $350 (70% reduction) for the software version. We've also made other updates to the MusicGlove software to allow patients to perform more customized exercise regimens that are tailored to their specific impairments and to expand the number of songs they can exercise along with.

Medgadget: Gamified neurorehabilitation systems have been out for a few years now. Based on your extensive experience, what are the main barriers to the adoption of such systems?

Dr. Friedman: Price is always going to a barrier, and it is one that we are very sensitive to. Often times, the individuals who need therapy the most are those that may have the most trouble paying for it. Unfortunately, insurance companies haven't made the long-term recovery of these individuals a priority. They are satisfied to get patients to a point where they are "good enough". We are not. And so we knew that the only way to provide a sustainable solution to these patients was to figure how to make a product that was affordable enough for them to purchase out of pocket. Now, for about the price of three outpatient therapy visits, patients can purchase a MusicGlove and have unlimited access to a fun, easy-to-use hand therapy tool that is proven to work. We are proud to be the first company to show that this model can be successful. Thousands of individuals have already used MusicGlove to take their recovery into their own hands since our launch in 2014, and more are joining them every day.

Medgadget: Is there anything else you think our readers should know about MusicGlove or your company?

Dr. Friedman: MusicGlove was our first product, but we didn't stop there! We also offer another device called FitMi that allows users to practice arm, leg and trunk exercises at home in addition to the hand therapy that MusicGlove provides. In the upcoming six months we will also be launching two new devices. One is a wearable intended for individuals with neurologic injury and the second is an exercise cycle for rehabilitation. Both of these devices will be the first Bluetooth-enabled neuro rehab tools that make therapy a social experience. Users will be able to join collaborative groups to achieve goals and stay motivated.

We also know that recovery is about more than just doing your exercises, so we've also focused on fostering community and education resources for stroke survivors. We moderate one of the largest stroke support groups in the country ( https://www.facebook.com/groups/flintstrokesupportgroup/) and we run one of the top stroke blogs in the U.S. with over 500 articles on stroke prevention, treatment, and recovery (www.flintrehab.com/learn). Our mission is to empower individuals with effective, engaging tools to spark their recovery, and we look forward to continued innovations to help us better achieve this goal.

Link: Flint Rehab...

Flashback: MusicGlove Hand Rehabilitation System Now Available...

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MusicGlove Combining Music and Games for Stroke Rehab: Interview with Dr. Nizan Friedman, CEO of Flint Rehab |

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Stroke is a leading cause of death and disability around the world. In the United States alone, nearly 800,00 people suffer from a stroke each year. Many of those who are lucky to survive continue to live with various long-term physical disabilities, including upper limb motor impairment.

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December 6, 2018

MusicGlove released in 2014

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This is an exercise tool for people who have impaired hand function after a stroke. The device has sensors on the fingertips which detects the movement of the wearer. The system detects gripping movements which are frequently used such as key-pinch grip, or a pincer grasp. Exercise with the device is simple. Simply put glove on and play therapeutic music which will then prompt the user to perform the grip exercises along with scrolling notes which are synchronized to a song. MusicGlove takes a similar appearance as the popular video game "GuitarHero". By using this approach MusicGlove has been able to transfer the "addictive gaming experience into a rehabilitation tool that users actually look forward to using" ( Raddawi, 2018).

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The cost of the device is $394

Cost is lower than traditional physical therapy

Uninsured patients can benefit at a lower cost than traditional therapy

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Patient motivation will affect progress

Must have a computer or a tablet

Patients must have movement in fingers if unable to move this device is not recommended

Not covered by insurance

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As a stroke nurse I have seen how difficult it is for uninsured patients to get access to proper rehab facilities. Rehab facilities are extremely expensive and most patients do not have the funds to cover this. MusicGlove seems like a very good option for these patients. I believe it has a great price point "for the price of three outpatient therapy visits" (Radawwi, 2018) patients can have unlimited therapy at home.

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Relator

Restorative

Adaptability

Individualization

Analytical

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1. Alice The Achiever

Alice provides a steady pace for everyone to follow. We are complete opposites. She is just what we need when introducing this device.

2. Chelsea The Commander:

Chelsea is needed to take control of situations and make decisions. She is very persuasive and knows everything there is to know about the MusicGlove.

3. Ivy- Individualization

Ivy works great in a team. She sees everyone's strengths and is flexible. She enjoys working with everyone. She is great at building relationships and introducing the MusicGlove to individuals.

4. William-Woo

William loves meeting new people. He has a talent for creating rapport with people. He works closely with Alice and Chelsea to introduce the MusicGlove.

5. Amelia- Adaptability

1. With everyone having such strong personalities Amelia is the referee. She is flexible and gets along with everyone and is the voice of reason when personalities clash.

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Raddawi, K. (2018). MusicGlove Combining Music and Games for Stroke Rehab: Interview with Dr. Nizan Friedman, CEO of Flint Rehab. Medgadget. Retrieved from https://www.medgadget.com/2018/12/musicglove-combining-music-and-games-for-stroke-rehab-interview-with-dr-nizan-friedman-ceo-of-flint-rehab.html

Flint Rehabilitation Devices. (2014, December 10) Flint Rehabilitation Devices. Retrieved from https://www.youtube.com/watch?v=E-0DF58FUDo