In the development of J58’s standing wheelchair, the end user is central: ‘You can fill a cemetery with innovations that ignore end user wishes’

Fellow Stephanie Jansen-Kosterink and Gabriel Costa (CEO of J58) were interviewed by Aafke Eppinga of Innovation Origins about the importance of patient-centered innovations, the ecosystem in Twente and making an impact. Below is a repost of this interview (https://innovationorigins.com/nl/bij-j58-staat-eindgebruiker-centraal-je-kunt-begraafplaats-vullen-met-innovaties-die-voorbijgaan-aan-wensen-van-eindgebruiker/).

 

The story of J58 has its origins in Brazil. When professional volleyball player Augusto Hosanna ends up in a wheelchair after a severe car accident, he has only one dream: to be able to play volleyball again. So Rivelino Montenegro, one of Hosanna’s best friends, came up with the idea of designing a wheelchair where his friend could stand – and thus play volleyball. J58’s founding team was complete when they met compatriot Gabriel Costa at a conference in 2017. All three bring their expertise: Hosanna knows from personal experience what it is like to be in a wheelchair, Montenegro has entrepreneurial experience, a medical background, and a PhD in material science, and Costa takes care of the technical side of things.

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Costa: “We are not the first to develop a standing wheelchair; there are already electric versions. But those are very heavy, and you can’t put them independently in a car, for example. Moreover, they are costly, and you are dependent on a battery. We wanted to design something with the advantages of such an electric sterol chair, but not the disadvantages.”

The result is The Next Wheelchair. A mechanical wheelchair made on the basis of gas springs enables precise movement, requires no motor or battery, is much lighter, and is many times cheaper than the electric version.

Whoever is not in a wheelchair takes a lot for granted

More importantly, the wheelchair allows users to experience the world on a par with the rest of the people. “Those not in wheelchairs take a lot for granted,” Costa now knows. “We can just look everyone in the eye. Wheelchair users can’t. Going to the supermarket independently is already a challenge; you must always ask for help to grab something from a higher shelf.”

This is also the experience of Jansen, a senior researcher at RRD who sees many patients. “If you are different, you would prefer to be as normal as possible, even if you’ve fully accepted being a wheelchair user. On top of that, it’s unhealthy to sit a lot.”

Many body processes depend on gravity, which occurs when we stand. For example, when you sit, less blood flows through your legs. Also, legs absorb less glucose while sitting, which can disrupt or reduce blood flow to the brain. Costa: “Because users can stand with our wheelchair, it improves circulation and strengthens muscle mass.”

A graveyard full of healthcare innovations

Instead of a tech push, what applies to innovations in healthcare is that users must be included in the development process. “You can fill a cemetery with innovations, AI algorithms, and apps for care that ignore the wishes of the patient or care workers and therefore did not make it through,” Jansen said. That’s why the end user is at the heart of RRD.

They share that philosophy at J58: the main starting point in designing the wheelchair has always been usability. Costa: “One of the biggest requirements is that users can move with our wheelchair to the toilet, bed, or another wheelchair. If you can’t do that yourself, our innovation doesn’t advance.”

Beyond the familiar

But how do you make sure you hook the end user in the right way? Jansen knows that it becomes problematic if you are not trained to talk to patients and look at a product from a tech lens. “So, we ask not only if the wheelchair is comfortable, but also when, how, and where patients would use it and what barriers they see to use it. We don’t ask those questions directly; the trick is to ask the question as openly as possible.”

Costa: “The famous saying of car manufacturer Henry Ford – ‘If I had asked what people want, they would have said faster horses’ – also applies in our case. We have to look beyond the known. Through our collaboration with RRD, we are succeeding. For example, in a pilot, we found it convenient to have someone sit in a wheelchair through the side.”

The most entrepreneurial university in the Netherlands

When the idea for a mechanical standing wheelchair arose in 2020, Costa was almost finished with his master’s degree in design engineering at the University of Twente. It is the most entrepreneurial university in the Netherlands, which is a perfect match. The budding entrepreneurs connect with Novel-T and gain access to coaching calls, an extensive network, and many funding opportunities. The startup also rents office space for a relatively low price at Incubase, an initiative of Novel-T, the University of Twente, and the Student Union. So Costa, born in Brazil and raised in Limburg, has settled in Twente.

‘The whole is more than the sum of its parts’

Right now, J58 is putting the finishing touches on the first production model. Once certification is in, the first pilot series can go into production this year. Talks are ongoing with manufacturers in South Africa and South Korea, but the goal is to grow the company from Twente.

What makes the Twente MedTech ecosystem so unique? Costa thinks it has to do with everyone being very approachable. “Even big companies, like Demcon, make time to run a pilot with us. Everyone wants to help each other.”

Jansen: “Are you familiar with Gestalt psychology? This movement believes that the whole is more than the sum of its parts: 1+1=3. That plays a big part here. We are not concerned with how we can improve ourselves but how we can get better together.”

Giving people back their freedom

In five years, Costa hopes The Next Wheelchair will be the global standard for wheelchair users. “The practical benefits of our innovation are nice, but our main goal is to give people back their freedom and independence. Our first test user has been in a wheelchair for 18 years after a diving accident. He took his wife to the test, and the first thing he did was kiss her. I will never forget that moment; our company is more than an engineering project.”

 

Scale-Up4Rehab: Important step forward in digitalisation rehabilitation sector

To ensure equal access to rehabilitation care and promote the resilience of health systems across Northwest Europe, a new 5-year project is being launched.

Scale-Up4Rehab will take a major step forward in the digitisation of the rehabilitation sector by being the first to build an open virtual rehabilitation "clinic," which will scale up existing virtual rehabilitation therapies. In five regional pilots (NL/DE/IR/BE/LU), acting as showcases, rehabilitation professionals in different care settings will integrate virtual rehabilitation into their daily practice.

Why is digitalisation in rehabilitation needed?

Remco Hoogendijk, Manager Projects & Innovation Sint Maartenskliniek (The Netherlands): "Access to rehabilitation is unequal, both between and within countries. Technology offers the opportunity to provide efficient care and access to dedicated rehabilitation care, regardless of patient location. Various forms of rehabilitation therapy using virtual technologies are already taking place. However, these digital applications are used only in local settings and economies of scale are not being exploited. Transnational collaboration is needed to achieve these economies of scale and take the digital transformation of the rehabilitation sector to the next level."

Rehabilitation plays an important role in improving the health and well-being of the population and the overall efficiency and sustainability of health systems. With an aging population, the number of people in need of rehabilitation will increase while there is a shortage of health care personnel.

Partners in this new project

Partners in achieving equal access to rehabilitation care and promoting the resilience of health systems throughout Northwest Europe are:

  • Rehabilitation clinics and university medical centers: St. Maartens Clinic, St. Mauritius Therapieklinik, Centre National de Rééducation Fonctionnelle et de Réadaptation, Roessingh Research and Development, University College Dublin, School of Public Health, Physiotherapy and Sports Science, University College Cork, Discipline of Physiotherapy, School of Clinical Therapies, Radboudumc Department of Rehabilitation, UniKlinik RWTH Aachen.
  • Universities, specializing in engineering and computer science research and development: University of Lille, University of Tilburg.
  • Innovation Networks: In4care, Health Valley Netherlands, Eurasanté.

Additionally, we will set-up a group of associated organisations, interested to follow the project, including:

  • Teeside University
  • XR4Rehab collaborative network
  • EIT Health Belgium-Netherlands
  • Shift Medical
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For additional information about our role in Scale-Up4Rehab, you can contact Stephanie Jansen-Kosterink:
FOTO ERIC BRINKHORST

Stephanie Jansen-Kosterink

Email: s.jansen@rrd.nl

Tel: 088 087 5717

Scale-Up4Rehab obtained a grant of € 6.5 million from Interreg North West Europe
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Measuring walking - are we doing it right?

Written by: Erik Prinsen, Corien Nikamp, Nerrolyn Ramstrand

Ever since Muybridge studied walking by making a series of photographs, gait analysis has become widely available to study walking. Instrumented gait analysis in particular has been essential in increasing our understanding of how individuals regain walking function after a stroke or amputation. It has also been used to quantify how we can influence walking ability with technology. Despite its wide application, there is no consensus on the best way to conduct an instrumented gait analysis, nor how to present its results. While the majority of trials have investigated straight-line overground walking, one may also question whether this is the most clinically relevant environment. So, are we measuring walking in the right way? This question is the main topic of a symposium that is organized by dr. Corien Nikamp and dr. Erik Prinsen from Roessingh Research and Development in Enschede, the Netherlands, together with Prof. dr. Nerrolyn Ramstrand from Jönköping University, Jönköping, Sweden. This symposium is part of the World Congress of the International Society of Prosthetic and Orthotics to be held from 24-27 April in Guadalajara, Mexico. In this blog, we are offering a sneak peek into the contents of this symposium.

When performing an instrumented gait analysis, many choices must be made. Which variables are of interest for my specific case? How much data am I going to collect? How am I going to present the data? These questions will be tackled during the symposium.

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How much data am I going to collect?

While there has been research investigating differences between biomechanical models, few studies have investigated the influence of the number of steps that are included in the analysis. This notion is not new, as Zahedi et al. in their 1987 paper in Prosthetic and Orthotics International already concluded that “it is first necessary to quantify the degree of repeatability due to the method of measurement and step to step variation, before attempting biomechanical comparison.” To our knowledge, however, step-to-step variation has not been studied in individuals with an amputation.

Therefore, Roessingh Research and Development conducted pilot experiments in which we asked three individuals with a transfemoral amputation to come to our lab five times while we collected around 200 strides using instrumented gait analysis. This allowed us to compare variability of gait within a measurement session but also between measurement sessions. Results of this pilot study showed that including a limited number of steps (up to 20 steps) can lead to differences up to 10% in walking speed when comparing across sessions. It also showed that during a measurement session, individuals tend to start at a higher walking speed which levels off towards the end of a session. This pilot study gave indications that the gait pattern of individuals with an amputation is more variable than we initially thought. It also suggests that we may need to include more strides than is common practice at this moment, or at least be aware of the potential risks of analyzing limited number of steps. During the symposium we will delve into the results in much more detail and open the floor to discuss experiences of other researchers.

 

How am I going to present the data?

Another choice that needs to be made is how we are going to present the data. A common way to present the data is using a stride time-normalization. When analysing human walking graphs of the joint kinematics (angles) are typically presented from initial contact to initial contact with an indication where the step-to-swing phase transition is, indicated at the instant of foot-off. While this may work on an individual level, it may lead to problems when presenting data of the group, or when presenting longitudinal data. This is particularly the case when there is variance in where the step-to-swing phase transition is located. This variance may lead to a situation that data of individuals that are still in the stance phase is combined or compared with data of individuals that are already in the swing phase for a part of the stride.

A thorough analysis of data Roessingh Research and Development gathered in a longitudinal study of stroke survivors showed that this does occur and it can seriously skew the graphs of joint kinematics. Furthermore, this trial showed that normalizing joint kinematics on the sub-phases of double limb support phases, single limb support phase and swing phase prevents skewing of graphs giving a much better representation of the joint angle. During the symposium we will show these data so you can see how data are skewed with your own eyes and how sub-phase time normalization alters the graphs giving a better representation.

 

What data am I going to present?

The final topic of this symposium is the question of which data to present. As mentioned before, many studying comparing different technologies have looked at joint kinematics or joint kinetics. While these are variables of interest, the relation between differences on these variables and the overall functioning of its user is not always straightforward. Therefore, looking at overall variables such as balance or cognitive load during walking might be more interesting.

One way of looking at cognitive load is measuring the blood flow in the frontal cortex of the brain, as measured with functional near-infrared spectroscopy. Jönköping University has extensive experience in collecting these data in individuals with an amputation. Their data showed that the cognitive load of walking with prostheses with advanced capabilities, such as auto-adaptive components, is lower when compared to walking with mechanically passive prostheses. They also demonstrated that patterns of brain activity may change in the absence of changes in walking speed or step length. These results are of high clinical interest as they clearly show the potential of more advanced prosthetic components on the overall functioning of individuals with an amputation, and the potential of cognitive load as an interesting outcome measure in gait research. In this symposium we will show you the magnitude of these differences and we will discuss the meaning of these results for individuals with an amputation and the prosthetics field in general.

 

Do you want to know more?

Did we spike your interest and are you attending the ISPO World Congress? You can attend our symposium on Tuesday 25th of April from 14.45 – 16.00 hr in the Main room. In case you are not attending, but you are interested? Please feel free to reach out to us!

Erik Prinsen

Erik Prinsen
E-mail: e.prinsen@rrd.nl
Tel: +3188 087 5761

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