Exoskeletons and Interactive Therapy for Neuromuscular Disease Patients and Stroke Recovery: Dr. Amalric Ortlieb, autonomyo

Speaker 1: 0:00

really just trying to provide them with more freedom.

Speaker 2: 0:08

Hi, i'm Alex and welcome to the X-Halth Show, where I talk to visionaries behind the latest innovations in healthcare for the extra health of the future. We're in Leugarage, a lab and office space for the business ideas born at EPFL, swiss Federal Institute of Technology in Lausanne. My guest today is Amalrik Ortlieb, mechanical engineer with a decade of experience in robotics, an inventor of an exoskeleton that allows people with neuromuscular diseases stand and walk again. You'll notice his father not speaking about his invention. Autonomio is an early stage-swiss startup that began with a robotic suit and now offers lower limbs rehabilitation, training involving a digital platform and VR for both clinics and home use. You'll hear today about stroke recovery, multiple sclerosis, duchenne, muscular dystrophy, spasticity, various exoskeleton kinds and how they differ And, of course, about Iron Man's powered exoskeleton. Amalrik, you told me there was a mother that saw a US military exoskeleton and she said like she would buy it for her son, and this is how it all started. Could you tell the story please?

Speaker 1: 1:24

Yeah, sure. So at the time I was just finishing my master's studies in robotics and I was looking for what next I would do And I really liked the technology we were developing in that lab already working with partial orthosis and exoskeleton. And we get contacted with this association where patients with neuromuscular disease Yeah, that was the story with that mom that initiated that project basically, and that was like the strengths behind this project to say, okay, we need to do something with that, there's new technology, and definitely she had a son that could not walk so well with the generative disease And so that's how it was barely initiated.

Speaker 2: 2:15

Okay, so now fast forward. How did you get involved with exoskeletons, like yourself and like how autonomial was born?

Speaker 1: 2:24

So it started when I was doing some semester projects. It's already during the master. You have access to different projects, to a lab that is doing that kind of things, the lab of robotics systems. That is now today the cold rehab cysts still a DPFL, but changed the head. The group leader in there And that's it.

Speaker 2: 2:47

Okay, and yeah, i was asking the autonomia how was it born? Because so you got involved in this project but you didn't have, probably, a founding company in mind, or did you have that from the beginning because you wanted to deliver the exoskeleton for the mother?

Speaker 1: 3:06

That's a good question. Yes, very often when you do a PhD, it's more a project coming from the Fond, national or some money that is purely dedicated to some research topics.

Speaker 2: 3:18

So it's academic, basically right.

Speaker 1: 3:20

Yeah, And then this project. it was really like the need was coming from real people. So from the beginning, that was the interest of this project is that you need to go somewhere. Was it then not just advance the research?

Speaker 2: 3:36

And you started working with the association, or was there any collaboration involved?

Speaker 1: 3:43

Yeah, they completely financed my PhD. So that's how it started, And today we incorporated company based on that. So it took several years several years first to finalize the PhD and then to transfer it into a company, find different grants to push it forward And now always looking for some investments to go forward with that.

Speaker 2: 4:07

Were you convinced from the beginning that that's a good idea to follow?

Speaker 1: 4:12

Definitely very, very convinced, of course, and that's a very, very nice project And we know that it's going to be a reality someday. But we also know today that there's many constraints, of course. A very deep tech technology, so very hard to put it on the market at a decent price, so in terms of access, it's not so easy to provide it.

Speaker 2: 4:42

Yeah, imagine the prices, or what could be the prices now.

Speaker 1: 4:45

What is nice is that there already exists quite some product on the market, so we don't have to go from scratch in defining the prices And those different companies. They sell about the price of a very nice car, so multiple tens of thousands of Frank's euros, us dollar.

Speaker 2: 5:05

Yeah, Okay. So maybe you could just say about your exoskeleton, Like how does it work?

Speaker 1: 5:16

That's quite interesting, but today, i think what is more interesting is to know what we want to do with it.

Speaker 1: 5:21

All right, yeah, because you start with what you want to do and then you go into yeah, what are the different functions? And what we realized is that you have some degenerative disease. That's one case, And in this case we saw that what is super interesting is that you can help the patients prolongate their ability to walk. So you cannot cure them. You can improve a bit their state because using more muscles, training more by having an exoskeleton, is something where they can have a better ability to walk. But you know, since it's a degenerative disease, that they're going to lose it somehow someday.

Speaker 2: 6:08

What diseases are we speaking about?

Speaker 1: 6:11

Mostly neuromuscular diseases. That's all of them are quite rare disease, so you have a lot of them. The most common of them is Duchenne muscular dystrophy and that affects mostly children, but you have a lot of them. And the other cases that we have is coming from trauma, for example, stroke, and stroke we talk about it because that's affecting one in four people today at some point. That's really huge, and when you have this trauma, then you need a lot of rehabilitation to recover your ability to do the different tasks, like walking basically. And that's where we saw that there is even a bigger impact because you're not just helping people walk longer, but you're really providing them the ability to train and recover that walking ability And that will last in the future.

Speaker 2: 7:13

Building on that, I also read in the paper that you sent me that there is 7% of the US population that is unable to walk 400 meters, And the paraplegic people, I mean they are up to 2% of it. So that's a huge percentage. It's like 23 million people in the US alone that have some issues with walking. Would that be also for them?

Speaker 1: 7:48

Yes, definitely That's quite striking on those numbers. They did those kind of research in the US. We don't have access to the same kind of review or analysis in Europe, but definitely you see that walking disorders is much bigger than you expect Most of the time is very often because you don't see those people in the streets, because most of the time they don't go in the streets since they have this disability. So it's not something you see and you face every day, but it's a huge topic.

Speaker 2: 8:21

Okay, so how does it work, or how do you want it to work?

Speaker 1: 8:26

So where we see that we can really make a difference is through this rehabilitation process, because you see that anybody that train will improve his level, his muscles, his motricity, like the way he controls his movement and the way the different sensors we have in our body can help us. And that's true also for patients. So when they train they get better, And we saw that the exoskeleton gave really them access to being verticalized again That's what we call when we basically stand up and walk again And that's all those things that bring back your muscles to life And you have better blood circulating through through different veins etc. So that's really having a huge impact just to stand and to move.

Speaker 2: 9:42

And I saw just upstairs here in your workshop so it looks basically like it's kind of like a robot without like full legs sitting on a table. so I can imagine to put it on you need to basically sit on it, so just like something like sit on a table and then what do you do?

Speaker 1: 10:03

So basically the process is that you have different straps. You first strap your foot, your two foot, on the soles of the exoskeleton, then you can straps your just under your knee. You have two straps were at the tbl level that you put on, and the last one is at the trunk level. We call it a corset in the beginning. So really brace that you put around, yeah, a bit above your pelvis and basically, since you're in your completely attached to it like a suit, you just click on and then you can start standing up and then walking, was it?

Speaker 1: 10:44

so when you click on what happens, Oh, it activates the full thing, like any, any device. Like you push the on button and then it starts realizing what's his position etc. And then he understand that he needs to perform Some assistance to provide you with the ability to stand. So it's gonna activate the mother's to give you some additional strengths and in the, in the knees and the hips so that you stand and that's what you call robotically assisted.

Speaker 1: 11:23

Yeah, so robotically assisted gate training is something that goes a bit back to days, so it has been, i think there's, since the early known ease And the first devices. We saw them in clinics and they are super big machine usually and they incorporate some prior type of exoskeleton, but they're usually a big machine where you completely There's a full structure to which it's anchored and there's all very often like a treadmill under it, so it's it's a static thing. But So what we do with exoskeleton dot are wearable today. It's a prolongation of what exists, but you really can use it at home and not only have it in clinics like it was before what did you start with when thinking about building it And what is it now?

Speaker 2: 12:19

what do you want it to be and what did you make the decision based on of changes?

Speaker 1: 12:26

Yeah, that's a very good question. so back in the days we were really like starting from scratch and I just remember me thinking like, yeah, in four years, when I'm gonna finish my PhD, that's gonna be something. and that was like an exercise. that was super interesting because you're like Having nothing and you have to project, project yourself into something in a few years, and we started to look at what are the different joints of the body that are the most important To actively assist where you need some assistance, and they are different ones, and we were one of the first exoskeleton using a hip abduction. so that's the movement you do sideways kind of, which doesn't seem to be so important when you walk, because people have the impression that they just move forward. but basically, when you transfer your weight from right to left, your, your pelvis motion is quite important and that's where the hip abduction movement is super important.

Speaker 2: 13:33

So this is still the PhD. What? what changed then within the project, or did it change? it didn't.

Speaker 1: 13:41

So the PhD focused a lot on defining a physical support device for people that have very different needs in terms of location of the symptoms.

Speaker 1: 13:57

Some of the people are very affected in the ankles or the knee or the hip, so they were very different levels.

Speaker 1: 14:03

Also very could be very asymmetric from from the left leg to the right leg, and the PG really focused on defining like a proper machine device to do it, and what evolved since then is really working on the end use and looking at what we need to do, and there we change quite a few things where we tried to go more towards this rehabilitation that we want to do at home, and for that we also need to have something that's not only the device but that's also the way to interact with the physiotherapist that is there to have exercises that are defined not only for this device but that are usual physical exercises that the patients need to do to recover.

Speaker 1: 14:56

And that's where we started also building a full digital platform where you have different exercises that are guided through video games basically. So that's like a home trainer virtual coach that you have in front of you, so you have it on your, on your TV screen, for example. You, you're standing in front of it and then you can start playing with different things, like imitating the different motions that the coach is telling you to do And having the different sensors from the exoskeleton that are connected to those, those video games. So you see directly on real time, like what you're doing and how you can improve it, how is your posture, where is your center of pressure, and you can play with it or correct it, and that's very interactive.

Speaker 2: 15:47

You initiate the movement or does the exoskeleton initiates a movement?

Speaker 1: 15:53

We definitely initiate the movement, or the one using the exoskeleton is initiating the movement. That something very important, since we really want to train people and improve what their their own ability. So it is really triggered by the user himself and then we can detect different things like different movements, like, or the little premise of a movement before it happens, or just the weight. The center of pressure of the person will indicate where the person want to go next or what he or she is going to do next.

Speaker 2: 16:35

Could you maybe recall one person, one user that tested the exoskeleton and tell about her or him, how they started using it and what were the impressions?

Speaker 1: 16:51

We've had different users over the time. We had a first user. That was quite nice because he was our test pilot and he was the one who's whom we we developed and tested the first version of the different strategy and also looking at what was his capabilities To be able to trigger and detect the different motion is going to do. And then we had the first clinical trial with was the local hospital where we had about 14 patients Of two different groups, like multiple sclerosis and your muscular disease, and they all had very different experiences And the very interesting ones we have very good results was one patients that recover, for example, a lot more sensation in one leg after using the device. That's something where she has a condition that she loses a bit the feelings, the sensations, in one of the leg. We had other patients that felt like they could walk for hours, where they can only walk for a few minutes without the device. So that's also super interesting to see how it's a as a rehabilitation device. They could benefit from longer training access.

Speaker 2: 18:09

How fast can they walk in it?

Speaker 1: 18:11

That's one of the main still drawback of the exoskeleton today, i think in general it's usually it's a bit slower than your natural walk and that's not only because of the power of the actuators, because that's one of the first big limitation, but that's also because you are having different phases where you detect what's the intention of the user and you need to make sure that the user is a bit stabilized in between all those phases. So we realized that, yeah, you're putting a bit more time and in the different gate phases when you're walking, And you mentioned the battery time, like how long do they last?

Speaker 1: 19:00

Yeah, today it's no more concerned that the development with batteries has been so, so huge that it's based on your design how much battery you want, etc. So today we go with minimal battery so that there is less weight on the user, and this we can go for two hours easy of training and that's a long training, isn't it?

Speaker 1: 19:27

For one person that's. That's a long training now. Now, if you think that's a rehabilitation center, would use it in a row with different users. You're like, yeah, this could hold for a full day maybe. And the trick for that is just to have removable batteries that you can quickly exchange and put the other in charge and go further.

Speaker 2: 19:48

How much does it weigh and does it matter really?

Speaker 1: 19:52

That's quite a good question. It's still quite heavy. If you want a full potential of assistance, we today are at a weight of 25 kilo roughly. We know we can still improve it. That's still a prototype versions and It doesn't matter so much because the system is self-supported, so once it's turned on you will not feel the weight of the device.

Speaker 2: 20:23

Because it can support itself not only the user, but also itself. Right.

Speaker 1: 20:28

Exactly, that's the point.

Speaker 2: 20:30

The thing is I was just thinking about Iron Man and how he puts his suit. He says deploy, and it's on, or basically there's something like a liquid thing. This exoskeleton appears like a liquid something and he calls nanotechnology. So we're pretty far from this. But how can then the user put it? Because, yeah, can people put it by themselves, or do they need assistance?

Speaker 1: 21:05

Yeah, that's definitely true that we're still quite far from the Iron Man suit and the way they wear it, but what's interesting is that in those movies they show the importance of this donating process. And we face also this thing where in a rehabilitation session you don't want to spend too much time in putting on the device if you have a physiotherapist that is here to help you and has limited amount of time. What we do today is the best is to have like your own exoskeleton, so you don't have to change or adapt the different dimensions of it, because of course it's meant to be adapted to, or adaptable to, different users. And when you have it already set up for you, it's quite easy to go and strap it at the different levels, and I think we have a record of like three to four minutes for doing it with a bit of assistance, that's true.

Speaker 2: 22:14

Now, could you also tell something about these tests that you did, or where these clinical trials, how would you call them And what did you measure? How did you measure and what were the results?

Speaker 1: 22:29

Yeah, we did this clinical study with the Shuev hospital.

Speaker 2: 22:34

Here in Lausanne.

Speaker 1: 22:35

Here in Lausanne exactly. So we did it and that wasn't interesting. We did it in the main floor of one of the building to have enough room to be able to walk on 50 meters, at least Basically. We did two training sessions to be sure that the users or the patients are used to wear it and they're comfortable with the different level of assistance that we can provide. And then we did a session in what we call the gate lab, where you measure about everything, so you put little markers on the body to be able to track the motion precisely And we also put electrodes to measure the muscular activity of the people using the device. That's a bit more noisy, that's a bit more tricky to really record. But really what we wanted to see out of the motion is can we, with the assistance of the exoskeleton, provide back some gate that is more symmetrical?

Speaker 1: 23:46

And the results were Oh, you definitely have almost full capacity of symmetry. Recovery was the device which was quite interesting, especially for patients who are affected with a bit of spasticity, So their muscles were quite tense all the time, And so that was quite interesting to see that you can like revert this way of being by having an external device like helping them do a proper motion.

Speaker 2: 24:18

How long did it take to revert?

Speaker 1: 24:21

Oh, it's when they wear the device. It's immediate. So they directly start relaxing in a way, because spasticity is like being tense and not relaxed somehow. And yeah, that helps. With the motion comes more relaxation. So the muscle understand that he has to relax at some point and just be contracted when needed.

Speaker 2: 24:51

You mentioned a few diseases and you also mentioned that patients have very different needs. Can you support, like, all of these needs or are there some limitations?

Speaker 1: 25:03

Patients have a lot of different needs. Of course we can look at the disease, but we can look at them in a global manner as a human being, and I think that are the first will is to be autonomous in their daily life and not be dependent on caregivers etc. And they just want to have like a natural life where they can socialize, they can move around, they can do their grocery, to go to the doctor if they want to go it, go visit their friends, etc. Here we're trying to give them more autonomy and independence in the way that we just try to provide them with this mobility capacity of being more free. Let's say so, really just trying to provide them with more freedom. And but of course they would have other pains or disorders that still impact their life.

Speaker 2: 26:26

This episode is brought to you by The Ex-Holes Show and me. So if you like this podcast, be generous, hit, follow, leave a review. That'll help me invite more such amazing guests for you. Thank you. I can hear you speaking about two things One is for training and the other is actually for using it in an everyday life. So you can support both patients themselves but also clinics in training or how to envision basically your business model.

Speaker 1: 27:00

Yeah. So today we really focus on to the rehabilitation process and not really on providing mobility, was the correction of the device. Let's say, like you would train to see better if we, if we take the alternative of like the vision but not being like glasses that you have to wear to be able to see Right. So we are more device that is only and purely used in a rehabilitation process today. Future maybe will be a corrective device, but that's that's the situation today. So definitely, today those devices are mostly sold into clinics And what we envision for the future, and where we see that there's really something missing, is that people don't have the the capacity to really train and do therapy at home because they're dependent on the tools and they're mostly dependent on the therapist and their availability.

Speaker 1: 28:08

So if they have, i mean but that's the global vision today of going towards more digital health and remote access to therapy also was the clinician. You know, today you can access your clinician by a phone call or a zoom call, let's say, but in the past that was not possible. So that's also something that give you way more access to the therapy because you can do it every day, whereas if you need depends only on the therapist and there are scarce resources. You don't have so many of them to be able to train every day, so that gives you access to more therapy basically.

Speaker 2: 28:53

Can these exoskeletons be connected to physiotherapy? So you have an exoskeleton at home and it's somehow connected to your physio who'd say like well, today you know you did this and this. Now, tomorrow, focus on this and that.

Speaker 1: 29:09

Exactly, that's exactly the vision that we have. So basically, we have this digital platform where it's filled with exercises that we are building with physiotherapists And when one physiotherapist is coming, he is browsing this library and he's speaking up the exercises that he wants his patients to do, and the patients will receive like kind of a calendar or plan where there is this different exercises on the different days of the week that he has to do, and there's also this exchange where the therapist can have access to see if the patient has done the exercises or not. Which is a very big topic today is the compliance to the exercises, to the training, which usually is pretty bad. Like we all have this experience where we go to our physical therapist or occupational therapist and he told us please do this exercise at home three times a day or something, and you come back and you say I tried, but I roughly did it, like on a few days, but very hard to comply with it.

Speaker 2: 30:25

So how can a user perform these exercises So I could see a big screen in one of your rooms upstairs and also a guy working on a VR set.

Speaker 1: 30:39

Exactly. We're basically exploring different platforms, and so you mentioned like a smart TV basically. So it's exactly like would be your phone, that's, you download the app, you know how it works today And you connect it to the device and you can just start instantly playing with it, just maybe log into your account so you're connected to it. And yeah, we're exploring also today the VR, so virtual reality, and we've seen that there's a lot of improvement into those headsets today. Not only they have the ability to show you another environment and immerse you in another environment, but they also have the ability to track all your upper body motion, even the signs you're doing with your hand. It's quite advanced and it's quite complimentary with what we're doing with the exoskeleton.

Speaker 1: 31:40

So you imagine you're coming in those games and basically the first thing that is needed is to see yourself, because when you see yourself, you're aware of exactly what you're doing, what is your posture, what you can improve, and you don't need the feedback from a therapist telling you, yeah, put yourself more in the right or in the left, or get your back on place, etc. And then we tried to have a bit of guidance or a bit of entertaining that get you into making some different motions, so there could be some different targets, that could be a position, that's a motion, or that could be something very visual where you have to step on, or something like this, and that's how you can really make this thing entertaining. And you see that people using video games tends to forget a lot about their condition, so their brain focus way more on performing a task And they usually cut completely off the reality of their condition or else, and they can train really way more extensively.

Speaker 2: 32:55

So you forget about what you can't do, really.

Speaker 1: 32:58

Yeah, that's something we've seen. definitely, That's the power of immersion.

Speaker 2: 33:05

And you mentioned that when you see yourself, so patients or users, they can see themselves on the screen or in the VR set or Yeah, vr it's way more tricky because they are in the first person, right So seeing yourself.

Speaker 1: 33:23

you can do it in VR by looking down and you will see your legs, but that doesn't give you a very nice approach because it's quite close and you don't see exactly the positions. So what you're doing is usually you're placing systems like mirrors and you can look at yourself like in the mirror and you will see what you're exactly doing right now.

Speaker 2: 33:48

Okay, that sounds like fun. What kind of games did you come up with?

Speaker 1: 33:53

So the best kind of games and we're collaborating was this professor at CHEV that also demonstrated it, arseny Sokolov, where he shows that if you take a physical therapy and you combine it with a cognitive therapy, you have way better results, because people are pretending to do motion at the same time that they're thinking about a cognitive task, have way better involvement in results.

Speaker 2: 34:22

What does it mean?

Speaker 1: 34:23

For example, we have a game where you have the name of a color. that's called a stroke game, basically. So you have one color like red, but visually it's written red but visually you see it in blue. So that's typically a cognitive task, because you have to think do I look at the signification of the word or do I look at the color in which it's written? And then you have to place this word into the corresponding color And you can have two or four different colors and you have to put the weight of your body on the left or the right, in the front or in the back, so that this word will move to the right color.

Speaker 2: 35:11

So you're basically in the suits. The suits support you, that you can stand, and then you need to move things around so that they fit into the right category.

Speaker 1: 35:21

Exactly.

Speaker 2: 35:22

And also there was upstairs this whiteboard with people draw there and you mentioned there's like another project. You want to say something about that?

Speaker 1: 35:32

Yeah, sure, so we are investigating how we can try to have multi-players, so as we are starting to put systems together and have this digital platform that allow you to connect to different, to your physiotherapist, basically in a remote way. So in this way, you can also think about putting different patients together remotely, and that's, most of the time, something that is super motivating, because you don't think that you're just the only one having this condition and cannot do things, but you're competing with peers that have same kind of symptoms. So that's, i guess, something that is very, very motivating for any person or patient.

Speaker 2: 36:25

You might visit one therapist who has like a bunch of patients, and then there is Sophie, mark, isabel, matthew, and then they are like yeah, guys, so do you have Diamond Knight 9 on Wednesday? They gather together and they practice together.

Speaker 1: 36:44

Yeah, exactly, that's the beauty of it, and I think that we also all have some kind of experiences with different kind of trainings or sport activity And we see that having like either a bit of competition or either a social link is the biggest source very often of motivation to go to that training at that time, etc.

Speaker 2: 37:09

How far from the market lounge are we?

Speaker 1: 37:13

So today we have pretty well demonstrated that we can work with patients, like the device works pretty fine. But of course, when you're talking about a real product, you need a bit more today, still a bit more content to it. Like our digital platform need to be super well defined so that there's all the functionalities to communicate with the therapist, to build the plan, etc. And we're still in this we can say early process. We're still developing content a bit And our goal now is to have, like this minimal, viable product that we can go to market with. We're in the field of medical devices, medical health, and there it's very regulated, which means that at the time you want to go to market, you really need to be fully ready with something that a product, let's say, or service that will not change for the next five years I would say, or 10 years, because that's the biggest burden is to change different part of it, And then you have to go through this regulatory path again and clinically demonstrate that it's always safe.

Speaker 2: 38:39

So you didn't mention the year, or do you have any year in mind?

Speaker 1: 38:43

No, so right now, we are expecting to be on the market in two years.

Speaker 2: 38:48

Okay, And then how do you foresee the market develop? Because I already I did some research and I know there are some FDA approved exoskeletons in the US, Not sure if they are for the same neurological diseases. Probably you could tell more about that right. So how yours is different.

Speaker 1: 39:12

Yeah, exactly So. exoskeleton is something that boomed and started in about 2014, where we see that the three pioneers that started being commercially available, mostly for people with spinal cord injury. So the purpose was a bit different. Exoskeletons evolved today, also for other type of patients, other pathologies, but also for industrial work. that's what we call occupational exoskeleton. So to help you wear your very heavy screwdriver during the full day and, yeah, Move the suitcases at the airport.

Speaker 1: 40:03

Maybe, yeah, oh, yeah, i know which one you're referring to. Yeah, definitely all those crouching motion where you have to take something low and put it up.

Speaker 2: 40:14

But it looks slow right. When you can see guys moving the suitcases, like now, when you put the exoskeleton the ones available now it definitely helps the spine, but it is slower right. So it is some technical limitation there.

Speaker 1: 40:37

I. usually they try to have devices in this field so occupational exoskeleton that are not active, so they don't have power supply actuators etc. So it's more like spring, like systems that helps you perform a task, where it just distribute the load from maybe not going through your spine but going directly through to your hips, and those systems have no limitations in terms of speed, or else because they're just passive systems.

Speaker 2: 41:14

So it basically depends on, like how fast do you want to move?

Speaker 1: 41:18

Exactly.

Speaker 2: 41:19

Okay, and that's also one difference from your exoskeleton right, because you have the power on your back, as you said.

Speaker 1: 41:27

Exactly So with those kind of medical devices that we're developing, then it's way more like a shared connection between, like the actuators and the muscles of the person. So you as a designer of those devices, you can choose or you can adapt the level of assistance and ask for the exoskeleton to really do more or do less, and then it's more dependent on this context or parameters that you can affect the velocity or etc.

Speaker 2: 42:08

Are there any other differences with the ones available already?

Speaker 1: 42:12

Yeah. So going back to the one I was mentioning as pioneers for spinal cord injury, all in the medical field, let's say we are today, have done a little bit of improvements, but we're still quite close to what was done at that time, meaning that you have quite a rigid body exoskeleton. You can see today soft exoskeleton also, which is quite a big trend, very interesting. A bit less capacity of providing physical support, but maybe more wearable and quite interesting too.

Speaker 2: 42:50

So just the stimulation is not supporting the upright position.

Speaker 1: 42:56

Yeah, and while we are working more today, I think it is developing not only the hardware, but also all the algorithms and the control behind it.

Speaker 2: 43:10

Can the exoskeleton be rainburst?

Speaker 1: 43:13

So that's the big point of the future And you were asking about how is the future, how do we see things? And I think that there is this big we could say political decisions or vision that would quite trigger in which direction exoskeleton will become something that we use more or not, because of course today we are facing the problem that it's quite expensive technology And to make it more available, then it's mostly up to the healthcare system to see if they want to reimburse and if the benefits that we provide are enough to demonstrate How to say that.

Speaker 2: 44:05

What do you need to basically make it happen?

Speaker 1: 44:07

You need a lot of conviction, you need a few years, because those systems are not fast, they're pretty conservative. We've seen that and in Switzerland, for example, you need about five years to get a new device Like that recognized the system in the reimbursement list. So yeah, you need a pretty much a lot of conviction, then financial support to go through the different clinical steps and, of course, if you are able to clinically prove your benefits or the benefits that you can provide, then There's no reason for them not to enter into the game and reimburse your device, especially because in the long term it's quite easy to demonstrate that if you can gain some ability So the patient says is more independent, etc then you will see that the long-term costs are decreasing a lot Because you you go from someone that is fully dependent on these everyday life to someone is Mostly independent.

Speaker 2: 45:18

So five years in a life of a startup Is it long or is it short time, and how do you want to survive it?

Speaker 1: 45:26

It's definitely super, super long. When your talking was investors, because that's That's where you're gonna find the money to, to build up your product and your device You see that, yeah, five years for them, it's, it's very, very long. So we are currently investigating different approaches where You can either have a different business model to penetrate the market. That would be, for example, instead of waiting on the reimbursement from the insurance companies and, in the first place, go to the Wealthiest individuals that could afford the different prices that you have. So that's one vision of it. You can also tackle different markets or bigger populations, because if you have bigger populations, then you will find more people with Enough money to pay for it.

Speaker 2: 46:26

It's just like with the early mobiles right. I mean first they were extremely expensive and big right, and then you know everybody had them.

Speaker 1: 46:36

Exactly. Yeah, that's it, and Yeah, we are also investigating not only different business models, but sub parts of the exoskeleton. Were off the service we're providing like selling only a digital platform and like that's both a way to reach the market faster and also to Evaluate if the market is responsive for that kind of technology, so you can build up step by step. Something was out like developing everything and going all at once on a market and like Discovering if that works or not.

Speaker 2: 47:16

So what's in the immediate future. Yeah, we spoke about like what the future could be in a few years, like what's in here, like what's the work for you, basically, just just now.

Speaker 1: 47:28

So right now, we were quite active I think was in the early stage Start up.

Speaker 1: 47:34

What is very essential is to have a very strong team, and that's what we were doing right now Is is trying to find the very right elements. Like we were two co-founders, two core team members, and we just like, enrolled someone new into into there was a different background and and that can provide more incentives about what is it? to push a product to the market, and typically a medical product, and that's really that Where we need to be very strong, as is in the team. And then, of course, our biggest daily struggle is to find The investment or the financials that will make us Go where we want to go. So that's our main, two of our main targets right now, of course. Then we need, of course, to to to develop more and more and to to make an MVP ready and Try to to go to the market, was it? while definitely, assessing the market is something you Keep are continuously doing and that's quite important. So finding long-term partners, different clinics and having access to a lot of Feedback on what you're doing and also to your different developments.

Speaker 2: 48:58

I could already see that you have quite a list of partnerships already. Your team seems real Component and enthusiastic. I just met them upstairs. So I wish you basically a good and stable financing for the future and Thanks very much for for this conversation.

Speaker 1: 49:19

Thanks a lot, alex. Yeah, it was a pleasure.

Speaker 2: 49:22

So, guys, if you want to check autonomia out, please go to autonomiacom, which is a U Com. I'm totally impressed by the odosity of researchers and startup founders doctors and old-repreneurs or ordinary parents turned healthcare innovators People battling the battles that no one thought before for the extra health of the future. So if you see a startup posting on LinkedIn, show them some love, hit like comment. That's fabulous. If you have a couple drops more of that altruism, follow the ex-host show, leave a review here. I'll be able to bring more of these visionaries to you. So a big thank you. You're awesome. See you next week.

Speaker 3: 50:09

The information in this podcast is for informational purposes only and should not be considered medical advice. If you have any medical questions, please consult your healthcare practitioner. The opinions on the show are Alex's or her guests. The podcast does not make any Responsibility or warranties about guests statements or credibility. While the podcast makes every effort to ensure that the information shared is accurate, please let us know if you have any comments. Suggestions are corrections. You