Neurophysium

Every disease is different, but in many ways different diseases can also be very similar. Many rare diseases tend to share many of the same symptoms, manifestations and needs. One such need is the need for Physical Therapy (PT).

Physical Therapy is a worldwide challenge, both in developed and developing countries. Some of the challenges involved with PT are:

• High recurrence: to be effective, PT has to be performed on a regular basis (weekly, daily or even multiple times a day);
• Available therapists: identifying a skilled physical therapist near the patient who understand the needs of that specific patient is already a challenge. Finding a time on their schedule, if there's any available at all, is an additional challenge;
• Transportation: even when patients find a therapist, getting to the therapist or getting the therapist to the patient can be extremely challenging, considering factors such as traffic, travel times, etc. In Brazil some patients spend more than an entire day getting to health facilities. For them, it is almost impossible to engage with continued PT;
• Coverage: many health insurers, if the patient is insured at all, limit the number of PT sessions for a given period of time;
• Cost: all of the factors above combined contribute to quite expensive PT treatments, particularly if they extend for a long period of time.

Based on all the barriers to access and problems mentioned above, our project aims to allow patients and families to execute guided PT sessions at home supported by a set of technologies and services that would scale PT access to anyone in need.

Our solution provides guided PT sessions over the phone. This is how it works:

1. Patients have access to training videos where a PT professional demonstrates the activity to be performed. The videos are specially developed to demonstrate the exercises exactly how to patient should do them (with or without the help from a caregiver or family member);

2. While one video shows the therapist, another video in the same screen shows the patient imitating the therapist;

3. As the patient executes each exercise, we use pose detection technologies to detect body movement and track how well they're performing the therapy. Those technologies provide datasets that we can compare (using AI/ML) to a gold standard dataset, previously developed using many video sessions from real therapists.

4. Then we need to obtain a metric of the strength the patient is applying in each movement. We are currently exploring stretchable electronics and other technologies to help us obtain that kind of information.

5. By using all the information gathered along the exercises and movements, we are able to generate a digital biomarker that tells us how much the patient is progressing along the therapy sessions, allowing for adjustments and route corrections.

An online team continuously evaluate the data and gives feedback to the patient. Also, the patient (or caregiver or family member) always have access to this teams to ask questions and get guidance.

Our solution serves all kinds of patients in need of physical therapy. Right now, we're focusing on neurological physical therapy just because creating the gold standard datasets is such a big task. But eventually the technology can be used to practically any kind of health condition (neurological or not) that requires physical therapy. As described above, the impact can be huge, particularly from an access-to-health point-of-view.

This undertaking wouldn't be possible without great partnerships. Medicinia is essentially a technology company. We know about data, artificial intelligence and software/app development. But we have neuroscience in our DNA (our founder is a neuroscientist) and we partner closely with several other institutions in Brazil. Brazil is a big country, with over 200 million inhabitants. Being a developing country, however, only a few reference centers receive most of the rare diseases demand in the country, neurological or otherwise. We work with three such institutions:

• The Brain Institute (BraIns) of Porto Alegre, Brazil, is a world-class neuroscience research academic unit of PUCRS, a university in South Brazil. At PUCRS' BraIns, we congregate neuroscientists, data scientists, neurologists and physical therapists that help us with the 'science behind the technology' in our solution. Together, we apply an entrepreneurial approach to research that we've coined 'Agile Science'.In addition to being a pre-clinical and clinical research center, PUCRS is also a nationally referred center for patients with any kind of neurological condition and is a decades-old epilepsy surgery center as well.

• FUNAD's CREM, in Joao Pessoa, is a neurological excellence center in Northeast Brazil. Thousands of patients are referred to that center, where they get access to the Medicinia platform.

• Amigos Multiplos, which is a nationwide association of Multiple Sclerosis patients also helps us develop the product by providing expertise and patient feedback.

We expect the financial aid to help us further develop training datasets (training videos + all the videos used to train the Machine Learning models). Also, we'd like to start researching stretchable electronics and other technologies that would provide strength information and others in addition to the movement information. Eventually, we want to build and validate (from a regulatory perspective) several digital biomarkers to be used as guiding metrics for physical therapy progression.

The use of pose detection technologies is innovative, but not necessarily that innovative. What makes us really innovative is that we're using that technology in addition to other technologies to create validated (via clinical trials) digital biomarkers for physical therapy in neurological patients.

Next year: reach 1000 patients in Brazil;

Five years: validate and obtain regulatory approval for a physical therapy digital biomarker for a specific neurological condition (Multiple Sclerosis, for instance). 

Will achieve this through our partnerships and the support of programs like the Horizon Prize.

Right now, we're measuring our progress mostly through number of patients enrolled. As a next step, we'll start following patients in cohorts, so we can compare groups and have an idea of how intervention and control groups progress.

The working hypothesis is that digital physical therapy (DPT) intervention will be more effective at improving neurological symptoms and outcomes than non-DPT. We believe we'll be able to unequivocally demonstrate that physical therapy is so valuable that even when performed from a distance by the actual patient (plus caregivers and family members), it is superior to standard PT by the simple fact that it overcomes the barriers to access managed above.

Our platform makes use of many different technologies that promote patient engagement and capture data from engaged patients. The core technologies include:

• Google's Pose Detection, which allow us to collect exercise execution data;
• Internally developed machine learning models, which compare patient PT execution with gold standard movements recorded by actual physical therapists. This is the technology that scores patient performance, gives feedback to providers and will eventually be used as a digital biomarker;
• We're currently researching other technologies including stretchable electronics and wearables, which could provide us with more information, such as muscle strength.

Other technologies we adopt are:

• React native for app development;

- pose detection to capture the patients' movements;
- AI to evaluate patient's evolution;
- a robust backend to follow-up with patients according to their journey

Diversity, equity, and inclusivity are very important for us. With that in mind, we consider all these factors in our recruitment process. Moreover, we are always promoting initiatives to make sure everyone feels comfortable to share their thoughts and collaborate. We are very happy to see that we have a culture where everyone feels encouraged to express their opinions and that this environment can be thought of as a competitive advantage for us since we tend to come up with more embracing and innovative solutions. Furthermore, 50% of our executives are women.

Our team is composed of:

- 8 women
- 2 LGBTQI+
- 3 men

We already have a member who is not from Brazil or USA. We are now aiming at including people from diverse ethnical backgrounds as well.

Right now, we're working to develop reimbursable digital biomarkers for physical therapy of diverse neurological conditions. Once the biomarkers get validated and approved by the regulatory agency (FDA, ANVISA, etc.), the business model will consist of reimbursement by health payers by the validated therapies, which will be officially prescribed by health care professionals. 

Right now, our greatest expectation is to find a pharmaceutical company that would be interested in partnering and licensing our solution at its early stages (pretty much like they would do for a new, promising pharmacological compound), so they can commercialize the solution in the future along other pharmaceutical offerings while we make royalties on sales.

Right now, we're working with Novartis in Brazil to build the digital experience around two of its treatments: Cosentyx, for Psoriasis; and Kesimpta, for Multiple Sclerosis. We're also helping Ionis, a San Diego, CA, pharmaceutical company that develops therapies for rare diseases, to develop its digital health strategy.