Design Problem Knee related injuries: Most common sports-career ending injury Post-ACL Surgery: Pain, scar tissue, muscle atrophy, decreased proprioception Physical therapy: Important for full recovery Problem Difficult and expensive to restore injured knee to pre-injury functionality.

Background & Demographics Background The average cost of ACL reconstruction ~$11,500 Total cost of recovery ~ $30,000 Recovery time can be up to 6 months Out-patient physical therapy 1-2 visits/week Check progress, review and modify program Patient Overexertion/Non-Compliance Poor results Re-injury tinyurl.com/3dzgqt Jerry Rice Rice's 2 nd Knee Injury Ends a Lost Season The New York Times Rice's 2 nd Knee Injury Ends a Lost Season The New York Times

Method Provide an suitable exercise regimen coupled with sensors to: Display physiological measurements for real-time biofeedback Record these signals for later evaluation by health care providers Design Brief Solution Develop an integrated exercise device for a more autonomous rehabilitation.

Basic Principles 6-8 weeks Control swelling Regain R.O.M., muscle strength PT visits few times per week Exercise minutes per day 2-4 months Stability and balance training Less frequent PT sessions Weight machines, exercise bicycles or treadmills Several months Full R.O.M. Normal muscle strength, no swelling Continue stability, balance and strength training Phase 1 Phase 2 Phase 3 General Rehab Process Target Muscle Groups Rehabilitation Metrics Qualitative assessment Cincinnati Knee Rating System QOL Questionnaire for ACL Deficiency Manual manipulation Quantitative assessment Surface/Needle EMG Range of Motion Volume of exercise

Delsys Myomonitor ® Competing Products Biodex System 4 ®

Reliability & Accuracy Must collect EMG data reliably and accurately enough to distinguish between a functioning knee and a sub-functioning knee Usability Must be intuitive, accessible, and attractive to use Simple User Interface User interface/data output must be easy to understand and analyze by both the user and the professional Cost Must not be prohibitively expensive - $5000 or less to build / $10,000 or less to purchase (to be subsidized by insurance company) Business Model Initially sold to physical therapy facilities or doctor’s offices, possibly rented out for home use Potential for partnership with an exercise equipment company Disposables - Electrodes Constraints & Specifications

Components Exercise equipment Sensors Display Data transfer BikeEllipticalLeg press Surface EMGGoniometerKnee cuff Exercise data Waist pack Muscle firing (EMG) Bluetooth

Idea 1 Components Elliptical trainer Surface EMG Bluetooth Targeted Muscles Calves Gluteal Hamstrings Quadriceps Partial-weight bearing Lower joint loading Drawbacks Less common ORTHOMETRICS Smart Elliptical Trainer 2007 ®

Idea 2 *Serrão F, et al. “Effect of tibia rotation on the electromyographical activity of the vastus medialis oblique and vastus lateralis longus muscles during isometric leg press.” Physical Therapy in Sport. 6(1) (2005). Components Leg press Surface EMG Goniometry Bluetooth/Wifi Targeted Muscles Quadriceps Gluteus Maximus Hamstrings Physical Therapy Phase II and later Drawbacks* ORTHOMETRICS Leg Press Trainer 2007 ®

Idea 3 ORTHOMETRICS Bike Trainer 2007 ®

surface EMG electrode user interface Idea 3 ORTHOMETRICS Bike Trainer 2007 ® bluetooth/wifi antenna

Exercise equipment Summary Biosensors Data processing User friendly efficient guided rehab program User friendly efficient guided rehab program

Dr. William Macaulay Orthopedic Surgeon, Columbia University Medical Center Director of Center for Hip and Knee Replacement Dr. Ranjan Gupta Department Chair of Orthopaedic Surgery, UC Irvine Professor of Orthopaedics, Anatomy & Neurobiology, and BME James Gossett Associate Athletic Director, Columbia University Dr. Evan Johnson Director of Physical Therapy at the Spine Center Administrative Director of the Spine Center Julianne Costa Occupational Therapist Registered Physical Therapist Dr. Tim Wright Orthopaedic Biomechanics and Biomaterials Hospital of Special Surgery Thank You Dr. Clark Hung Associate Professor of Biomedical Engineering Dr. Elizabeth Hillman Assistant Professor of Biomedical Engineering Keith Yeager Senior Staff Associate, Laboratory Manager