Stroke Technology and Innovation Cuts
Let's Talk About it-Part One-Upper Extremity Rehab Technology
I’ve been writing about this for some time, how technology enabled solutions could transform stroke care. We’ve also had guests on the Know Stroke Podcast to highlight some of the early work of rehab tech startups to showcase their work.
My question to you, with all the federal cuts slashing university funding, is it time we come up with a new game plan to break down all the current barriers to make neurological rehab technology more accessible to patients in clinic and in home?
How can we start to work together to solve this problem in new ways?
Hiding and being silent in our labs and clinics won’t work and provides a failed formula. When universities don’t get this federal injection of funds to support innovation, vital research projects will be frozen, labs and programs will be forced to close (as some in my own state already have) and jobs will be lost.
And lost in this equation is the most important sobering fact that patients will not receive the vital new potentially life saving medications or treatments to improve lives. Instead lives will be lost. Yet, we aren’t really talking about it.
[Personal Sidebar] Here’s why I am talking and writing about it. I have had, and currently have family members and patients benefiting from new life saving and extending drugs that have worked miracles in their own health journeys, and many of these miracles began with research born out of university labs.
It is not my place to share their personal stories here but I do hope their providers who treat them for cancers, multiple sclerosis (MS), Parkinson’s Disease (PD), are also speaking out for them and at least taking pen to paper to fight this injustice.
I can only speak to stroke and that’s what I write about from my own lived experiences and research working both within and outside university trying to do better for stroke. For this preview from my book, I am breaking down the research on what recent technologies are being funded at universities for upper extremity stroke recovery.
I reflect deeper in my book on the full chapter for this topic how I had attended many campus tours on the east coast over the past four+ years when my college age kids were considering engineering and computer science majors.
It was striking to me as a stroke survivor when we toured the labs at RPI, WPI, MIT, RIT,NEIT and URI that all programs were showcasing some of the early work by their students and professors and ALL were working on some type of upper extremity rehab device for neurological injuries, mainly stroke. All of them!
Much more on this in my book, but it certainly got me writing and reflecting especially after I was later hired in a clinical consulting role in one of these labs and learned how much work needs to be done to help engineers know stroke and prepare a product for commercialization. I encourage you to listen to this recent podcast episode with Gary Viles of Neuro Rehab Recovery, Inc where he talks about having a clear integrated goal by your engineering team what problem statement they are trying to solve.
In parts two and three in this article series and in my book, I’ll be covering lower extremity rehab / gait technology and stroke recovery apps and survivor engagement platforms. These are important discussions to have if we are going to impact change in the stroke care pathway and bridge rehab gaps into the home.
Part One-Upper Extremity Rehab Technology
Let’s Talk About It
While private and public universities in the US are remaining mostly quiet about what they are scheduled to lose, or have capitulated and paid ‘fines’ to keep funding open perhaps, I wanted to shed some light through my research for my upcoming new book and personal experiences working at university in a research lab on the types of technologies being studied for upper extremity rehab. I include how much money is being spent or already committed and what may be at risk to try to help stroke survivors. I used ChatGPT to help me summarize and cite the projects awards from publicly available federal and state documents.
For this article I am focusing on upper extremity research and innovation, as it is one of the most disabling side effects from stroke. Again, in my next post I’ll look at restoring gait and mobility and the research dollars in the US being spent looking to help innovate care with this other disabling side effect after stroke, gait impairment. In the final part of this series, I’ll dive into stroke recovery mobile apps and care coordination / engagement platforms.
Background
Over the past 15 years, the National Science Foundation (NSF) and the National Institutes of Health (NIH) have funded many projects focusing on rehabilitation technologies for upper extremity and hand neurorehabilitation after stroke. For this article I am providing data on 13 awardees of funding and I also reference the awarding agency, the amount awarded and the year awarded. I’ve included research award notices and SBIR links when I could cited by ChatGPT.
(At the end of this article I’ve provided a key to learn more about these funding pathways and how they are intended to work).
While I did not break down all projects specifically by type, ie) functional electrical stimulation (FES) or smart gloves, these awards cited encompass a broader scope of related technologies aimed at improving upper extremity motor recovery. I chose this date range because it represents the approximate amount of time in my clinical career that I’ve been following this type of rehabilitation research for stroke.
Note: Some of these awards reference direct brain stimulation innovation technologies for this article but I’ve left out others that are considered needing more advanced clinical support with additional surgeries or procedures needed to onboard the patient before beginning care delivery using the technology (VNS, DBS, TMS, BCI).
Here is a list of notable funded projects in stroke upper extremity rehab
My goal is to educate you and provide an idea of the magnitude of dollars being spent, and this is not a comprehensive list. Mostly, these are some of the most notable that I’ve been following and in some cases local to me and my alma mater, the University of Rhode Island.
STTR Phase I: A Body Area Sensor Network with Smart Glove Base Station for Improved Physical Therapy
Awardee: Lasarrus Clinic and Research Center, Baltimore, MD(SBIR)
Awarding Agency: NSF
Total Award Amount: $224,969(SBIR)
Award Year: 2019(SBIR)
Abstract: This project aimed to develop a low-cost wearable Internet-of-Things (IoT) device for upper extremity physical therapy rehabilitation. The system includes a smart glove base station designed to track and enhance patient recovery through biofeedback, promoting neuroplasticity. (SBIR)
SBIR Phase II: A Machine Learning-Driven Telerehabilitation Solution Designed to Promote the Personalized Recovery of Hand and Arm Functions Post-Stroke
Awardee: NeuroTechR3 Inc., Warren, NJ(National Science Foundation)
Awarding Agency: NSF
Total Award Amount: $997,735(SBIR)
Award Year: 2023(SBIR)
Abstract: This project focuses on developing a personalized telerehabilitation system for hand and arm motor recovery in stroke patients. It incorporates machine learning to create a customizable solution that synchronizes rehabilitation plans with patient recovery trajectories, potentially improving patient outcomes through remote clinician supervision and progress tracking. (National Science Foundation)
SBIR Phase I: A Robotic System for the Physical Therapy of the Wrist and Hand
Awardee: Rehabnetics Medical LLC, Minneapolis, MN(SBIR)
Awarding Agency: NSF
Total Award Amount: $275,000(SBIR)
Award Year: 2024(SBIR)
Abstract: This project aims to develop a robotic wrist-hand exoskeleton device that provides tailored physical rehabilitative exercises based on quantified measures of therapeutic progress. The system seeks to enable prolonged and intensive restorative training to improve function in patients with upper limb motor deficits resulting from neurological conditions such as stroke. (SBIR)
PFI-RP: Brain-Controlled Upper-Limb Robot-Assisted Rehabilitation Device for Stroke Survivors
Awardee: University of Houston, Houston, TX(National Science Foundation)
Awarding Agency: NSF
Total Award Amount: $749,999(National Science Foundation)
Award Year: 2018(SBIR)
Abstract: This project aimed to develop a brain-controlled robotic rehabilitation device for stroke survivors. The system utilizes non-invasive brain interfaces to extract information about the patient’s motor intent, driving powered, assist-as-needed upper-limb robotics to promote neurorecovery of function. (National Science Foundation)
A Fully Remote Telehealth Brain-Computer Interface and Assessment System for Motor Rehabilitation of Chronic Stroke
Awardee: Neurolutions, Inc., Santa Cruz, CA(SBIR)
Awarding Agency: NIH
Total Award Amount: $1,658,238(SBIR)
Award Year: 2022(SBIR)
Abstract: This project focuses on creating a mail-delivered, internet-connected system that enables home-based EEG screening and motor assessment for chronic stroke patients. The system aims to facilitate remote assessment, enrollment, and treatment of patients with upper extremity motor deficits using a brain-computer interface-controlled robotic hand exoskeleton, thereby increasing access to advanced rehabilitation care. (SBIR)
We featured Neurolutions on our podcast.
Take a break. Are you adding up the dollar amounts so far?
These projects listed certainly reflect the commitment of NSF and NIH to advancing rehabilitation technologies for stroke survivors, with a focus on innovative solutions such as smart gloves, robotic systems, and brain-computer interfaces naming a few to enhance upper extremity and hand function recovery.
But how do they take the next steps and launch out of lab?
What is their commercialization strategy in a market filled with barriers including the following:
High Costs and Lack of Insurance Coverage (Let’s be honest poor to zero!)
Lack of Awareness of the Tech Among Patients and Providers
Digital Divide and Tech Literacy Barriers
Limited Clinical Integration and Data Sharing (Don’t fit in to clinical workflows)
One thing that shocked me from being involved in some early stage innovation at university in an I-Corps/MIT/URI joint partnership is a statement made by one of the presenters, regarding funding at NSF that ‘over 95%’ of all funded federal research out of university labs failed to move to commercialization.
Wait there’s more.
An expanded list of more notable awards:
SBIR Phase I: A Robotic System for the Physical Therapy of the Wrist and Hand
Awardee: Rehabnetics Medical LLC, Minneapolis, MN
Awarding Agency: NSF(SBIR)
Total Award Amount: $275,000(National Science Foundation)
Award Year: 2024(SBIR)
Abstract: This project aims to develop a robotic wrist-hand exoskeleton device that provides tailored physical rehabilitative exercises based on quantified measures of therapeutic progress. The system seeks to enable prolonged and intensive restorative training to improve function in patients with upper limb motor deficits resulting from neurological conditions such as stroke. (SBIR)
SBIR Phase I: A Novel Bimanual Upper-body Exoskeleton for Stroke Therapy
Awardee: Harmonic Bionics, Inc., Austin, TX(SBIR)
Awarding Agency: NSF(SBIR)
Total Award Amount: $225,000(SBIR)
Award Year: 2018(SBIR)
Abstract: This project focuses on developing a bimanual upper-body exoskeleton designed to address shoulder and arm rehabilitation challenges in stroke patients. The device aims to enhance recovery outcomes by facilitating repetitive, therapeutic movements, potentially reducing hospital stays and improving daily living activities for stroke survivors. (SBIR)
Home Therapy for Upper Limb Stroke Rehabilitation Using the HandSOME Exoskeleton
Awardee: Catholic University of America, Washington, DC(Grantome)
Awarding Agency: NIH
Total Award Amount: Not specified(SBIR)
Award Years: 2016–2019
Abstract: This project involves the development and clinical evaluation of HandSOME (Hand Spring Operated Movement Enabler), a passive exoskeleton designed to assist hand movement in stroke patients. The device aims to enable successful practice of reach and grasp tasks, even in subjects with severe hand impairment, through home-based therapy. (Grantome)
Motorized Hand Exoskeleton for Stroke Rehabilitation
Awardee: SpringWear, LLC, Baltimore, MD(SBIR)
Awarding Agency: Department of Health and Human Services (HHS)
Total Award Amount: $100,000(SBIR)
Award Year: 2023(SBIR)
Abstract: This Phase I SBIR project focuses on developing and testing a motorized hand exoskeleton aimed at improving hand function in stroke survivors. Building upon prior research, the device seeks to increase range of motion and provide grip force amplification to aid in activities of daily living, promoting neurorehabilitation of hand motor control. (SBIR)
Boost: A Pragmatic Inpatient Rehabilitation Strategy for Improving Musculoskeletal Arm Recovery After Stroke
Awardee: Flint Rehabilitation Devices, LLC, Irvine, CA(SBIR)
Awarding Agency: HHS(SBIR)
Total Award Amount: $1,704,490(SBIR)
Award Year: 2021(SBIR)
Abstract: This project aims to test a novel rehabilitation strategy involving a moveable wheelchair armrest called Boost, designed to enable stroke patients to perform repetitive arm therapy during inpatient rehabilitation. The device seeks to facilitate increased upper extremity motor drive early after stroke, potentially improving recovery outcomes compared to conventional treatment. (SBIR)
An Adaptive Closed-Loop Robotic Exoskeleton for Upper Extremity Motor Rehabilitation
Awardee: University of Rhode Island, Kingston, RI
Awarding Agency: NSF
Total Award Amount: $460,000(The University of Rhode Island)
Award Year: Not specified
Abstract: This project focuses on developing a multimodal, wearable exoskeleton actuated using a haptic forcefield for upper extremity training. The research involves creating a closed-loop adaptive assistive strategy based on shared control theory and validating the rehabilitative platform on stroke patients with upper extremity impairment. (The University of Rhode Island)
NSF Grant for RE-GAIN Project
Awardees: Professors Kunal Mankodiya and Dhaval Solanki The University of Rhode Island
Awarding Agency: National Science Foundation (NSF)
Total Award Amount: $500,000 The University of Rhode Island
Award Year: 2024
Abstract: This three-year grant supports the "RE-GAIN" project, focusing on designing medical rehabilitation technologies for stroke survivors under 65. The project integrates e-textile wearables, virtual/augmented reality, and AI to restore motor and cognitive abilities, facilitating reemployment. A key component is the development of smart gloves for upper limb rehabilitation, offering visual cueing and feedback to promote fine motor skills. The University of Rhode Island
Wearable Hand Exoskeletons for Rehabilitation of Function After Stroke
Awardee: SpringWear, LLC, Baltimore, MD
Awarding Agency: HHS(SBIR)
Total Award Amount: $100,000
Award Year: 2022(SBIR)
Abstract: This project involves the development of wearable hand exoskeletons aimed at assisting in the rehabilitation of hand function in stroke patients. The devices are designed to facilitate repetitive task practice, potentially improving motor recovery and functional use of the impaired hand. (Grantome)
These projects certainly all demonstrate the commitment of NSF and NIH to advancing rehabilitation technologies for stroke survivors, focusing on innovative solutions such as exoskeletons and braces to enhance upper extremity function recovery. But how many get out of the lab and on to stroke survivors arms and hands to impact brain recovery? Let’s talk about it!
A recent poll by the Metadata and presented during a recent Digital Medicine Society Journal Club meeting showed that trial enrollment and recruitment is indeed a big problem mainly because trials still lack patient centricity and as a result fail at recruitment.
How do we do things differently?
How do we ensure researchers are building for survivors and know their real lived experiences so they are truly making products user centric?
How do we lower costs, track outcome data and get these technologies paid for so they can actually get to market and in to stroke survivors homes?
How do we facilitate inter-collaboration between universities and between departments to more efficiently share data, enroll participants and still protect sponsor IP without ‘recreating the wheel’ each time one of these funded studies cited above gets started?
Did you total up all the award amounts above?
Please comment with the amount below or better yet restack if this resonates with you!
I’ll be talking about stroke gait technologies and apps for connecting stroke care next.
In the meantime, which research awards did I miss here?
Please chime in!
Keys to Learn More:
For extra reading, here’s how the federal cuts are hurting NSF research right now!
In case you have been ignoring it:
Yes, the Trump administration has proposed and implemented significant cuts to National Science Foundation (NSF) funding for research. Most of the NSF's budget supports fundamental, or "basic," research at universities and research institutions. Commercialization is not always an immediate goal of this type of research but funding cuts here at early stage “Spark” and “Fusion” levels open the door to further funding steps. I share my own story in my book on how I followed this pathway to test an early innovation concept for stroke care.
Key points regarding the federal funding cuts:
Proposed Budget Cuts: The Trump administration proposed a 57% cut to the NSF's budget, aiming to reduce it from roughly $9 billion to $3.9 billion. This was part of a larger plan to reduce federal government spending and refocus agency priorities.
Targeted Areas: The proposed cuts specifically targeted research related to climate change, clean energy, "woke social, behavioral and economic sciences," and diversity, equity, and inclusion programs, according to the White House.
Grant Cancellations: In addition to budget proposals, the Trump administration has terminated over 1,600 previously approved NSF grants, worth approximately $1.5 billion. The majority of these terminated grants focused on STEM education, particularly those aimed at broadening participation among underrepresented student groups.
Impact on Funding Rates: If the proposed budget cuts were enacted, the NSF would only be able to disburse about one-quarter of the grants it currently does, potentially lowering the application success rate from 26% to 7%.
Congressional Pushback: A U.S. Senate committee has pushed back against the proposed cuts, voting to keep funding for the NSF and other federal science agencies largely intact for the 2026 fiscal year. This reflects a potential willingness of some lawmakers to deviate from the administration's proposed budget.
Uncertainty and Concerns: The changes have created uncertainty and alarm among scientists and researchers, with some expressing concerns about the future of scientific careers in the United States and the impact on the nation's global scientific standing.
What is STTR?
STTR stands for Small Business Technology Transfer, a U.S. government program that provides early-stage funding to small businesses to develop innovative technologies through partnerships with nonprofit research institutions,such as colleges and universities. It is a complementary program to SBIR (Small Business Innovation Research) and is designed to stimulate technological innovation and commercialization by fostering partnerships between small businesses and research entities.
Key aspects of the STTR program
Partnership:
Unlike SBIR, STTR requires a formal partnership with a university or nonprofit research institution for cooperative research and development.
Purpose:
The program aims to help bridge the gap between scientific research and commercial products, increasing private sector innovation and economic growth.
Funding:
STTR is a set-aside of federal research and development funding for small businesses.
Commercialization:
Successful proposals must include a credible plan for commercializing the developed technology. I believe this is where many of the current engineers and researchers working in lab fail to understand the patient experience and their product is not user centric and/or doesn’t fit clinic workflows.
End Note: Read the article I posted about the President of URI and how he recently spoke up about how federal cuts are effecting us all in RI already!
Slashing NIH Funding with a Chainsaw Hurts Us All
This is a topic I’m covering in my latest book, and one of the subheadings is tentatively set to read:
It's important to remember that these are proposals and actions taken during a specific time period. The actual impact and long-term consequences of these cuts remain to be fully seen and understood. Scary indeed-so speak up!
