(AUREA 2018 AWARD NOMINATION): MOTIMOVE – Device for movement assistance for persons with disabilities

The young Belgrade-based company 3F-Fit Fabricando Faber has developed a devise meant to assist persons with disabilities in moving, based on the implementation of functional electrical stimulation, which provides more functions compared to the existing solutions in the market, is simpler and more flexible to use.

Functional electrical stimulation (FES) generates movements by activating paralyzed muscles using brief, low-intensity electrical impulses. As a method of rehabilitation, FES was implemented around 60 years ago, but was not mass used due to the insufficiently developed technology and knowledge in the field of neuroscience.

The new system developed by the Belgrade-based company MOTIMOVE follows the expertise and years of experience of a team of experts from the Faculty of Electrical Engineering in Belgrade, recognized in the world in the domain of development and implementation of electronic stimulators and wearable systems for persons with disabilities. The originality and the advantage of the device compared to the existing solutions is reflected in both the hardware, a high-power stimulator supporting new functions, and the software, primarily the user interface and the options for connecting with a wide variety of sensors.

For the purposes of designing the MOTIMOVE device, a modular approach was adopted in order to secure the production of three types of electronic stimulators: 1) a simple, inexpensive device meant directly for persons with disabilities, 2) a device of medium complexity costing lower than competing products for clinical applications in therapy and 3) a highly sophisticated device not present in the market and needed by research centers developing new methods of electrical stimulation application.

The previous experience of the Belgrade company's team in implementing electronic stimulators has resulted in patents which have found their way to companies in the European market, whereas the company is now developing a new device in cooperation with the Lyon-based ANTS foundation, which co-finances the Innovation Fund, which has accepted this project.

Prototypes of the system are being tested at a clinic in Lyon, as well as at the Rehabilitation Clinic Dr Miroslav Zotovic in Belgrade, and the manufacture of the final product has started. The sale of the first MOTIMOVE devices is expected to begin by the end of 2018.

INNOVATION

Electrical stimulation has become an important element in improving life quality: pacemakers generating regular heartbeat, defibrillators intervening with fibrillation and preventing death, or a cochlear implant providing an auditory function to the deaf are just some examples.

The market also offers electronic stimulators enabling foot drop correction following a stroke, temporally and spatially limited standing and walking for persons suffering from spinal cord injuries, arm movements and catching in persons who have suffered injuries of the central nervous system, as well as maintenance and strengthening of an atrophied muscular system. However, the systems meant for movement assistance to persons with motor disabilities are not implemented to the extent they should be, due to technological limitations and the complexity of movement stimulation, since each one is different. Furthermore, they are complex to use and not efficient enough.

MOTIMOVE, made by the Belgrade-based company 3F-Fit Fabricando Faber is a project which takes into consideration all the existing barriers preventing the mass usage of FES in persons with motor disabilities. It is based on an electronic stimulator which communicates via a wireless connection with a smartphone, tablet or a computer through an intuitive graphical user interface, which allows users to choose the type of function and set personal parameters of the stimulation. The stimulator has an option of using information from miniature sensors mounted on the user's body or the objects the user interacts with. Following the initialization through the usage of the graphical interface, the stimulator becomes independent from the computer and performs the programmed function until the user intervenes.

MOTIMOVE thereby eliminates a range of problems limiting the implementation of FES to help people with disabilities, and the innovative elements it features are: 1) a new interface between the device and the user, which provides selectivity in external impact of electrical impulses on the nervous-muscular system, thereby considerably reducing the problem of the tiring of the said system; 2) a new method of the interaction of the user with the assisting system through the implementation of smart technology; 3) a new biomimetic control algorithm, the result of years of research in the field of neurosciences.

MOTIMOVE is meant for movement assistance in persons with disabilities, suffering from multiple sclerosis, cerebral paralysis, or recovering from a stroke or a spinal cord injury.

How does the device work?

FES generates movements by activating paralyzed muscles using brief, low-intensity electrical impulses, impacting the organism through electrodes on the skin surface. All the existing stimulators work using the identical principle – producing a series of brief impulses carrying a defined amount of electricity, which must interact with the exact spot on the body in order to activate an atrophied or a paralyzed muscle, thereby producing movement.

The new feature of the device made by 3F-Fit Fabricando Faber is a multi-channel modular stimulator with connections towards matrix electrodes, enabling distributed asynchronous activation of individual neuro-muscular systems in the organism. In other words, an automatic procedure enabling the stimulation to be applied in several places, thereby better impacting the spots producing movement, has been developed. The procedure is far closer to physiological activation of cells moving muscles, since muscle fibers are treated with a lower frequency, thereby reducing their tiring.

In addition to that, MOTIMOVE also has connections meant for signals from the sensors mounted on the body or the objects the user interacts with. The stimulator supports the implementation of hybrid control, which features an intelligent system for recognizing intentions on the higher level, uses a model of final states based on production rules on the medium level and uses the possibility of model-based integration control on the lower level. No other stimulator on the market features these characteristics.

The basic motor functions MOTIMOVE supports are: riding a stationary and a regular tricycle, standing, sensor-controlled walking, catching, pain treatment and muscle strengthening for the prevention of atrophy and maintaining the range of movements in joints. Neither of these activities is possible without electrical stimulation and the market doesn't offer devices enabling this in a acceptable way.

The innovation of the Belgrade-based company is reflected in the integral solution – the hardware, that is, the stimulator superior to the competition in power and its support of new functions, the possibility of the usage of a greater number of sensor connections (the competition provides only one), and the software, primarily the user interface and the possibility of simple control without the need for previous knowledge.

Initially, the idea for the development of the device originated at the Faculty of Electrical Engineering, where several stimulation systems have been developed in the past years, and new knowledge has been acquired through years of experience, resulting in the new device with a modular implementation: as a highly sophisticated scientific stimulator – meant for research labs to test new things (1), for the needs of clinics using new methods (2) and a regular one that would be available in the market for home use (3).

SOCIAL USEFULNESS

In the European Union, 700,000 people have a stroke each year, whereas around 11,000 suffer a spinal cord injury. In Serbia, 25,000 cases of stroke are registered each year. The number of stroke survivors in the EU is currently around 3.5 million, whereas there are around 360,000 of those who survive spinal cord injuries.

Both the stroke and the spinal cord injury most often result in a motor disability which prevents the person from taking part in social and typical daily activities (unassisted standing and moving, feeding, maintaining hygiene and similar activities), whereas the costs of basic everyday medical care, as well as of prevention of complications, are very high and are a burden on individuals and the entire society (estimates says that, in the USA, annual costs of enabling a patient to take part in everyday life are on the order of USD 1 million).

As a rehabilitation method, FES generates movements by activating paralyzed muscles, and expert literature shows that intensive exercising is important for the activation of neuroplasticity and that it accelerates development of recovery of motor functions.

Although it was implemented close to 60 years ago as a rehabilitation method, FES has not been mass used due to the insufficiently developed technology and knowledge in the field of neurosciences. MOTIMOVE now eliminates limitations in applicability present in the existing systems. The general benefits of MOTIMOVE stimulation are: improved circulation and state of muscles and skin, the slowing down or prevention of loss of bone mass, the lowering of spasticity, the lowering of the incidence of urinary infections, improved bladder function and a general improvement of the state of the organism, with a gradual return of some of the lost motor functions.

MOTIMOVE was fully developed by engineers of 3F-Fit Fabricando Faber (Serbian know-how), by which Serbia has been placed on the map of the leading countries in the development of this field. Furthermore, the system is a solution of young PhD candidates from the Faculty of Electrical Engineering, which contributes to the keeping of young, educated people in the country. Five people were hired on the development of the device.

Employees and consultants at 3F-Fit Fabricando Faber have a long-term cooperation with partners from all over Europe (Spain, France, Denmark, Austria, Hungary, Germany, Sweden, Croatia, Slovenia), as well as from Canada and the USA, and in addition to being hired on this project, there's a remarkable recognition of the researchers based on scientific papers, monographs and patents.

FINANCIAL POTENTIAL

The development of MOTIMOVE is based primarily on personal experience of the employees and the consultants of 3F-Fit Fabricando Faber acquired through the development and implementation of electronic stimulators and wearable systems for persons with disabilities at the Faculty of Electrical Engineering in Belgrade, with experience in working on and running projects financed by the European community (FP6, FP7, H2020) and the Ministry of Education, Science and Technological Development of Serbia.

Previous activities have resulted in patents transferred to one of the biggest distributors of rehabilitation equipment, Otto Bock Medical Systems (Germany) and the Tecnalia foundation (San Sebastian, Spain), which means that they've found customers in the European market.

The company 3F-Fit Fabricando Faber was formed right before the application for the Innovation Fund's Contest for the financing of innovative projects under the Early Development Fund, and the development of the MOTIMOVE business is also based on the cooperation with foreign partners crucial to the distribution.

The French foundation ANTS from Lyon co-finances 20% of the project financed by the Innovation Fund. EUR 80,000 was provided by the Innovation Fund for the development of the new device, whereas the French association provided EUR 16,000.

The newly acquired funds will be used for the production, whereas another EUR 100,000 has been invested in the development in the past year and a half, as an extension to the previous patents. The company has already started developing the final product (since the device is currently in the prototype stage) and they expect the sale of the science mode to start by the end of 2018 in smaller amounts. The procedure of certification for the CE tag is in progress as well.

Germany's Hasomed and Sweden's CEFAR produce similar systems in the market, but these are multi-channel stimulators, where devices are primarily used for the training of athletes and have preset functions for certain groups of muscles. In addition to upgraded functions, intelligent control and increased flexibility, the device of the Belgrade team will also be price-competitive. Stimulators in the highest mode (meant for research institutions, the so-called science mode) will cost around EUR 2,000, and those for home use between 250 and 500 euros, which is up to twice as cheap as other solutions in the market.

Prototypes of the MOTIMOVE system are now being tested in a clinical environment in cooperation with medical experts in line with the rules of evidence-based medicine and fully in line with the Declaration of Helsinki. This is possible thanks to the successful cooperation of many years with the Rehabilitation Clinic Dr Miroslav Zotovic in Belgrade, where 2 prototypes have been installed, whereas the device is also being tested in cooperation with clinics in France and Denmark.

The Belgrade-based company has also agreed cooperation with the Dutch company MOTEK Force &DIH, the biggest world distributor of rehabilitation robots meant for persons with disabilities, on the joint development of a hybrid system which makes parallel use of an exoskeleton and electrical stimulation to the end of optimizing the function.

If the MOTIMOVE device for movement assistance for persons with disabilities is your investment of the year favorite, you can vote for it on the official website of the Aurea award.