Program: Innovation to Commercialization

An advanced wearable robotic exoskeleton for assisting people with lower limb disabilities

Human locomotion is influenced by many factors, including neuromuscular and joint disorders that affect the functionality of joints and can cause partial or complete paralysis. Reduced mobility is estimated to affect over 1.5 million people in the United States alone. Many individuals require mobility assistive technologies to keep up with their daily life, and the demand for these devices increases with age.

 

A wearable robotic exoskeleton is an external structural mechanism with joints and links corresponding to those of a human body. It is synchronized with the motion of a human body to enhance or support natural body movements. The exoskeleton transmits torques through links to the human joints and augments human strength.

 

Dr. Arzanpour has developed a novel wearable robotic exoskeleton for assisting people with lower limb disabilities, such as spinal cord injury patients. The robot is highly versatile and capable of guiding the lower limb joints to perform all normal and complex movements. The technology is light, modular, portable, programmable and relatively inexpensive, and is particularly innovative in its versatile hip, knee and ankle joint mechanism, such that the normal range of motion of the natural joints is preserved.
Human in Motion has recently completed XoMotion-R, the world’s most advanced rehabilitation exoskeleton.  XoMotion-R has received its first regulatory approval, clearing the way for it to be marketed and sold in Canada. Set to revolutionize ambulatory training in rehabilitation facilities, XoMotion-R is designed to aid patients with spinal cord injuries (SCI), stroke, and other neurological conditions by providing unparalleled support with its self-balancing and hands-free functionality.

 

End of Award Update – October 2024

 

Results

This project was focused on R&D development and testing of our next-generation exoskeleton system. We initially went through several rounds of prototyping and improving the robot. The prototypes were internally tested, and improvements were made from the feedback we received. As a result, we completed the product design and are currently assembling the units to conduct our clinical studies for FDA approval. We also went through multiple rounds of financing from private investors. In August, we received our Health Canada approval, which is our first regulatory approval. This will allow us to start our sales in Canada and we are very excited about that.

 

Impact

 

Motion disability drastically reduces the quality of life for millions of people who are affected and their families. Currently, 17 million people in the US have serious difficulty walking less than a quarter mile a day. That includes 3.3 million who are unable to stand up and walk. The impact of comorbidity complications of motion disability, such as obesity, low employment rate, mental health, and secondary health complications, have an even greater impact on people’s lives and society. Every hour, 320 new cases of Traumatic brain injury, 90 new cases of stroke, and 2 cases of spinal cord injury happen in the US alone. Some of them with severe injuries lose their walking ability forever and must rely on a wheelchair for all their mobility needs. Others with milder injuries can regain their mobility through outcome-based rigorous rehabilitation therapy.

 

Human in Motion Robotics Inc. (HMR) has designed the next generation of exoskeleton systems (a wearable robotic suit) to (i) enable completely paralyzed individuals to walk freely, naturally and independently, and (ii) maximize the outcome of physical therapy and revolutionize the standard of care in rehabilitation. The currently available exoskeletons in the market can only walk forward. Users must balance their weight and the robot’s weight using arm crutches. They must be accompanied by others to assist them with balancing and all other motions that the robot can not support. Therefore, these robots can neither meet the mobility needs of fully disabled individuals nor the comprehensive, safe, and objective needs of rehabilitation. HMR exoskeleton has filled the functionality gap of the existing robots and addressed the needs of both groups.

 

Potential Influence

Our revolutionary exoskeleton articulates all the motions that are needed for complex maneuvers such as forward, backward, and sideways walking (multiple speeds), turning, change of direction, steps, slopes, and crouching. With this unique capability, our intelligent motion generation algorithm can create stable human-like gaits without the need for arm crutches and human attendants. This ground-breaking technology has integrated hardware design excellence with intelligent software algorithm innovation to create a versatile wearable robotic masterpiece with applications above and beyond physical rehabilitation and mobility. Our vision is to offer this disruptive wearable robotic solutions to empower all humans to tackle challenges beyond their physical capabilities.

 

Next Steps

We are currently focused on conducting clinical studies to get FDA clearance for several indications, including spinal cord injury and stroke. The FDA clinical studies are mainly focused on device functionality and safety. Further clinical studies are needed to demonstrate efficacy and establish best practice protocols based on long-term therapy outcomes. We are currently meeting with potential national and international partners interested in collaborating with us to conduct studies in their centers.

 

AAPLE-Walk: A novel gait-mimicking exercise machine for cardiovascular fitness and rehabilitation

Heart disease and diabetes are just two of many conditions that can occur in people after a spinal cord injury (SCI). Exercise can play a significant role in mitigating the risks associated with these conditions, but typical exercise options for people with SCI or other lower limb disabilities are usually limited to seated upper body exercise (for example, wheeling or hand cycling). Physical activity guidelines have been proposed for SCI, and although conventional exercise confers some cardiovascular (CV) benefits, the current options may not be enough to prevent widespread health decline post-injury.

Hybrid exercise, in which passive leg exercise is combined with active arm exercise, represents an under-explored area with significant clinical promise to improve CV outcomes over and above what is possible with arm exercise alone. In parallel, research is emerging about the benefits of upright walking therapy on recovery of neurological function and improvements in the secondary complications that accompany SCI, such as neuropathic pain. However, this type of therapy currently necessitates the use of expensive machines and/or trained personnel at specialized rehabilitation centres.

Dr. Borisoff has developed a new exercise machine, called AAPLE-Walk, that aims to provide arm-driven, walking-like leg movements while standing and exercising. This machine would provide comprehensive benefits to CV fitness and elicit lower limb muscle activity, potentially improving the secondary conditions of multiple diseases. 

Dr. Borisoff has developed a proof-of-principle prototype of this machine, and next steps include further refining this prototype so the usability and health impacts can be evaluated. 

It is clear that better exercise methods are needed for those with disabilities. These methods should challenge the heart better than simple, arm-only exercise, as well as beneficially impact an array of secondary complications. AAPLE-Walk may be an answer. The ultimate goal for this device is a product suitable for home use—or, with additional features, a device suitable for high-volume use at clinics. If successful, this would be low cost and offer more comprehensive benefits compared to expensive therapy machines currently on the market.

Novel infection resistant coating for indwelling urinary devices

Urinary catheters are polymer tubes inserted into the bladder to drain urine. Over 25% of patients in hospital are fitted with a catheter during their stay. These tubes are a major cause of infection in hospitalized patients and result in longer hospital stays with skyrocketing health care costs and may result in death. In fact, infections acquired in hospitals are the fourth leading cause of death in hospitalized patients. 

Currently, antibiotics are our only method of attempting to deal with these infections, but they do not work well. Bacteria form large communities, known as biofilms, on the surface of the catheter, which can render antibiotics ineffective. Additionally, bacteria have developed ways to inactivate antibiotics and become resistant, making them difficult to kill.

Dr. Lange has developed a breakthrough technology based on a special coating for catheters. The coating is inspired by nature—it’s very similar to what marine mussels use to attach to surfaces—and prevents bacteria from attaching to the catheter surface without killing the bacteria, which would induce resistance. Instead, by preventing bacteria from attaching to surfaces, we leave them exposed for our immune system to kill.

Dr. Lange’s preliminary studies have shown that this new coating prevents the attachment of different types of bacteria to the catheter surface in test tubes and in a realistic urinary environment in animal models. The coating doesn’t break down over time and can be used to cover many different types of materials. 

The next steps for this technology will be producing catheters with this coating, including testing its effectiveness over long periods of time in larger animals, ensuring it cannot be rubbed off, and that it stays active under conditions it would face in medical environments. Although this project is specifically looking at catheter infections, the data that Dr. Lange will generate will provide a general method for preventing infections associated with other medical devices, another major problem in hospitals.

Engineered T regulatory cells to treat Crohn’s disease

Inflammatory bowel disease (IBD) is an incurable disease that affects about 230,000 Canadians. People with IBD suffer from diarrhea, abdominal pain, weight loss, intestinal blockages, and other complications. Current treatments can control symptoms in many people, but they are not curative, and can have side effects like increased risk of infections. The causes of IBD are so far unknown.

People with IBD appear to have abnormal immune responses to the bacteria (microbes) that normally live in the intestine. This response involves blood cells, called helper T cells, that react to microbes, especially when they are not suppressed properly by another type of T cell that inhibits inflammation  (known as T-regulatory cells, or Tregs).

Dr. Levings will develop a new IBD treatment that captures the natural ability of Tregs to control inflammation, using a new technology called Chimeric Antigen Receptors (CARs) which has shown promising results in cancer studies. The technology changes Tregs in such a way that they treat intestinal inflammation without affecting the rest of the body’s immune system.

Dr. Levings has validated this technology in a laboratory setting, and the next steps include testing it in animal models, creating new versions of the specific CAR she has developed, and interviewing and surveying physicians and patients to find out how receptive they would be to using CAR Treg therapy for IBD.

Novel PET imaging agents for prostate cancer detection

Positron emission tomography (PET) imaging provides the most accurate and sensitive detection of cancer in patients. Yet PET is challenged by cumbersome methods that impede the clinical production of PET imaging agents and diminish their distribution and use. A critical unmet need for PET imaging is access to user-friendly methods to simplify and speed up time-sensitive radiosynthesis to deliver imaging agents to clinics.

Dr. Perrin and team have invented a chemical tag that lets chemists turn any molecule into a PET imaging agent. Now, Dr. Perrin will deploy this method to develop commercial products for imaging prostate cancer, which affects 23% of Canadian men and demands the use of PET imaging for early detection.

These tags create novel prostate cancer-specific probes which allow tumours to be labeled in record time and in a user-friendly manner for clinical radiosynthesis, and provide superior pre-clinical mouse images. These must be tested and evaluated before progressing to human trials and clinical production.

This innovation could allow prostate cancer to be detected earlier and better, increasing cure rates and the long-term survival rates of this deadly and common disease.

Treatment of sinusitis

Chronic rhinosinusitis (CRS) is an inflammation of the nasal sinuses, and is one of the most common medical complaints in North America, affecting up to 16% of the population. It leads to around 24 million physician visits per year, with an aggregated cost of more than $6 billion. Although the pathophysiology behind CRS isn’t fully understood, it appears to be largely triggered by bacterial biofilm infections. The microbes associated with these biofilms are diverse, and treatment options (including antibiotics) are limited and often fail to cure the disease.

Dr. Hancock will develop a novel topical intranasal treatment for CRS, based on anti-biofilm peptides. These peptides have already been shown to kill multiple species of bacteria in biofilms, especially the most resistant pathogens. Dr. Hancock has screened a library of peptides for their efficacy against multiple bacterial species, including several significant CRS pathogens.

Dr. Hancock will select a lead and backup anti-biofilm peptide with the most efficacy against sinusitis bacteria in their biofilm state, minimal toxicity when provided topically, and with optimal anti-inflammatory properties both in vitro and in animal models.

This research could directly lead to a new therapy for CRS, which would trigger immediate clinical and commercial development. Dr. Hancock has brought on partners for the first two years—Dr. Armin Javer of the St. Paul’s Sinus Clinic, and the Centre for Drug Research and Development, and has already identified a prospective development partner, Victoria-based company ABT Innovations Inc.

Molecular classification for stratification and improved clinical management of endometrial cancers

In the current landscape of endometrial cancers (ECs), there is a shortfall in the management, treatment and evaluation of EC patients. Treatment tends to not be standardized, patients are commonly over- or under-treated, and diverse ECs are grouped together in clinical trials. Because of this inconsistency in diagnosis, it is difficult, if not impossible, to properly assess and compare how different treatments work.

In response to this gap, Dr. McAlpine has developed a molecular-based classifier called "ProMiSE” –  Proactive Molecular Risk Classifier for Endometrial Cancer, which assigns EC patients to one of four prognostic groups. This classification would greatly improve the reproducibility and reliability of pathological diagnoses of endometrial tumours. The tool can be used to help categorize ECs into different risk classes to help guide surgery, treatment and surveillance based on the molecular features of the individual cancer. It can also identify women who may have inherited conditions placing them at increased risk of other cancers.

The next step for ProMisE is making the tool available across Canada. Although it is low cost and uses methods familiar to pathology laboratories, one of the testing components is currently unobtainable outside of a research lab setting. Dr. McAlpine is currently working with a Vancouver-based company to acquire, add and test this component in order to make ProMisE widely available.

Then, collaborating with eight other cancer centres across Canada, Dr. McAlpine will collect EC data, classify the data with ProMisE, and compare the treatment given with how molecular classification would have directed care.

This study is the last step in bringing this new molecular test to clinical use. With access to ProMisE, not only will there be immediate changes to how women with EC are managed, but it will allow the design of new studies to define the best, most personalized therapies for every woman with EC.

Servo-controlled device to maintain physiological functioning

300,000 individuals live with spinal cord injury (SCI) in the US alone, of which 180,000 suffer from orthostatic hypotension, sudden falls in blood pressure upon standing. Such dysregulated blood pressure can also be caused by multiple sclerosis, autonomic failure, autonomic neuropathy, or neurological cancers. A high quality, efficient, and cost effective method is needed to help these individuals regulate their blood pressure.

Dr. Krassioukov has developed a device and algorithm for controlling autonomic processes in patients using electrical stimulation, based on the surprising discovery that electrical stimulation of the spinal cord circuitry caudal to SCI can control the activity of disconnected sympathetic circuitry to regulate blood pressure. The device can be individualized, and electrical output may increase or decrease based on the information received from the patient’s physiological monitor.

Dr. Krassioukov’s product may improve patients’ control of autonomic functions such as dysregulated blood pressure due to SCI or other injuries or diseases, improving their quality of life and ability to manage symptoms, at a lower cost and with improved effectiveness than current methods.

Smart Text Analytic Tools (STAT) for analysis of patient-centred communications to strengthen health systems in BC

Healthcare stakeholders, including health authorities, facilities, pharmaceutical companies and insurers are increasingly acknowledging the importance of big data to enhance understanding of health behaviours and health systems. Existing analytic tools available to navigate the volume of diverse data types at a frequency that can match the speed at which data is generated are in early stages of development, and often lack validation due to limited access to health data. The ability of healthcare stakeholders to make sense of this valuable data is restricted by a lack of capacity and user-friendly analytic tools. 

Dr. Lester leads the UBC mobile health (mHealth) research team, which has been developing a set of smart-text-analytic-tools (STAT) to analyze patient and care provider communication data in the form of open natural language text. The WelTel digital health platform was created by Dr. Lester and has been tested in a diversity of geographic (Kenya, Canada, USA, South Africa) and health settings (HIV, TB, Asthma, maternal and child health) since 2005. The result of twelve years of mHealth research is a dataset consisting of hundreds of thousands of text messages sent by patients and providers. Topics of discussion include advice related to medication side effects, information requests, and the need for access to psychosocial and logistical support services. This data has the potential to identify outpatient self-reported priorities over time, informing patient-centered improvements in health system responsiveness and preparedness. 

The UBC mHealth research group will further develop STAT into a minimum viable product  that can analyze a variety of open natural language text data using natural language processing. This tool will allow both public health systems and private enterprise to streamline approaches to analyzing large volumes of text-based data.

Near infrared spectroscopy for the hemodynamic monitoring of acute spinal cord injury

One of the only treatments that could potentially improve paralysis in patients who have suffered an acute traumatic spinal cord injury (SCI) is the elevation of the mean arterial blood pressure (MAP) to provide enough blood supply to the injured spinal cord. It is, however, difficult to know what the MAP target should be for a given patient to optimize their neurologic recovery.

Currently there is no measurement tool that provides real-time information about the spinal cord blood supply and oxygenation, and allows them to know if their efforts to elevate blood pressure are actually improving (or worsening) the injured spinal cord. Such a tool would provide information to guide clinicians in their treatment decisions and allow them to personalize their care and optimize neurologic outcomes.

Dr. Kwon will explore the potential of near-infrared spectroscopy (NIRS) as a monitoring tool to provide this information, with the explicit goal of developing this technology into a device that can be commercialized to be used in SCI patients. NIRS works by shining near-infrared (NIR) light through tissues and then recording how much light is transmitted versus how much is absorbed by molecules within the tissue. By measuring near infrared light absorption in tissue, NIRS can measure how much oxygen and blood is being delivered, potentially informing us of whether cells within the tissue are being irreversibly injured due to oxygen deprivation.

Dr. Kwon’s research will translate a promising technology (NIRS) into a clinical application for acute SCI patients. His initiative is focused on providing a tool that will assist clinicians in their hemodynamic management of acutely injured patients during a time when their efforts greatly impact patients’ neurologic outcomes.

End of Award Update: February 2023

 
Most exciting outputs

Product/technology – Near Infrared Spectroscopy (NIRS) Biosensor for the Spinal Cord. We managed to bring the technology forward to the point of implanting an NIRS sensor into a human spinal cord injury (SCI) patient.
 

Impact so far

We are still very early in our human testing, and from our first patient have identified the need for sensor refinement and further safety/performance testing (which this award is helping us to conduct).
 

Potential influence

We will ultimately change how the hemodynamic management of acute SCI is conducted.
 

Next steps

Right now, the most pressing issue is to get our newly refined sensors (arriving soon) and then conduct further safety/performance testing.