1. R1: Robotic Mobility Activity Center in a Fitness Facility for People with Disability PI: David A. Brown, PT, PhD (University of Alabama at Birmingham) Co-investigators: Christopher Hurt, PhD (UAB); James Rimmer, PhD (UAB/Lakeshore Collaborative); Julio Santos, MSME (HDT Robotics) Research Assistants: Carmen Capo-Lugo, MSPT, PhD(c); Tara Pearce, PT, DHS A project update for the Advisory Board Meeting, July 26 th July 2013, Chicago Sponsored by:

2. Disclosure I am co-inventor of the KineAssist devices shown in today’s presentation and may receive royalties from any future sales of the devices. I am co-founder, shareholder, and consultant to HDT-Robotics which holds the license to market and sell these devices.

3. Major Partners HDT Global – developers of the KineAssist Technology Lakeshore Foundation – premier health and fitness center for people with disabilities University of Alabama at Birmingham – major Research I institution with strength in Rehabilitation Science research and training Rehabilitation Institute of Chicago – co-developers of KineAssist technology and home for the MARS project

4. What is the KineAssist MX? KineAssist – Mobility Activity Center A centralized platform for executing a wide array of user-driven walking and balance-related skills challenges that can result in improved performance of daily mobility activities.

6. Program Overview Goal: Comprehensive assessment and intervention regimen centered around a robotic mobility activity center for the purpose of transforming the lives of individuals who have walking and balance limitations. – Aim #1: Utilize the KineAssist MX system to test the concurrent validity of a suite of assessments designed to measure force generating capability (FG); speed generating capability (SG), dynamic balance (DB), aerobic endurance (AE), and response to locomotor challenge (LC) in stroke survivors. Relationship to 10m walk test and Life Space Assessment (Years 1 and 2) – Aim #2: Utilize the KineAssist MX system to test the effectiveness of a targeted, client-specific training program designed to improve walking speed and increase mobility participation. (Years 3 – 5)

7. Conceptual model showing life-space levels as a series of concentric areas radiating from the room where a person sleeps. Peel C et al. PHYS THER 2005;85:1008-1019 ©2005 by American Physical Therapy Association

8. Dynamic Balance (DB) Training (graded, challenged, puzzle-solving) Step onto step (height) Step over hurdle (height) Targeted long step (length) Forward reach (length) Step onto foam (height) Forward push (length) Backward push (length) Sit to stand (height) Step onto slip surface (inclination) KAMX Assessment Tool: KAMX Modified Berg Balance Test (compared with standard BBS)

11. Change in walking speed after 6 weeks of Dynamic Balance Training

12. Locomotor Challenge (LC) Training (every step a challenge) Backward stepping Stepping over hurdle Targeted long stepping Narrow base stepping Foam shoe stepping Forward push Backward push Variable speed stepping Stepping on slippery surface KAMX Assessment Tool: KAMX Modified Dynamic Gait Index – 4 (compared with standard DGI-4)

13. Locomotor Challenge requires attention, problem solving, continuous adjustment – intense cortical involvement

14. Speed-generation (SG) Training (walking to the point of tripping) While in “assistive” push mode, individual is progressively pushed at faster and faster speeds until they can no longer keep up with the treadmill belt. Bouts of “sprint” training occur at highest speed where stability could be maintained KAMX Assessment Tool: SG Test (compared with standard 10m walk test – comfortable/fast)

15. “Push” mode accommodates faster walking speeds with less effort

16. Force Generation (FG) Training (walking against horizontal resistance) Individuals are asked to walk at comfortable speed Resistance is added while individual attempts to maintain speed Training bouts occur at highest resistance while speed is maintained KAMX Assessment Tool: FG Test (compared with Biodex test – isometric ankle dorsi/pantarflexion, hip flexion/extension)

17. KAMX FG Test Nonimpaired Stroke survivor

18. Aerobic Endurance Individuals are asked to walk at comfortable speed with body-weight support Individuals walk for 5 mins x 6 bouts at 60- 80% maximum heart rate KAMX Assessment Tool: KAMX GXT (compared with 6 min walk test)

19. Work Rate (Watts) VO2 (ml/kg/min) Bruce Protocol Modified VO2max KA Test 4.2 % difference

20. Progress report Development of KineAssist MX-based assessment tools – FG Test (manuscript in prep) – SG Test (JNER publication) – KAMX GXT (manuscript in prep) – DGI-4 (KA mod) (case study manuscript in prep) – BBS (KA mod) (case study manuscript in prep) Fabrication of KA-MX prototype and Toolkit

22. Plan for the year Deliver KAMX to Lakeshore Foundation Publish papers Recruit 24 participants and validate KAMX tests and relate to 10m walk test and LSA Pilot test with training protocols