63. Balancing Act- How UprightVR is Enhancing Senior Mobility Through VR Technology

In this episode of the Raising Tech Podcast, Amber Bardon welcomes Ramiro Maldonado, Director of Business Development, and Geoff Wright, Chief Science Officer from UprightVR. UprightVR is at the forefront of using advanced virtual reality technology to assess balance and develop personalized fall prevention strategies, aiming to enhance mobility, safety, and quality of life for the elderly.

UprightVR leverages virtual reality to assess and enhance balance, providing a unique and effective solution. Its user-friendly interface and immersive environment make it accessible to both clinicians and non-clinical staff, ensuring ease of use across various settings. The system's portable setup allows for frequent, on-the-spot assessments, making it a cost-effective option for senior care communities. Beyond identifying fall risks, UprightVR also offers rehabilitation modules and integrates with broader care strategies to improve overall outcomes, contributing to comprehensive care for seniors. 

For more information about UprightVR, visit their website.

Ramiro Maldonado (ramiro.maldonado@uprightvr.com): Director of Business Development at UprightVR, with a background in physical therapy, specializing in vestibular and neurotherapy.

Geoff Wright: Chief Science Officer at UprightVR, co-founder, and inventor, with a background in neuroscience and engineering, currently a professor at Temple University.

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Transcript

Welcome to raising tech podcast. I'm your host, Amber Bardon. Today, our guest is UprightVR. UprightVR offers advanced virtual reality technology for precision balance assessments and personalized fall prevention strategies, enhancing mobility, safety, and quality of life for the elderly .

We have two guests joining us today from UprightVR. Ramiro Maldonado is the director of business development, and we also have Geoff Wright, who is the chief science officer. Welcome to the show. 

Thank you. 

So I am, Really looking forward to hearing more about UprightVR.

I think falls management and falls technology is such a cool area of technology in the senior living space. I think we're seeing a lot of new companies come out into the space. We're seeing a lot of attention paid to it, which is really nice. And I know a little bit about your company and about your product, but I don't know exactly how it works.

 Let's do introductions and then let's talk a little bit more about what UprightVR [00:01:00] is.

Ramiro Maldonado: Cool. Yeah. So thank you so much, Amber. Yes, my name is Ramiro. I've been a physical therapist. For wow, probably a little bit over 15 years now at this point. Practice clinically for a little over 10 and I geared my clinical education towards vestibular and neuro therapy. What that basically means that I just catered my education towards.

What causes balance impairments and what causes business impairments? And that was very much. So just where my passions lied and in clinical world I then moved over into the world of rehabilitation technology. Bounced around there for a little while and then found out about what they were doing at UprightVR.

 I'm coming on my first year with them, in August will be a year.

Amber Bardon: Congratulations on a year. 

Ramiro Maldonado: Thank you. 

Amber Bardon: Thanks for that background. Right over to you, Geoff.

Geoff Wright: Yeah. So I'm the co founder of the company and inventors. So I had been working with virtual reality technology for Probably over 25 years now, way back before it was even affordable. My background is in neuroscience and [00:02:00] engineering, and I'm currently a professor at Temple university in Philadelphia.

 We started the company back in I think 2018, I think officially incorporated 2019. And the focus has been on fall prevention but really my background is in studying postural control and we call it posturography. So balance control. And I'd been doing that for a couple of decades after training with physical therapist, neuroscientists engineers, and people who have really looked at all the different aspects of what

Geoff Wright: contributes to how we keep ourselves upright and how we balance. And because we're two legged creatures, we're constantly unstable. And this gets worse with age because we're dependent on regular feedback from our vision, our vestibular system, and our tactile sensors to keep us upright. The idea is we use virtual reality and we also use some of the built in gyroscopes and cameras that are built into the headset in order to track whether [00:03:00] someone's moving unusually while we're testing their balance.

And so that's the main underlying idea of what UprightVR is doing is it's testing person's ability to keep their balance in unusual situations and in common situations. 

Amber Bardon: So one of the things I've learned about as I mentioned earlier, there's so many false technology products out there is that each company seems to have a really different approach.

So there's cameras, there's AI devices there's the lamp, so why did you decide to go in the direction of VR? What's the benefit of that? How did you come up with that idea as to take as your approach? 

Geoff Wright: Yeah, it's a great question because people don't intuitively recognize what's going on with balance and the fact that virtual reality is actually manipulating your visual input.

So it's trying to create representation of your environment, which is information that you use to keep your balance. When you're standing in a room and you may not know it, but unconsciously your visual [00:04:00] system is taking in information about orientation cues like the orientation of the door and the horizontality of the desk and unconsciously your brain is using that to help you keep balance while simultaneously your vestibular system is giving you

it's like a little gyroscope in your inner ear. That's telling you whether you're leaning to the left or the right or you're moving forward or backwards. Okay. And interestingly, with virtual reality, it's actually specifically designed to either have to solve that problem for you or to be able to manipulate that.

So you can make someone seem like they're moving all over the place, even when they're not. And your brain has to figure out, wow, am I moving the way the vision is saying, or am I moving the way my Somatosensory and vestibular system is saying that I'm moving. And so if your brain can't solve that problem then it's at greater risk for not being able to keep balance and

even though we're not constantly in a world that's being manipulated and spun around. We actually are encountering these [00:05:00] types of things all the time. Like you could be standing on a street corner and a big bus passes by you and that captures your visual system. And it says either something is moving in front of me or I'm moving and my brain has to figure out very quickly whether it's me that's moving or whether it's something in the environment that's moving.

And this gets worse with age is that we can't resolve that conflict that our brain is subjected to regularly. 

Amber Bardon: That's really interesting. Walk me through if I were to put on your VR headset, what would I experience? How would it feel for me as the person being assessed?

And what is the staff person seeing? And who's typically doing the assessment? Is it a physical therapist? Or tell me a little bit more about those processes. 

Ramiro Maldonado: Can definitely have a clinician perform the test if you'd like, but the beauty around the test is that it's a very clean and understandable interface. So what you effectively see as the person undergoing testing procedure is, you'll wear these set of goggles that look like goggles.

If you're not familiar with the [00:06:00] world of VR, and then you're put into an environment that looks a lot like a space capsule. It looks like you're out in space. You could have a look around. It's like a bit of a Star Trek scene. And you're looking out of a window. You get to see this nice galaxy and earth and all this kind of stuff.

So it's just a nice, calming environment. And that's what the individual kind of experience in that VR world. And then the individual that's performing the test again, they can be a clinician, but it could really be anybody that just knows how to safely guard an individual because 1 of the things I love about the tool is that everything is wonderfully standardized. So when we start to test, it just starts this cascade of events where it starts out with saying " Hey, listen, welcome to the upper VR scene. Have a look around. Isn't it cool what you're looking at? Understand that we're next to you the entire time and we won't start until you're ready."

 Once they get used to the testing procedure. And then once they get use that environment, they get used to the testing procedure. And then even notifies the individual what's going to happen during each 1 of the test. For the very 1st, 1, it's just " okay, for this condition, all that's going to be happening is you're going to have [00:07:00] your eyes open and you're just going to try to stay as still as possible."

And we do that for every single 1 of the conditions, which there are 8 of they take 20 seconds total for actual data gathering. So the actual testing procedure is relatively short. It's around 3 minutes or so test itself. Takes about 10 minutes, but again, because so standardized, you could have someone who's not necessarily with a clinical background do that testing procedure.

Everything is stored in a cloud so that a clinician could then review the results later if necessary, or if they want to be the 1 going through that test, they could do that. And testing relatively takes about 10 minutes or so. So that's what they're seeing.

And there's some unique things about some of the environments that we introduce that individual that really helped to help us tease out if this person is highly visually dependent, or if they have an impairment and what's known as the vestibular system, which is what people will call their equilibrium or if they have anything where they.

Have difficulties with integration of these systems. Are those 3 components that Dr [00:08:00] right mentioned before somatosensory visual and vestibular, they all communicate with each other. And sometimes the issue is integration and how those systems communicate with each other. And we expose individuals to environments that allow us to tease that out a bit.

For instance, 1 thing that we could do in the world of VR we had manipulate the environment in such a way. That 1 of our conditions, we actually spin the environment a bit, which sounds scary at 1st. But what we often find is that people see that they're like, whoa, this is cool and interesting.

It's not a fast spin. It's just a nice, slow spin. And what that helps us to do is tease out those integration issues that I was just mentioning. And so we could pull all this information out. Takes about 10 minutes to perform and overall the overwhelming experience has been people just being like, wow, that was really interesting and cool.

And, I can't believe that I was able to do this entire thing. That's going to give me information about my balance in just 10 minutes. And all I had to do was just stand right here and perform this test. So that's the whole thing in a bit of a nutshell. 

Amber Bardon: Okay, that makes sense.

I can visualize myself going through it as you were describing [00:09:00] it. So I'm not an expert, I'm not a clinician, but my general understanding on how, falls management the components of it. So there's the assessment piece which you're doing. And then after the assessment's completed, there's the care planning and how do we address this? And then there's the actual, tracking if a fall occurs and what's the follow up. So I'm curious, are you focusing on just that first piece or what happens next with the information? And are you able to incorporate any of the other pieces of falls management into your product?

Geoff Wright: Yeah, and it's another really good question because it doesn't stop with just identifying that there is a false risk and we actually have now added in rehab modules so that we can say if we identify specific fall risk Factors and they are modifiable fall risk factors, then we can address them by either doing some standard physical therapy, a balance training course or Tai Chi or even dance classes, which really can help with balance.

Or you can do our virtual reality rehab [00:10:00] modules, which we've designed specifically for addressing whatever deficits we've identified by doing the assessment. But in any kind of fall risk I guess matrix, you have the individual who is. Trying to keep their balance. You have the environment, which is not actively trying to make them in balance, but is the source of so many falls.

It's like just a simple trip over a change in the over a curb or a change in the surface. So things like that can obviously be useful. amended or changed to and modified to make it a more agreeable environment. And then the third thing is the types of tasks that we have the individual, the environment and the tasks that they're doing.

And sometimes the tasks such as activities of daily living, which you really need to do to get through your day versus things that are perhaps more challenging. And can you Change your behavior so that you're not doing the most risky things. But are there compensations that you can work around? So the goal is to [00:11:00] address the whole problem, which is the individual, the environment and the tasks that they're doing and seeing if you can get them to where they can function in a way where they're happily and independently getting through their day.

Amber Bardon: Can you talk a little bit more about the environment? How do you incorporate that into the assessment? Is that just more of a, like a physical look or does your product actually have a way to assess that? 

Geoff Wright: Yeah, no. So we leave that to impart to working with the experts of environment design.

But just through working with physical therapists and they make modifications to the environment just through the natural course of their training. So our device itself doesn't identify that or doesn't identify environmental. Problems or issues that need to be addressed, but it does identify that this individual may be at greater risk if they're in a dark environment.

If we see that they are highly visually dependent, then we say you might want to put some active lighting into the room so that when they get up in the middle of the night to maybe [00:12:00] use the restroom, then, you a nightlight should be on so that they have some visual feedback to help them.

Because it turns out that they maybe have really weak tactile senses and that they're at risk if they're trying to depend on just their sense of touch and their vestibular system. So that kind of thing we can identify and then that guides the the facility manager the person who is trying to create rooms that are really ideally designed for seniors that that have certain risk factors.

Amber Bardon: Okay. 

Ramiro Maldonado: To add to that bit is I forgot to mention that at the end of this test that we perform, this wonderful report is created. That's instantly generated. That identifies any area that, might have a. A risk concern exactly where in the balance system there might be an impairment.

It's written in such a way that someone without a technical background could very clearly understand where the deficit is. But then also on that report is a very kind of scientific. Breakdown of what's going on, and that's meant for the clinician to [00:13:00] then guide their practice. And then overall, what I think is great about the tool is this wonderful fall management piece of it.

So we could track all of this information. We store all of this information and we can see how many people were. High risk for falls month by month. And were you able to pull them out of of high risk to medium risk to low risk? And so say, Mrs Smith comes in at high risk and you're able to pull her through ideally to low risk by following maybe some of our rehab protocols as well.

Some of the protocols that you may put in place. But if you suddenly were to see a drop and Mrs Smith drop, she we got her to low risk and now all of a sudden we test her. She's back to high risk again. That would be also an indication for the individual to say, okay, what happened here?

Did is there a change? Was there a change in medication? Was there a change in medical status for this individual? So you could get ahead of any issues before ideally she's had that fall. So you could go into it. It'll give you that that impetus basically to deep [00:14:00] dive and figure out what's going on here.

Okay. 

Amber Bardon: Yeah, that makes sense. So that kind of leads me to ask you my next question, which is, I'm imagining that 1 of the benefits to using Geoff, versus other falls management tools is the portability and the size. And that's probably a, less of a barrier to entry and cost of the system as well.

And then it sounds like. it's also allows you to do frequent testing. So can you tell me a little bit about, what are some of the other advantages of your product versus others? And then how often do you recommend doing these assessments and testing? And I'm assuming that would be an advantage over some of these other systems that are a little bit more cost prohibitive or have to be operated by a skilled clinician.

Geoff Wright: Yeah that really is one of the things that was in the main thrust of of This device is there are some really great equipment that's been around for decades. And yet, if you go into clinics or you go into c. R. C. S. You're not going to see this equipment. It can cost over 100, 000, and it has this huge footprint.

And once it's [00:15:00] set, it's not moving. What? What if we could take that type of research grade and clinical grade equipment and make it portable and Then be able to take it to the room of a resident or take it to take it on the road. If you needed to go do home care. So it is just the headset and a little piece of of clinical foam that we use to manipulate the stability of the ground.

So that's all you need. And it's it's all weighs all of a couple pounds and you can carry it anywhere. So that means You can test somebody as frequently as you want. If you if you have somebody that has changed health status or change medication, or they came in saying I recently fell and I'm scared to get going again.

And so you can assess what might have caused this fall and determine whether they have some sort of sensory motor deficit, and then you can start addressing that. And then you can test them again every week or so. And you could do it in the safety of their home, or if they're able to get to the [00:16:00] clinic, then that's certainly an advantage.

Yeah we call it we call it ultra portable because portable is now being co opted by people that have giant pieces of equipment that is, if you're a heavy weightlifter, then you can actually move this equipment around, but you don't need to be a weightlifter for ours, you just need to be able to carry an attache case or something like that.

Ramiro Maldonado: And I definitely want to downplay that because the doctor I mentioned so this tool is capable of performing an advanced test. That in order to perform this test, you would be out in the field looking for something called computerized dynamic posterography. And as Dr, I mentioned, the tools that are currently in the world that could perform that.

Are extremely large take by the entire room and again, started around 100 to 150 K and this is. As sensitive as a tool as that, they could bring it directly to the resident right in their room. A fraction of the cost, which is just a reason also why I was very drawn to the team and the product and its capabilities to put the sheer power that is as portable.

Amber Bardon: That's [00:17:00] really incredible. We don't have to get into it, but I'm really curious. Like how did you do that? That's so innovative to be able to take that technology and make it so portable and accessible. 

Geoff Wright: Yeah. It's funny that the technology is moving in. I mentioned that I've been working with VR for A quarter of a century but some of the things that were innovated by others, I realized could be applied to these other applications.

So the built in we call them IMUs, inertial measurement units, which are really gyroscopes and accelerometers, the kinds of things that you might have seen in jet rockets just 25 years ago, but now they're making them so small. They can fit them in this commercially available headset. But what we had to do is.

Then compare that to other really using expensive equipment that I had in my laboratory, we compared how reliable that was. And we showed that it really is just as good as some of this expensive equipment. So now we need to develop our own algorithms to see if we can then [00:18:00] quantify. The change in postural control and we use I'm trying to have to throw out fancy words, but some of things like kinematics, which is the measure of your body movement, and we can quantify that down to the millimeter accuracy and say, Oh if you've got a change in your kinematics, then that means that you're.

Probably showing some deficit in your sensory motor system that wouldn't be detectable by just visually inspecting someone. So you can watch somebody try to keep your balance. And you can say only if someone is wobbling around like a drunken sailor, can you tell that they probably have a balanced deficit?

Whereas with this device, you could have very subtle deficits that we can pick up on and and quantify them. And then. And then get an actual fall risk ratio. 

Amber Bardon: It's amazing. Does your technology then integrate with any of the medical record system so that you can have data going back and forth around the assessment and then any follow ups and outcomes and then, progress.

Geoff Wright: Yeah so we have looked at a [00:19:00] number of the EMRs and because there's no standardization out there and there's a lot of competing electronic medical record systems, we felt that we weren't going to be able to accommodate all of them. So what we did is we designed our own. What it basically is a cloud based database that gives you an electronic report that then you can you can either manually integrate with someone else's E.

M. R. or you can use that in order to track an individual. So we store all this information in the cloud. So it's accessible to the user, such as the clinician or the retirement community managers. 

Amber Bardon: Makes sense. So looking ahead, are you able to share what are the plans you have for future development of UprightVR?

How do you see this technology evolving? What can you tell us about that? 

Geoff Wright: Yeah we've been having some really great brainstorming meetings over the last few weeks that we've had like a five year plan for. For a while and it's constantly evolving, but we currently have [00:20:00] so we started out as just an assessment and the goal was to develop then these rehab modules, which now we have a suite of rehab modules.

A dozen of them that you use. They're like games. But they're specifically designed for treatment. And then we also we're currently Developing machine learning algorithms that are going to take those assessments and match them with the most effective rehab to say, okay, if you've got this pattern of deficit, then what you need to do is it automatically tells you what rehab you need to do.

We also have number of other assessments, which are important to the clinicians. There's a balance assessment, but then there's a lot of other types of assessments that are related to keeping your balance that may involve just sensitively testing the vestibular system, sensitively testing the visual and we call it the ocular motor system.

So your visual motor system. And so we're designing. Other assessments, which we've been [00:21:00] validating in some studies that I'm doing in my lab. And now we're just incorporating them into our commercially available offering. So those are really close to on the they're more than on the horizon.

They're actually, some of them are ready pretty close for release and they just need to go through some internal testing and others are going to take a little bit longer to develop, but I think that, reasonably some of these can be integrated within the next six months. 

Amber Bardon: Wow. Exciting.

Ramiro question for you. We've covered a lot in a very short period of time. Is there anything we haven't talked about that you want listeners to know about Geoff? 

Ramiro Maldonado: Yeah, for sure. Some things I consider balls the silent epidemic that is going through just all populations.

And some of the biggest indicators are fall is, 1 of the biggest 1 is obviously have you had a fall in the past year? That's a clear risk for fall. The 2nd 1 is a fear of falling. So that's another very high. Indicator that someone's going to fall soon.

What I find about fear around something, it's often about [00:22:00] not understanding a thing, so people just don't really understand why they're imbalanced. So what they tend to do is they just. Unfortunately, start to actually slow down and start to sit more and become more immobile, which actually starts to increase the risk of potentially having a fall.

What I think is really powerful about our tool is that It's an empowering tool because we identify exactly where and in your profile you have a deficit, it helps you to understand this beast. Essentially, you know exactly where it is. And it's not a fear inducing thing. It's an empowering thing.

And so now you're armed with, okay, this is exactly where I need to address my impairments. And this is how I can get better. And people start to realize okay, this is not a sentence for definitely going to fall. This is now a way out. And how I've become more mobile and more independent again.

So that's something I just really want to, out there for people to understand about the tool and and, where I see it. 

Amber Bardon: I love that you said that, and I love that you're framing it as an empowerment tool, because [00:23:00] combined with your accessibility and portability, it really, Brings the ability to assess for falls to a much broader audience.

It sounds like. 

Geoff Wright: If I can add to that, I think, and Ramiro knows this all of our case success stories. 1 of them is exactly that where we tested a bunch of seniors and men in a series of the 4 that we actually quantify. We. Said they all came in with very high fall risk. We put them through about six weeks of physical therapy or Tai Chi, and at the end of it, they all had improved and gotten their fall risk significantly down.

And many of them said they were just so pleased when it was for them. It was a competition in their mind to say I can change those numbers and they all did. They all just went from lots of reds to lots of greens, which is a positive movement. And it was really nice to see how excited and involved they invested.

They were into taking power over this. This, [00:24:00] usually you get a bad medical wreck, a medical report from your doctor and you think Oh no, my cholesterol is high. And then you realize that you can do things to lower this, or you can do things to improve your balance. 

Amber Bardon: That's such a positive note to end on.

So thank you for sharing that story. And thank you so much to both of you for joining us today. If listeners want to learn more about UprightVR, how can they find you? 

Ramiro Maldonado: Yeah, so we have a website up right? Vr dot com. There's a request for info at the end at the bottom there. If you want to reach out to me directly, my email address is my 1st last at upright.

Vr dot com. So that's Ramiro dot Maldonado at upright. Vr dot com. I try to respond as quickly as possible. Again, our website. The info email there at the bottom of that website, as well as my own email, feel free to reach out. Happy to talk about this stuff. Excited to talk about this stuff.

Amber Bardon: Yeah. Fabulous. We'll post that in the show notes as well. And thank you so much both for joining me today. 

Geoff Wright: Yeah, thank you for inviting us. Very good time. 

Amber Bardon: You can find us online at [00:25:00] RaisingTechPodcast. com where you can see all of our episodes and contact us to provide feedback or submit an episode idea. We are on social media everywhere at Raising Tech Podcast. If you enjoy Raising Tech, please leave us a review and share with a friend. Music is an original production by Tim Resig, one of our very own Parasol Alliance employees.

As always, thank you for listening.