The Hardtech Podcast
Nuvio Episode with Matt Cumella (Founder & CEO, Nuvio)
Hosts: Grant Chapman & Drew Westrick (Glassboard)

Auto-generated transcript, lightly cleaned for proper nouns.

[0:00] Welcome to the podcast.

[0:09] Everyone, welcome back to the Hardtech Podcast. I'm here not with my usual guest. I've got drew CTO joining us today. Welcome back. I know I drew the short card. I think DeAndre is having a lovely time down in Orlando. So if anything I wish I was where he was and I wish he was here.

[0:24] So. But I've got an awesome, you know, guest today, so I'm pretty pumped to be included. Yeah Matt, I'm so glad you got to come back and the wonderful world class board and you get to visit one more time. So you brought a couple of friends, but only you could be on the pod today. So thanks for joining.

[0:37] Yeah yeah. Great to be here. Awesome. So for everyone listening, Matt runs an amazing company called Nuvio. It is a medical device that has some really neat technology in it. And it started acoustically as just a way better version of the product than it was out. Competing competitors is a neat, I'll call it Core Advantages. And then you decided that that wasn't good enough, and we had to go put really cool sensors in it and go from there.

[0:59] But before we jump into the company and you know, and what it does and all the cool stuff. Who are you and how did you get to the point that you're running a really neat device? Tech

[1:08] startup? Sure. Who am I?

[1:14] Physical therapist. My background I have a doctorate in physical therapy. I also have a board certification in geriatrics. Which means I've really leaned into the population clinically around where our product sits as a physical. I mean, I got into PT in a bit of a roundabout sort of way, super involved in sports when I was young, never considered the idea of becoming a physical therapist in college.

[1:47] I very much had not as many injuries as you would expect for typically, I think it's like, oh, you got PT and become a physical therapist. I didn't really have those injuries. I, I more so couldn't find what I wanted to do as I was going through art, maybe business school, maybe healthcare. I almost like funneled down to there's only so much left that I could pay attention to.

[2:10] PC got on my radar, got a ton of experience screening physical therapists. Leaned into that. I went to grad school at the University of Central Florida in Orlando. Nice. There you go. Not too far from there right now, where I went to, it's been three years. Pretty hard core. But I originally absolutely went to school thinking that I was going to be like the PT for the Celtics, which, you know, from Boston.

[2:39] So there you go. Yeah, but but I really care who I'm sitting with right now. I'm going to stay in that.

[2:44] But athletic leaning right. It was like this is the this is the reason I'm going to do this is because athletics are cool. I like sports. Let's be in the industry and help

[2:52] out 100%. And you do clinicals in school.

[2:55] My first clinicals were in like sports med clinics still going that route. And then I had a very interesting you we did for clinicals. And on my third you have to do what's called an inpatient setting. So it's like you have you have outpatient versus inpatient, which is kind of hospital versus sports bank clinic. And I had an inpatient setting lined up.

[3:16] I had a clinical starting on a Monday. On a Wednesday, my clinical instructor, which would have been the physical therapist I was essentially working under, quit her job. Or we found out on that Wednesday that she was quitting her job, and so had a complete pivot into a much more intense clinical setting, not in a generic acute care hospital, but in a burn trauma, a step down ICU unit.

[3:41] Oh, wow. So I went from sports med outpatient to shooting my pants trauma ICU in a setting on that. Right. It's Wednesday and now it's Thursday. And I've got like three days to just completely immerse yourself in this new world. Yeah. And, you know, had some friends who had kind of, like, gone into the setting and whatever, but I was absolutely like, just like thrown into that on a Monday.

[4:06] And from day one, it like, changed me. It it very much changed me. My very first patient, on, on day one was a 400 pound guy in ICU who was there after a car accident, who had a major incomplete spinal cord injury and could barely move. And I watched my five foot two clinical instructor, brilliant clinical instructor, but just small transfer him.

[4:38] So basically help him out of bed and help him learn how to get out of bed. And the way she was able to leverage, almost like an athlete herself, to help him learn how to do that and relearn how to do that in this new body he had. It totally set the tone for the clinical, and it didn't make me want to.

[4:55] The next eight, 12 weeks, whatever it was, didn't make me want to lean into like a burn trauma ICU setting specifically. But maybe we want to lean into helping people do accomplish daily tasks in difficult scenarios, right? Kind of less the focus of like optimize at an athletic level and the focus of optimizing almost like daily life. Your independence him

[5:15] and her like, wow.

[5:17] Like they're going to do the impossible here together 100%. And it's less than

[5:21] that. Like top 5% of performance, it's getting 85% of your points back. Yes, yes. And what I absolutely learned over that time frame of that clinical was the value of that for who you're helping, which is what you're going into any sort of health care setting for it.

[5:36] And I just that was something that that was a meaningful experience. And from then on out I was inpatient something. It's what I want to be focused on. And I wound up I wound up in aging care. So I went from Orlando, I went to back to Boston, which is from Connecticut, had a lot of friends who graduated and moved to Boston.

[6:00] Big health care town. Kind of made sense to move to. Sure excited about it and wound up getting more into the agent care setting side of things. So mostly post-acute care. So if you go to the hospital and you're not ready to go home, you go to an inpatient rehab facility and everything there is I mean, typically, the first patient who arrives at that kind of a facility is not quite as intense as that gentleman, that 400 pound gentleman.

[6:27] But like they are what you would call dependent or less sure need a lot of help and your job is to get them, ideally, in most cases walking out, maybe with some help,

[6:37] but they're ready to go home and ready to keep making that transition. And and just for everyone at home, this is like I'm imagining like my grandmother got her hip replaced post-surgery.

[6:45] She goes on a walk, yet you're helping her walk with her new hip, and she's weak because she's been through major surgery and she's in her 80s, so she doesn't recover as fast as the rest of us. So you're teaching her how to be self-sufficient, go to the bathroom by herself, shower by herself. Like, take care of these daily needs.

[6:59] Yeah.

[6:59] Or you just had a stroke or some other major, major event. Or probably more often than not. And this is the thing that drew me to geriatric care was a lot of times it's, an acute event that's really stacking on top of a history of, of issues of small things that winds up being there's a complexity to it in those settings.

[7:25] That is the primary diagnosis, as they were there for something like pneumonia that you or I would not need to stay for. But they do because the length of what's, you know, the sort of history of what's going on and how much in a moment can impact someone like that. And that clinically was very interesting and very like, let's figure this out, like solve this puzzle sort of thing.

[7:45] Yeah, absolutely. And that's what drew me, I think, to stay in post-acute care was there's actually a lot of sort of goings on, a lot of lot of, you know, the clinical team needing to work together in many sorts of ways. And the patient population can be like, you just have, yeah, entirely different cases, but they're all like, yeah, flex in their own way.

[8:06] Walk in the door,

[8:07] I think like your guys's profession and maybe like oncologists are up there to it's like your entire job is basically just to like prove like that you're going to beat the odds, right? Because I feel like there's always the adage of like, oh, yeah, like he'll never walk again. And then it's like, you know, here's a guy, like running a marathon.

[8:23] And I like, think at the end of the day, it's like, I mean, a lot of that. He's like, yeah, like they put in the effort. But I think part of it too is just like the physical therapy, like what you can do with people just blows my mind, right? I mean, I had a buddy of mine, a gentleman that I knew growing up and like be effectively had to like relearn how to walk at like college age and again, like it was a similar deal where they basically said to him, like, you'll be lucky to walk again, but like you'll never play basketball again.

[8:47] And like, you know, he he eventually went on to like, actually like play basketball like briefly at a collegiate level. Right. Within a couple of years. But it's just like, that's one of those things that I've at least always been, like, fascinated by your profession in so far that it's just like, it's amazing what you can help people do in terms of getting from zero back to some level of of ability.

[9:10] Right? That's not always 100%. But I think that for some people, even getting from 0% to 50% is a life changing event,

[9:17] right? Yeah. It's gonna say 100%. Yeah. Absolutely. Right. Right. Yeah. And I think a lot of it is, is you wind up working with people who are either in, you know, new bodies, new new things going on, and they're going to be permanent.

[9:35] And you're you're not going to have 100% come out of it. It's going to be your new baseline is going to be 56. Sure. What it was before. Or it's just lengthy, lengthy paths and roads

[9:47] back to 100%. Right. And if you don't take the path the right way, you'll never get there. Right? Like like there's a time variant nature of this getting there, right?

[9:55] Like, if you don't do the things now, you're going to build up the scar tissue or the healing won't happen in the right way and we're not going to get there. So let's be diligent even though it sucks in the moment. Yeah. Well, and mobility is just it's such a self-fulfilling prophecy, especially in older age. Right. Because I think we've all seen this.

[10:09] It's like usually there is, you know grandma, grandpa, that is great. They have this acute event, whether it's a fall or a hip replacement or, you know, some surgery that kind of, you know, puts them back on the mobility side of things. And then it's like it's just a domino effect. Like once that loss of mobility happens, you know, either you know, it's the weight gain or the bed source, like there's all these other like comorbidities that then like start to stack up.

[10:33] And to your point, you know, if you're already kind of playing with 5 or 6, you know, that are already kind of priest act, it only sometimes takes 1 or 2 to kind of knock the house of cards over. Right. So I think like getting that mobility back sometimes is, I mean, to put it bluntly, like a life or death situation.

[10:48] Right? It's like either they're going to to get back to at least where they, where they were and live a healthy lifestyle, or this is going to kind of be the slow thing that, you know, starts to, you know, have these other things that then are going to start to stack on behind it. Right? So

[11:03] and the sort of horror, you know, cold hard truth of it is that there are lots of Mrs..

[11:09] There. I mean, there are so many cases where you see it start to, you know, become unobtainable. Maybe what what it looked like could be obtainable on day one. And that's no one's fault, right? It's part of the challenge of the complexity that maybe you would be drawn to if you're someone like me, but also the reality of the complexity and the complexity against the timeline and the complexity against another human needing to work together in the complexity against a human and everything mental.

[11:40] And that goes along the physical and all of that. And, you know, we'll get into sort of what Nuvio does and but but honestly, that's that's a lot. Seeing those misses motivated me. Sure. Entrepreneurial I think because yeah, to optimize in a ways that I think a lot of times we, we stereotype into. Oh is what it is.

[12:00] Yeah. This is

[12:01] the process right? Yeah. I was trained this way. This is all I can do. So let's a good natural transition of like so you're practicing PT you've been doing this for a couple of years. Some amount that I'm sure you'll fill in. But was there this like magic moment when you saw something happen more than one time that sparked?

[12:17] This is what I want to change and why?

[12:19] Yeah, yeah, I absolutely have sort of a handful of patients that still like are logged in my mind, but I so graduated 2014 and I got my board certification, geriatrics in 2018. And it was the first four years where I really sort of like, felt like I was holding my skills and deciding to focus on aging care.

[12:42] In PT now, it's more common to do a residency right out and maybe get that board certification right out the way an MD might. It wasn't so much when I came out of school, and so that board certification was a very active pursuit of kind of working with this population permanently. And I don't know exactly what it was, but I would say it was it was close to when I moved into a certain setting.

[13:09] It's called the Castle. It's a continuing care rehab center setting where you have a short term rehab facility that's tied to an acute care hospital, that they get all the influx of that. But then also a lot of your patients wind up continuing on and living there. So it's an independent living assisted living community. And in that setting practicing, you would treat them on the short term side.

[13:34] And then if they went home, they would still be your patient, which is unique. A lot of times when you're an inpatient, they go see a physical therapist in their hometown. Yeah. And the doctor who's under their care and the lead physician, like the whole team is in cask is the team follows you. And I think that gave me a unique experience of seeing the challenges and complexities and successes and failures on both sides of the inpatient.

[14:02] Yeah. Unique perspective.

[14:03] Right. Because you can kind of like build a relationship. And it's not like I'm only dealing with the acute or the long term side. It's sort of this transitionary like continuing care kind of thing. Right. And not to bury the lead. Seeing patterns over time is a thing that we'll get into later, which is really important in medicine, is like, yes, if you see your doctor once every year, they can read your chart and say, right, cool, we're good today.

[14:25] But it takes that all the time touchpoint to see these slow changes that lead to the big outcomes.

[14:30] Yeah, right. Yeah. And being able to follow those same patients and often see their motivations over time and what they wanted out of their care and what their goals were and how I could help them, led me to, to notice some gaps in how I could literally help them.

[14:52] And these are usually cases, you know, especially short term rehab, post-acute care, nine and a half out of ten have some sort of insisted need, but you're almost not there. If you don't physically need something like a walker, or you are wheelchair bound when you get there or you know you more that help than a walker, like an exoskeleton, these sorts of cases.

[15:12] And so you're using those types of assistive devices constantly in your care. And the gaps I just felt like I noticed were my patients wanting, you know, you've given me four posts and tennis balls here, right? I feel like I could do more. I feel like, is there anything better, you know, these these kinds of questions. We

[15:34] put a man on the moon.

[15:35] What do you mean? You give me four aluminum poles and tennis balls, right? We just use this $20,000 a piece

[15:40] of equipment during my session. Yeah. And then you send me back to my room. Do they at least pre install the tennis balls, or do people still cut them and put them on because like, that's the thing that I know.

[15:50] But that's the thing that blows my mind is like we haven't even made the step yet where it's like, everyone does this, but the but no one ever thought like, maybe we should just update the base level design.

[16:02] Like it's been this way for, what, a decade or more, right? I mean, it was it was always a funny scene that was probably like once a quarter the rehab aid, who's usually like a high school student, like it gets a bring it over the big tennis balls and for a couple hours you get the knife out.

[16:17] Yeah, yeah. Is it like tennis where where they get three and they pick two to put on the walker. You know, they kind of pick the best two out of the

[16:25] three.

[16:29] They throw the one back to the, you know to

[16:31] the tennis ball in turn. You know in my brain is just going I can't believe that this doesn't have more workers comp claims with that knife going straight through that interns hand. And like that the, the the, insurance adjusters haven't stopped. Yeah, yeah, yeah. So then walk us then kind of through like how you had this idea and then, you know, how did that become, like, actionable.

[16:50] Like, how did you wind up with even, like, the opportunity to, to do this? I think, you know, obviously, I know some of your backstory, but I think this is kind of cool to almost like a jobs in sort of laws kind of thing. Right?

[17:02] Yeah. It's very, very sort of like interesting path. It was probably a year or two of me having the idea of whether it was my patients telling me, or a lot of times you'll notice things in the clinic where when you are at 50% instead of 100%, what does that mean?

[17:18] It means 1% goes a lot further. Sure. And so usually things happen in the margins. And so as a PT, if your job is to help someone get out of a chair so that they can do it every day at home, it's not just like their strength or their balance and being able to do that. It might be the way they they place their feet or the way they're able to use their hands.

[17:38] And so you would see things in the clinic that you could create a scenario where they'd be successful. That wouldn't translate because those margins would get lost in their environment. And so that's that's assistive needs almost in a nutshell. It's like those margins need to go really far. And so I'd see gaps with that that would bother me and make me want to think about how could you do this differently so that these margins would just even

[18:01] if just the margins were right, and like if they could get the Walker three inches closer to them, they'd make it a lot easier to get out of a chair, like that kind of

[18:10] thing.

[18:10] When you're talking about margins, the right place to put their hands. Yeah, yeah. Their feet didn't hit the edge of the walker the way they wanted to get out of the chair, or they didn't have to, you know, lean over their device to just, you know, move a casserole across the countertop or to open a door or a lot of these refrigerator seemingly marginal sure moments that just fill our days that, you know, you have the luxury of not having to even think about if you if you don't need something like discount device.

[18:38] And I was mainly motivated by feeling like so difficult to getting out of a chair is the number one reason for disability and false like if you it's like intuitive when you think about it. But we often think about walking in balance. Like once you're up as that like sure all independence issue, you have to get out of the chair first, right?

[18:55] Literally. And it's a common problem, obviously, if you have the balance and strength issues associated with walking, you're going to have those getting out of the chair. And so my main motivation like mechanically was like, why can't why is the walker not something that helps them, you know, put them all the time. Like if it helps them better, getting up out of the right just makes all the more sense as the, the, the utility of that tool will only go further.

[19:20] And on the other side of this was more more tech enablement, more sort of connected care side of things is for this, this population, unlike in athletics, you were doing a lot of things to try to mirror their everyday to understand how well, because their goals are really to get better in everyday tasks. So you're we do a lot of objective tests and measures like you would go to the doctor, same thing, but they're mobility related.

[19:49] So how are you able to do this or that. And for those tests they're as analog as the walkers. We use their I love this story. There lay tape down on the floor to get walking speed, which I think is becoming common knowledge is a really important number. Yeah. You use the phrase

[20:05] count ceiling tiles I think frequently with us and I'm like, really?

[20:09] And you're like, yeah, like we count ceiling tiles. Most every

[20:12] physical therapist probably knows the length of either a ceiling tile or a floor tile. Yeah, in post-acute care or acute care, because in the flow of your day, in the in the flow of treating your patients, we don't have the tools to do it beyond that. But we have to.

[20:27] Yeah, we have to do tests that require distances and understanding all of that. Yeah. So

[20:33] instead of ten stone it's he you know he had a great day. He made eight and a half tiles. Yeah. Yeah. And he didn't have tiles in about two minutes and we're good. Yeah. Or he only did six tiles today. We're two tiles short.

[20:44] Yeah. And this is this crazy part. Like, this is like the most important recovery care for these patients, right? They've just had a cute injury. Whether it's a fall or a surgery or all these things. And they went through an insane amount of technology to fix whatever happened. Yeah.

[20:57] And as we get them back to functional, we're literally like counting the ceiling tiles, see how far they walked.

[21:02] And the surgeon who used that insane amount of technology to replace their hip or fix their femur after it fractured. We'll be looking for the number that I get from the ceiling tiles as a measure of how their patient is doing at. Right, right, right. Their surgery. Did I put the hip in. Right. Yes. 100. And so this is this really funny thing where like, it all matters, right?

[21:25] It all ties together and you need to be able to do it as a as effectively as possible. Yeah. If you want to improve

[21:31] surgery, you have to measure clinical outcomes. If you're not doing that, then no one knows what methods are actually, you know, creating the clinically

[21:39] significant, you know, benefits. Right. And so it felt like efficiencies.

[21:43] It also felt like at more of a macro level, we were being asked to do more objective measures. Like we meaning administrators where they go get gait speed every time. Yeah. Then we've got a, we've got now a lot of clinics will just have a place where the tape is on the floor permanently or permanently, or they have tape every ten meters along all of their hallway walls.

[22:04] And these are just things that are not they're not sustainable enough, right? They're not you know, they're not true infrastructure. Right? Right. There's something that is because

[22:12] it's still eyeballing the distance and the time. Right? Right. Like this is still a human eyeballing a distance in a time and like, internally stop watching, let alone maybe they're stop watching their watch, but

[22:23] yeah.

[22:23] And you just hit on something that I've, I've leaned into and focused more on in product development. It wasn't part of, you know, in my mind at the time, but the amount of subjectivity that comes into play. Sure. If I'm doing the ceiling tiles every day, I start to understand generally how long this hallway is off those ceiling tiles.

[22:44] But I also may wind up with a different number than the PTA I work with, and the other PT and the OT I work with. And so now we all have a plus or -20% number. Yeah. On how these patients are doing on measures that are supposed to be objective. And that stacks and 20%

[23:01] might be the difference between a good week and a bad week for this patient.

[23:03] And the trend can look the wrong direction or at worst just noisy.

[23:07] Right. Yeah. And so, you know, between those two factors, the mechanical feeling like it could be elevated and, you know, basically move better for the patient. And you know, you would say like move smarter in terms of like being able to actually get data that was meaningful and could provide value across the continuum of stakeholders that get involved in these cases.

[23:28] That definitely sent me down the path that that became new.

[23:32] And so Nuvio started, I'm assuming in a garage or a fever dream of some kind. It it it is

[23:39] originally in a basement before I had a crutch, but massive failures. I would go like on the odd weekend and buy PVC pipes or like Dow rods and try to put stuff together.

[23:50] Very much being like just a PT totally full time and absolutely failing at it, like putting something together. And then I wouldn't do it for 3 or 4 months because it be like, this is this is it more stuff? Yeah. And then Covid expedited things for me. My wife and I moved to, Park Slope in Brooklyn on March 12th of 2020.

[24:14] Wow. Literally like is the Saturday before the Monday, like the world shut down. Yeah. And and we moved to the epicenter. I was going to say not not a great time to be moving to Brooklyn. Crushed it. My wife's job was actually center of Times Square. Oh, boy. Stepped foot in her office. They wound up selling it and going remote, like, sure.

[24:33] But like, yes. And New York was the first fall of that. And so all very different. And we we had some family in New Hampshire, and we did one of the common things at the time of like cities kind of go outside of the city for a few months and figure things out. And there was no there was no it was also like I hadn't gotten my my feet underneath me, but something new I was doing per diem PT, which is not uncommon to kind of like do that when you go somewhere new.

[25:03] Sure. Where you want to land. Yeah, yeah. Pays well. It's just it's a little bit like Rough Shot and I just kind of, you know, we were everything going on. We were like, we're just going to be up in New Hampshire. And so I just didn't essentially wasn't working for like 2 or 3 months in that interim period.

[25:19] And they had a garage. And I literally it literally just like made me spend more time because I had more time to spend. And what I did that I give a lot of credit for and why, like I have such an appreciation for what you guys do is I, I tried my best to connect with those who do what you do, and it became this amazing knowledge share where I think because I had a product that was helping people, they were more okay with consulting me for basically for free.

[25:48] And it was so much of conversations where they were like, well, this is what success looks like almost. This is the path you need to go down. You need to not just do random right now rods together with no process, no tracking, no reporting of what was successful. It was, you know, what was not successful, like go through these steps.

[26:05] If you didn't run it down, it didn't happen. Yeah, yeah. Then come back to something. Yeah. Being a cute

[26:09] PT that wants to help people, I mean, that definitely helps you get ahead, you know, in your entrepreneurial career. Exactly.

[26:15] And so so that was that was just like 2 or 3 months of of listening to people like you guys and winding up.

[26:23] I mean, it was not like, oh, we're gonna do this now. It was just like winding up somewhere a little bit further down the line and not just sort of like bang your head against the wall. And

[26:32] yeah, I guess it somewhat started from there. And so, you know, you start having a prototype. What was the first thing you were solving in that prototype?

[26:40] What was that first like a ha moment?

[26:43] So a more stable device in general than for post and tennis balls that also had a, a component to help you out of a chair, which could be as simple as having a good place to put your hands that worked effectively to kind of help you push yourself up out of a chair.

[27:03] And honestly, the first prototype just felt like it did the job. It was you put it next to what was on the market and it was like, oh,

[27:13] this is this is interesting. And for everyone listening, like the new one, like the product that it became has these really awesome ergonomic handles way lower than you would think you'd see on a walker, because they're not made to be used when you're walking there at this great height to lift yourself out of a deep chair or a couch, which is where most people struggle, right?

[27:29] A nice hard dining room table chair isn't that hard to get out of because they're not sunk in. Their hips are in the wrong place. They can grab the top of the walker usually, but if you're sunken to a couch or a lazy boy or on an edge of a bed, there's nowhere good to grip because you don't have the right center of mass.

[27:44] Yeah, you just put really obvious handles, which again, I've been working with you so long I'm like, I didn't even think of this years ago because once you see it once, you can't see it. Yeah.

[27:52] One of the biggest problems I, I always had that like a lot of the patients that I have in my mind, that were sort of the inspiration is the way that we train people.

[28:04] If you have a balance issue or a strength issue such that you just need your hands to push up from the. We as therapists are almost forced to do something that we very rarely do, which, like therapists, is always like good mechanics, right? Lift the right way, all this kind of thing. We're forced to train people to use their hands in a way that is like suboptimal, inefficient, inefficient.

[28:27] It's like it almost looks like the wrong way to do it. You watch people like push up and then it's like this leap of faith and or they're like pulling on their, their walker to do it right. It's not effective, but there's no alternative. And so that's that's what always bugged me is that what happens cases who these patients when you would put them in a position for success in the clinic.

[28:45] They were smart enough to know, like, why can I do it when all you do is make these little adjustments? But then I struggle so much. And that would be my explanation was like, well, in the everyday environment and kind of like the built world or this is just it's not intuitive. Right.

[28:59] And again, I think again, for your demographic, it's like at this point, I mean, a lot of people are just operating on muscle memory, right?

[29:05] I mean, it's it's 60, 70 years of I've always done it this way. And then trying to re map somebody's brain, you know, that's been around that long. You know, it's just not quite as the plasticity isn't quite the same as it is if you're a five year old kid trying to, you know, learn something different. Right. So I'm sure that plays into it as well.

[29:26] So we've got a prototype that has handles in a weird place that feels like a not a big innovation. But again, I've used the thing I understand the mechanical difference. It's insanely different than any of the competition. Yeah. What is the other like major feature of

[29:40] the the Walker itself. So it it also has benefits during daily tasks.

[29:47] So what we really did and I say we because it slowly became a we and it became a product development process. And the amount of times we tried to make small changes to what was on the market rather than like almost a retrofit, right, rather than a wholesale hardware from the ground up. And failed was because all of our competition was designed in the 50s, 60s and 70s.

[30:13] And those simple small changes like just put some lower handrails on those devices, they don't feel stable or they're not effective, right. You're not able to leverage them and have those good mechanics, right? It's no easier than pushing up from like for example,

[30:29] they'll tip. Yeah, you you kind of just need to change the geometry of the walker to do.

[30:35] I think what you guys wanted to do, which is to like make those handles like, lower and work. Right. Because again, if you're not familiar with most walkers, we call them like X style walkers, where they kind of have this like seat in the middle or there's like kind of like this, this cross beam, right, to actually create like the structural rigidity.

[30:50] But that cross beam kind of intrinsically gets in the way of your legs. And so, you know, I think like your guys's point, it's like the person's not actually able to get the walker close enough so that their center of gravity is like over the top of it. Right? So that's like back to your thing where it's like kind of like the walker.

[31:06] It's almost like they're trying to pull it over on themselves because they're not able to get it like close enough to get that leverage right.

[31:13] You need to get your hands in the right position that works for you, that you can get over top of them, really push, not pull. Have good mechanics, have the device be stable through that motion right, and then be in a really easy position to now be up and standing.

[31:26] And it wasn't sort of rocket science, but I think it was paying attention to details that are otherwise easy to dismiss as marginal. And maybe the competition. Just saying just throw some lower handrails on it, make a marketing ploy. But then being out there in the field and just being like, that's definitely is not working. And they're not using the handles and they're still, you know, having trouble out of a chair.

[31:49] Yeah. Right. Yeah. And then I, I think the other thing about the Nuvio, one that I just loved when I watched your demo the first time was you're because that x cross isn't there anymore. You guys have we called the h structure, right? The h frame. Now the age frame, the that it opens up the center core of the device that's now hollow.

[32:06] And I can I as the user can step into it. Yeah. Right. I know I am not walking behind a walker. I'm walking in the middle of this ring of stability. So, hey, my hands can be anywhere. If I'm turning over, I can brace myself here and I'm in the middle of this structure of stable, and I can pull that up against an edge.

[32:22] It was your kitchen sink demo that, like, blew my mind watching someone try and wash a coffee cup out in the sink with a standard walker felt uncomfortable or balanced and unsafe for someone who had bounced the shoes. And I couldn't believe that this happened. Also, you brought this in because you were Walker. Let someone go all the way because it's either like in front of them and in the way, and now they're trying to reach over and like, reach into a sink.

[32:43] Right? Or they kind of putting it to the side, but now they're like, you're basically like abandoning the walker to like, pivot over to like do the sink, but then you like have to pivot back. Which to your point, if you like, have balance issues. Like it's not like you're again, back to this whole thing. There's like you're trying to figure out like, okay, where's my handhold?

[33:00] And how do I get from this stable counter back over to a walker with again, like not putting my weight on it and like tipping it over or something. Right.

[33:07] That really interesting conversation around disability tech, right, is you want to help people be as independent as possible and as as functional as possible, as if, you know, they they don't have that need.

[33:20] Right? Right. But to do that, you have to give them a piece of technology or equipment that inherently is unnatural. Yeah, right. To both them and to the environment. So we weren't designed to move with a walker. Yep. Holding on to and our environment is not necessarily going to be designed to be a good mirror for that. And so with I think a lot of disability tech walkers included, there are moments where like, you want to be designing it as much for moments where it is supporting you and helping you as it is getting out of your way.

[33:51] And that's just simply one of those examples of like, yes, a traditional world leader may be supporting and helping you in a, you know, getting a job done sort of way, but then it gets in your way in key moments where where you've got to be able to function and just kind of just kind of go on with your day.

[34:07] And that, that was that was as much part of our kind of focus when we were developing things was like, well, this functional moment said to stand, we've got to support this functional moment, reaching tasks that are just

[34:19] your days full of it. We gotta get out of your way. Yeah. And I think that culminated in you had to make a unique design to make that all work.

[34:26] So you have a design that has this H frame. It actually folds differently than all of the other walkers. So it gets out of the way differently is the word I'll use, like when I fold one of those up and I lean it against the wall itself. Supports I don't have to leave against the walls, you know, my grandmother's I use like I had to leave it against them or just going to tip over yours.

[34:42] Self-supporting. I can wheel it down the hallway, right? I can fold it into its like compact position and then carry it, wheel it next to me instead of feel like I have to pick it up because the wheels are tangled or it wasn't. The other ones were made to be moved when they're collapsed, which is also nice, because you're also kind of in that moment now thinking about like the caregiver.

[34:59] Right? Because again, a lot of folks, you know, they're they may not be the ones that are, you know, loading the walker like into or out of a car. Maybe that's their husband or their wife or a loved one. Right. And so again, I think that's like kind of just back to this, like rethinking the whole product holistically for like, how does it, you know, do the thing that it needs to do for the patient.

[35:19] How does it then exist within that patients environment in a way that's like not getting in their way in is more intuitive. And then the final piece, which is like, you know, how do you assist people that are then rendering care to them? And like also building in some features to like make their life easier where they're like not lugging around a walker, like having again to like, you know, do something that's unnatural or not intuitive.

[35:38] Right. So I feel like you guys kind of nailed like all three of those aspects, like with Nuvio one, which again, is like really cool and like it's one area where I think as like an engineer, we really, I think, need to do a better job of like thinking about how the product is going to be used and making it more intuitive.

[35:58] Right. I think we're all engineers are famous for like building complexity for the sake of complexity and then like being like shocked when we're like, oh, like, you know, I built this amazing device that solves all these problems. But, you know, I didn't take the time to make it intuitive enough to use, and therefore people don't use it the way that, like I intended them to use it.

[36:16] Right. Like I think everybody thinks back to like that whole like, you know, scandal at Apple. I hold it differently. But like, that's that mentality of like, oh, you're using it wrong. No. If the vast majority of your customers are using your product in a way that isn't like making it like work optimally, then that's not on them.

[36:35] That's on like you, the engineer, the design or the entrepreneur. Right. And so like, I really like that you guys like focused heavily on that aspect, which is like that intuitiveness of using the device and not just expecting people to conform to like how you designed it, because which is kind of easy to do. Right? Because it's like, oh, we did this super novel, amazing thing.

[36:56] We just everybody should adapt to how we, you know, how we designed this and take advantage of all these features. Whereas with you guys is just more natural that people can use the device and just intuitively unlock, you know, the things that you designed into the product.

[37:11] Right? And really important for us early on to recognize, like I think in this space and you guys have already like hit on the different stakeholders just in a couple minutes going through it.

[37:21] Right. These assistive technology it's assisting someone and with when you need assistance you often have loved ones more involved or you have a care team more involved. And so it's actually this really interesting space where from a product development standpoint, it can be more challenging because you can't ignore the other stakeholders. You can't ignore the fact that, like, odds are someone's going to be helping you in and out of the car and they are then going to be right the device back into the house or around the car or into the trunk.

[37:51] And so you have to factor them in. Otherwise they're going to say, well, I want to go get something else.

[37:56] And my favorite narrative, tell people that I haven't been in product much, is the end user is likely not the most important user to think about, because that's the obvious case. We need to think about the manufacturing team, the logistics.

[38:08] How do you ship this thing? Who is going to unbox it? Who's helping them use it? Where? Where is it stored? Where is it? Who's touching it? When is not being used by the end user in the good to great in product happens in the margin. Like you said earlier, the patients like it's all about margin and good to great happens when you take count all the users involved in the story.

[38:25] So fast forwarding from one which I love and referred to as the acoustic Nuvio because it's an analog device, it's a roll later, it has some really cool features, and you've been selling those in early, early distribution, which is really cool to see how some awesome reviews for everyone watching. Please go look it online. The ID team who did it knocked out of the park wasn't even us.

[38:46] I can't take credit but got to go shout out. It's a really pretty walker and this is a piece of someone's life now they're going to carry it with them. And so that's been on market. But I want to make sure we get time to touch on where where you're taking the product. So you now have a product that helps people.

[39:00] And you were not done yet. You were still hungry. So Matt, please tell tell the next chapter.

[39:06] Yeah. Yeah. To two hardware products is hard.

[39:14] Going going back to sort of early days where we tried to retrofit and failed. Part of that was retrofitting technology. And, you know, the idea, I wouldn't say from the beginning, but but pretty early on became like, how do we put a physical therapist in your walker in terms of the data it can collect? And it was pretty clear that you wouldn't be able to collect the right data the right way by refitting into the 1970s type frames as much as we would have wanted to baby.

[39:44] Right. So when we designed, when we developed the hardware, we always had in mind wanting to make it a great platform for embedded systems to support data collection and support that kind of

[39:57] connected care. No more counting ceiling tiles, right? Yeah, because it kind of goes back to you mentioned this earlier and this there's this like duality of, you know, we want to be more objective and quantitative with the outcomes, which means that like you as the PT now are taking more data, right.

[40:15] Like you're counting more steps, you're counting more stride lengths. You know, there's all these different metrics that you're being asked to provide to make it less, you know, up to individual Pts to say, oh yeah, he looked good today versus not so good today, right. Like you're getting more quantifiable, which is great. But then there's the flip side of that, which is like that now takes more time to acquire that data.

[40:35] And I'm sure when they ask you to collect ten extra metrics, they're like adding, you know, 15 to 20 minutes to do that in your PT session. Right? Like that's how that works, right? Like they just they just double the amount of time with the patient to do that. No.

[40:49] Please put five right. Yeah. You can sense my sarcasm there though. So like I that's the other part that I feel like the the new version of the product, like it's like not only are you helping solve this now for patients at home, which is part of, I think, even your story native. But it's also like potentially helping patients and physicians in the clinic, right, because they're able to still sort of work directly with the patient on the items they don't work with.

[41:13] But then again, it kind of comes back to this theme of like making the product just work in the background for both patient and clinician in this case. Right. Maybe you can tell us a little bit more about that.

[41:23] Yeah, we we always wanted to be probably another another layer of things was workflows, clinical workflows. Right. That's it.

[41:35] You want to collect good data as a clinician that is meaningful and evidence based, because you want to be able to justify what you're doing. And I keep using the word want when you really need right. You need it to get reimbursed. You need it to be able to look the family in the face and, and look the surgeon in the face and say, we did everything we could, so we did everything we could.

[41:57] But you you want to optimize how you're collecting that. And I think there's there's two sort of aspects of this that I always found interesting was, you know, when I was noticing, okay, we really shouldn't have to count ceiling tiles in all of this. It was at the early sort of wave of what now is much more consistent, which is standardizing functional assessments.

[42:21] So there are objective measures that are now standard in every post-acute care setting that you must be collecting with every patient that were not standard when I started this. So it's only moving in this direction of get objective with your measures, which is great, right? Which is great when that happens in healthcare historically, if a if a tool comes along to support that, it's not really like smart hardware.

[42:50] It becomes like supporting infrastructure, right? So it becomes supporting. There's a reason we're standardizing this stuff because it's really important. And then suddenly you standardize it. And now you've made the Pete's life better in the moment. Now you've probably got a really piece of valuable information, whether the PT is bare with the patient in the moment or it's in between sessions and visits and oh, the doctor probably cares about that, and the nurse probably cares about that in another way, and all of these sorts of layers of things.

[43:16] And so we wanted getting back to background. We wanted to make it really easy and background and really valuable for what you were picking up in the background, not just some data collection for data collection sake, but into all of those

[43:28] kind of that aggregate of things. Well, and it's I think the, the cool thing that you are talking about earlier today was the crawl walk run of these metrics.

[43:37] Right? Beforehand it was how far did you walk today? That was the standard of care. Now you have, you know, 4 or 5 that are being added that have to be recorded in every session to get reimbursement. And you and I are talking about the next 10 or 20. We want to pioneer in with the data you're collecting that we can do.

[43:54] That is wasn't possible for, and it'll be blindingly obvious 5 or 10 years from now that this should have been collected the whole time. So I think that that velocity of data collection is what's cool. And I want to jump into, you know, you were designing the acoustic version to be accessible for sensors right before the sensors were reality.

[44:13] You were the company was too early. The technology was probably even too early. And let's let's jump into the story of like, when did the the sensors really start getting integrated and how did that start?

[44:25] It started probably about a year and a half ago. And we had, I would say, conceptualized what we expected to make sense, but maybe it more conceptualized or focused on maybe the outputs. What do you want to come out of this with? What we wanted to come out of this with. And that's putting a physical therapist in your walker.

[44:50] And then how to execute on that has been tremendously helpful with glass Glassboard and really pointing us, you know, down paths initially in that in that concept phase that really started heavily like a year and a half ago. And then the execution of that. And, you know, I think there have been a lot of challenging questions that have been answered by the direction technologies going and by the realities of the platform that we have right to integrate and what is going to make the most sense to integrate into that.

[45:24] Then all the stuff that goes to prototype versus production, having margin, having hogs, all that wonderful stuff that I learned was a team,

[45:31] of course. Yeah, they teach that in school. Right, right. School. Yeah. Yeah. Oh it's awesome. But again, I think it's been it's been such a fun journey because you came to us with such a defined product.

[45:42] Not many of our early stage clients come with. Like, this is what I want to come out of this with, and this is the platform we need to go into, which most people think engineers love to be blue sky. Let me do everything. We actually work absolutely best given a set of hard constraints and a really hard problem to solve and say if it was in the paint within these lines, and then we get to be creative.

[46:01] And how do we leverage technology in how do we, you know, seamlessly blend this world of new technology, existing platform, these medical outcomes that have to be had and we get to have a blast. I mean, full story. Forever listening like this has been one of the most fun. Here's the concept I want to here's the thing. We got to go deliver to you and go into clinic with and what, 4 or 5 months?

[46:22] And we could have never done this had we had to invent the science, the technology. But we got to lever on these existing things in the robotic space, in the autonomous vehicle space, in the IoT space that we get these Lego bricks that happen to be the right place at the right time for what you wanted, and got to stack those together to come up with an awesome clinical outcomes.

[46:40] I think really the device being sort of like just properly constrained, right? It's like there wasn't unlimited constraint, but they're also was just enough that it was like, okay, the vision for what

[46:50] he's trying to do here is very clear. Like that was clear to me, I think probably literally from like the first meeting. Right? It was

[46:56] like once I saw what you guys had done to, you know, to kind of the the mechanical structure of the walker.

[47:04] And then it was like, okay, you know, you know, it took me some time to get up to speed on the verbiage of all these different metrics that we were going to measure. But it was like once I kind of understood that it was like, okay, backing in then to the technologies to unlock, that was a lot easier because I think from my perspective, the vision of what you wanted out of the process was always clear, and then it was really just up to us to figure out how to, like, deliver accurately on those metrics.

[47:29] Right? So like that's that perfect environment, I think, where, you know, if it's if the oceans way too wide open in blue, right. It's just like, okay, what are we doing? You know, I have some clients or even I struggle where I'm like, it's hard for me to like, come up with a technology roadmap because I'm not even really sure what we're measuring or who we're measuring it for or who the customers are.

[47:45] I think like when when people come to us and they're like, hey, like, this is who my in customer is, this is exactly what we do for them. This is what we're looking to measure in the outcomes. Then it's like, okay, yeah, like this is just enough to work with, right? To say, okay, now we get to to really like choose how to enable all of those like outcomes.

[48:04] Right. And the flip side is over constraints. Some people come in and say, oh, we've already picked this and this and this or you know, the the device is really locked down, you know, can you work a miracle with three nuts and bolts and you're like, oh, I'm going to do the best job I can. But like, I can't promise you a lot because the box to work in is really small.

[48:19] So I think that this has been a product that it really has been like the right fit. And I think overall, again, I think we all see this even today. And like some of the meetings we've had, it's like the vision has always been very, very clear. Right. It's really just kind of down to continue to figure out how to execute against against that

[48:36] vision for I think, Nuvio and what you guys are just trying to do, at the end of the day, it's like it's this continuity of care is what keeps I keep

[48:42] coming back to, which is like helping people in that acute care setting, which is like right after, you know, maybe

[48:48] a big event or a surgery and then maybe in the home. And then also when they come back, maybe to the clinic, if it's, you know, outpatient therapy. But like if you can create a device that can meet them in any one of those environments and then can collect that data and can feed it back to the people that need it, whether that's the patient or their caregiver or their physician.

[49:07] That's where I think you get like when I use that phrase continuity of care. It's like it's always happening. It's not just like, oh, I only get the care when I go to my physical therapy appointments. It's I'm like constantly getting that care, that whole concept of, you know, physical therapists in your pocket. Sometimes that's what you need because you can't be in physical therapy every single day for many folks.

[49:28] Right. And I think what's what's really important to note is like, this is, I don't know, trends in evidence are going in this direction. Right? This is this is the way the industry is going. Like we hear about hospital to home, about aging in place, you know, staying out of different settings, not wanting to go in a nursing home across all of that for aging is also just like episodic care.

[49:53] Sure. Point of care. Go see a therapist. Go see a doctor. Yep. To continuous care. And that's where reimbursements are starting to restructure themselves in that direction. That's where the evidence is telling us, especially for this population. Like how well you move every day. I mean, we are we're all wearing things on our wrist. Right, right, right. That's what the data says.

[50:15] And the signal around how you know, how much risk there is for you for falling or how functional you are. Those really like heavy metrics that matter for someone who needs something like a walker or who just left, you know, an inpatient facility, live in those everyday mobility signals just as much, if not more important than like me understanding what is telling me about my recovery tomorrow.

[50:43] Right? And so that's that's exactly what we're trying to fit into that matrix to. It's this massive network effect and opportunity that we have. We have tried to be as thoughtful as we can to to basically fit into both, you know, sort of like the now and what makes sense. But but where it feels like things are going at a,

[51:02] at a macro level.

[51:04] So cool. And I think it's, it's really neat that your mechanical hardware was engineered to fit in this woman's life. Yeah, right. Like it is you set out with that goal. I think you crash that and the connected system we've been able to put in that hardware also fits into someone's life. I think this is the other thing that I just think is the magic outcome of connected medicine, and especially the way that you've been able to pull it off.

[51:25] We have a device that if someone didn't know it was smart, would still use it correctly and they would be collected. There is no pair of this thing. Start this thing, start a session. There is no you know, things would be natural for all three of us. It is. It just happens in the background. Yeah. On top of that, the sensors themselves are collecting data.

[51:44] Yes. To meet the current standard of care, to meet the current measurement criteria, we putting today's physical therapist in your pocket. You had the foresight to call your shot on a couple of metrics that don't exist yet, that aren't there yet, that aren't standard of care, that might only become standard of care because your device is the only one that has the measurement to capture it.

[52:02] And that's what excites me about what you're working on. It's awesome to deliver a great product that lives in someone's house. It's awesome to deliver great connected device that delivers better care that doctors can see what's happening real time. It's really cool that all two, all three of the metrics and the one about uncover habits and product, you're going to be the new standard of how the research is done right is a the sensors have gotten cheap enough.

[52:24] They've gotten good enough that you were collecting data that no one has in the lab today,

[52:28] but we can put it into a product that can live in everyone's home. And that is the ambitious part of the whole thing. And if you pull me back to the garage days, the crazy thing to to sort of think about and talk about, but, you know, going into this and wanting to help more than my caseload in patients, the ultimate is absolutely being able to be the data layer that unlocks, you know, you can talk about a lot of ambitious things that have nothing to do with the patient at the end of the day, or do have

[53:01] something to do with the patient at the end of the day. But the data layer that unlocks the ability to, to care for, for this population just immensely better, right? There's there's so much unknown because of how analog things have been for a population that has so much challenge around it, so much challenge. That's family challenge, right?

[53:25] Right. That that touches a lot of people in their lives. And I think, you know, it's not data collection for data collection sake. It's purposeful data collection that can that can have an impact. A lot of times where you whether you want to think that it's going to have an impact on you or not, I think I always tell people is that most people, like I've treated people who like it's they needed a walker in their 19 years old because they just had a motorcycle accident, or they're 95 and they just, you know, you would call them frail.

[53:58] They both tend to have the same experience needing a piece of assistive tech for the first time, which is they are both just so surprised at what what it means, like like how different things are that they need it. It's not just like the visual of the little old lady walking across the street, right kind of thing. Right?

[54:16] It's an impact on every aspect of their of their day in life that that sort of like surprises them. And most of us are exposed to it the longer we want to live. Yeah, right. And so it's a really interesting opportunity that's been, I think, like a big driver for, for us at Nuvio, you know, got you guys on board.

[54:38] We always make the joke that everybody who we work with suddenly start seeing these things, like, everywhere. Yeah, yeah, there's.

[54:47] Yeah. They're all that. Yeah yeah yeah yeah. Cool. I love the, the narrative of hey, I was didn't know what I wanted to do. Got into this field, saw these problems, got locked in the garage because of Covid and ended up coming out building a mechanical device, now a connected device, now a company with the platform.

[55:05] And that's the narrative for everyone listening that, like, product can be for anybody. As long as you can see the problems that need to be solved. Yeah, yeah. Well, thanks for joining us. Has been an awesome episode and even more fun day overall.

[55:19] Yeah, thanks for having me, guys. Cool. Thanks, Matt. Cool. We'll catch everyone later. Thanks for listening