One of the things I like most about being a developer is soaking in the culture and knowledge of the area I’m working in. In my previous jobs, I learned about wine making, e-health and e-commerce.

So have I learned so far during my time at Jintronix?

I learned about brain neuroplasticity or how human beings after they accidently lose the capacity to move half of their body, are able to teach another part of their brain to take over.

I learned that one of the challenges patients are facing while engaging in the physical rehabilitation process is commitment.

I learned that not the same movements and body parts are involved when lifting the arm with palm facing down or palm facing up.

I learned about Protected Health Information and how as a company who handles sensitive information for patients, we have to protect this data very carefully.

So when programming, what’s the point in knowing all this?

Understanding the area I am working in and getting interested in the needs and constraints of the people I want to serve is making a huge difference when creating a brand new way to deliver rehabilitation services. Not only do we need to understand the way physical rehabilitation is usually performed to put up the right workflow, we also need to get immersed in the context to have the capacity to propose solutions that people would never have thought of.

That’s what we do at Jintronix: we work closely with professionals and we become genuinely interested in how clinicians work and what difficulties patients are facing.

We just want to learn from them so we can come up with a product that will blow their minds.

Julie Guého
Developer
Jintronix Inc

Being a start-up company focused in a very new application of technology, it can be a challenging process to define an identity for ourselves that is easily recognizable and understandable by anyone who is, well, not in the company. And so, what better way to introduce ourselves and our product to the community than by inviting them into our little workshop?

On Thursday, May 2nd, we hosted our very first wine & cheese event at our Montreal office. Practicing and upcoming clinicians, physical and occupational therapists and kinesiologists came to see what we had to offer, and it turned out so much better than we could have ever hoped for.

Not only did we have the opportunity to show the Jintronix Rehabilitation System, but we had the pleasure of engaging in insightful conversations with like-minded passionate medical practitioners, sparking creativity and discovering new possibilities in the way physical rehabilitation is delivered.

By Lex Youssef

There’s no denying that video games don’t have a glowing reputation as constructive forms of entertainment. Today’s tragedies that result from gun violence eventually link to the influence of interactive entertainment through mainstream journalism; and it’s quite easy for someone to make that connection, whether or not one agrees with it. The most popular titles engage players in a high-adrenaline, reflex based competitive arena; digital people shooting other digital people to stay on top and claim their status as the best warrior.

I’m not denying that I’ve played these games. When I’m not developing, designing, acting or singing (he does what now?), I love to unwind and flex the geek muscles to make sure they don’t atrophy. However, and while this may be obvious to some, I think it’s important to state that the diversity of video game genres and the variations within each is astounding. Truly astounding. I’ve found myself playing games to evolve myself; to experience beautiful stories, make choices that affect the characters and environment around me, and ultimately feel the consequences of those decisions that would bring me to tears, even days after the story had concluded.

It’s an incredible feat to have software move you in such positive ways, and that has been a driving factor in the way that I approach work here at Jintronix.

Now, I wouldn’t say that we’re a game development studio, because we’re not. If you haven’t Google’d, Bing’d, Yahoo’d, Altavista’d or whatever’d us, Jintronix is developing medical software for physical therapy.

I know that we can’t expect the people who will be using our system to be gamers; they’re simply trying to recover as effectively as possible.

Gone are the grandiose environments, the heroic protagonist, the intricately sinister villains and the gut-wrenching plot twists. Gone are the complex user interfaces, the strategic planning, the daring chase sequences and the romantic relationships. There are so many characteristics embedded into today’s games that we simply cannot rely on, because it’s not the point.

The point, again, is for the patient to recover.

At first, this made me worry. How can we expect patients to be engaged with our system if we don’t have any of these fantastic qualities that have kept me so engaged in games before? People don’t want to feel like their time is being wasted; there needs to be some level of growth, some form of progression. How is that done for someone who doesn’t want to play games?

I didn’t realize it until the first time I saw a stroke survivor playing an off-the-shelf Kinect game at a clinic. The Kinect is a depth sensing camera developed by Microsoft and it allows patients to interact with a software application through natural human motion. No wires or special clothing required; it’s just you and your body in control.

It’s not new to bring motion controlled gaming to the clinic. It started with the Nintendo Wii; a video game console that revolutionized the way people play. This type of activity encouraged people to get up and move about in order to win the game. This style naturally lends itself well to the rehabilitation space, as patients are now engaged to perform their exercises. So when the Kinect was released for the Xbox 360, clinics became very excited! And naturally, so did their patients.

As I mentioned just a few moments ago, I didn’t realize how this could possibly work until I actually saw the stroke survivor playing with the Kinect. The game didn’t have a protagonist that he could relate to, nor did it have a fantastical setting, with a clear goal and seemingly insurmountable obstacles. But it didn’t need to.

The patient is the protagonist, and his path to recovery is the hero’s journey. Now that’s growth if I’ve ever seen it. And it’s a truly beautiful thing.

Lex Youssef
Developer & Co-Founder
Jintronix Inc.

The thing I enjoyed most about TEDMED was how different it was from typical conventions. It really practiced what it preached, with healthy food being served for meals, lounge areas for people to relax and have conversations with new friends, and even musical guests. It was a holistic approach to creating awareness like I have never really seen before. And I think that is the key, awareness. It was not necessarily trying to educate you on one specific point, but rather it showed you how other people think, in an attempt to broaden your point of view. I found this refreshing and felt TEDMED really fills a unique niche in a space which has for years, been so closed off.

With all this energy and creative problem solving in the air, TEDMED is able to achieve its main purpose, creating new connections and conversations. Everyone was talking to everyone, and as a startup this was invaluable for us. They didn’t just invite us to sit there and look pretty; no, they wanted us to be involved in these conversations, and for people to engage with us. Mission accomplished. I am still sorting through the giant stack of business cards I accumulated over the course of those few days. It was a fantastic opportunity where we were able to meet a large group of interesting professionals from all over the health space.

Some of the major themes being explored were focused around medical data, how it is shared and accessed. We found this particularly interesting since with our system, we are creating all kinds of new data for physical therapy that has never existed before. Since physical therapy has been so hands on traditionally, requiring a great deal of visual examination, there has not been much opportunity to gather data from patients outside of the clinic. Now with new camera sensors becoming available to the general public at extremely affordable prices, we are starting to see new applications being developed to quantify movement patterns for the first time.

At Jintronix, we are developing tools for clinicians to monitor and gather movement data from their patients, both inside and outside of the clinic. As these sensors become more versatile and robust, we are only going to be able to gather even more data, with greater accuracy. Knowing what to do with this data is a completely other challenge which we tackle in several ways.

Overall, TEDMED 2013 was a complete success in my mind. They created an amazing atmosphere for new relationships to form, and helped broaden the way people perceive any one subject. In a society that has become more and more focused and specialized, I think it is important to take a step back, look at a problem from other points of view and gain new insights. This is not always easy, but with the efforts of organizations like TEDMED, this kind of approach to problem solving is seeing new light and personally, I think that is a good thing.

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“I get that all the time,” the 24-year-old Massachusetts Institute of Technology graduate and entrepreneur said. “Not just from patients and physical therapists, but from investors, too.

“To be frank, that’s a challenge we all have to overcome.”

It’s a fair question, but Tan and his 20-something colleagues — friends since their days at Selwyn House, the exclusive Westmount boy’s school — use their youth as an asset.

They parlayed a three-month stint at Microsoft’s accelerator program in Seattle last spring into $1.5 million in seed money to test their innovative product in clinics in and around Montreal.

By next summer, it should be ready for sale: a software package that works with Microsoft Corp.’s Kinect motion-sensing platform so that rehab patients can exercise at home, looking at a screen.

The idea was born of experience: Tan learned all about physical and cognitive therapy at close hand several years ago when his father, Montreal fertility physician Seang Lin Tan, had a stroke.

“When we tell people that this is driven from personal experience and that we’re very passionate about what we do, it sort of makes up for our lack of experience,” Jintronix’s founder said.

“Ultimately, we know we’re only going to be able to take a risk in life when we’re young,” said Tan, who studied biomechanical engineering at MIT and public health at Cambridge University.

Born in Singapore, Tan comes from a family of achievers. His brother, Leonard, 28, recently graduated in law in the U.S. Their mother, Grace, ran the M.D. MBA program at McGill University.

Their father is renowned for his clinical research work at the Royal Victoria Hospital’s reproductive centre, and was only in his mid-50s when he had his stroke. He’s now fully recovered.

His experience of rehab left something to be desired: fun.

“It’s a rather antiquated process, pretty much what it was in Second World War,” Tan said. Patients see their therapist, go home to do their exercises, come back to the clinic to do more and get evaluated.

The movements they do are usually mundane, rarely pleasurable: figure-eights and such. Tan thought there was a better way, so for his senior thesis in his final year at MIT, he found a solution.

He hacked a Nintendo Wii motion-tracking device and successfully tested it with rehab patients at a hospital in Boston, winning an MIT award for new ideas.

After his stint at Cambridge, he returned to Montreal and got busy.

He assembled his team, did a market study, saw there was a need in Southeast Asia where his family is from. Failing to find financing there, he turned to private investors in Canada.

The team developed a prototype using the Kinect platform, which got them to Microsoft in Seattle, which got them more investors. With Health Canada approval, the official launch is set for June.

Tan is keeping his development team here in Montreal, because Quebec has some generous multimedia tax break programs — very generous, in fact.

They allow him to pay 60 to 80 per cent of his developers’ salaries. There are four on staff now, soon doubling to eight, and they earn between $55,000 and $85,000 a year.

The business side of Jintronix, however, will be based in Seattle.

The team had a baseline software platform ready in September, and is now testing it in clinics in Montreal, Laval and Hawkesbury, Ont., with Toronto, Boston and Seattle soon to come.

“There’s definitely a future for this,” said Emmanuel Lo Monaco, owner of Hawkesbury Physical Therapy, where the device has been tested on half-a-dozen neurology patients since October.

“One of our biggest difficulties is mobilizing handicapped people to come to the hospital or clinic, especially if they live far away. With this, they can stay at home and do the therapy remotely.”

At Jintronix’s office in an old building next to Future Shop on Ste. Catherine St. W. in downtown Montreal, programmer Lex Youssef showed how the machine works.

He simulated a couple of exercises on the screen, sat back and performed the movements, closing his hands over virtual objects, bringing his hands together.

“These are exercises to build motor skills, but they also allow the clinician to evaluate the progress the patient is making,” said Youssef, the company’s chief technology officer.

The device connects to a patient’s PC. The software records how well each exercise is performed, and that data is accessible on Jintronix’s web portal to the clinician.

In one exercise, fish chase other fish around the screen, manipulated by the patient. The clinician can read the “score,” such as how many centimetres per second the patient moves.

The clinician can then raise the level of difficulty. The software also records how much time a patient spends on each exercise, proof whether they’ve been doing them properly — or at all.

One of the bottlenecks in development Jintronix faced was figuring out which movements to tailor the software to; Which ones had been clinically validated. Hence the testing with physios.

For now, communication between the physio and the patient works via a simple messaging system, but it eventually will be adapted for video conferencing, live viewing and streaming.

Won’t patients miss seeing their therapist?

No, Tan replied, because “this isn’t meant to replace the face-to-face contact — it’s meant to supplement it outside the office, when the patient is not with the physical therapist.”

The problem now is that patients see their physio once a week or maybe twice a month. In between is the problem, Tan said. Patients get a list of exercises to do, but don’t do them to the letter.

Some just give up, halting their progress until their next visit to their physio, who can only ask — but not see — how well they’ve been performing.

But won’t all this cost more? Not at all, Tan replied.

All patients would need is a Kinect machine, which retails for about $200. They’d also pay their physio a fee — about $50 to $100 every three months — for monitoring their progress remotely.

Tan expects that because of the out-of-clinic cost savings, the technology will eventually be covered by medicare, or if not, then by insurance companies.

The applications are endless: stroke patients, people with brain or spinal-cord injuries, musculoskeletal disorders, multiple sclerosis, Down syndrome and other congenital diseases and such.

The market in North America for rehab services is huge — about $20 billion, with 1.1 million new patients in the system every year. If Jintronix can capture just a fraction of that, it’ll be a bonanza.

It’s not as if Tan and his team are getting old waiting.

“The perspective we have is, we’re young enough and we have enough freedom in our lives that we can do something like this,” he said.

“When we get older and have other responsibilities and duties, we can’t be quitting our jobs for a project that could easily evaporate in a year or two.”

On the web: Watch a video of how it works at www.jintronix.com

jheinrich@montrealgazette.com

© Copyright (c) The Montreal Gazette

See source: Montreal Gazette

When I started working at Jintronix, I began to visit a lot of physical rehabilitation clinics and speak to a great deal of clinicians. One thing I began to notice, wherever I went, was the lack of technology used. I think the most advanced piece of hardware I saw was an electric treadmill. The reasons for this is simple, physical therapy works, and as the old adage goes, “if it is not broken, don’t fix it”. One challenge we identified was ensuring everyone has access to a sufficient amount of therapy. Physical therapy is traditionally labor intensive and time consuming, for both the client and the clinician. At Jintronix, we began to think that technology could be used to expand these clinical services, just like technology has expanded so many other services over the years by leveraging existing resources. By providing clinicians with more powerful, modern tools, we are going to be empowering them, and provide patients/clients with access to greater amount of care.

Historically this has not been so easy to do. Physical rehabilitation is just that, physical. It requires physical interaction, which is resource intense. Digital systems that could be used to allow people to physically interact with technology are typically expensive, technically complicated (requiring specialized training), and historically limited to a clinical setting, sometimes for safety reasons. It is only recently, with off the shelf sensors becoming affordable, computers becoming commonplace, and high speed Internet readily available, that technology is finding its way into physical rehabilitation in a big way.

Companies like StrokeLink and PhysioTec provide great resources for patients to receive more guidance when they are at home, allowing them to continue their physical therapy in a guided manner. These kinds of system are possible thanks to the widespread adoption of computers, high speed Internet, and tablet computers like the Ipad.

Jintronix wants to take it one step further, by using new, affordable depth sensing cameras. These sensors are able to track your motions in 3D space, so not only are we providing guidance, but monitoring as well. You are able to get immediate feedback, and so will your clinician, meaning there is a continuous delivery of care.

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The article interviews Dr. Saposnik, who has explored the use of the Nintendo Wii as a tool for stroke rehabilitation. This is not new to us. We have spoken to dozens of clinicians who use the Nintendo Wii for the same reasons, often because it is low cost, easy to use, and fun. What is surprising to me is that the Nintendo Wii was released back in 2006, and it is still one of the most widely used virtual rehabilitation devices in the market. It was not even designed for physical therapy! When we ask therapists what they like about the system, they often reply that it is fun for the patients, and there are some good games that serve as therapy exercises. When we ask them how many games, it is about two or three, out of dozens.

This is to be expected. The Nintendo Wii and its games were not designed with physical therapy in mind. Only certain activities are going to be appropriate, and even then there are limitation to its effectiveness as a physical therapy tool.

I never had to stand up from the couch to perform this running activity.

First, its scoring system is not particularly telling of a patient’s progress, so it does not serve as an effective assessment device. Second, while the controllers are wireless, you are still required to hold a physical controller. For stroke survivors, for example, this might require the controller to be placed within their affected hand, and then tied into place, since they may not be able to hold the controller properly on their own. Finally, you can cheat at the games. For instance, for one running activity, you are supposed to run in place, with the controller held against your hip. A way to achieve a higher score would be to simply take the Nintendo Wii remote and shake it quickly up and down. The system has now way of detecting if you are ‘cheating’ or not, and therefore requires constant supervision by a clinician to ensure you are performing the proper movements.

Don’t get me wrong, I love the Nintendo Wii, and I am excited to try the new Nintendo Wii U, but it is not designed for physical therapy. Now some of you might be asking why we are using the Microsoft Kinect. Wasn’t it designed as a gaming peripheral for the Xbox 360 gaming console? You are right and it was, but now it is more.

This is an example of how the Kinect generates a “skeleton” of your body.

Microsoft first released the Kinect as a motion capture device for their Xbox 360. It essentially allowed you to control the games with your own body, not using any physical controller. You are the controller essentially. Shortly after, people began developing other really interesting application, such as using the Kinect as a 3D scanner, or attaching them to robots so they could navigate around a room. Microsoft dubbed this movement the “Kinect Effect“. It was shortly after this movement began, Microsoft released the software development kits for the Kinect, for free, as well as developed the Kinect for Windows’ PC. They essentially provided everyone with the tools necessary to develop Kinect applications, sparking creativity and inovation. For Jintronix, we began to use the Kinect for physical rehabilitation, because we felt it addressed many of the issues of the Wii.

First, we are developing our own software, so we are able to analyze and provide meaningful clinical feedback. We are not relying on ‘stars’ to let you know if you are getting better. Second, the Kinect is a depth sensing camera, which means it tracks your movements in 3D space without you having to hold any hardware, so just about anyone can use it. Third, it is able to track the movements of all the major joints in your body at the same time, so if your therapists wants you to work out your shoulder, and you are moving you back, it will know, which means so will they. This is an extremely important feature of the Kinect, because often during a person’s therapy, they will try to accomplish the goal of the exercises, however possible, even if that means they are not performing the activity correctly. These are known as compensation movements.

Ultimately we are trying to increase the access and quality of virtual rehab services. The Nintendo Wii is not able to provide sufficient clinical content, and who can blame it, it is being used for a purpose it was never intended for. That being said, the Wii has greatly advanced the acceptance of video games as a means of delivering physical therapy, as demonstrated by the Heart and Stroke Foundation, and researchers like Dr. Saposnik. Now that the idea of games for rehab is more accepted, it is time to take that notion to the next level, and deliver more clinically meaningful experiences. The Kinect, by nature of its design, is simply a more versatile tool, with the potential for a greater number of applications.

At Jintronix this is normally in the form of a celebratory dinner. Just recently we went to Casa Grecque to celebrate the successful closing of our seed round with Madrona Venture Group. We ordered some food for the table, and shared a few bottles of wine. It was good to have the whole team relax for a few moments and enjoy our accomplishments.

I find it is also important to celebrate the small victories. Maybe you just finished a lengthy report, or finally set up that meeting you have been working to get for the last month. Taking the time to pat yourself, and your colleagues, on the back is what will give you the energy to push through those really tough times. Sometimes it can feel like you are not accomplishing much, but all that work is important, so when you do finish something, enjoy it. You will become more productive, your work place will remain a friendly environment, and you will sleep better for those few precious hours you allow yourself every night.