Podcast | Episode 5: Cyberdyne & HAL Robot with Meghan Kettles and Jessica Dunn

Clinical Expertise

Dec 23, 2019

Welcome to the Brooks Rehabilitation podcast where we talk to our rehabilitation professionals to shed light on the stellar programs and services we offer to help our patients reach their highest levels of recovery.

This episode focuses on the two lead physical therapists in the Brooks Cybernic Treatment Center, Meghan Kettles and Jessica Dunn, who use the HAL (hybrid-assistive limb) robot with our patients. This technology is the cutting edge of rehabilitation and we’re proud to offer it in Jacksonville, FL. We also talked about their journey with the program and their training trip to Japan!

Send us an email with your questions, comments or podcast ideas to podcast@brooksrehab.org!

Listen to the full episode on your favorite podcast app! Search ‘Brooks Rehabilitation Podcast.’ You can also listen online. Below is a transcript of our newest episode.

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Podcast Transcript

Michele Orallo: Welcome to the Brooks Rehabilitation Podcast. My name’s Michele Orallo.

Tracy Davis: My name is Tracy Davis. This week we had on, Meghan and Jessica to talk about our Brooks Cybernic Treatment Center and using the HAL assistive technology. I’m just going to use our website here to explain exactly what all this is. Maybe you’ve heard of Cyberdyne and the Brooks Cybernic Treatment Center, but hopefully this helps out, because we get into a little bit of detail in the podcast about it, but this little intro should help you out.

HAL’s the world’s first robotic medical device that has been shown to improve a patient’s ability to walk. The Brooks Cybernic Treatment Center … so the Brooks Cybernic Treatment Center is our facility located within our hospital in Jacksonville, Florida, is the only US-based facility offering HAL technology to those with a spinal cord injury.

Michele Orallo: If you’d like to send us an email, you can email us at podcast@brooksrehab.org.

Tracy Davis: If you would like to connect with us on social media, it’s at Brooksrehab.org on Instagram, Facebook, LinkedIn, YouTube, pretty much any social media platform. We would love to connect with you and have you get to know more about us. We had a great conversation with Jessica and Meghan. They are the two lead therapists in the Brooks Cybernic Treatment Center. They’re going to go into a little bit of the history and a little bit of where the Cybernic Treatment Center is headed. Let’s get right into it.

Meghan Kettles: My name is Meghan Kettles and I’m a physical therapist at Brooks. I work part-time with the Cyberdyne robot in the NRC, and then my other role is running the hybrid program for the hospital.

Tracy Davis: Okay. What does that involve? The hybrid program.

Meghan Kettles: That is a program we have for patients while they’re here in the hospital for them to be able to utilize some of our rehab technology and be able to get a little bit of extra therapy while they’re here. It introduces them to the NRC and just gets them a little bit more motivated and going. It’s really specifically looking at our rehab technology and utilizing that so that patients can get the most out of every day they’re here.

Tracy Davis: Okay. That’s great. I didn’t realize we had that program.

Meghan Kettles: Oh yes. Marketing wants to promote that a little bit more.

Tracy Davis: Good. Good. We should.

Jessica Dunn: My name’s Jessica Dunn. I’m also a physical therapist working with Cyberdyne, and I also work at our San Pablo location as an outpatient neuro physical therapist there.

Tracy Davis: Oh, I didn’t realize you were over there.

Jessica Dunn: Yeah. They’re great over there.

Tracy Davis: That’s a beautiful clinic now too. I mean, it was before too, but it looks really good now. It’s very big.

Michele Orallo: How long have you guys been with Brooks?

Meghan Kettles: I’ve been with Brooks for just over seven years.

Jessica Dunn: I’m about six and a half years now.

Tracy Davis: Oh, wow. Okay. Let’s talk a little bit beforehand. Just shortly, what made you guys both want to become a PT?

Meghan Kettles: Mine actually was a suggestion from my mother. I was an athletic trainer in high school and really liked that. I had finished undergrad and moved to New York and didn’t know what I wanted to do, but I knew I was going back to school. She was like, “What about PT? You always liked your PTs growing up?” Because I got hurt a lot. I was like, “Oh, why didn’t I think of that?” That’s where it started. I wanted to do something that helped people and that was interesting to me, and I did always like my PTs growing up.

Tracy Davis: Sure. It’s a very rewarding career.

Meghan Kettles: Yeah.

Tracy Davis: Jessica.

Jessica Dunn: I never had PT growing up, but I knew I wanted to be in healthcare and I knew I couldn’t do needles at all, so I looked into physical therapy. I also wanted to help people, and it looked like something that I would enjoy doing. I did some observation and decided that was the road I would take.

Tracy Davis: Oh, wow.

Jessica Dunn: I’m happy I did.

Tracy Davis: Yeah. Well, that’s good. It would be a whole different podcast if you said you weren’t happy that you did. Before Cyberdyne, what were you guys doing at Brooks? Because Cyberdyne’s only been here since March 2018.

Jessica Dunn: I’ve hopped around the system a little bit since I started. I started in Orange Park doing neuro outpatient therapy there. Then I did our neuro residency program back in 2014. Then I stayed in the hospital for a little bit and then I went back to outpatient over at San Pablo. I’ve been over there for probably three years now, over at San Pablo. Then started with Cyberdyne a couple of years ago.

Tracy Davis: Great.

Meghan Kettles: Starting out at Brooks I was PRN, but then was basically full-time PRN. Progressing from there, working in different programs. I really liked floating and being on the different floors. Eventually a full-time float position opened up and so I took that and was a full-time float for a couple of years. Then took over the hybrid program just under three years ago. I was doing that as a part of my role and that’s grown a lot.

We’ve been able to make it where I’m basically split between Cyberdyne and that. I really like neuro, that’s always been in my focus. I worked in research studies before and during PT school that got me into that. That’s also how I really thought Cyberdyne would be interesting having worked in a bunch of local Metro training studies before. It was definitely the newest technology, so why not give it a shot?

Michele Orallo: How were you involved in Cyberdyne? How did you start?

Jessica Dunn: I wanted to work with robots.

Michele Orallo: Because I know you guys have a small team. What is it? Like four of you guys?

Tracy Davis: You saw Terminator and then you were like, “I want to do that.”

Jessica Dunn: I’m not scared. I just saw the opportunity come up and I thought it was really cool technology and wanted to be a part of it so I hoped on board.

Tracy Davis: Because I feel like I remember something going out about them selecting certain PTs to join the program and you had to apply or something like that, right? How much of it was in your radar as to even what it is even before you joined?

Meghan Kettles: Well, initially actually before this time, we had started looking at Cyberdyne and were planning on going over there, over to Germany the first time. There was a first round of application process. That’s what? Probably four. Almost four years ago now? I had applied for that and been selected in that first round. Then everything all of a sudden got put on hold the night before we were booking our plane tickets because of FDA clearance. Then there was like a two-year gap.

Tracy Davis: Yeah. I think I remember that.

Meghan Kettles: Since it had been such a long time between, they wanted to open up the applications back up to … It had to be full-time employees, I think was one of the main stipulations, so to give any new employees or anything a shot at it as well. I applied again and Bob was like, “Well, if we didn’t pick you, I’d never hear the end of it.” Because I would bug him about it regularly. That’s how I got started. It’s been on my radar for about four years in some way, shape or form.

Tracy Davis: Just so people know, Cyberdyne, they’re based in Japan and then they have another facility in Germany, or is it their facility or is it some [inaudible]?

Meghan Kettles: It’s another facility.

Tracy Davis: Okay.

Meghan Kettles: Cyberdyne is based out of Japan. The facility in Germany we were initially going to train at in that first round, but Cyberdyne decided in the interim that what they saw was that they thought it would be better for us to come directly to them to be able to be exposed, because they have a number of clinics in Japan. Being able to be at headquarters, especially because we were going to be partnering with them, so having us come over there to really be immersed probably is the best word.

Jessica Dunn: Oh, we were immersed.

Tracy Davis: True. It’s true.

Meghan Kettles: Yes, we were.

Tracy Davis: Yeah. You guys went to Japan. Have you ever been to Japan?

Jessica Dunn: I have not been to Japan before that and it was so awesome. It was a great experience.

Tracy Davis: The goal of the trip was what exactly?

Jessica Dunn: The goal was to train, to learn how to use the device so that when we brought it back here, we would know how to utilize it with our patients. We went over there. We were in Japan for about 10 days and we worked very closely with the therapist and the managers there at their facility in Japan that’s right by headquarters. We spent some time at their headquarters going through some behind the scenes information and safety.

We got to meet with the R&D team, which was really cool. We got to ask them a lot of questions about why they chose the way that they develop the device. We got to meet with some of the other staff and their team, and then we worked directly with the patients at their studio. We did a couple of days just training with just putting the robot on each other.

Then we probably spent maybe five other days in the clinic working with their patients there. Then we came back home and we got to use it here with our patients

Tracy Davis: Started pretty immediately whenever you got back?

Meghan Kettles: No. We were there for … Like Jess said we had a day and a half off while we were there of training or meetings, and then we got back. Then the robot didn’t get FDA clearance until … We went to train at the very beginning of October. FDA clearance came in December of 2017, towards the end of December of 2017. Then we didn’t get our first patients going until late February of 2018. We had a few months of lag time.

It was getting back into the groove and reminding ourself and actually using it on some very different patients because as I think Jess would agree, we’ve discovered as much as we know about the robot, everyone’s different.

Tracy Davis: Sure. Sure. I remember the FDA clearance was a big milestone because we couldn’t progress until we had that in America. Other countries have been using Cyberdyne in different capacities than we were already, but that was the American clearance for us, right? For us to be able start using it. Okay. Right.

Meghan Kettles: Yeah. I think at the time … I don’t know if they had opened their clinic in Poland yet, but I still think it was Germany… and Japan only at that point. I think they’ve got now one in Poland, Italy.

Jessica Dunn: Malaysia. I just found out that they got FDA clearance in two weeks in Malaysia.

Tracy Davis: Wow.

Michele Orallo: What?

Meghan Kettles: Very different than the U.S..

Michele Orallo: Yes. Yap.

Tracy Davis: That was fast. Yeah.

Jessica Dunn: That’s new.

Meghan Kettles: Took a number of years over here.

Tracy Davis: Sure. You guys got back and then you started. What was it like starting off? It was February, March of 2018? We had the whole build-out over there. The NRC got completely rebuilt and changed to the Cybernic Treatment Center, and then you started. What was it like first day getting going with the first patients?

Meghan Kettles: Intimidating. I think being the only people in the U.S. who had it, and still only people who have it, all that’s been invested in time and effort to move forward with it, and then jumping in and being like, “Okay. This is it.” I think we both had really high expectations in what we wanted to do to make it successful and to benefit our patients as much as we could. It was a lot of fun, but it was definitely … The first couple of patients, there’s a big learning curve.

Our first couple of patients were really great, but were some different challenges that we hadn’t seen yet. It was a good learning experience.

Tracy Davis: Sure.

Jessica Dunn: We had a lot of cameras around.

Michele Orallo: Oh yeah, they had. Got to get used to that.

Tracy Davis: Oh, that’s right. That’s right. There was so much media coverage. Yeah.

Jessica Dunn: Yeah. Getting used that was fun.

Meghan Kettles: We had that whole media day then the grand opening.

Tracy Davis: That’s right. I wasn’t here for that. I was at a conference or something. I remember that being a huge thing. Wasn’t Dr. Sankai here for that?

Meghan Kettles: Yep.

Tracy Davis: That’s right.

Meghan Kettles: Yeah. We started training our patients a couple of weeks before the grand opening, before the build-out was completed, which was good. Gave us some trial time before all the cameras were around. It was definitely a lot of fun, but different. You don’t think of that when you go into PT school. You’re not thinking that’s where you’re going to be.

Jessica Dunn: Robots.

Meghan Kettles: Robots, cameras.

Jessica Dunn: We learned our best angles.

Tracy Davis: Yeah. Or-

Jessica Dunn: And our worst angles.

Tracy Davis: Yeah. Well, because you have those three cameras on you all the time for the screens, right? For each of the patients, there’s three. One in the front, one on the side, is that it? Is it two?

Meghan Kettles: It is two yeah, for each.

Tracy Davis: There’s two. That’s right. Okay. Yeah. I think we got a little bit ahead. Tell us more about Japan. What was your time there, even outside of training like?

Jessica Dunn: Outside of training, we stayed in a city called Tsukuba Japan, which is where their main headquarters is. It’s about an hour north of Tokyo. It was a little less going on there so we didn’t do too much outside of training when we were there, but we were there for one weekend. For the weekend, Meghan, myself, Bob and Michael Spigel was with us, we went to Tokyo for a couple of days and it was awesome.

Michele Orallo: So jealous.

Jessica Dunn: It was so amazing. Yeah. We walked so much. They were laughing at me because I’m just so unaware of how big Tokyo is. I thought we walked like half of Tokyo in one day and they were like, “No. We walked like a 10th of Tokyo with that.”

Tracy Davis: It’s like New York or something.

Jessica Dunn: Yeah.

Tracy Davis: Yeah.

Meghan Kettles: Well, I had been to Japan once before, 10 years ago now, which is crazy, and it was before smartphones so I had tour books and all sorts of stuff. I spent most of my time in Tokyo the last time. When we were getting ready to go out for walking around and seeing sights in the morning, Jess was like, “I feel like we saw a lot yesterday. I mean, we were walking. We walked like 13 miles.” I was, “Here, I’ll show you a map.”

Jessica Dunn: One block.

Meghan Kettles: I’m like, “This is where we were.” I forget how much bigger than New York it is, but it’s massive.

Tracy Davis: It’s bigger than New York?

Meghan Kettles: Yeah.

Tracy Davis: Oh, wow.

Jessica Dunn: Oh, yeah.

Tracy Davis: Because I was just in New York in October and I was blown away with how big it was.

Meghan Kettles: Yeah.

Jessica Dunn: It’s such a cool city though. Everyone is super friendly. It’s very clean.

Meghan Kettles: So clean.

Jessica Dunn: Yeah. Everything there is clean.

Tracy Davis: Not like New York.

Jessica Dunn: No.

Meghan Kettles: No. I think Japan is a really … I think it’s a fascinating place. They’ve got a lot of history, a lot of culture. It’s very safe and clean and friendly, like Jess said. There’s just something interesting and different everywhere you look. Everything’s sold in a vending machine as well. That was always the fun part.

Michele Orallo: The food there is probably really good.

Tracy Davis: Yeah. I was going to say Michael Spigel had some stories about food but-

Jessica Dunn: Yeah. Some great food and some interesting food.

Meghan Kettles: Interesting. Yeah.

Tracy Davis: Because I know they do a lot of raw stuff and I cannot do that. That freaks me out.

Jessica Dunn: I’m a texture person so there was a lot of things I couldn’t-

Tracy Davis: Yeah. Yeah. If it goes in gummy, I’m not going to eat it.

Jessica Dunn: Same. Yeah. Same thing.

Tracy Davis: Yeah. I need fire to hit that thing at some point.

Jessica Dunn: We did have the best sushi though of course. One of my favorite times in Tokyo or places we went to, we went to their fish market. It’s like outside, they’ve got down the alleys, everyone’s out with their fresh fish and their fresh catch. There was a sushi restaurant right in their fish market there and it was the best. It was awesome.

Tracy Davis: Yeah. Nice.

Meghan Kettles: Yeah. Some of the people from Cyberdyne that worked with us there and then still work with us remotely now, they took us around. Speaking of food, they were afraid because we didn’t speak the language. In Tokyo, there’s a lot of people who speak English, but in Tsukuba, it’s outside about an hour and a half. There’s not as many people who speak English and so getting dinner every night was interesting. There were a lot of funny moments. There was a lot of laughing outside of training for sure.

Tracy Davis: You guys didn’t have a translator with you?

Meghan Kettles: We did for portions, but not after hours or anything like that. They were-

Tracy Davis: Did you try use the Google Translate app?

Meghan Kettles: Yes. All the time.

Tracy Davis: I was going to say, so does it work well? I’ve never actually used it.

Meghan Kettles: It works pretty well.

Tracy Davis: Okay.

Meghan Kettles: Because they’ve got characters too, so-

Tracy Davis: Oh, that’s right. Yeah. Yeah.

Meghan Kettles: But a couple of the people who work with Cyberdyne when we were telling them some stories about going out and being dismissed from restaurants-

Jessica Dunn: Because we just couldn’t get past the hostess.

Meghan Kettles: Because we didn’t know how to say anything. We’re like, “Three.” They’re like, “Uh.”

Jessica Dunn: We just kept bowing and they were bowing, but-

Meghan Kettles: A lot of pointing.

Jessica Dunn: … that was it.

Meghan Kettles: There’s a lot of making Xs with your hands or your arms, actually, not us, but them. We’re like, “What did we do?” They were very concerned and they were like, “Did you eat enough? Did you get food?” They actually took us out to dinner and made sure we were fed because they were very concerned we weren’t able to get enough food. It was very sweet. They looked out for us as well.

Tracy Davis: That’s good.

Meghan Kettles: Gave us some different experiences.

Tracy Davis: That’s good. Michele’s a big traveler. You’re about to go to Iceland.

Michele Orallo: Yeah. I’m about to off to Iceland next week.

Jessica Dunn: Jealous.

Tracy Davis: Is Japan on your list?

Michele Orallo: Japan is on my list. Yeah.

Tracy Davis: Yeah.

Jessica Dunn: I was actually- Had booked a trip to Iceland-

Michele Orallo: Really?

Jessica Dunn: … with a couple of friends and then got hired for Cyberdyne and had to go to Japan the same week.

Tracy Davis: Oh, jeez.

Michele Orallo: Oh my gosh.

Jessica Dunn: Yeah. It’s still on my-

Michele Orallo: Japan’s pretty, cool.

Meghan Kettles: Yeah.

Jessica Dunn: Iceland’s still on my list. Yes. I was very happy to go to Japan but Iceland’s –

Michele Orallo: Yeah. You still want to go.

Jessica Dunn: Yeah.

Tracy Davis: Wow. Okay. Let’s get into more of the after Cyberdyne had started and everything. You guys have multiple, multiple patients in now each, right? Do you know off the top of your head?

Jessica Dunn: Ooh.

Meghan Kettles: 38 or-

Tracy Davis: Total?

Meghan Kettles: … something like that.

Tracy Davis: Or each?

Meghan Kettles: Total.

Tracy Davis: Okay.

Meghan Kettles: Maybe 40.

Tracy Davis: Because you guys don’t really swap patients, right? You work with that patient throughout their 60 sessions?

Jessica Dunn: Initially we worked with our own patients separately, however, maybe over the last six months or so we’ve been swapping out a little bit.

Tracy Davis: Because now you’ve got the tenure of it and you’ve got it down where you can do that a lot easier. Sure.

Jessica Dunn: We have learned a lot over the last couple of years.

Meghan Kettles: Yes. A lot.

Tracy Davis: Yeah. Yeah. What’s it been like? I mean, as far as working with a regular patient going through PT. Are you still predominantly spinal cord injury with Cyberdyne? What’s it like as a physical therapist?

Jessica Dunn: We get to work with our patients very closely with Cyberdyne. We are seeing them five days a week for an hour and a half, five days a week, we get to know our-

Meghan Kettles: Some of them.

Jessica Dunn: Most of … actually.

Tracy Davis: Is that more? That’s more than you would see a regular patient?

Jessica Dunn: In outpatient therapy, we would see somebody for an hour, and maybe twice a week is probably on average. To see someone every day for three months, you really get to know somebody. That’s really cool. We’ve built some really good relationships with people. We’ve had a lot of people come internationally.

Tracy Davis: That’s right.

Jessica Dunn: It’s been a lot of fun to learn a little bit more about their cultures.

Tracy Davis: We’ve had like Argentina, Austria, isn’t … Susan. Then I’m trying to think of where else?

Jessica Dunn: Bolivia.

Tracy Davis: Bolivia.

Jessica Dunn: Ireland.

Tracy Davis: They came here specifically for Cyberdyne.

Jessica Dunn: For Cyberdyne.

Meghan Kettles: Yeah.

Tracy Davis: Yeah. Then-

Meghan Kettles: We’ve had up to, I think Amy said nine countries and 16 states.

Tracy Davis: That’s great.

Meghan Kettles: Most of our patients haven’t been local, and not just necessarily international, but from the country too. They’ve come from California, from Kentucky, from all over.

Tracy Davis: Yeah. I did a little video on some of those international patients, and just to add a little a Brooksiness in here, a lot of them found just how great our community is. They found NRC and Adaptive Sports and everything like that after they came for Cyberdyne. They thought they were just coming for Cyberdyne, but they really found community amongst all the other patients. I’ve always thought that was a really, really cool thing.

Just shows all the things that we offer. We don’t offer just one thing. We can offer the whole shebang. Okay. You guys have been working with … Right now we’re in December of 2019, so you’re almost two years in. Just overall the experience of using this extremely high-end technology, what’s it been? What sticks out in your head the most?

Meghan Kettles: Yeah. I think at first we were all, me, Jess and Bob were, for the first few patients, especially the first few weeks of having it on anyone, we were like, “Oh, this is not just physically draining.” Mentally we were exhausted because there’s a lot of problem-solving that goes on. When you’re first learning it, patients and therapists, you’re coaching your patients, but you’re also mentally coaching yourself and trying to be like, “Okay. What do I need to adjust to make this better and more successful?”

I think that that has absolutely gotten much less mentally fatiguing, but everyone is a different challenge because someone who presents one way you think … I mean, at least for me, sometimes I’m like, “Oh, yeah, I know what this is going to look like.” Then I’m like, “No. That’s not what I was expecting.” Which I think is true of a lot of patients in PT in general, the robot just amplifies it sometimes.

Jessica Dunn: I think something that stands out for me is the patient results too. We’re seeing some really, really great results and improvements in a lot of our patients. We’ve figured out which patients really, really benefit the most from this device, and even those that don’t benefit as much still show some sort of changes that they didn’t see in traditional therapy before they used the device.

I think that’s been a big thing over the last couple of years, is figuring out how much more we’re getting out of using this device versus the traditional therapy approach, which has been really exciting for us.

Tracy Davis: Sure.

Meghan Kettles: Yeah. It’s definitely been a really unique thing to see and everyone’s results are different, but it seems like everyone has gotten some really good benefit. The meaningfulness of that to them, especially people who have been doing traditional therapy for maybe … We’ve had patients who’ve had injuries that are 40 years old, their injury is 40 years old. They’re in their 60s at this point or somewhere around there and they’re even still seeing benefit from it.

That meaningfulness to them is really great to see and something that stands out I think. It’s just that variability and the uniqueness of it to be able to put it with them and what they’re looking for has been really neat to see.

Tracy Davis: Sure. In case we forget to mention it in the intro or if we do a bad job of mentioning in the intro, just give us a quick overview of what HAL is doing, what the technology is doing for the patient whenever they get hooked up and what makes it different than something like Indego, which is, correct me if I’m wrong, Indego runs on its own through an app and you’re telling it what to do. Whereas Cyberdyne the patient is really telling it … Your body is telling it to move.

Jessica Dunn: Yeah. With Indego, you have to be able to shift your weight over a limb in order for it to then move. It is more passive. Cyberdyne is very active. I think that’s the big difference, is it’s more of an active device so the patient is driving the machine. The electrodes that are placed on the muscles of their legs, those electrodes detect that muscle activity that’s being sent down from the brain and that’s what drives the robot.

Then we’re using different settings to create a better movement pattern, but it’s all driven on the patient’s own intent, their own volitional movement, which makes it very much different than the other exoskeletons that are out there right now.

Tracy Davis: That’s the crazy part of it, is whenever I first started seeing it and then I see Bob not wearing it and then having the … Are they electrodes? [inaudible] called?

Jessica Dunn: Yes.

Tracy Davis: The electrodes attached to him and he’s moving the robot. That’s weird. That’s super weird if you’ve never seen anything like that before. It looks like some sort of a weird magic trick or something like that. I think that’s what … And that was all part of the marketing that was done for it and everything. He was going all over the place telling everyone about it. That’s what freaked me out about it. Then what that’s doing, is the goal to … It’s starting to help the brain and muscle reconnect from that injury?

Jessica Dunn: Yeah, exactly. Trying to recreate those pathways and improve that motor control and that motor pattern. It’s a lot of biofeedback. They go to move and then they see the robot move with what they intended to do is great biofeedback for the system. Then all of our app settings that we have up there, they’re able to see what their muscle activity is doing in real time. They’re able to see their weight shift. They’re able to see their posture with our cameras. All of that biofeedback plays in to improve that neuroplasticity.

Michele Orallo: I think we did a connect tour for student interns at one point with the Cyberdyne and the HAL, and we put the … I don’t know what they’re called. Electrodes?

Jessica Dunn: Yeah.

Meghan Kettles: Yeah.

Michele Orallo: We put the electrodes I think on my arm or my leg and they were like, “Think about moving your leg.” I was like, “That’s weird.” I’m doing it. I’m like, “That’s so weird and creepy.”

Tracy Davis: Yeah. You just think it.

Michele Orallo: Yeah.

Tracy Davis: You don’t actually move your body.

Jessica Dunn: Yeah.

Meghan Kettles: Yeah.

Tracy Davis: Because a patient they wouldn’t actually be able to move their leg, but they just think about it and then the HAL moves their leg.

Michele Orallo: Yeah. It’s a really cool experience.

Tracy Davis: It’s super weird. Yeah.

Michele Orallo: Yeah. Weird, but cool.

Tracy Davis: On that, what do you think in the future? I don’t know if you know anything about what Cyberdyne’s currently working on or anything, but now I’m thinking arms and everything else. I would assume they’re working on stuff like that, but it seems really setting us up for a crazy future.

Meghan Kettles: Yeah. When we were in Japan, we got to see Professor Sankai’s lab as well. He has a big research lab and he is-

Tracy Davis: He’s the owner of Cyberdyne. He’s the one who created Cyberdyne.

Meghan Kettles: Yeah. He’s the creator of the robot. He’s researching all sorts of things, everything from stem cells to a device to help with dysphagia, so swallowing, to additional HAL-type devices that are maybe for just a single joint or just for protection from lower back injuries and things like that, that they’re actually already using in Japan in some places for industrial workers to help with lifting and things like that. Those are just the things that we know of.

They definitely have an amazing lab and perspective on things and really unique and exciting. Every time I hear him talk, I’m just like, “Oh, that’s so cool. Who thinks of that?” It’s a really awesome company to get to know. There they’ve been really great and welcoming. I think it’s definitely got a lot of potential. Just got to get other things through the FDA.

Tracy Davis: Yeah. It makes me think of a future … The HAL right now it’s cumbersome to … Without you guys helping them get in, it’s not something you can just jump in yourself. It just makes me think of a future, however many years down the road it would be, where someone has a spinal cord injury, and then they’d wear something on the outside of their body and then now they just live their life with that on. You know what I mean?

It’s like an assistive device that now they just live with that and they can live their life normally. Maybe they can move parallel. That’s not very easy with HAL right now, because I did wear it once. Don’t know if you guys remember that.

Meghan Kettles: Oh, yeah. Photo shoot.

Tracy Davis: Yeah. We were doing a photo shoot and I wore it. You didn’t hook me up to the electrodes or anything like that. It was just for a photo, but it just makes me wonder the future that we could have. I mean, look at the stuff we have now.

Jessica Dunn: Yeah. They have a space of land that they are planning eventually to create a Cybernic community?

Meghan Kettles: Cybernic city.

Jessica Dunn: City?

Meghan Kettles: Science city actually, I think is what he called it. Yeah. I was recently able to go to the Mayo Neuro Convergence conference very briefly in Puerto Rico where Dr. Sankai was also presenting, bringing one of our former patients there. He was talking about that. One of his aims for … There’s a panel, and it’s where do you see yourself 10 years down the line?

He was talking about how having that idea of the city where there’s things that are integrated into apartments that are like medical devices that are monitoring people with whether it’s they have heart issues or diabetes, blood sugar, or other things where they need medical attention. Instead of having to go to the doctor, the medical staff can just be monitoring them based off of … He was talking about having just clothing.

Things integrated into people’s regular clothing that could send alerts to medical staff. Decreasing that gap between someone’s ability to access healthcare and trying to make it more a part of their life without them having to think so much about it.

Tracy Davis: Sure. Sure. Wow. Yeah.

Jessica Dunn: That’s so cool.

Tracy Davis: It is. It’s weird.

Meghan Kettles: I know. When he started talking about clothing, I was like-

Tracy Davis: It’s weird to think about.

Meghan Kettles: I’m like, “If anyone could do it, he probably can.”

Tracy Davis: The more I hear about him, the more I think he’s like the Elon Musk for health and healthcare medical stuff, because Elon Musk’s all about rockets and cars and that kind of stuff. Now he seems to be the other billionaire that’s all about helping people’s lives.

Meghan Kettles: He told me one night at dinner the first visit that they did here for our grand opening, he goes, “If you ever think of something that you want to help somebody move, you tell me and I will make it for you.” I go, “Ooh.”

Tracy Davis: Who says that?

Meghan Kettles: I know. He’s like, “Anything to help people.” That’s part of why they don’t sell their devices because he wants to make sure that his technology stays in a field where it’s purely meant to help people and isn’t used for other things that might not be so savory. He just wants to help people. He’s so cute.

Tracy Davis: Because you could also get hurt. You could get hurt wearing HAL if you weren’t in the right environment. You can’t just move freely as you think, especially side to side and stuff like that. I could see why they’d want to make sure it’s being used in an environment that’s controlled and…

Meghan Kettles: Yeah. They don’t want it to be used for things like military purposes or anything too.

Tracy Davis: Oh, jeez.

Meghan Kettles: That’s really-

Tracy Davis: I didn’t even think about that.

Meghan Kettles: No. That’s his biggest thing and he’s very open about that, is wanting to make sure that it’s focused on helping people.

Tracy Davis: The name is based on Terminator, right? He’s a movie fan. Because I get these comments on Facebook and stuff on our Brooks Social and a lot of the comments were making fun of that. I think they thought that it was a funny coincidence that they noticed, but it’s actually on purpose.

Meghan Kettles: I don’t know that we ever got a specific exact response confirming that, but I mean, he’s a very big … I mean, HAL is also an odyssey, space odyssey.

Tracy Davis: Oh, okay. I didn’t know that.

Meghan Kettles: But he’s made it work for what he’s doing. He is very much … We had iRobot, the laws of robot in our training at first.

Jessica Dunn: At their studio, they have little figurines of some of the American movie characters.

Michele Orallo: Oh my gosh.

Jessica Dunn: At the studio where we trained, they had those big life-size like-

Meghan Kettles: Gundam robots.

Jessica Dunn: … Terminator robots. I’m leaning towards, yes, it was purposeful.

Meghan Kettles: It was definitely not unintentional. That’s-

Tracy Davis: Sure. Yeah. He won’t go full Skynet. We don’t have to worry.

Meghan Kettles: They have a good sense of humor, so I think that that’s definitely played a part in it.

Tracy Davis: Sure. What do you guys see in the future of the Brooks Cybernic Treatment Center, if there’s anything you can share, or just Cyberdyne, HAL and all that in the future, how’s Brooks going to be a part of that?

Jessica Dunn: Well, we’re trying to expand, so over the last two years we have only been treating patients in the NRC. However, in 2020, we’re looking to … No confirmed sites yet. However, we’re looking to get the device into other Brooks’ sites and then also other sites outside of the Brooks system.

Tracy Davis: Okay. That would mean you’d have to train other therapists and their-

Jessica Dunn: We’re going to be the main training center. Me and Meghan are going to be training everybody.

Meghan Kettles: For the U.S.. Yeah. We’re supposed to be the national training site.

Tracy Davis: You’re essentially robbing people of a Japan trip pretty much.

Meghan Kettles: Sorry.

Tracy Davis: Because they only get to come to you. Maybe you can have some sushi for them or something.

Meghan Kettles: That shows how much we’ve impressed them. That’s how much Cyberdyne likes working with Brooks is they actually trust us to do that. They’ll be here and back and forth. Yeah. That’s the direction that Jessica and I are moving. We also have a research study going on and have had for about a year for spinal cord injury.

Tracy Davis: Yeah. We didn’t talk about that too much. HAL has also been used for research here at Brooks too in our research department. What’s been going on with that?

Meghan Kettles: We have had a total of three participants fully complete the protocol. It is a safety and efficacy study for U.S. spinal cord injury patients. Since it just got FDA clearance, we’d gotten the approval from the IRB I think right before we got FDA clearance. Then had to go back and revise it and then we had to get IRB approval again. That’s a 60-session protocol. It’s for patients with chronic spinal cord injury. Someone with a spinal cord injury for at least a year or more, and we’ve seen some good results with that.

We’ve also done some other stuff with the research center. With our first two patients, we used them as somewhat case studies to help drive what that protocol looks like and what things we need to plan for since we’re still in the learning stages of things. It’s been great working with that, and it’s still going on. The goal is 24 patients over a three-year period. They’re still currently enrolling.

It’s just research since it’s the first U.S study. It has to be on safety and efficacy and then we can expand from there.

Jessica Dunn: Another thing we’re excited about for 2020 is we’re now going to be accepting insurance coverage for use of the robot. We have been on a private pay basis for the last two years. Now we’re going to be treating it like traditional therapy, but using Cyberdyne and HAL as a modality as you would, for example, Indego or something like that. We’re excited about that because I think it’s going to expand the access a little bit for our patients and so that’s really exciting for 2020.

Michele Orallo: Yeah. Very exciting.

Tracy Davis: Yeah. That’s going to be huge. I’m excited for the future of the program and expanding beyond just spinal cord and onto many other things and getting it into other clinics. Thank you. Thank you guys for coming. We really appreciate it.

Jessica Dunn: Thanks for having us.

Michele Orallo: Yeah. Thanks.

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