Episode 25: Using Augmented Reality in Physical and Occupational Therapy with Lindsay Watson of Augment Therapy
Combining the best of augmented reality and telehealth to improve the delivery of pediatric physical therapy
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In this episode you’ll discover:
Why innovation and investing in pediatrics is often overlooked
Why digital health tools are so needed in the rehab industry, in particular
How Remote Therapeutic Monitoring (RTM) fits into that equation
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Read the transcript:
Carrie Nixon (00:17):
Hi everyone. Welcome to the latest episode of Decoding Healthcare Innovation. I am thrilled to be here today with Lindsay Watson. She is the CEO and co-founder of Augment Therapy. Augment Therapy is a digital health company that uses augmented reality experiences as well as telehealth and remote patient monitoring to engage children, specifically children in physical and occupational therapy. Lindsay, welcome to the show.
Lindsay Watson (00:47):
Thank you for having me, Carrie. I'm very excited to be here.
Carrie Nixon (00:50):
We're going to have a great conversation today and I want to start Lindsay by asking you what motivated you to start Augment Therapy and tell us a little bit about exactly what you do.
Lindsay Watson (01:02):
Well, I am a physical therapist first and foremost, and I've been practicing for 20 years and the past 17 years working mostly with children in the school-based setting and then I would moonlight a little bit in outpatient orthopedics in the adult care market and with a side of kids there in outpatient as well. It was really my difficulties and struggles engaging kids in those settings that really catapulted me to start a digital health company. I looked around in the market and I recognized that there was really a huge lack of innovation in pediatrics in particular, and I was just really frustrated that pediatrics seemed to be consistently overlooked in the solutions that were already out there. And I decided rather than complain about these problems, I better get to work and try to solve them myself. So I got to work.
Carrie Nixon (02:04):
I love it, I love it. I love that mentality. And I also love the fact that you are yourself, a clinician and a therapist who saw the problem comes at it from the perspective of a therapist and is working to solve that problem, right, working to get it done. So you mentioned sort of the lack of innovation in the pediatric healthcare space. What do you think is driving that?
Lindsay Watson (02:33):
I think a lot of it actually has to do with number one is that the funding that's so necessary to get innovation off the ground, I think there are some kind of old beliefs that the market is too small that there's too much risk involved. And so quite frankly, people think they can't really make enough money in that market. But what that has resulted in is a real swath of our population where 20% of all hospital beds are held by pediatric patients. One in five kids has developmental disabilities right now in the US actually one in six, one in five are obese. I mean, these are enormous problems that everyone is not paying attention to. And so now there's enormous opportunity really to fix these problems, not only because it's simply the right thing to do but now because everyone has overlooked it now there's a wealth of opportunity to get it right.
Carrie Nixon (03:39):
Yeah, it's really interesting. I mean, small children does not equal small market lots and lots of children that need lots and lots of care, and frankly it's where parents are oftentimes willing to invest more in their children's care and wellbeing than they are in their own health and wellbeing. So it's interesting that that has been overlooked, but you're working to remedy that. Tell me a little bit specifically about augment therapy and the way that you have tried to get at. You mentioned it being difficult to keep kids engaged in their therapy. First of all, what types of therapy are your patients in need of and how are you keeping them engaged?
Lindsay Watson (04:26):
Well, most of the kids contrary to popular belief that the majority of kids are kids that are, let's say, just trying to improve their they're arm pitching in the little league game, things like that. Most of these kids actually have chronic conditions and so they are lifetime consumers of rehab. And my early years as a therapist, I would spend a lot of time listening to the patients, quite frankly because if what is the driving motivating force for each individual patient, a therapist often leverages that for therapeutic benefit to the patient. So I was noticing trends from these children that technology was a very motivating thing for them in games. And so I would modify tools that were already out in the market and use them in my therapy sessions, but they never really did it very well and I was getting frustrated with that. In addition, I was noticing trends in how we deliver care, and I was noticing at the time, I think this was about seven years ago, telehealth was becoming more and more proficient and all the tools I found in the market were really focused on the senior market and adults.
(05:56):
And I kept thinking, gosh, when this comes to pediatrics, it is just going to rock the boat because from what I could tell, what the market was telling me was these issues of care delivery were more profound in pediatrics and would likely be more accepted in the pediatric market faster, but no one was doing it. And so I really became kind of fascinated by this combination of gamification plus telehealth, plus remote monitoring. And I felt like those three were going to be the three things that were going to really unlock the key to better care and better satisfaction, not only for the patient but the providers. And that really was the kind of launching point for me was I couldn't find that sweet combination of those three in the market, and I decided really to put my own internal fears about not being qualified to do it, I decided to quiet those feelings and just go for it.
Carrie Nixon (07:04):
I think that is a feeling that a lot of founders and in particular a lot of female founders do have to sort of quash how can I, a physical therapist or a lawyer go about being an entrepreneur and founding like a company in a whole new way of doing things. So congratulations to you for realizing that that's something you've got to push down and pushing through that and making it happen. I love it. So you mentioned that a lot of the pediatric consumers of occupational and physical therapy services have chronic conditions. Tell us a little bit about some of the chronic conditions that you are typically seeing and that you have worked with.
Lindsay Watson (07:57):
Well, in the settings I worked in most of the conditions were children with cerebral palsy down syndrome, developmental delays, autism a lot of neurological syndromes spina bifida. Those were the things I very often treated. And these kids really what makes a difference for them in getting better faster is doing more than just what I do with them during a given session. A lot of times I'm treating that child even just one time a week, and that's expecting dieting for one meal a week to have an impact on your waistline. And it's the same as true for these therapies is oftentimes these kids are in therapy for decades on end just with that one time a week or twice a week at most interventions. And it's no wonder that those kids have to consume care for so long. And I really felt like the reason why we weren't seeing higher adherence higher compliance with everything was really we were just working in the wrong medium.
(09:17):
So often Mia's therapists we're handing parents that are already overwhelmed and exhausted just from getting their child to therapy. We hand them in addition a piece of paper and we say, if you want your kid to walk someday and talk someday, you really need to do this every day. And invariably that falls down over time and you could see the personal frustration from these families. They feel like a failure as well, but I felt like it wasn't their fault. It was really our fault for not meeting them on a ground that was more convenient and more likely to have success for them overall. So that was really what motivated me to get up off of my butt and make a difference.
Carrie Nixon (10:07):
So it's not only meeting the kids where they are for their therapy that works in the best way for them, it's also meeting the parents where they are. I can imagine <laugh> the feeling of overwhelm with having to bother pester and bother your child to do a boring, silly, maybe kind of uncomfortable, painful physically physical therapy regimen that they don't want to do every day. And so if you can convert it to something that they actually enjoy, that is a win for everyone for sure. Tell us a little bit about just some of the games that, how do you gamify these things? Try to paint a picture for our listeners.
Lindsay Watson (10:50):
Yeah, that's my favorite part to talk about because normally you're right, the exercises that we do are all repetitive. They're boring. And so for example, we will take an exercise, let's say a child that is early post-surgical after a surgery and some kind of orthopedic surgery and they have to shift their weight onto their surgical leg. For most kids, it's a really fearful, scary thing painful thing. That is one of the earliest exercises that we do, and we'll have them stand there and shift their weight onto their leg. Well, in Augment Therapy, what we do is we're just an application on an iPhone or an iPad and that camera sees the child and we connect that device to a television in front of the child to enlarge the picture, make them really feel immersed, and then we alter the environment around them. So we just change the setting in which they're doing these basic evidence-based exercises.
(11:58):
And for this exercise, we put the child inside of a virtual snow globe. So they're the star on the screen, and in order for them to make it snow inside the snow globe, they have to shift their weight onto their affected leg the whole time. We're collecting data on that movement and we can send it to the therapist at any time. They can be in the room virtually in real time. They can use it in the clinical setting and use it as an augmentative tool, or they can actually remote monitor a patient's actual adherence and compliance with the exercises. So that's another one I love is we call it puddle jumper. And the kids have to jump forward and they're prompted and directed how to do it with an avatar of their choosing. The avatar can even speak in multiple languages to the child if that's a barrier.
(12:56):
And we make their living room or their hospital room into basically a swamp environment and we make the floor look like water and in order for they have to jump forward after it's demonstrated by the avatar, and then they see a ripple effect all around the floor with water, and then we capture data on their ability to jump. And so it really is powerful for a therapist in particular where a lot of the data we capture and document is actually guesstimated from visual estimations of the patient. Now we're actually able to track that data and show real nominal progress that's visible to the patient and provider.
Carrie Nixon (13:41):
And that is so motivating to be able to see that progress both for the parents, the provider, and even the kids.
Lindsay Watson (13:49):
Well, and so many of these kids too with these chronic conditions, oftentimes there with an orthopedic surgery for example, the rate of recovery is a very quick shift upwards like that. But with these chronic conditions, a lot of times the progress is so minimal that it's almost imperceptible. So we think it's really powerful that with these tools you can actually see that progress is happening, even though it may not be visible to the naked eye, it's there. And that's important for therapy long term in particular.
Carrie Nixon (14:25):
Yeah, absolutely. And for the folks who are listening who are just listening and not watching the video part of this, I love watching Lindsay's face when she's describing these games. It just lights up amazing. Lindsay, do you get to actually take part in deciding what these games are going to look like? I mean, that sounds fun.
Lindsay Watson (14:45):
Oh, I mean, it's the best part of the job. I was doing that a lot more earlier in the beginning of the company. Now I actually passed the baton in many ways to the customers that we're working with. We take a lot of pride, our team, in listening to the providers and really getting their feedback. We hear constant stories of how the tool is being used, and we take that input and we can iterate very quickly. And that's another thing we think that really sets us apart but it's those stories of the patients using it that really catapult our team to move so fast and so hard all the time. For example, we heard a story recently about a patient at one of our customer's location that had been in bed for four days and had refused to get out of bed for those four days.
(15:48):
The patient was in for a sickle cell pain crisis, and they had tried everything to get this patient out of bed. And the software in this hospital at Rainbow Babies and Children's in one of the floors, they have our software in every patient room. So these kids have access to exercise opportunities all day long, and this patient did get up for these exercises finally with the solution and did 15 minutes of sustained exercise in their first out of bed episode. I mean, those kinds of things. As a therapist, that's incredibly difficult to get a child that's in severe pain to overcome that and get up and move and ultimately feel better. So it's the best part of this job.
Carrie Nixon (16:40):
That's amazing. I love it. And the way that you described this makes me think that your business model for serving patient patients is worth diving into. So you are not a direct to consumer or direct to patient platform. Your customers are the actual physical therapy practices or occupational therapy practices that are conducting this therapy, so that therapy so that the therapists can remain very actively involved with the patient and the patient's progress. And so that aser, these services are reimbursable. Is that right?
Lindsay Watson (17:22):
Yeah. Our goal really is to help these providers leverage digital health tools in a way to expand their reach achieve better outcomes, and achieve higher satisfaction in the process. And our tool, we enable these providers to leverage one tool, one solution for all the settings that they practice in therapy. We practice an inpatient outpatient, and really in the home, we have to extend our care across all those settings. So you're right, that's how our business model is right now, and we really are helping these hospitals and outpatient clinics expand their reach through a digital health tool that usually is often not designed by a clinician and it's inherent in the design that we're trying to solve, the real problems that they feel.
Carrie Nixon (18:18):
Yeah, absolutely. Well, let's talk about the reimbursement aspect for a moment because I think that is really important, especially to make sure that we have access that's access to this type of thing available to all rather than in the cash pay model. How does reimbursement work?
Lindsay Watson (18:39):
Well, when always a complex answer, right? In our delightful healthcare system but when you're using our tool when a physical therapist is present, there are codes that are already present and billable that therapists can leverage. They just use this just like they would any other tool in their practice tool belt. And so those codes are present. Also, therapists can leverage the telehealth codes during the public health emergency, physical therapists and occupational therapists, other therapists are able to bill telehealth codes. We're hoping that persists beyond the pandemic. And then there are these new remote therapeutic monitoring codes that are just truly changing for the rehab industry in particular. Normally what our true method of our standard of care is to give those handouts to every patient to do a home exercise program, and then we never know what is done and what the objective data is.
(19:49):
Well now digital health companies like Augment Therapy are actually meet these definitions of being a medical device and those codes can actually be leveraged by an outpatient clinic or a hospital setting for the supply code of our application. And the time that those clinicians spend reading those data reports, modifying those home exercise programs, really keeping a tab on your patient adherence and performance outside of practice, they can be reimbursed for that time spent. There's a lot of confusion still about those codes. So we're trying with partners like yourself to get the word out that these are important not only for the bottom line of these practices, but really for better care so that these codes really are going to change everything for the rehab industry in such a positive way.
Carrie Nixon (20:51):
Yeah, I think that's exactly right. You're referencing these new remote therapeutic monitoring codes that went into effect January one of this year, and I do believe they provide a tremendous opportunity for a much more continuous touch, high touch with patients that are undergoing a variety of types of therapy to make sure that that therapy is actually helping them to progress and with forward movements. So I really think it's a step in the right direction and I'm excited about it too.
Lindsay Watson (21:22):
Well, and when you see what the metrics are right now for what our industry is, I really think this is the change maker for our industry. The standard norms are less than 30% of most patients actually adhere to these home exercise programs. I mean, that's the equivalent in another industry of less than 30% of patients taking their heart medication. It's like it's powerful. And so it's no wonder that then patients end up consuming more care. And so these digital health tools that can actually have an impact on your adherence and consumption and carry over from those sessions in person, I think it's going to make a really big difference for everyone. And I'd love to see our standards of care change in the industry where people are just far more adherent to what we're prescribing them.
Carrie Nixon (22:25):
Yeah, absolutely. I mean, Lindsay, you are the perfect example of clinician driven innovation, right? But what do you think is so unique about that? Why don't we have more clinicians out there doing the kinds of things that you're doing?
Lindsay Watson (22:43):
Well, for me, I think I really always felt that I had to stay in my lane, and all the kind of leaders in my field that I looked up to were people with extra certifications and letters after their name and academia or doing profound research. And those were the examples that I looked up to in my industry and I felt like, okay, this is the path to doing better care and being a better therapist. But for me also, once I kind of got past this notion that because I was a clinician that I couldn't actually make an impact on care delivery in a digital way once I got over myself, that was when I really unlocked I think what my actual potential was. And I do owe a lot of that to my co-founder, Steve Blake. He really taught me so many things about the fact that my brain is so deep in the consumer end point end game that that's a benefit and not a drawback. I had initially the internal voice was always telling me was a problem.
Carrie Nixon (24:06):
Yeah, no, absolutely. Sometimes it's good to ignore that internal voice. Yeah,
Lindsay Watson (24:11):
Oh yeah. In my case, the voice can be pretty loud at times and just not listening was a very good thing. Yep.
Carrie Nixon (24:18):
I hear ya. I hear ya. So Lindsay, what's next on the horizon for Augment Therapy? You, you've closed a couple of funding rounds and you're putting those funds to good use. What else is coming down the path for you all?
Lindsay Watson (24:32):
We'll likely do another fundraiser probably in about six months or so. But now what we're really focused on are those earliest customers that we have, for example, at Rainbow Babies in Children's Hospital, Children's Hospital, Los Angeles two educational service centers in Ohio Banner Healthcare. We're getting ready to launch very soon. There's just a lot of great hospitals and customers in our pipeline that we want to expand out to in time and really take the world by storm. Our goal is also to innovate in the adult market as well. I think it's far easier for a pediatric company like ourselves to solve some adult problems rather than for an adult company to solve problems in the pediatric market. A lot of adult companies, I think to your point earlier in the conversation, just kind of make it smaller put a bunny on the screen, and now you have a pediatric pro product. Well, the problems of the pediatric market are unique and we think though that what we have learned from the pediatric market can absolutely be applied in the adult market. And so we intend to go for that a little bit as well too.
Carrie Nixon (25:51):
That's great. I'm excited to hear that. I mean, I'm doing some physical therapy for a little shoulder issue right now at the moment, and it's kind of boring, frankly, and that's fine, whatever. I'm doing it, but why not gamify that, right? Adults like the challenge as well. They like to get to see those points get on the board. So I love the notion of that.
Lindsay Watson (26:16):
Well, and what we've found in a lot of our testing that we've done too, is well, we've also made the intent to build our solution, not too little kiddish. So we have sophisticated music. We actually have a composer on our team that creates original scores with a lot of these concepts of how to incorporate tempo and everything for therapeutic benefit to the patient. So we have another layer of benefit, but what we've found is just simply by putting an adult avatar on the screen adults are just as engaged as kids are in our solution. So it works for us big people too.
Carrie Nixon (26:59):
<laugh>. Awesome. Amazing. I love it. Lindsay, thank you so much for joining us today. I've loved hearing about your journey, and I am really looking forward to continue following that journey. Can you continuing to follow that journey?
Lindsay Watson (27:13):
Well, thank you so much, Carrie. I feel lucky to know you and to work with your team, and I can't wait to do some more good in this world.
Carrie Nixon (27:23):
Absolutely. All right. Thanks everyone for listening, and we'll talk to you on the next episode of Decoding Healthcare Innovation. Have a good one.