AS PROMISED, WE'RE GOING TO TALK A BIT THIS MORNING ABOUT THE STATE OF THE SCIENCE CONFERENCE AND AGAIN, WHAT I WOULD REALLY LIKE IS ACTIVE PARTICIPATION AND FEEDBACK ON WHERE WE'RE GOING TO GO WITH OUR 2020 PLANNING OPTIONS. SO AS YOU WILL REMEMBER, WE TALKED A BIT ABOUT IT THIS LAST -- YESTERDAY. IN 2016, WE HELD OUR FIRST SORT OF IN THE MODERN ERA, RIGHT, STATE OF THE SCIENCES CONFERENCE AS REQUIRED BY LEGISLATION AND IN 2016, REALLY THE GOAL AND THE INTENT OF THE CONFERENCE WAS REALLY TO ENERGIZE THE FIELD. THE OTHER FEEDBACK WE HAD HEARD QUITE A BIT WAS THAT FOLKS DID NOT REALLY REALIZE THAT REHABILITATION EXISTED OUTSIDE OF THE CENTER FOR NATIONAL REHABILITATION RESEARCH, THERE WERE QUESTIONS ABOUT WHAT TYPES WERE BEING FUNDED ACROSS THE NIH SO WE MADE A COMMITMENT TO INSURE THAT ALL OF NIH WAS FUNNELING REHABILITATION RESEARCH SO WE HAD A NUMBER OF INVESTIGATORS FUNDED BY AGING, NATIONAL INSTITUTE OF DIABETES, AND KIDNEY DISORDERS, RIGHT? SO PEOPLE WERE UNFAMILIAR WITH THE FACT WE WERE FUNDING REHABILITATION AND END STAGE REASONABLE DISEASE, RIGHT? SO REALLY THE PURPOSE WAS TO GET FOLKS EXCITED ABOUT THE BREADTH OF THE OPPORTUNITY AND GAIN FEEDBACK ON THE RESEARCH ITSELF. SO AT THAT POINT, WE HAD A DRAFT, BREAKOUTS IN EACH OF THE PRIORITY AREAS WITH SCIENTIFIC TALKS AND FEEDBACK ON WHAT SORT OF THE FOCUS WOULD BE AND THEN WE HAD AN OPEN TOWN HALL. SO WE HAD MULTIPLE PLACES FOR PEOPLE TO GIVE FEEDBACK ON WHAT WE WERE DOING. SO THIS TIME WHAT WE WANTED TO GET A SENSE OF THE FEEDBACK WAS WE WANTED TO HEAR FROM THE COMMUNITY OF WHAT YOU ALL THINK THE GOAL IS. THE OTHER IS LAST TIME WE DID A REALLY KIND OF DIFFERENT KEYNOTE. WE HAD EXPLORED NEW WAYS OF DOING THAT THIS TIME, SORT OF A DIFFERENT PERSPECTIVE OR METHOD OF GOING ABOUT THE KEYNOTE BUT WE WOULD LOVE TO HEAR THAT KEYNOTE, LAST TIME IT WAS A MUSICAL SET OF GIG AND WE HAD SOME OTHER THINGS IN THE WORKS IN THE BACKGROUND IF WE WANTED TO POTENTIALLY GO CREATIVE AGAIN AND THEN, YOU KNOW, WHAT SHOULD BE THE FOCUS OF OUR SCIENTIFIC PRESENTATIONS. WE PROBABLY THIS TIME WILL HAVE FEWER SPEAKERS THAN WE DID LAST TIME. I THINK LAST TIME WE HAD 47 SPEAKERS ACROSS BREAKOUT AND THAT WAS A LOT, ACTUALLY. WE WILL PROBABLY NARROW THAT THIS TIME. WE ALSO WANT TO MAKE SURE THAT WE'RE GETTING COMMUNITY PARTICIPATION AND WHEN I SAY COMMUNITY, I MANY BROAD COMMUNITY, I DON'T MEAN SCIENTIFIC COMMUNITY. I MEAN BROAD COMMUNITY. ALSO WE WOULD LIKE TO GET FEEDBACK ON THE PLAN RAE VISION AND THEN HOW DO WE GET THE METHODS TO INFORM PROGRESS AND THE FUTURE. THAT IS A LOT TO ACCOMPLISH. SO WE HAVE SOME PROPOSALS FOR YOU AND I APOLOGIZE THIS IS A LITTLE BIT SMALL BUT I WILL GIVE YOU SOME OF THE THINGS WE HAVE TALKED ABOUT. SO ONE IS TO FOCUS ON TRANSNIH INITIATIVES OR TRANSFEDERAL INITIATIVES. SO WE ARE DOING A LOT IN TRANSNIH THAT IS IMPACTING REHAB BE SO WE COULD COVER THAT AND WE PROBABLY COULD EVEN FILL A TWO-DAY CONFERENCE WITH IT. WE CAN REPORT ON THE PROGRESS TO DATE FROM THE NIH REHABILITATION PLAN AND FIND WAYS TO ADDRESS GAPS AND I HAVE SOME OF THE AREAS WHERE WE REALLY HAVE MADE SOME SPECIFIC PROGRESS. OR WE COULD BE FUTURE LEANING AND DEFINE PRIORITIES BASED ON THE STATE OF THE SCIENCE AND GIVE TALKS ABOUT GENUINE -- GENOMICS, INVESTIGATOR SCIENCE, THINK ABOUT MAYBE DOING SOME SORT OF CHALLENGE OR AWARD FOR YOUNG INVESTIGATORS. SO THIS IS ONE OF MY FAVORITE QUOTES FROM WILLY WONKA, WE HAVE SO MUCH TIME AND SO LITTLE TO SEE, WAIT A MINUTE, STRIKE THAT, REVERSE IT. I FEEL LIKE WE HAVE A LOT WE COULD DO AND WE HAVE TWO DAYS AND SO I KIND OF FEEL LIKE, YOU KNOW, KID IN A CANDY STORE A LITTLE BIT AND THAT IS WHY I WENT TO WILLY WONKA BECAUSE THERE IS A LOT WE COULD PICK FROM, I FEEL LIKE. WHEREAS WHEN WE STARTED FOUR YEARS AGO, I FEEL LIKE WE WERE KIND OF LIKE OKAY, HOW DO WE TELL THE STORY. THIS TIME I FEEL LIKE THERE'S MANY STORIES WE CAN TELL, ALL OF WHICH COULD ENGAGE THE COMMUNITY DIFFERENTLY. SO I WILL KIND OF GO BACK TO THIS AS THE FRAMEWORK THAT WE WILL USE TO TALK THROUGH THIS AND I WOULD LOVE TO SORT OF START WITH GOAL BECAUSE IF WE CAN CLARIFY THE GOAL, THEN A LOT OF OTHER THINGS WILL FLOW FROM THAT GOAL AND WOULD LOVE TO GET YOUR FEEDBACK ON THIS. AND AGAIN, I WILL RESERVE TIME AT THE END OF THIS PRESENTATION -- I WILL CONFIRM, WE GO TILL 10? I WILL RESERVE TIME AT THE END AND REMEMBER I WILL BE ASKING SOME OF YOU TO JOIN SUBCOMMITTEES ONE FOR THE RESEARCH AS PLANNED AND ONE AS OUR SUBCOMMITTEE TO ADVICE US AND NIH WILL BE DOING -- THE BULK OF THE WORK WILL JUST BE GETTING GUIDANCE THROUGHOUT THE YEAR AND WE WILL REPORT BACK IN DECEMBER. SO LET'S START THE CONVERSATION WITH A GOAL. AND I KNOW IT IS EARLY AND I KNOW I DIDN'T BRING COFFEE TODAY BUT I AM GOING TO ASK YOU IN YOUR SLIGHTLY DECAFFEINATED STATE TO GIVE US SOME FEEDBACK. >> SO I AM KEEPING -- GOING BACK TO THE INPUT FROM THE COMMUNITY FROM SCI 2020, AND THAT MAKES MAY WONDER IF THERE WOULD BE VALUE IN THINKING ABOUT ORGANIZING IT AROUND WHERE WE ARE IN TERMS OF PARTICULAR SCENES, LIKE PAIN, FOR EXAMPLE, OR WHEELED MOBILITY OR HAND FUNCTION, WHICH CUT ACROSS DIFFERENT AREAS OF DISABILITY THAT HAVE COMMON REHABILITATION-RELATED GOALS IN THOSE AREAS. >> AND MORE STATE OF THE SCIENCE OR MORE POINTING TO FUTURE? [ OFF MIC ] >> I AM IN THE MIDST OF WRITING AN NIH-REQUIRED PROGRESS REPORT AND IN IT, I AM REQUIRED TO SAY WHAT DID YOU PROMISE TO DO, WHAT HAVE YOU DONE AND WHAT ARE YOU GOING TO DO IN THE FUTURE AND THAT STRIKES ME AS A POSSIBLE TEMPLATE FOR A GOAL HERE. YOU HAD ONE OF THESE TO SAY THIS IS WHERE WE WERE, THIS IS WHERE WE THOUGHT WE WOULD GO, THIS IS WHAT WE HAVE ACCOMPLISHED AND THEN LET'S SEE WHAT OUR GOALS FOR THE FUTURE WILL BE. >> OKAY, KATHLEEN AND THEN ALLEN? >> I WAS WONDERING WHEN WE HAD THE RE REVERSE PANELS, WE DIDN'T USULLY TALK TO EACH OTHER SO TO HAVE IMPROVED COOPERATION WITH PEOPLE WHO DON'T USUALLY RESIDE THERE AND THEN TO ENGAGE PEOPLE WITH DISABILITY IN NOT ONLY THE DAY BUT THE PROCESS OF THE DAY AND THEN OKAY, SOME DAY FOR ALL PEOPLE, TO ENGAGE WHAT WE HAVE DONE THIS FAR AND WHAT WE DO NOW. >> ALLEN? STEAL SOMEBODY ELSE'S, STEAL MINE. >> I THINK IT IS IMPORTANT WHAT ART SAID, IMPORTANT TO LOOK BACK BEFORE LOOKING FORWARD. WHAT WAS ACCOMPLISHED, WHAT WERE THE CHALLENGES, WHAT WERE THE UNEXPECTED ASSISTS THAT CAME ALONG THE WAY. AND A SUGGESTION TO HAVE COSIGNING IS A VERY GOOD IDEA AND MAYBE SPEND SOME TIME TALKING ABOUT WHAT THOSE COULD BE. >> RICHARD? >> IF YOU GO TO 35,000, LIKE THE GOAL OF HAVING A CONFERENCE REALLY IS ONE OF THREE THINGS. EITHER YOU NEED TO GET INFORMATION TO SHARPEN YOUR FOCUS WHICH FELT A LITTLE BIT LIKE THE NICHD ONE WE HAD WHICH WAS TERRIFIC, OR TO DISSEMINATE INFORMATION PUT TOGETHER WHICH COULD CHANGE THINGS TODAY IF PEOPLE ADOPT IT AND THEN THE OTHER IS TO BRING IN MORE PEOPLE TO BUILD ON THE WORK YOU ARE DOING AS OPPOSED TO JUST DISSEMINATING IT. OR YOU COULD HAVE A CONFERENCE THAT DOES ALL THREE OF THEM BUT THOSE ARE THE THREE LARGER GOALS, I THINK. AND IT SEEMS TO ME WE HAVE A LOT OF GREAT WORK THAT IS HERE THAT SHOULD BE DISSEMINATED, YOU KNOW, WITH AN EYE TOWARD BRINGING MORE PEOPLE INTO THIS AND SORT OF SETTING OUT OUR AGENDA FOR PEOPLE. SO AGAIN, THE WORD COLLABORATION HAS COME UP SO MANY TIMES EVEN IN HERE AND SO TO BRING IN MORE COLLABORATORS AND EXPAND, YOU KNOW, THE NUMBER OF PEOPLE WORKING WITH US IN ORDER TO GET MORE OF THIS TO HAPPEN. >> ACTUALLY, I WAS THINKING ALONG THE SAME LINES, THAT WE WANT TO GROW THE FIELD AND IN ORDER TO GROW THE FIELD, ONE COULD DO, YOU KNOW, KILL TWO BIRDS WITH ONE STONE, WHICH IS TO SET IT UP SO WE ATTRACT NEW PEOPLE TO THE FIELD BUT ALSO DISSEMINATE INFORMATION TO ATTRACT MORE PEOPLE. BECAUSE I THINK OF MORE RECENT CONVENTIONS, THEY ARE MORE WHAT IS GOING ON AND THE NEW SET OF SCIENCE BUT THEN THE NEW PEOPLE COULD COME IN AND TELL US WHERE THEY COULD COLLABORATE ARE US SO I AM THINKING THOSE TWO AT THE SAME TIME. >> VERA AND RICHARD AGAIN? >> I WILL PULL UP THE REAR WITH A THIRD ADVOCACY FOR THAT DISSEMINATION AND OTHERS TO CARRY THE MESSAD MESS-- MESSAGE FORWARD. WE HAVE LARGE NUMBER OF PEOPLE DOING THAT ALREADY SO WE'RE AWARE AND SO MORE CAN COME ABOARD. >> I THINK THE SUGGESTIONS TO GROW THE FIELD ARE TERRIFIC. LIKE AT THE FOUNDATION, PEOPLE ARE LIKE WHY ARE WE TALKING ABOUT AUTISM, CHRISTOPHER REEVE SO WE WANTED TO MAKE THIS SEXIER AND COOL TO BRING INVESTIGATORS IN NOT BY GIVING THEM MONEY BUT INCREASING THE CACHE AROUND IT. AND WHEN YOU THINK OF MEDICAL RESEARCH, CURING CANCER, THE BRAIN, IT DOESN'T HAVE THAT CACHE, AND YET IT DOES, THIS& COOL AND FASCINATING STUFF OF WHAT IS POSSIBLE TODAY AND BEING ABLE TO USE IT BETTER. SO TO GROW THE FIELD AND MAKE IT AS EXCITING AS IT REALLY IS AND NOT JUST THINKING OF THERAPIES AND THIS AND THAT BUT REALLY CHANGES IN LIFE TODAY, IS REALLY COOL. >> JUST TO GIVE FEEDBACK ON THAT COMMENT. WHEN YOU WERE TALKING ABOUT KEYNOTES, IT IS SOMETHING I THINK WOULD BE SORT OF EXCITING AND CONTROVERSIAL BUT THIS IDEA OF TRANSHUMANNISM WHICH IS THE IDEA THAT YOU CAN AUGMENT -- WE CAN AUGMENT OURSELVES TO IMPROVE OUR ABILITIES, OUR INTELLIGENCE, EXTEND OUR LIVES BUT IF YOU ARE WORKING WITH A PATIENT, YOU ARE SORT OF IN THAT FIELD ALREADY AND ARE THERE IS REALLY IMPORTANT ETHICAL ISSUES AND IT IS A REALLY INTERESTING FUTURE. I MEAN, IT IS ALREADY HAPPENING. WE HAVE THE CRISPER BABIES IN CHINA AND THERE'S REALLY INTERESTING STUFF, ACTUALLY, LIKE PHILIP KENNEDY IMPLANTED HIMSELF, YOU KNOW, SO TYING INTO THE IDEA THAT THIS IS -- I MEAN, IT IS INCREDIBLY CUTTING EDGE AND LEADING INTO THINGS THAT ARE GOING TO BE BE REALLY REVOLUTIONARY FOR SOCIETY. SO I DON'T KNOW IF YOU WOULD WANT TO SPEAK ON THAT IN A WAY THAT IS -- LIKE -- [INDISCERNIBLE] >> RALPH? >> ONE THING THAT CAME OUT OF THE SCI2020 MEETING THAT I THOUGHT WAS ENLIGHTENING IS A LITTLE BIT OF MISMATCH BETWEEN WHAT ACADEMICS DO WHEN THEY ARE REETCH RESEARCHING AN AREA VERSUS WHAT THE ADVOCATES AND CONSUMERS WANT AND SO I WOULD ASK ARE WE RESEARCHING THE RIGHT ISSUES OR ARE THERE CERTAIN POCKETS WHERE WE STILL HAVE TO GET THAT A-HA MOMENT AND ESPECIALLY TALKING THE WHOLE FIELD, WOULD BE GREAT FOR THE YOUNG INVESTIGATORS TO SUDDENLY SEE OH, THIS IS AN ISSUE THAT PEOPLE WITH DISABILITIES HAVE. SO IN OUR FIELD, IS THERE A NEED FOR THAT TO KIND OF GET PEOPLE TO CONNECT A LITTLE BIT MORE TO THE NEED AS OPPOSED TO THE THINGS THAT ARE ACADEMICALLY INTERESTING. >> KATHLEEN? >> I TOTALLY AGREE WITH THAT. I SEE WHERE WE RESEARCH SOMETIMES AND THEN WHAT THE ADVOCATES WANT, IT IS REALLY VITAL TO HAVE PEOPLE WITH DISABILITY IN THE LOOP IN THESE CONFERENCES AND PARTICULARLY THIS AREA, VERY POWERFUL, TO KNOW WHAT THEY WANT. AND IT IS NOT ALWAYS, LIKE ONE PERSON SAYS OKAY, I WILL DO THIS BUT THERE ARE SEVERAL VARIETIES AND WE NEED TO BE MORE OPEN TO THAT, TO KNOW WHAT PEOPLE WANT. >> OKAY, SO IN TALKING ABOUT THE -- I'M SORRY, GREG? >> I THINK THAT IN TERMS OF THE LOOK TO THE PAST AND THE PROGRESS THAT HAS BEEN MADE, IT WOULD SEEM THAT COULD BE DONE IN THE CONTEXT OF THE KEYNOTE ADDRESS OR SOME OPENING ADDRESS. YOU KNOW, SIMILAR TO THE SCI CONFERENCE, I WOULD THINK YOU WOULD WANT THIS CONFERENCE TO BE TRANSFORMATIONAL IN TERMS OF PEOPLE'S THINKING AND THIS CONCEPT OF REHABILITATION BEING SUCH A LARGE PART OF, YOU KNOW, THE EXISTING PORTFOLIO. I THINK IF YOU THINK OF THE VA SYSTEM, REHAB IS SUCH A LARGE COMPONENT. YOU GO THERE AND THEY HAVE FIVE SERVICES AND TWO OUT OF FIVE ARE PART OF THEIR SERVICES AS SUCH A BIG COMPONENT AND THE EMPHASIS I THINK FOR THE CONFERENCE MAKES THE MOST SENSE IN TERMS OF REALLY FOCUSING ON THE FUTURE. I THINK IT IS A REAL OPPORTUNITY TO HIGHLIGHT THE AREAS OF YOUR REHABILITATION PLAN BUT SORT OF INTERWEAVE THESE REALLY TIMELY TOPICS IN TERMS OF PAIN AND AGING AND DEVELOPMENT AND ENGAGEMENT, PARTNERSHIP WITH THE CONSUMER, PRECISION HEALTH, SOME OF THESE AREAS COULD BE INTERWOVEN INTO YOUR EXISTING PLAN, I THINK. >> OKAY, SO DAVID AND THEN GREG? >> JUST ON THE -- WHAT RALPH WAS SAYING AND KATHLEEN AS WELL, FOR THE CONSUMERS, MAYBE THE SBIR FOR SOME COMPANIES THAT HAVE -- THAT ARE SORT OF THE BRIDGE BETWEEN CONSUMER NEED AND CUTTING-EDGE RESEARCH, THEORETICALLY SO CONSUMERS CAN EXPRESS NEEDS BUT SOMETIMES DON'T KNOW WHAT TECHNOLOGIES CAN MEET IT AND THEN SCIENTISTS ARE WORKING ON SCIENTIFIC PROBLEMS AND THE COMPANIES ARE TRYING TO BRIDGE THAT, I THINK, IN A LOT OF WAYS, LISTEN TO THE NEED, LISTEN TO THE SCIENCE AND FIGURE OUT WHAT CAN ACTUALLY BE USEFUL WITH PEOPLE AND IT REALLY HAS TO BE USEFUL FOR THE COMPANY TO BE EXISTING, RIGHT? SO I DON'T KNOW IF YOU HAVE THAT IN THE PAST ONE BUT LIKE A SESSION ON COMPANIES OR IF YOU ARE -- YOU KNOW, MAYBE SOME THAT WERE SUPPORTIVE, MAYBE SOME THAT WERE NOT SUPPORTIVE BUT SUCCESSFUL? >> OKAY, GREG? >> SO I WANTED TO SPEAK UP ON BEHALF OF BESS KENMORE WHO SENT ME A QUICK NOTE -- >> I HAVEN'T CHECKED MY E-MAIL YET -- YEAH, YEAH, SO THIS GOES ALONG WITH WHAT CRAIG WAS SAYING EALIER, LOOKING TO THE PAST AND HOW THAT WAS APPROPRIATE AT THE LAST CONFERENCE BUT MOVING FORWARD AND THINKING ABOUT WHERE ACTUALLY QUOTE HER HERE, SHE SAYS I THINK WE NEED TO EMBRACE THE SKATING WHERE THE PUCK WOULD BE AS A METAPHOR TO MOVE IT FROM INCREMENTAL TO INFLUENCE IN THE FIELD AND THAT IS A GREAT WAY TO LOOK AT THIS. SO REALLY IDENTIFYING WHERE THE GAPS ARE AND THEN WHERE WE NEED TO GO, NOT THAT WE CAN'T DO ANYTHING LOOKING AT WHAT WE HAVE DONE, BUT THAT SHOULD BE A MUCH SMALLER PROPORTION. >> THE NEED TO GET TREATMENTS OUT THERE, I THINK THAT IS REALLY POWERFUL TO HEAR THAT MESSAGING, ESPECIALLY IN THIS TYPE OF SETTING BUT SO THAT'S ONE THING. THE OTHER THING IS HOW TO EFFECTIVELY TRANSLATE BASIC RESEARCH TO THE NEXT STEP OF IMPLEMENTATION IN THE CLINIC. AND SO I THINK A PANEL ON THAT WOULD BE PRETTY INTERESTING, YOU KNOW, WITH THE INDUSTRY INCLUDED AND, YOU KNOW, WITH THE FDA, TRYING TO GET THE WHOLE SPECTRUM OF I DISCOVERED THIS MOLECULE THAT IS REALLY INTERESTING IN MY LAB, WHAT ARE YOU GOING TO DO NEXT AND LIKE I DON'T KNOW MUCH ABOUT LARGE ANIMAL RESEARCH SO, YOU KNOW, FOLLOW SOME PATHWAY, MAYBE EVEN ON SOMEBODY WHO HAS GONE ALL THE WAY SO YEAH. >> SO I AM HEARING -- RICHARD, GO AHEAD? >> JUST A BIT ON THAT. BRIAN AND I WERE TALKING ON THE WAY OVER HERE IN THE BUS AND WE WERE SAYING HOW BUILDING A GREAT PRODUCT OR HAVING A GREAT EXPERIMENT IS HARD BUT ACTUALLY IMPLEMENTING SOMETHING OR HAVING A GOOD COMPANY IS A LOT HARDER AND THERE IS SO MUCH FLOATING AROUND HERE AND, YOU KNOW, I WILL USE SKATING TO THE PUCK, I LOVE THAT ONE, TO WHERE THE PUCK WILL BE IS ONE THING BUT ALSO GETTING OVER THE GOAL LINE IS ANOTHER GOOD SPORTS ANALOGY THAT WOULD BE IMPORTANT FOR US TO FOCUS ON SO MAYBE WE COULD TURN THIS INTO A SPORTS CONVENTION. >> I WAS GOING TO SAY I HAVEN'T HEARD SOCCER YET, MAYBE TENNIS? >> A LOT OF SINGLES -- >> YEAH, HOWEVER WE WANT TO DO IT. [ OFF MIC ] >> MIGHT BE INTERESTING TO HEAR FROM A PANEL OF LIKE INNOVATORS WHO HAVE BEEN SUCCESSFUL OR PROBABLY SHOULD HAVE BEEN BUT THEN FAILED ETHICALLY SO YOU CAN LEARN ABOUT WHT HAPPENED. >> PEOPLE LOVE TO TALK ABOUT EPIC FAILURES ON VIDEOCASTS SO THAT WOULD BE AWESOME. YOU KNOW, I THINK WE COULD HAVE -- THERE IS ONE PERSON IN PARTICULAR WHO I THINK WOULD ENTHUSIASTICALLY TALK ABOUT AN EPIC FAILURE. I WILL KEEP THAT IN THE BACK OF MY MIND. EPIC FAILURE IS ALWAYS FUN. FEEL LIKE I DO THAT ON A REGULAR BASIS. SO I AM HEARING SOME CONSENSUS AROUND, YOU KNOW, WHAT IS DEFINITELY KEEPING CHECK OF WHERE WE HAVE GOTTEN IN TERMS OF PROGRESS BUT THAT IS NOT A MAJOR HIGHLIGHT. IT SOUNDS LIKE PEOPLE WANT TO REALLY FOCUS ON WHERE ARE WE GOING AND IS IT AN INCREMENTAL OR MAYBE NOT AN INCREMENTAL BUT A PUSH TOWARDS IMPLEMENTATION OF THINGS THAT WE KNOW HAVE MOVED AND IS IT A SORT OF HOW DO WE PLAN FOR THE FUTURE, WHAT TYPES OF COLLABORATIONS AND SCIENCE DO WE NEED THAT WE DON'T CURRENTLY HAVE? THOSE ARE THE TWO THINGS I AM HEARING EMERGING. I THINK, YOU KNOW, IN MY MIND, HAVING A FOCUS ON THE INDIVIDUALS THAT ARE GOING TO ULTIMATELY RECEIVE THE SERVICE, EITHER WITH TEMPORARY OR CHRONIC CONDITIONS, DEFINITELY HAS TO BE AN INTEGRAL PART. SO EDDIE BROUGHT THIS UP AND MAYBE WE CAN SPEND A BIT OF TIME. WHAT ARE SOME OF THE THEMES OR AREAS? I HEARD SOME POTENTIAL INDUSTRY PARTNERSHIPS, SOME THINGS ON PRECISION MEDICINE, ON, YOU KNOW, TECHNOLOGIES, WHERE HAVE WE SEEN AREAS OF THEMES THAT YOU ALL WOULD LIKE TO HAVE HIGHLIGHTED? RALPH? >> THE PRECISION MEDICINE, I THINK THE ISSUE OF HOW DO YOU FIGURE OUT WHAT IS RIGHT FOR A GIVEN PERSON, YOU KNOW, GIVEN THEIR NEEDS AND THEIR PROGNOSIS, TAILORING IT TO THE PERSON AND GETTING THE -- YOU KNOW, OPTIMIZING THE OUTCOMES, THAT IS SUCH AN ESSENTIAL PART OF WHAT WE DO AND PRECISION MEDICINE IN A WAY, PERSONALIZED MEDICINE, THAT MIGHT BE WORTH GOING INTO IN A PARTICULAR SESSION. >> GREG? >> I THINK ONE RECENT EXAMPLE THAT COMES TO MIND IS THE TRANSFORMATIONAL CHANGE THAT HAS COME WITH SPINONEUROMUSCULAR AND GENE HEALTH. YOU HAVE THE FIRST GENE THERAPY APPROVED BY THE END OF THIS MONTH, AN APPROVED FDA THERAPY. AND THEN WE HAVE TO ADDRESS THE ISSUES OF THESE PATIENTS ARE BEING TREATED THROUGHOUT THEIR LIFESPAN. SO YOU CAN TREAT AN INFANT AND PREVENT A LOT OF DISABILITY, THEY STILL DEVELOP MOBILITY IMPAIRMENT BUT WE'RE ALSO TREATING PATIENTS WHO ARE QUADRAPARATIC AND WEAR HAS AND THAT TECHNOLOGY. THEN YOU GET INTO PATIENTS WHO ARE VENTILATORY DEPEND DENT SO THERE ARE ALL THESE REHABILITATION ISSUES THAT STILL GET INTERWOVEN OFFER THIS CURATIVE-TYPE THERAPY THAT GETS SORT OF ESSENTIALLY ADMINISTERED TO A PATIENT THROUGHOUT THE LIFESPAN OF THE DISEASE. AND I THINK THE -- YOU KNOW, I NEVER DREAMED THAT WE WOULD SEE A THERAPEUTIC IN TERMS OF A PRECISION HEALTH APPROACH THAT WOULD HAVE THE KIND OF OUTCOME WE ARE SEEING BUT WE STILL HAVE ALL THESE REHABILITATIVE ISSUES TO ADDRESS IN THIS POPULATION. SO I THINK THAT WOULD POTENTIALLY BE REALLY A QUITE EXCITING PRESENTATION THAT COULD REALLY, YOU KNOW, INTERWEAVE THE REHABILITATION ASPECTS TO THE PRECISION HEALTH ASPECTS AND ALSO IT CUTS ACROSS THE ENTIRE LIFESPAN OF PEOPLE WITH MOBILITY IMPAIRMENT. >> USING THE SPORTS ANALOGY, WE COULD THINK IN TERMS OF PERFORMANCE HEALTH REHAB STYLE, OPTIMIZING PERFORMANCE AND HEALTH OVER THE LIFESPAN BECAUSE THAT WILL CUT ACROSS ALL THE FUNCTIONAL GOALS WE RETEAM TALKED ABOUT THAT ARE ANCHORED IN HEALTH AS WELL AS MUSCULOSKELATAL PERFORMANCE. I BELIEVE THAT OPTIMIZING FUNCTION IS A UNIVERSAL DESIRE WITHIN THE REALM OF REHAB MEDICINE AND HOW CAN WE MOVE IT DOWN THAT CORRIDOR. >> YOU KNOW, EVEN LIKE ADAPTIVE FITNESS OR PHYSICAL THERAPY FOR PREVENTIVE OR INCREMENTAL OUTCOMES, LIKE THAT'S -- WOULD PROBABLY BE WORTH HAVING SOME CONVERSATION ABOUT AND WE HAVEN'T REALLY BROUGHT THAT UP YET. >> SO I COME BACK TOO TO THE IMPLEMENTATION SCIENCE PIECE BUT THE METHODS OF HELPING PEOPLE UNDERSTAND WHAT THAT INVOLVES I THINK ARE STILL LIVELY OR UNDER APPRECIATED OR UNKNOWN IN TERMS OF AN AREA FOCUS. >> SO LET ME DO A FOLLOW UP QUESTION TO THAT. IS IT DEMONSTRATING WHAT CAN BE DONE IN IMPLEMENTATION TRIAL IN TERMS OF OUTCOMES? IS IT REALLY JUST GIVING PEOPLE AN OVERVIEW OF THE SCIENCE? IS IT HOW DO WE TRANSFORM PRACTICE, GIVE ME A SENSE OF WHAT YOU WOULD WANT TO SEE. >> I THINK THERE IS A LACK OF UNDERSTANDING ABOUT HOW TO GO ABOUT IMPLEMENTATION SCIENCE IN TERMS OF THE METHOD LOGICAL ASPECTS OF IT AND THE BARRIERS SO MAYBE GIVING PEOPLE AN APPRECIATION FROM JUST THE METHODS WITH REHABILITATION BECAUSE THERE ARE IN OTHER REALMS BUT NOT IN OUR FIELD, THAT WE COULD BUILD FROM. >> SO THAT BRINGS TO MIND GIVEN THE THINGS WE HAVE TALKED ABOUT HERE, MAYBE THINKING ABOUT THINGS FROM THE PERSPECTIVE ACROSS THE WHOLE SPECTRUM OF TRANSLATION. HOW DO YOU GET FROM THE PRE-CLINICAL IN THE SMALL ANIMALS TO THE LARGE ANIMALS AND FROM THE LARGE ANIMALS TO HUMAN LAB-BASED STUDIES AND THEN FROM LAB-BASED STUDIES TO THE CLINIC AND THEN GETTING THE CLINICAL IMPLEMENTATION TO BE AS EFFECTIVE AS IT COULD BE. >> FROM PRECLINICAL TO COMMUNITY, THAT WHOLE THAT TRAJECTORY. >> I THINK IN TERMS OF BUILDING ON THE CONCEPT AND IMPLEMENTATION OF THOSE. >> RICHARD? >> ALMOST WHETHER IT IS FROM GETTING HERE TO THERE OR BENCH TO BEDSIDE, I MEAN, IF YOU START THINKING OF ALL THE CHALLENGES AND THE OBSTACLES AND AGAIN, WE HAVE COMMUNITY ENGAGEMENT UP THERE BUT, YOU KNOW, THE OBSTACLES TO GETTING SOMEONE WHO HAS A RIDICULOUSLY BUSY LIFE THAT WE CAN BARELY CONTEXTUALIZE TO GET THE HOUR TO DO WHAT WE NEED TO DO, TO GET A THERAPIST WHO IS UNDER TIME -- PRESSURE AND ECONOMIC PRESSURE, TO GET FROM THE DIVISIONS OF THE HOSPITALS AND WE HAVE SEEN SO MANY CENTERS THAT COME TOGETHER BECAUSE YOU DON'T HAVE A COORDINATOR SO IF YOU LOOK AT THOSE OBSTACLES ALONG THE IMPLEMENTATION PATHWAY, IT IS A NICE FRAMEWORK FOR ALL THE WORK WE DO. >> INSTEAD OF BENCH TO BEDSIDE, WE SHOULD HAVE BENCH TO BACK IN THE COMMUNITY. >> YES, IT IS ALL ABOUT TAKING IT OUT INTO THE COMMUNITY AND YOU KNOW WHEN WE THINK ABOUT TALKING ABOUT BARRIERS, I THINK IT IS EQUALLY AS IMPORTANT TO CELEBRATE THE FACILITATORS, DESCRIBE HOW WE CAN TRANSCEND THE BARRIERS AND LEVERAGE THE FACILITATORS AS WE MOVE THIS CONVERSATION FORWARD, DISSEMINATE THE INFORMATION AND LOOK AT THE ELEMENTS OF IMPLEMENTATION SCIENCE. WE HAVE TO TALK ABOUT WHAT WORKS AS WELL. >> THAT IS WHY I LIKE THE SMA MODEL. IT IS A GOOD EXAMPLE OF A SYSTEM THAT HAS WORKED. THERE HAVE BEEN SOME BASIC EXAMPLES OF BASIC SCIENCE OUT OF THE LABORATORY AND LOTS MORE TO COME AND OPPORTUNITIES THIS HAS CREATED SO WE COULD BUILD THIS AS A MODEL THAT HAD A LITTLE BIT OF LOOKING BACK AND A LOT OF LOOKING FORWARD IN A WAY OF ENGAGING NEW PEOPLE. >> ROB? >> SOMETHING FORWARD THINKING, TOO, I THINK IN THE NEXT FIVE YEARS WHICH IS THIS STRATEGIC PLANNING CYCLE, HOW IS DIGITAL HEALTH GOING TO EFFECT AND CHANGE WHERE IT EVOLVES FROM AI, AUTOMATED, DIAGNOSTIC TYPE STUFF. MIGHT BE INTERESTING TO HAVE A LITTLE ON THAT. >> I THINK TO HAVE THE QUESTION OF WHAT TOPICS WE COULD ADDRESS, WE ALSO LOOK AT THE AUDIENCE. LIKE WHO ARE WE TARGETING AS THE AUDIENCE AND THEN ONCE WE HAVE GOT THE AUDIENCE, THINK ABOUT WHAT IS IT WE WANT THEM TO TAKE AWAY FROM THIS CONFERENCE AND IF THERE ARE SPECIFIC THINGS WE WANT THEM TO TAKE, THEN MAYBE WE SHOULD BUILD THAT -- THOSE THINGS INTO THE CONFERENCE SO THAT THE AUDIENCE WILL HAVE AN IDEA FROM THE BEGINNING TO THE END AND THEN WE CAN MAKE SURE THAT THE END OF THE CONFERENCE TERMINATE INTO WHAT IT IS WE WANT THEM TO TAKE AWAY AND DO. YOU KNOW, THERE ARE SOME TECHNOLOGIES THAT ALLOW PEOPLE TO DO THINGS LIKE BUILD CONNECTIONS AND PARTNERSHIPS SUCH AS COGNITIVE CITIES AND DESIGNS AND WHEN INTRODUCED EARLY, PEOPLE GET AN IDEA HOW TO USE THEM AND HOW THEY ARE GOING TO USE THEM AT THE END OF THE CONFERENCE AND THE SUCCESS RATE BECOMES A LITTLE BIT HIGHER BECAUSE PEOPLE KNOW WHAT THEY WILL DO SO AT THE END OF THE CONFERENCE, THEY ARE ABLE TO USE THOSE TO MAKE THE QUESTIONS INSTEAD OF TRYING TO FIND OUT WHAT THEY NEED TO DO AFTER THEY FINISH THE CONFERENCE. SO I WOULD -- THAT SHOULD BE SOMETHING BUILD INTO THE CONFERENCE SO PEOPLE KNOW WHAT TO DO WITH THE OUTCOME. >> OKAY, WHEN WE THINK ABOUT WHO THE AUDIENCE IS, WHEN I AM LISTENING TO THE CONVERSATION RIGHT NOW, WE'RE INVITING CHANGE AGENTS TO BE PRESENT FROM ACROSS THE SPECTRUM, WHETHER IT IS CONSUMERS, CLINICIANS OR RESEARCHERS AND SO ANYBODY WHO IS WILLING TO BE PART OF REIMAGINING REHAB MEDICINE SHOULD HAVE A SEAT AT THE TABLE AND YOU KNOW THAT IS WHO WE'RE GOING AFTER BECAUSE THEY CAN GET THE INFORMATION THAT WE'RE TRYING TO DISSEMINATE OUT AS WELL AS TAKE IT OUT INTO THE COMMUNITY WITH THE IMPLEMENTATION SCIENCES WE'RE SPEAKING OF TODAY. BUT PEOPLE WHO WANT TO HAVE DISRUPTIVE ENGAGEMENT, IS THAT WHAT BETH WAS SAYING, BE PART OF MOVING THE PUCK FORWARD OR SKATING TO WHERE THE PUCK IS BUT PEOPLE WHO ARE WILLING TO BE PART OF CHANGE, NOT JUST HEAR ABOUT IT AND NOD. >> OKAY, SO WE DEFINITELY HAVE SOME EMERGING THEMES BUT IT SOUNDS LIKE YOU WANT TO BE FOLLOWING ON THE SCI2020, WE WANT TO BE A LITTLE DISRUPTIVE AND PUSH FROM A NUMBER OF PERSPECTIVES. SO PUSH FROM A PRECISION, TECHNOLOGY PERSPECTIVE, IMPLEMENTATION PERSPECTIVE AND THEN MY QUESTION WITH THAT IS HOW DO WE ENABLE IT, RIGHT? SOME OF THESE THINGS, WE MAY NOT HAVE READY EXAMPLES. SOME, WE MAY, AND SOME, WE MAY NOT, RIGHT? SO YOU GAVE US THE SMA EXAMPLE BUT WE MAY NOT HAVE, YOU KNOW, READY-MADE EXAMPLES IN SOME OF THE AREAS WE JUST TALKED ABOUT. HOW OPEN ARE WE TO LOOKING AT OTHER FIELDS? DO WE WANT TO BRING THAT IN AND HAVE A DISCUSSION WITH THE REHAB PERSPECTIVE? SO THE APPROACH IS GOING TO BE A LITTLE BIT DIFFERENT, TOO. IF YOU INVITE IN FROM OTHER FIELDS, THE OTHER PIECE OF IT IS YOU BRING IN THE COLLABORATION BUT WE MAY HAVE TO FORCE THAT A LITTLE BIT AND MAY HAVE TO INTRODUCE SORT OF A PANEL OF, YOU KNOW, AN INDIVIDUAL WHO IS BRINGING IN SCIENCE WITH THE DISCUSSION ABOUT APPLICATIONS TO REHAB BUT IT MAY NOT BE A ONE TO ONE FIT. OR WE CAN EXTEND OUT A LITTLE BIT AND SEE WHAT WE CAN FIND OUTSIDE OF NIH, RIGHT? NOT BE PAROCHIAL AND INTENSIVE ON A NIH FOCUS. SO NAOMI AND THEN ROBYN. WE NEED TO HIT THAT -- IT IS THE SWITCH THERE, NAOMI, IF YOU PUSH... >> JUST A LITTLE PIECE OF HISTORY BECAUSE I WAS GOING TO DO THIS AT BREAK BUT SINCE YOU JUST BROUGHT IT UP, WITHIN A WEEK OF WHEN I JOINED NINDS, I WAS INVITED TO A CONFERENCE THAT DISCUSSED THE INITIATIVE SO NOW THAT YOU HAVE RAISED THIS, I WANT TO MAKE YOU AWARE THAT THE GENE THERAPY THAT BRIAN CASPER ULTIMATELY SUCCEEDED IN WAS NOT ACTUALLY ONE OF THAT CONTACTS DIRECT ORIES BUT THERE WAS THE SMA CONTRACTS THAT WOULD ACTUALLY BE A GREAT FRAMEWORK TO DISCUSS HOW NIH REALLY WAS A SHAKER AND MOVER ON THAT AND I DON'T THINK BRIAN'S WORK WOULD HAVE GONE WHERE IT DID IF THE REST OF THE -- >> WELL, THERE WAS THE NEURO-NEXT NETWORK -- >> WELL, THAT BECAME PART OF IT BUT IN TERMS WHAT HAVE YOU JUST RAISED AND I AM MEANING THIS AS A VERY POSITIVE STATEMENT, THERE IS A NIH HISTORY TO THAT EXAMPLE AND KIND OF INTERESTING THAT HOW MANY PEOPLE IN THE ROOM EVEN KNEW THAT NIHDS HAD THAT INITIATIVE? SO WHAT A PERFECT EXAMINER. EVEN THIS DISCUSSION IS BUILDING COLLABORATION WITHIN NIH TO BUILD ON WHAT I THINK IS AN INCREDIBLE SUCCESS STORY. BASICALLY WHAT WE DID IN THE INITIAL PLANNING DISCUSSION IS TO SAY HOW CAN WE SPEED THIS UP, GO THROUGH A CONTRACTOR TO GET THE GRANTS OUT A BIT MORE CONVICTLY, TO HAVE THEM BE A BIT MORE DIRECTED SO SOMETIMES SCIENCE CAN DO THINGS A LITTLE DIFFERENT WHEN THERE IS AN OPPORTUNITY AND BUILD ON THAT. BUT THEN WOULDN'T IT BE TERRIBLE IF WE HAD NOT JUST HAD THIS DISCUSSION AND THE REHAB SIDE OF MAKING THIS SO MUCH MORE SUCCESSFUL FOR PEOPLE WOULDN'T HAVE HAPPENED SO THERE IS A HUGE STORY THERE TO TELL. >> WELL, ABSOLUTELY AND THE MULTICENTER NINDS FUNDED NATIONAL HISTORY STUDIES, END POINT DEVELOPMENT THAT ENABLED THE CLINICAL TRIALS AND NOW I AM TREATING PATIENTS WHO ARE QUADRAGERATIC WHO ARE USING WHEELCHAIRS AND HAVE COMMUNICATION CHALLENGES AND THE ASPECTS HAVE NOT GONE AWAY FROM THIS POPULATION EVEN THOUGH THE PRECISION HEALTH HAS HAD A HUGE TRAJECTORY AND IMPACT ON THE DISEASE SO I THINK THAT WOULD BE A REALLY GREAT EXAMPLE. GETTING BACK TO THE TECHNOLOGY ISSUE, DAVE TALKED ABOUT ISSUE AS SORT OF THE EXTENSION OF THE HUMAN CONDITION AND INTEGRATION AND TECHNOLOGY AND OUR HEALTH SYSTEM HAS THIS ANY IF I HAVE OF HEALTHY AGING IN A DIGITAL WORLD AND THEY ARE SORT OF POINTING TO THE ENTIRE WORLD AND I THINK YOU COULD APPLY THAT CONCEPT HEALTHY AGING IN A DIGITAL WORLD TO A POPULATION WITH DISABILITIES THAT CUT THE LIFESPAN AND HAVE UNIQUE ASPECTS TO A DISABLED POPULATION. >> ROBYN? >> TO YOUR EARLIER QUESTION, I MEAN IT, DOES SOUND LIKE WE'RE LOOKING FOR A LOT AND YOU SAY SHOULD WE BE LOOKING OUTSIDE OF REHAB AND I THINK WE HAVE NO CHOICE BUT TO LOOK OUTSIDE REHAB AND IF WE'RE GOING TO -- TO INDIRA'S POINT, IF WE'RE LOOKING FOR BARRIERS AND FACILITATORS, THERE MAY BE SIMILARITIES THERE EVEN THOUGH IT IS A DIFFERENT AREA AND TO ROB'S POINT OF EPIC FAILURES, THERE MAY BE GOOD EXAMPLES OF HOW THEY OVERCAME THE BARRIERS AND REALLY GOOD DISSEMINATION STRATEGY SO I THINK IT WOULD BEHOOVE US TO LOOK OUTSIDE OF REHAB FOR SOME REALLY GOOD EXAMPLES OF WHAT WORKED AND WHAT DIDN'T. >> SO KAREN, THAT IS A GOOD SEGUE TO MENTION THE PROGRAM WE HAVE IN THE VA, THE QUALITY ENHANCED RESEARCH INSTITUTE OR QUERY -- >> YES. >> AND THAT IS A PROGRAM ASSOCIATED WITH THE OFFICE OF RESEARCH MBA BUT FOCUSSED ON THE PATIENT CARE SIDE LOOKING AT METHODS OF IMPLEMENTATION AND IMPLEMENTATION ITSELF WITHIN THE VA TAKING SOME OF THE RESEARCH FINDINGS OF THE INVESTIGATIONS THAT WE SUPPORT AND TRANSLATING THE RESULT OF THAT RESEARCH INTO THE HEALTHCARE SIDE. SO THAT IS A GOOD EXAMPLE WHERE IT IS NOT PARTICULAR TO REHABILITATION BUT IT IS TAKING HEALTHCARE STUDIES AND TRANSLATING THAT INTO A HEALTHCARE SYSTEM SO THAT IS A PROGRAM TO BE AWARE OF IF LOOKING FOR EXAMPLES OUTSIDE REHAB. >> OKAY, SO LET ME ASK THIS OTHER QUESTION BEFORE I MOVE TO VOLUNTEERS. I ASKED YOU ABOUT ENGAGING THE COMMUNITY. WE HAVE TALKED ABOUT ENGAGING PEOPLE WITH DISABILITIES, ENGAGING PEOPLE OUTSIDE OF REHAB. WHAT ARE WE DOING IN TERMS OF ENGAGING YOUNG INVESTIGATORS? HOW ARE WE PERSUADING A NEW GENERATION OF SCIENTISTS THAT MAY NOT BE LOOKING AT THIS AS AN AREA OF GROWTH? HOW ARE WE GETTING THEM EXCITED? AND WHERE ARE WE GETTING THEM? WHERE IS THE HOOK? HOW DO WE ENGAGE THEM? OTHER THAN BY RAISING THE BLINDS MYSTERIOUSLY. DAVID? >> THERE IS THE K PROGRAMS WHERE YOU CAN INVITE THE K TRAINEES TO ORGANIZE A SESSION, WOULD BE ONE IDEA. K-12, LIKE WITH THE ASSISTANT PROFESSORS AND THERE IS THE -- [INDISCERNIBLE] >> SO K-12 THROUGH OUR EXISTING PROGRAMS BUT I AM EVEN THINKING POTENTIALLY YOUNGER THAN THAT. [ OFF MIC ] >> I DON'T KNOW, HOW YOUNG YOU WANT TO GO? AND MY QUESTION IS I THINK ABOUT IT FROM THE PERSPECTIVE OF HOW DO WE GET THE YOUNGER GENERATION TO THINK ABOUT THIS AS A FIELD OF SCIENCE THAT THEY WANT TO GO INTO? I MEAN, WE JUST DID TAKE YOUR CHILD TO WORKDAY AT NIH, RIGHT, AND WE DID A LIVE STREAM BASED ON SOME OF THE WORK TO BE DONE AND PETER PIDCOE AND WE HAD A GROUP OF 25 KIDS IN THE ROOM, AGES 9-15 RIGHT? AND WHEN HE DID THIS DEMONSTRATION OF ROBOTIC DEVICES FOR BABIES, THEY WERE LIKE WHAT? YOU ARE GOING TO PUT A BABY ON THAT THING AND WHAT HAPPENS IF THE BABY GOES DOWNSTAIRS, COULD YOU PUT IT ON ANIMALS, I MEAN, THEY WENT EVERYWHERE WITH THIS THING, COULD YOU TEACH A DOG TO WALK IF IT WASN'T WALKING AND REALLY TALKING ABOUT THE TECHNOLOGY, THE MOTHER BOARD SORT OF PIECE OF THIS, TALKED ABOUT FORCES AND TRAINING MOTOR AND THESE KIDS' EYES LIT UP AND IT WAS ONE OF THOSE THINGS AND REMINDS ME, I WANT DID ANOTHER ONE ON ROBOTIC PROSTHETICS AT A CHARTER SCHOOL, 3RD AND 4TH GRADERS AND I DID -- IF ANY OF YOU HAVE USED THE BACKYARD BRAIN SYSTEM, I DID TWO ELECTRODES AND I HAD ONE OF THE KIDS CONTROL MY HAND WITHOUT LOOKING AT IT AND THEY WERE LIKE WHAT? IT IS NOT JUST SOPHISTICATED SCIENCE, AS A $75 TOY THING BUT THEY THOUGHT IT WAS AWESOME AND YOU GET FOUR OR FIVE KIDS, CITED ABOUT WHAT COULD YOU DO WITH THAT, YOU ARE GROWING THE FIELD IN A DIFFERENT WAY AND I AM JUST TRYING TO THINK ABOUT SOMETHING DIFFERENT TO BRING WHERE, YOU KNOW, K-12'S ARE ALREADY IN, RIGHT? AT LEAST WE HOPE THEY ARE. BUT I JUST WANT TO THINK ABOUT ENGAGING DIFFERENTLY. >> JUST A -- YOU KNOW, I GET A LOT OF HIGH SCHOOL STUDENTS WHO WANT TO WORK IN MY LAB AND I AM AMAZED AT HOW MANY PROSTHETIC ROBOTIC 3D PRINTED HANDS HAVE BEEN BUILT IN THE U.S. BY HIGH SCHOOL STUDENTS. IT HAS TO BE LIKE 100,000 OR MORE AND SO YOU HAVE KIND OF THE GO-TO PROJECT FOR A HIGH SCHOOL, YOU KNOW, ENGINEERING, PRE-ENGINEERING STUDENTS, IS A REHAB PROJECT AND VERY FEW OF THEM END UP GETTING USED AS PROCESS SHED TICK HANDS BUT THAT IS WHAT THEY ARE DECLARED TO BE, LIKE I MADE THATTH AS A PROSTHETIC HAND. SO THINKING ABOUT THAT, IF YOU HAVE A HUNDRED THOUSAND HIGH SCHOOL STUDENTS WHO MADE A REHAB PROJECT AS THEIR ENTREE INTO STEM, HOW DOES THAT TRANLATE INTO KEEPING THEM IN REHAB? THERE MAY BE A LEVEL OF DISAPPOINTMENT THAT I MADE THIS THING AND NEVER MADE IT TO BE USEFUL FOR SOMEONE WITH A DISABILITY. >> DO THEY SEE IT AS A REHAB PROJECT? >> THEY DEFINITELY TALK ABOUT IT AS BEING A PROSTHETIC HAND AND THEN LIKE ANOTHER KID THEY ARE BUILDING IT FOR. >> DO THEY SEE IT AS A REHAB PROJECT? THE HAND IS AN ENGINEERING PROJECT BUT I THINK THERE IS A SPECIFIC IDENTITY HERE. >> SOME OF THE CLASSES MAY HAVE A CLIENT THEY ARE BUILDING IT FOR AND PUT IT ON THE -- IT DOESN'T SEEM TO GET TO RIGOROUS TESTING WITH ANYONE. I MEAN, THE MATERIALS ARE PROBABLY NOT -- >> ONE OF THE THINGS I HEARD YESTERDAY THAT WAS MOST STRIKING WAS NAOMI DOING THINGS THAT SOUNDED OVERTLY LIKE REHAB BUT THEY WEREN'T CALLING IT REHAB AND I AM WONDERING IF WHAT WE NEED TO DO IS CHANNEL SOME OF THIS ENERGY THAT STUDENTS HAVE ABOUT BUILDING DELIVERABLES INTO SOMETHING THAT IS REHAB ORIENTED. THEY MAY BE DOING IT BUT NOT THINKING OF IT THAT WAY. >> ROB? >> YEAH, YOU KNOW, THIS KEEPS -- I AM THINKING ABOUT THE FIRST ROBOTICS CHALLENGE THAT A LOT OF YOU -- IT IS A HIGH SCHOOL KIND OF COMPETITION WHERE THEY GO TO ROBOTICS IF YOU DON'T KNOW WHAT IT IS BUT I AM WONDERING IF NCMRR COULD DO SOMETHING LIKE THAT WHERE YOU BUILD IT OUT FOR HIGH SCHOOLS AND UNDER GRADUATES. BE KIND OF COOL. >> WE CAN -- SO AGAIN, IT IS JUST -- PART OF IT IS WHAT YOU GUYS ARE TALKING ABOUT, TELLING A NEW STORY, BRINGING IN PARTNERS, BRINGING IN ENERGY, AND I WANT TO THINK ABOUT IT FROM DIFFERENT PERSPECTIVES. WE FIRST HAD 800 CHALLENGES ACROSS THE COUNTRY. THAT IS AN EASY POOL OF SCIENTISTS TO GET EARLY AND THEY MAY NOT BE ROBOTICISTS LATER ON BUT THEY AT LEAST HAVE THAT BUG. THEY ARE DOING ANOTHER ONE ON BIOFABRICATION NOW, SAME GROUP. SO THOSE KIDS ARE OUT THERE. I AM JUST TRYING TO THINK OF NEW AND INTERESTING WAYS TO GET SOME ENGAGEMENT AND GET SOME FOLKS INTERESTED IN BRANDING THE SCIENCE THAT WAY. RICHARD? >> TWO THINGS. LIKE MICROSOFT HAS THEIR ANNUAL HACKATHON AND A LOT OF THOSE HAVE THAT. IT WOULD BE PRETTY EASY TO GIVE THEM A BUZZ AND SAY WE WANT TO HAVE ONE PROJECT SPONSORED BY NARMRR AND HAVE SOME TALKING OR THINK ABOUT THAT AND MICROSOFT IS THE ONE THAT IS THE BEST BUT ALL OF THOSE GUYS HAVE THAT SORT OF THING. AND THE OTHER THAT ROBYN WAS TALKING ABOUT, STAR WARS DAY, BE A PRETTY COOL THING TO HAVE A PROJECT TO BRING FUTURE TECH TO THIS AND THINK OF IT AS A PRODUCT DELIVERABLE THAT REALLY IS COOL BECAUSE THERE IS SO MUCH REHAB, I MEAN, FROM DARTH VADER'S MASK, THE HAND AND SO FORTH AND MAKE IT SOMETHING FOR THE YOUNG KIDS AND IN NEW YORK CITY, THERE ARE ALL THE INDEPENDENT SCHOOLS, MY DAUGHTER IS WORKING IN A BIOLOGY LAB BUT KIDS ARE ALWAYS LOOKING FOR THOSE SORT OF THINGS SO IF YOU BROUGHT IN A NETWORK OF LABS, HAD A GEOGRAPHICAL BREAKDOWN, SEND OUT A CALL FOR SUBMISSIONS, LIKE LEARNING EXPERIENCES THAT KIDS WOULD BE WOWED WITH AND I THINK YOU COULD RIDE ON THAT INFRASTRUCTURE THAT ALREADY EXISTS AND THOSE ARE THREE THINGS. LOVE IT. >> SO I FEEL LIKE WE HAVE GOTTEN SOME REALLY GOOD IDEAS FRAMEWORK AND I APPRECIATE THE DISCUSSION BECAUSE I DO THINK WE HAVE SOME AREAS TO FOCUSES ON WHOEVER VOLUNTEERS FOR THIS PARTICULAR PROJECT AS A SUBCOMMITTEE MEMBER. I PROMISE WE WOULD HOLD A LITTLE BIT OF TIME. THERE ARE TWO SUBCOMMITTEES THAT WE WILL FORM THAT WILL BE REPORTING BACK TO THIS GROUP. THE FIRST WILL BE ON THE RESEARCH PLAN, THE SECOND ON THE CONFERENCE. MY THINKING IS THAT THE CONFERENCE GROUP MAY NEED A LITTLE BIT MORE FREQUENTLY IN THE INITIAL TO GET THE AGENDA AND THE FRAMEWORK SET. THE PLAN MAY NEED A LITTLE LESS FREQUENT IN THE BEGINNING, MORE FREQUENTLY TOWARDS THE END. I AM THINKING PROBABLY THE COMMITMENTS ARE FOR THE CONFERENCE, TWO TO THREE CALLS BETWEEN MEETINGS INITIALLY. THE PLAN, PROBABLY ONE TO TWO BETWEEN THE NEXT MEETING AND THEN A LITTLE MORE FREQUENT AS WE MOVE TOWARDS COMPLETION. NEVER MONTHLY, I DON'T THINK, PROBABLY TWO TO THREE AGAIN IS THE FREQUENCY AND MEET EVERY SIX MONTHS. SO WHO THEN WOULD BE WILLING TO BE OUR TRUSTY VOLUNTEER? I WILL START WITH THE PLAN AND THAT WOULD BE REALLY ADVISING US ON THE FRAMEWORK OF THE PLAN, METHODS BY WHICH TO ADVICE, CONTENT WE MAY WANT TO INCLUDE AND THEN REVIEWING DRAFTS. SO BARBARA? TRICIA? JENNIFER? WE WILL START WITH THAT GROUP. WE WILL ALSO SOLICIT SOME OF OUR NEW MEMBERS IN DECEMBER. RESEARCH CONFERENCE VOLUNTEERS. SO ART, EDDIE, ROB AND CRAIG. OH, WOW. AND THEN DAVID AND RICHARD -- I THINK WE CAN CONTINUE TO -- I WILL FIND OUT BECAUSE YOUR TERM IS ENDING SO I WOULD HAVE TO FIGURE IT OUT BUT MAYBE WE CAN PICK YOUR BRAIN EVERY SO OFTEN FROM A GRAND PERSPECTIVE, AN IDEA GENERATOR. SO WE HAVE ART, EDDIE, ROB AND CRAIG. SO WE WILL STILL HAVE THESE DISCUSSIONS AROUND THE PLAN AND THE CONFERENCE AND IN THESE SESSIONS AS WELL SO DON'T FEEL LIKE YOU ARE GOING TO BE SEPARATED FROM EITHER. THERE WILL BE UPDATES AND DISCUSSIONS IN THESE MEETINGS. ANY FINAL THOUGHTS WITH RESPECT TO CONFERENCE PLANNING OKAY, SO I HAVE MY PEOPLE THAT ARE GOING TO BE WORKING WITH US. I AM EXCITED ABOUT IT. WE WILL START BY SAYING THERE ARE SOME MEETINGS ON THIS AND THINK ABOUT AGENDA DRAFTING ESPECIALLY SO THE CONFERENCE IS MOVED TOWARDS GETTING THAT APPROVED FOR OCTOBER 2020. SO WHAT WE WILL DO NOW, WE HAVE A BREAK NOW, CORRECT? SO WE WILL COME BACK AT, WHAT, 10:15? ALL RIGHT, SO WE WILL COME BACK AT 10:15 AND BE READY FOR A COUPLE MORE PRESENTATIONS AND THEN COMMENTS FROM OUR REQUIRING MEMBERS. >> THANK YOU FOR THE CHANCE TO PRESENT TO YOU GUYS AND VERY INTERESTED IN GETTING FEEDBACK. IT'S A RARE OPPORTUNITY TO HAVE THIS GROUP OF PEOPLE LOOK AT TALK LIKE THIS. SO PLEASE INTERJECT AND GIVE FEEDBACK. I WOULD LOVE THAT. SO I'M GOING TO TALK MOBILE DEVICES TO EXTEND THE REACH LOCATION. THIS IS A PICTURE OF MY LAB SHOWING YOU DEVICES WE WORKED ON. SOME OF THE STUFF WE DEVELOPED HAS BEEN COMMERCIALIZED. IS THAT MIC WORKING? CAN YOU GUYS HEAR? OKAY. SO I HAVE POTENTIAL CONFLICTS OF INTEREST AND THAT'S BEEN DISCLOSED, MY UNIVERSITY HELPS MANAGE THAT. WHAT DO YOU IMAGINE WHEN YOU THINK OF A MOBILE DEVICE TO EXTEND REACH OF REHABILITATION? WHAT IS IT? WHAT COMES TO MIND? WAS THAT YOUR IMAGE? ARE I WANT TO SHOW YOU FROM THE HUMAN ROBOTICS COMPETITION. I THINK I CAN DO IT JUST REMEMBER TO PUSH THAT. THAT'S NOT WORKING. SO THIS WAS THE DRPA HUMAN ROBOTICS COMPETITION IN 2015. SIMULATING (INAUDIBLE) >> I LIKE TO MAKE THE JOKE WHEN I STARTED WORKING AT ROBOTICS FOR REHABILITATION IT WAS ALREADY GOING TO TAKE JOBS FROM REHABILITATION THERAPISTS. ACTUALLY WE ARE CREATING A NEW FIELD OF FOR PHYSICAL THERAPISTS TO PROVIDE CARE TO ROBOTS. SO I GOT IN THE FIELD WHEN I HAD A FRIEND WITH CEREBRAL PALSY WHO NEEDED HELP COOKING AND EATING AND I THOUGHT COULD YOU BUILD A ROBOT TO HELP SOMEONE BE LIKE AN AID. VERY DIFFICULT PROBLEM. YOU CAN SEA SEE IT'S STILL A DIFFICULT PROBLEM. WE ARE SEEING,'S BEEN A RESURGENCE OF ROBOTICS COMPANIES BUT A LOT ARE NOW SHUTTING DOWN WHICH IS REALLY ASTONISHING. THIS ONE SOLD ABOUT A MILLION ROBOTS BUT THESE LITTLE HOME ROBOTS BUT SO THIS IDEA OF A ROBOT THAT CAN ASSIST YOU IN DOING YOUR TASKS OF DAILY LIVING IS STILL OUT THERE. SO WHAT HAS WORKED, THERE'S BEEN MORE PROGRESS IS IN WEARABLE DEVICES. I LIKE TO THINK OF IT ON A COUPLE OF AXE SERKS. ON THE BOTTOM HERE YOU HAVE ASSISTIVE VERSUS THINGS THAT MEASURE. SO THINGS APPLYING FORCES TO HELP GET THINGS DONE AND THINGS MEASURING. AND THEN YOU HAVE A LAB BASED GOING OUT INTO THE COMMUNITY. I WORKED, THIS INVENTION CAME FROM MY LAB HERE, WE'LL TALK ABOUT THAT BRIEFLY. AND -- BUT TODAY I'LL FOCUS ON THE HOME AND COMMUNITY. I DO WANT TO MENTION I THINK THIS UPPER EXTREMELY ASSISTIVE DEVICE, I HAVE THE WORK WE DID DOES HERE A 3-D PRINTED SKELETON FOR KIDS WITH SHOULDER WEAKNESS. THAT'S PROBABLY THE BEST EXAMPLE OF SOMETHING THAT'S WORKED BUT THAT IS A HARD PROBLEM BECAUSE HOW DO YOU ANCHOR IT TO THE BODY. WEAR -- HOW DO YOU WEAR SOMETHING WITH YOUR ARM MOVEMENT, I WAS TALKING WITH KENT AND HE'S WORKING ON THAT PROBLEM SO INTERESTING IDEAS ON THAT. SO WHAT I'LL GIVE YOU TODAY IS JUST A BRIEF OVERVIEW OF MOBILE REHABILITATION. THEN I GOT TO GIVE YOU -- I GOT TO GIVE YOU SEVEN IDEAS ABOUT UP PER EXTREMITY REHABILITATION IN SEVEN MINUTES. THINK IT'S A CONTEXT FOR -- I WILL TALK MAINLY MOBILE DEVICES FOR STROKE REHABILITATION SO I GOT TO GIVE YOU THE SCIENTIFIC CONTEXT, THE WAY I'M THINKING BASED ON RESULTS AROUND THE WORLD AND OUR OWN LAB. SO SO THEN I'LL GIVE YOU PERSONAL EXPERIENCE TOWARDS COMMERCIALIZING CONSUMER STROKE REHABILITATION TECHNOLOGY. AND SHOW YOU WHERE WE ARE WITH THAT. THE CLASSIC PAPERS IS THIS PAPER BY PATEL THAT CAME OUT, STUDY INVOLVED WITH NSF WHERE WE LOOK AT MOBILITY TECHNOLOGY IN EUROPE AND WE WROTE A REPORT ON IT. BUT THIS WEARABLE REHABILITATION PAPER IS HIGHLY EXCITED PAPER FROM THAT. JUST TO GET YOUR MIND GOING, BROAD MOTIVATION IS HOW CAN WE CARE FOR INCREASING NUMBER OF INDIVIDUALS WITH COMPLEX MEDICAL CONDITIONS? HOW DO WE PROVIDE REMOTE HIGH QUALITY CARE, HOW TO MAXIMIZE THE INDEPENDENCE OF PARTICIPATION OF THE INCREASING NUMBER OF INDIVIDUALS WITH DISABILITY AND I ADDED THIS, HOW TO USE MOBILE DATA TO IMPROVE REHABILITATION SCIENCE. I THINK THAT'S A GREAT SCIENTIFIC OPPORTUNITY. WAYS WEARABLES CAN BE USED FROM THIS PAPER, HEALTH AND WELLNESS SAFETY FOR EXAMPLE FALLS T FALLS PREVENTION, ASSESSMENT OF TREATMENT EFFICACY, EARLY DETECTION. THERE'S INTEREST IN THAT. THEN BY MAIL TALK ABOUT HOME REHABILITATION. THE BIG PICTURE, THERE'S A TON OF WEARABLE TECHNOLOGY NOW, CARRYING IT AROUND ON OUR BODIES ALL TIME WITH OUR CELL PHONES. AND THEN HERE IS A LIST OF SENSORS THAT ARE AVAILABLE NOW. THAT YOU CAN -- AND SO WE'RE ALREADY CAPABLE OF GETTING DATA ON A LOT OF THINGS, JUST GOING TO KEEP IMPROVING, THERE'S GOING TO BE MORE DATA REQUIRED BUT STILL UNCLEAR WHAT TO DO WITH IT AND THERE'S A BIT OF DATA DELUGE SO YOU CAN GET WAY AHEAD BY GETTING TONS OF DATA BUT NOT KNOWING HOW IT WILL BE USEFUL. OTHER COOL STUFF I WANTED TO YOU CAN TATTOO ON IS A INTERESTING IDEA AND SENSORS BUILT INTO CLOTHING SO YOU'RE GOING TO GET MORE AND MORE SENSORRIZED POTENTIALLY IF WILLING TO HAVE THAT HAPPEN. I WANT TO MENTION FOR PEOPLE WITHOUT DISABIITIES, THERE'S PRETTY DECENT EVIDENCE, THIS IS FROM JAMA, THAT FOR EXAMPLE PEDOMETERS INCREASE PHYSICAL ACTIVITY IMPROVE DIFFICULT TO CHANGE HEALTH OUTCOMES SO SYSTEMATIC REVIEW, THE RESULTS SUGGEST THAT USE OF PEDOMETER IS ASSOCIATED WITH SIGNIFICANT INCREASE IN PHYSICAL ACTIVITY AND DECREASES IN BODY MASS. CURIOUS HOW MANY ARE USING A PEDOMETER NOW. IF YOU ARE -- SO YOU CAN SEE. THERE IT IS. INFILTRATING. YOU MIGHT HAVE IT ON YOUR PHONE IF YOU DON'T HAVE A SENSOR. AN ISSUE IS ARE -- HOW DO YOU APPLY THIS FOR PEOPLE WITH DISABILITIES, THIS IS A PAPER BY (INDISCERNIBLE) LOOKING AT DIFFERENT SENSORS AND PUTTING ON DIFFERENT LIMBS AND SEEING HOW ACCURATELY THEY COUNT STEPS FOR PEOPLE WITH INCOMPLETE SPINAL CORD INJURY AND PEOPLE WILL THE STROKE. YOU CAN SEE THAT, THERE'S UNDERCOUNTING ACTIVITY IN GENERAL. SO THEY AREN'T OPTIMIZED FOR PEEP WITH DISABILITIES YET, THAT'S A BIG ISSUE. SO I WANT TO GIVE YOU THESE SEVEN IDEAS ABOUT UP PER EXTREMELY THAT WE HAVE RELEVANT FOR WEARABLES TRY TO DO IT IN SEVEN MINUTES, I WAS GOING TO CALL THIS A STROKE SLAM OR STROKE UPPER. HERE IS THE FIRST VOLUNTEER ASKING IN OUR LAB AND I ASKED HER TO TRY TO LIFT AND TOUCH HER CHIN. YOU CAN SEE HOW DIFFICULT IT IS TO MOVE THE LIMB. REALLY INTERESTED IN THAT PROBLEM, HOW DO YOU GET INTO THAT STATE, CAN YOU GET OUT OF THAT STATE. RIGHT SIDE OF THE BRAIN, DAMAGE, LEFT SIDE AFFECTED. HERE IS A BEAUTIFUL ARTIST RENDITION OF ALL THE PATHWAYS THAT YOUR BRAIN CAN USE TO TALK TO YOUR SPINAL CORD AND MOTOR NEURAL PULSE SO WHEN I SEE THAT, WE WORKED ON COMPUTATIONAL MODELING. THE SORT OF IDEA I WANT TO GIVE YOU IS I THINK STROKE RECOVERY IS YOUR BRAIN SEARCHING PARTLY BRAIN SEARCHING FOR THE PATHWAYS THAT ARE GOING TO WORK. SO IF YOU HAVE -- SO A LESION THAT FLOWS OUT THE WHITE MATTER, BUT THERE'S OTHER PATHWAYS THAT PERHAPS YOU HAVEN'T BEEN USING BECAUSE THEY WANT THE ONES THAT WERE MOST EFFECTIVE TO USE BUT THEY ARE AVAILABLE AND YOU HAVE TO DISCOVER THOSE PATHWAYS. INDEED WHEN YOU LOOK AT BRAIN ACTIVITY, USING FMRI, HERE IS A HEALTHY CONTROL PATIENT PERSON WHO IS OPEN AND CLOSING THE RIGHT HAND. RELATIVE FOCAL ACTIVITY OVER THE HAND KNOB AREA. WHAT YOU SEE AFTER STROKE IS YOU SEE WIDESPREAD ACTIVATION ON BOTH HEMISPHERES. TO ME THAT'S REPRESENTATIVE OF A SEARCH. SO YOUR BRAIN IS LOOKING FOR ALTERNATE PATHWAYS THAT ARE AVAILABLE EVEN ON THE OTHER SIDE OF THE BRAIN, THERE'S A FEW TRACKS THERE THAT DO HELP YOU OUT. SO WE MODELED THIS AS A SEARCH. THING IS, IT'S A SEARCH THAT HAS A DIFFICULT REINFORCEMENT LEARNING PROBLEM WHICH IS THAT SO YOU ARE GETTING -- DID I MOVE MY HAND BETTER OR NOT. FROM THAT YOU HAVE TO ADJUST THE ACTIVITY OF MILLIONS OF NEURONS. SO YOU HAVE ONE VARIABLE AND THEN YOU GOT A MILLION ADJUSTMENTS THAT TUCK MAKE SO CREDIT ASSIGNMENT PROBLEM. HOW DO YOU ASSIGN CREDIT TO ONE THAT HELPS YOU AND YOU CAN SOLVE THAT CREDIT PROBLEM THROUGH REINFORCEMENT LEARNING BUT YOU HAVE TO DO A LOT OF TRIALS IN ORDER TO SOLVE THAT. THAT'S WHERE REHAB COMES IN. THE OTHER DIMENSION THIS IS A STUDY FROM (INDISCERNIBLE) IN RATS, SHOWING YOU HAVE A PROLIFERATION OF DENDRITIC SPINES WHEN RATS ARE GETTING REHAB WHICH IS DEFINED HERE AS DOING -- SO YOU GET STRUCTURAL CHANGES TO NEURONS ADS WELL SO NOT ONLY IS IT A SEARCH FOR NEW PATHWAYS BUT YOU ARE THROUGH REHAB CHANGING THE STRUCTURAL OF THE PATHWAYS AND CONNECTIVITY OF THE PATHWAYS THROUGH REHAB. THAT NEEDS TO BE SHAPED T. AMAZINGLY WE STILL DON'T KNOW HOW MUCH DOSE IS ENOUGH. SO THE BEST EVIDENCE COMES FROM RATS AGAIN, THIS WAS PUT OUT BY CORE BET'S LAB, LOOKING AT A META ANALYSIS OF STUDIES ON STROKE MODEL OF RATS THEY HAD DIFFERENT RATS, DIFFERENT REACHING PERTY IN THIS PELLET REACHING TASK YOU CAN SEE IN THIS WHAT WE ALL IMAGINE WHICH IS THERE'S A FLAT ELBOW AREA. SO YOU HAVE TO GET UP TO SOME SORT OF THRESHOLD AMOUNT OF ACTIVITY, HERE 400 REACH PER DAY, THIS IS THE LIVER FIVE TIMES A WEEK FOR TWO WEEKS. THAT WOULD BE YOUR TARGET. SO YOU THINK ABOUT HOW MANY STUDIES AND REHAB MAYBE A BIT DOWN IN THIS AREA HERE AND THEN HAVE WE GOTTEN UP INTO THIS AREA CONSISTENTLY. WHAT IS THAT AREA FOR HUMANS, THAT'S A VERY INTERESTING QUESTION AND REALLY NEEDS TO BE DEFINED BETTER. ANOTHER -- SO I THINK I'M ON THE IDEA FIX RIGHT NOW. SO THIS ONE, THIS IS A STUDY FUND BY AN RO1 FROM NCRR, WORK WITH STEVE KRAMER AND WE MADE PREDICTION THAT IF YOU GOT WE HAD A ARE PRESIDENT THAT ASSISTED YOU MOVING YOUR FINGERS AND SUBJECT PLAYED GUITAR HERO, THIRD MOST POPULAR VIDEO GAME, WE HYPOTHESIZE IF YOU DIDN'T HAVE INTACT APPROPRIATE OWE CEPTIVE FUNCTION AT BASELINE, YOU WOULDN'T BENEFIT FROM THE ROBOTIC SYSTEMS AS MUCH. THE PREMISE IS YOU HAVE SOME SORT OF HEAVY END PROCESS GOING ON WHERE YOU NEED SOMATOSENSORY FEEDBACK ROBOT HELPING DRIVE BY ASSISTING YOUR MOVEMENT. THAT'S WHAT WE FOUND, WE'LL GO THROUGH THIS SLIDE HERE, PUBLISHED NEUROLOGY BUT ESSENTIALLY WHAT WE FOUND IS AFTER STROKE THIS IS, 50% SUBJECTS PROPRIA STEPS LOSS, WE SAW WITH ROBOTIC THERAPY, SOME HAD MODERATE IMPROVEMENT. WHAT WE FOUND IS THAT BETTER PROPRIA SYSTEMS AT BASELINE BENEFIT WHO IMPROVE. THERAPISTS NOD THEIR HEADS THEY KNOW THIS BUT IT'S NOT SHOWN RIGOROUSLY BUT THERAPISTS KNOW IT, WE LOOK AT 50 MEASURES OF ANATOMY BRAIN ANATOMY AND FUNCTION, TWO CAME OUT WE HAVE LESS SENSORY SYSTEM INJURY DEFINED ANATOMICALLY AND MORE SENSORY MOTOR CORTICAL CONNECTIVITY. THOSE IN OUR MODEL PREDICTED ALONG WITH BEHAVIORAL FIGHTING IMPACT BETTER PROPRIA ACCEPT SHUN, THAT PREDICTS THE GAME. YOU SEE INDIVIDUALIZATION OF THERAPY, DEPENDING HOW GOOD SENSATION AT BASELINE, YOU SHOULD BE SENT TO DIFFERENT TYPES OF THERAPY BASED ON THAT. NOT ONLY THAT, BUT AMOUNT OF CORTICO SPINAL TRACK MATTERS AS WELL. I WANT TO -- I THIRD NEXT IDEA, THIS IS 6. THIS IS A BIG DEAL IN THE FIELD RIGHT NOW, PROPORTIONAL RECOVERY. AND PROPORTIONAL RECOVERY IS THIS IDEA YOU CAN TAKE A PERSON WHO HAD A STROKE, MEASURE THEIR BASELINE ARM IMPAIRMENT USING THE FUGERMIRE SCORE AND FROM THAT YOU CAN PREDICT WHERE THEY END UP, ABOUT 70% OF THE PEOPLE. 30%, THEY RECOVER LESS THAN YOU PREDICT. KIND OF LESION WHERE IS THE ROLE FOR REHAB, YOU CAN MEASURE BASELINE AND KNOW WHERE THEY END UP. WE HAVE DONE REANALYSIS OF THAT, WE HAVEN'T PUBLISHED SO HERE IS PERCENT, THIS IS THREE OR 400 PEOPLE WE SCAN OFF OTHER PEOPLE'S DATA SETS, SO HERE IS PROPORTIONAL RECOVERY, SO YOU HAVE THE LIGHTER COLOR HERE, THIS WOULD BE US THIS IS IMMEDIATELY AFTER STROKE, THE SCORE, COMPLETE PARALYSIS, 66 IS NORMAL MOVEMENT, SO YOU CAN SEE THIS WIDE DISTRIBUTION, THEN THESE AVAILABLE SHIFT, SIX MONTHS, THEY SHIFT SO THEY'RE HERE AND RECOVER PRETTY WELL, THAT'S THE PROPORTIONAL RECOVERY , OUTHIRE COVER WELL. YOU HAVE THESE NON-FITTERS HERE, THE LIGHTER COLOR. THEY START LOW HERE AND THEN THEY SPAN OUT HERE FROM 0 TO 40. THESE ARE DARN IMPAIRED T. WINSTON BIBLE (INAUDIBLE) SHOWS IF YOU TAKE TMS, AND YOU MEASURE MOTOR POTENTIAL THESE PEOPLE BASELINE DON'T HAVE MOTOR POTENTIAL SO IT'S INDICATIVE THAT CORTICO SPINAL TRACK DOESN'T HAVE DAMAGE, DOESN'T HAVE INTEGRITY. THESE PEOPLE HAVE BETTER CORTICO SPINAL TRACK. SO THESE PEOPLE ARE FAILING WHEN YOU LOOK WHAT THEY ARE FAILING AT, THEY ARE FAILING AT HAND DEXTERITY DISTAL ARM MOVEMENT, THAT CAUSES THEM TO HAVE LOW SCORES. WE LOOKED AT OUR OWN ROBOTIC THERAPY STUDIES AND STEVE KRAMER WE LOOK AT A META ANALYSIS OF ROBOTIC THERAPY STUDIES AND WHEN YOU LOOK AT -- THESE ARE DELIVERED IN THE CHRONIC STATE. SO WHEN YOU LOOK AT THOSE THERE'S A SWEET SPOT FOR AYE YOU CAN SEE THE SHAPE LIKE THIS, THIS HOLDS UP FOR A WIDE VARIETY OF STUDIES, THIS IS THE LINE OF THE MINIMAL CLINICALLY IMPORTANT DIFFERENCE YOU CAN SEE PEOPLE HOW THEY HAVE SMALL BUTCH UPS FOGEL MIRE, BUT HERE THE SWEET SPOT, YOU MAP THIS HERE TO CHRONIC STATE THESE ARE GOING TO BE MEP NEGATIVE AT BASELINE NON-FITTERS. SO IT'S INTERESTING THE NON-FITTERS SEEM TO BE THE ONES THAT HAVE THE MOST POTENTIAL. THEY MIGHT HAVE RECOVERY IN THE MAP BUT THEY -- THIS IS RIGHT IN THE AREA HERE IS WHERE YOU IS THAT RIGHT GETTING AT THE CHRONIC STATE SOME LEVEL OF HAND FUNCTION BACK. SO. SOME BOX OF LOCKS SCORE FOR EXAMPLE, I DIDN'T SHOW THAT GRAPH SO LOOKS LIKE PEOPLE ARE GETTING PROBABLY JUST A LITTLE CORTICO SPINAL TRACK ABLE TO MAKE USE OF TO GET A BIG RESPONSE FOR REHABILITATION, BIGGER NOT HUGE BUT BIGGER. AND SIGNIFICANT. MOTIVATION IS EXTREMELY IMPORTANT, I'M AN ENGINEER AND AS WE GOT -- GONE THROUGH THIS I REALIZE HOW IMPORTANT PSYCHOLOGY IS. PSYCHOLOGY PROBABLY HAS AFFECTS THROUGH DOPAMINE FOR EXAMPLE FOR THINGS LIKE MOTOR RETENTION. ONE OF THE MOST STRIKING COMMENTS FROM ONE OUR VOLUNTEER CENTER STUDY WHEN WE ASKED THEM HEY DO YOU LIKE THE ROBOTIC DEVICE OR -- AND THEY SAY YES I LIKE IT BECAUSE IT HELPS ME TO DO SOMETHING, IF I COULDN'T DO IT ONCE WHILE A HUNDRED TIMES. TO PROVIDING PHYSICAL ASSISTANCE IMPROVES MOTIVATION IS IMPORTANT. I HAD ANOTHER SLIDE THERE. THIS IS THE LAST THING I WANT TO SHOW ABOUT THE OVERVIEW OF STROKE, THIS IS FROM KATHERINE LANG. PEOPLE ARE USING WRIST ACCELEROMETERS, KATHERINE'S GROUP BEING PRIMARY TO MEASURE ACTIVITY AFTER STROKE. YOU -- A NEAT FINDING IS THAT INTERESTING FINDING IS THIS IS HOURS OF UNAFFECTED UPPER ACTIVITY AND THIS IS HOURS OF AFFECTED UPPER LIMB ACTIVITY, SO YOU HAVE ASYMMETRY, THERE'S ALSO LYNN YEAR RELATIONSHIP SUCH THAT IF YOU USE AFFECTED LIMB LESS YOU ALSO USE UNAFFECTED LIMB LESS. SO NOT ONLY ASYMMETRY BUT IT'S COUNTER INTUITIVE. YOU THINK IT MIGHT HAVE BEEN IF YOU USE THIS LESS YOU USE MORE. YOU CAN USE INCREASE IN ACTIVITY AS WELL, WHICH IS INTERESTING. AMAZINGLY, THERE ARE I THINK JUST TWO STUDIES THAT LOOK AT USING A WEARABLE FOR UP PER EXTREMITY AFTER FEEDBACK PERSON. SO WE TALK ABOUT THE FIT BIT AND HOW THERE'S SYSTEMATIC REVIEWS OF MULTITUDE OF STUDIES. IN STROKE UP PER EXTREMITY IS USED FOR MEASUREMENT. THERE'S A DEVICE THAT VIBRATE TO REMIND YOU TO MOVE AND THERE'S ONE STUDY THAT CAME OUTLOOKING AT A BAR THAT WAS SHOWING LIKE ARE YOU MOVING ENOUGH. AMAZINGLY THERE'S FEW STUDIES FOR WEARABLE FEEDBACK FOR PEOPLE WITH STROKE. I HAD SOME SLIDES ON PARKINSONs WE DID ANALYSIS ON PARKINSON'S E SAME THING, MAKING MEASUREMENTS IN PARKINSON SO YOUR PHYSICIAN HAS MORE OBJECTIVE EVIDENCE TO TITRATE YOUR MEDICINE BUT IT'S NOTHING ABOUT REHAB OR FEEDBACK OR THINGS LIKE THAT. SO THERE'S A SLOWNESS OR GAP IN USING WEARABLES FOR TO ENHANCE OR GIVE PEOPLE TOOLS TO EXERCISE MORE. SO HERE IS THE LAST PART. THIS IS PERSONAL EXPERIENCE TOWARDS CONSUMER TECHNOLOGY. IT STARTED WITH -- THIS IS TRICKY. SO HERE IS A SOPHISTICATED FOR BONES, WE HAD A CONTRACT NIH AND NIBIB AND NCMRR, PATIENT USED TO DRIVE A CYCLE BEFORE HE HAD A STROKE. YOU CAN SEE HOW ENGAGED HE IS, THE ROBOT IS LEARNING IN REAL TIME HOW MUCH HELP HE NEEDS TO STAY ON THE ROAD BUT NOT STAY PERFECTLY ON THE ROAD AND ONE COOL THING WHAT WE FOUND IS THAT YOUR BRAIN HAS AN AUTOMATIC ALGORITHM FOR SLACKING SO IF ROBOTS ARE HELPING YOU TOO MUCH YOUR BRAIN WILL MATHEMATICALLY DECREASE THE AMOUNT OF EFFORT YOU ARE DOING SO WE HAVE TO HAVE OUR ROBOTS BE SLACKERS ADS WELL WHICH MEANS THAT IT'S NOT HELPING THEM RIGHT IN THE MIDDLE OF THE ROAD. AND IT HAS TO BE SOFT AND COMPLIANT, PATIENTS LOVE IT, THERAPISTS LOVED IT, EXTREMELY SAME RESULTS AS SIMPLER THINGS SO WE CONVINCED OURSELVES SO IT'S A TYPICAL RESULT, THIS IS ACTUALLY FROM -- SPRING WHICH I WILL SHOW YOU BUT THOSE RESULTS ARE SIMILAR. YOU CAN HAVE CHANGE HIGH VARIABILITY IN RESPONSE, THIS IS CHRONIC PATIENTS, PRE-TO POST SIX MONTHS FOLLOW-UP,BETTER MAINTAIN USUALLY WITH ROBOTIC THERAPY, POSSIBLY RELATED TO HAVING MORE SUCCESS AND MORE DOPAMINE, CALLED DOPAMINERGIC HYPOTHESIS, OFTEN BETTER RETENTION COMPARED TO A CONVENTIONAL THERAPY, PROBABLY BECAUSE OF MORE SUCCESS. HERE IS THE MOTIVATION SIDE, THE LAST STUDY WITH FINGER ROBOT WE HAD A GROUP GETTING HIGH LEVEL ASSISTANCE AND PLAYING REALLY WELL HITTING NODES ABOUT 80%. THEN WE HAD A GROUP THAT GOT -- WE TITRATED THE ASSISTANCE SO THEY ONLY GOT 50% SUCCESS, RATED THEIR MOTIVATION THROUGH THEIR NINE TRAINING SESSIONS. SO THE GROUP THAT'S GOT HIGHER MORE HELP FROM THE ROBOT, IT WAS ANTI-SLACKING HELP BUT HIGHER HELP, THEY REPORTED BEING MORE MOTIVATED TO CONTINUE THIS FOR THE THERAPY THROUGHOUT. INTERESTING ROLE SO ROBOTS HAVE PSYCHOLOGICAL ROLE BY VIRTUE OF ASSISTING. SO THIS STUFF WE DID A COMMERCIALIZING, I PRESENTED IT. SO THIS IS A ACTUALLY A -- DEVICE, IT DOESN'T HAVE ACTUATORS ON IT, JUST SPRINGS THAT RELIEVE THE WEIGHT OF THE ROBOT WITH ARMAND WITH SUPPORT FROM CHILDREN I SHOWED YOU EARLIER. SCALE UP REACH BY STROKE PATIENTS IT HAS A GRIPPER ON IT, THAT DETECTS WHEN YOU MAKE TRACE LEVELS OF BRUNT FORCE, I DON'T THINK IF LUKE IS HERE BUT DISCUSSIONS CAME UP WITH THAT IDEA. DURING THAT CONTRACT AND ANYWAY, SO THIS IS NOW LICENSED TO A SWISS COMPANY, A $60,000 DEVICE IN A THOUSAND FACILITIES. SO I'M TALKING WITH THEM NOW THEY JUST SOLD THEIR THOUSANDth ONE AND WE WANT TO SEE WHO IS USING IT AND WHY. SOME PLACES I GO, IT SITS IN THE CORNER, THERAPISTS LIKE EXERCISE CYCLE. LOT EASIER TO USE, DON'T HAVE TO LIKE TURN THE COMPUTER ON. DON'T HAVE TO SET UP A PROGRAM, DON'T HAVE TO BE WORRIED ABOUT LIKE I'M GOING TO BREAK THAT, LOOKS COMPLICATED, I DON'T WANT TO BREAK IT. OTHER PLACES THEY USE A LOT. SO WE WANT TO GO AND SEE WHAT ARE THE BEST PRACTICES FOR INTEGRATING A TOOL LIKE THIS INTO YOUR THERAPY. AND THERE'S AN INTERESTING THING WHERE IT LOGS ALL USAGE DATA SO IF PEOPLE AGREE THEY CAN SEND ANONYMIZED USAGE DATA TO US TO SEE WE CAN GET QUANTITATIVE INFORMATION. $60,000 SO PROBABLY MILLIONS OF PEOPLE HAVE USED THAT DEVICE. BUT REALLY IT'S MAINLY SORT OF FLAGSHIP FREE STANDING REHAB HOSPITALS. SO AGAIN FOR RO1 WE ARE INTERESTED IN THIS ROLE THAT YOU NEED TO BE MOVING YOUR FINGERS IN ORDER TO GET A REHAB EFFECT OR COULD YOU DO THE TRAINING ISOMETRICALLY. A STUDENT WHO IS A MUSICIAN, WE ARE MAKING VIDEO GAMES, I LIKE TO SAY THEY'RE LIKE A TWO ON SCALE OF TEN. LET'S USE GUITAR HERO. THE THIRD MOST POPULAR VIDEO GAME INVENTED PROGRAMMED BY UCI STUDENT. AND AS WE ARE BUILDING THIS COMPLEX ROBOT WE JERRY RIGGED A SENSOR, GOT CONDUCTIVE FABRIC AND MAKING DIFFERENT GRIPS, YOU PLAY GUITAR HERO. THE FIRST STUDY WE DID WE COMPARED THERE'S THE ORIGINAL GLOVE WHICH IS MORE GLOVE WE COMPARED THAT TRAINING TO SQUEEZING ISOMETRICICALLY PLAYING THE SAME NUMBER OF NOTES ISOMETRICALLY COMPARED TO ONE ON ONE THERAPY WITH THE THERAPIST. THIS WAS A REPEATED MEASURES THING WHERE YOU GET TWO WEEKS OF THAT, TOOK A BREAK, TWO WEEKS, TWO WEEKS, BUT WE SAW THE CHANGES CAME WHEN YOU DID MUSIC GLOVE. THIS IS BOX AND BLOCKS SCORE HERE. A SMALL STUDY TOOL SUBJECTS BUT BECAUSE WE HAD WITHIN SUBJECTS DESIGN IT HAD DECENT POWER. INTERESTINGLY THEN, WHEN YOU ASK PEOPLE WHAT THEY LIKED WHICH WOULD YOU LIKE TO USE THEY LIKED THE MUSIC GLOVE MORE THAN DOING CONTROL THERAPY OR ISOMETRIC, THEY WANTED TO MOVE THEIR FINGERS. SO YOU NEED TO MOVE YOUR FINGERS, THE GAMING THE MUSIC. SO MY STUDENTS AND I FORMED A STAR COMPANY CALLED FLINT REHABILITATION, WE GOT AN SBIR GRANT TO COMMERCIALIZE THAT, WE WORK FOR THE CLOTHING MANUFACTURER AND THERE'S 2000 USERS OF THAT TECHNOLOGY T. SO AS WE ARE DOING -- SBIR GRANTS WE STARTED MORE STUDIES AND THIS IS A STUDY AT HOME, LET'S GIVE PEOPLE TO TAKE HOME, EVERY RESEARCHER HAS THEIR FAVORITE PLOT, YOU HAVE TO HAVE YOUR FAVORITE PLOT, ALL YOUR FAVORITE PLOTS, THIS IS THE CUMULATIVE NUMBER OF GRIPS COMPLETED AS A FUNCTION OF DAYS IN THE STUDY. AND THIS IS THE RED LINES WHAT WE ASKED THEM TO DO. YOU CAN SEE THE FIRST WEEK ON AVERAGE THEY ARE DOING WHAT WE ASK AND THEN ADDICTIVE EFFECT TAKES OVER. NOW THE VARIOUS -- SOME DROPPED OUT BUT PEOPLE -- WE ARE GETTING A LARGE NUMBER OF MOVEMENTS. THIS IS CHANGE IN MOTOR ACTIVITY LOG. SO YOU HAVE A PRETTY BIG -- LARGE CHANGE, ALMOST BIG AS IN THE CONSTRAINT EXIT TRIAL. WHEN YOU DO A BOOK OF EXERCISES AT HOME AND IT DOES THAT. THIRD STUDY, WE SAID HEY IS IT FEASIBLE FOR SUBACUTE USE AT HOME. WOULD IT BE MORE EFFECTIVE EARLIER BECAUSE YOU HAVE SORT OF DIFFERENT EXPRESSION OF GENES EARLY AFTER STROKE, PROLIFERATION OF PLASTICITY, SO WE SCREENED 169 PATERS, 92 MET INCLUSION CRITERIA BEFORE CONSIDERING HAND IMPAIRMENT AND THEN ONLY 13% HAD MODERATE HAND IMPAIRMENT APPROPRIATE FOR THE MUSIC GLOVE. WE RANDOMIZED 17 PATIENTS SIX DROPPED. WE DON'T HAVE THAT MANY DROP, SUBACUTE STROKE PEOPLE HAVE A LOT GOING ON IN THEIR LIFE. THEY HAVE SOME HAND FUNCTION NORMAL BLOCKS OF 60 SO DO YOU ABOUT 20. WE FOUND HERE IS THAT SAME PLOT, IN THE SUBACUTE PEOPLE THOUGH THEY HAVE EVERYTHING GO ON WITH THEIR LIFE THEY WERE EVEN SORT OF MORE AGGRESSIVE WITH THE TRAINING. FROM THIS IS NOW THE DISTRIBUTION ACROSS PEOPLE, SO WE ARE TRYING TO RANK ORDER PEOPLE IN THE STUDY WITH NUMBER OF GRIPS THEY COMPLETED SO IT'S A USER SHIP CURVE, SOME DIDN'T GET INTO IT AT ALL, GETTING INTO PERSONALIZATION IDEA AND WE HAD THESE USERS OVER HERE. BUT SO IT'S FEASIBLE FOR SUBACUTE USE, WE LET PEOPLE HAVE THE POSSIBILITY CHALLENGE THEMSELVES, THEY CAN ADJUST THE SOFTWARE SO THEY CAN HAVE MORE GRIPS, CHANGE THE DIFFICULTY OF THE SONG, LOOK AT THAT, ON AVERAGE PEOPLE INCREASE DIFFICULTY AS THEY WENT ALONG. PEOPLE THIS IDEA OF MOBILE TECHNOLOGY IN THE COMMUNITY, PEOPLE WILL DO THINGS THAT ARE LOGICAL WITH IT. GIVEN THE FREEDOM. ON AVERAGE. WE SAW AT THE END OF THERAPY, THREE WEEK PERIOD WE SAW SIGNIFICANT INCREASE BOX AND BLOCKS, IT SEEMS TO BE -- IT'S A SIGNIFICANT RELATIONSHIP KIND OF ROUGH HERE CHANGE IN BOX AND BLOCKS IS DEPENDENT ON TOTAL AMOUNT YOU PAY THE GAME HERE. IF YOU LOOK AT THE CHANGE OVER ABOVE CONVENTIONAL GROUP SUBACUTE CHANGE IS HIGHER THAN WHAT WE FOUND IN THE CHRONICS PHASE, THOUGH THIS IS A SMALL STUDY ENROLLMENT DIFFICULTIES. PEOPLE FLINT STARTING SELLING THIS, THEY HAD 8,000 PEOPLE SOMETHING CALLED THE COMPANY IN THE FIRST YEAR AND SAID DEVELOP GOOD SCREENING, THEY DON'T ENWANT TO SEND A GLOVE TO SOMEBODY THAT COULDN'T USE IT. A LOT OF PEOPLE DIDN'T HAVE HAND FUNCTION ABILITY TO USE IT BUT PEOPLE ARE SERGING FOR -- SOMETHING TO CONTACT HOW DO YOU KEEP GOING AT FORMAL REIMBURSED REHAB. WE WANT TO SELL AT A PRICE YOU CAN BUY OUT OF TO CONDCT, AROUND $300 YOU CAN USE IT FOR. SO THEY HAVE THIS IDEA OF DOING A DEVICE THAT'S USEFUL NOT FOR DISTAL DEXTERITY BUT WIDER VARIETY OF THINGS. SO THEY MADE THESE -- INITIALLY WHEN THEY TOLD ME I DIDN'T THINK IT WAS A GOOD IDEA. YOU CAN SEE SOMEONE EXERCISING THERE, SHE'S TRYING TO FLIP THE PUCKS OVER, FEEDBACK ON THE GAME. THERE'S MUSIC PLAYING, TRYING TO GET THROUGH NUMBER OF REPS IN A CERTAIN NUMBER OF MINUTES. THIS IS NOW FOR PEOPLE WITH MORE SEVERE HAND IMPAIRMENT, YOU CAN PUT ON THE FLOOR ON YOUR LEGS, THEY WORKED WITH A BELOVED OCCUPATIONAL THERAPIST THAT HAD TO RUN A STROKE 30 YEARS, DEFINE 30 EXERCISES YOU CAN DO. IN EACH EXERCISE, HOW YOU DO IT. THAT'S NOW SOLD ABOUT I THINK THERE'S 5,000 USERS OF THAT. SO AGAIN, THAT WAS DRIVEN BY CONSUMER FEEDBACK AND THERAPIST FEEDBACK. NOW WHEN PEOPLE GET THAT THEY SAY IT WOULD BE GREAT TO USE FUNCTIONAL THINGS TOO SO NOW WE HAVE SBIR GRANT TO DEVELOP -- WE WILL USE THE PODS AS THE SENSORS BUT NOW WE HAVE CUPS SWITCHES AND DOORKNOBS. HERE THE ZIPPER HERE. THESE WILL BE IN THE SENSORS, SENSORS WIRED INTO THE WIRELESS CIRCUITRY HERE, IT ALL INTEGRATE TOGETHER IN A BRIEFCASE. SO TO FINISH WEARABLE THINGS. THIS IS FIT BIT FOR FINGERS SO YOU WEAR A MAGNET THAT IS A RING. DOING WRIST ACCELERATION NOW DECKING THE CHANGE IN MAGNETIC FIELD AS YOU ROTATE YOUR WRIST AND FINGERS. WE CALLS IT PEDOMETER FOR THE HAND. IT DOESN'T COUNT OUR MOVEMENT BUT IT'S COUNTING YOUR HAND MOVEMENT. WE COMPLETED A FEASIBILITY STUDY WITH 22 PARTICIPANTS. INDEED WILLING TO WEAR IT, THE CONTROL GROUP WORE IT BUT IT SHOWED TIME OF DAY. EXPERIMENTAL GROUP WORE AND SET PERSONALIZED GOAL AT 15 TO 20 DAYS OVER THREE WEEK PERIOD. TEN HOURS A DAY BOTH GROUPS WILLING TO WEAR IT. SO THAT'S FEASIBLE. WE DIDN'T SEE A DIFFERENCE, THIS IS PRELIMINARY SO LOOKING AT THIS, I WANTED TO PUT IT OUT THERE BECAUSE -- I DON'T KNOW. IT'S INTERESTING YOU CAN GIVE FEEDBACK BUT LOOK AT THIS, WE ARE GETTING 300,000 COUNTS OF FINGER MOVEMENT. FOR SOME OF THEM. THE BLUE GUYS HERE ARE EXPERIMENTAL GROUP THAT GOT FEEDBACK. WITH THE DAILY GOAL SETTING AND THESE GUYS ARE THE ONES THAT THE CONTROL GROUP JUST GOT TIME OF DAY. THIS IS THE CHANGE IN BOX AND BLOCKS. WE PLOTTED HERE AS FUNCTION OF HOW MUCH REHAB THEY DID. SO WHEN WE FED A LINE TO THE GROUP THE 11 SUBJECTS AND -- THAT ARE GETTING FEEDBACK IT'S SIGNIFICANT AND WE HAVE THESE -- BUT IT'S DRIVEN BY HYPERUSERS HERE THAT DID A LOT OF ACTIVITY. THE GROUP THAT DIDN'T GET THE FEEDBACK ALL OVER THE PLACE IN TERMS OF AMOUNT OF DAILY ACTIVITY IN TERMS OF BLOCKS IN TERMS OF THE RELATIONSHIP. WE USE INTRINSIC INVENTORY TO SAY HOW MUCH DO YOU LIKE THIS THING, HOW IMPORTANT IS IT, HOW MUCH PRESSURE YOU FEEL, WITH THE VALUE AND USEFULNESS. SO HERE YOU CAN SEE EVERYONE THOUGHT THE FEEDBACK WAS VALUABLE, THIS GROUP WE ARE ASKING THEM NOT ABOUT TIME OF DAY ON LIST BUT ABOUT THE LOAD OF EXERCISES THE THERAPISTS GAVE THEM SO THEY VIEW THAT AS VALUABLE TOO SO NOT A HUGE DIFFERENCE BETWEEN BLACK LET EXERCISE AND WEARABLE DEVICE WHICH IS INTERESTING. WEARING THE MAGNET IS MORE COMPLICATED SO TAKE HARDWARE INITIALLY WE HAVE AND MEASURE WRIST AXEL RAKES AND GIVE FEEDBACK BUT LET'S TUNE IT UP SO IT'S SENSITIVE TO HOW THOSE PEDOMETERS ARE UNDERESTIMATING ACTIVITIES WITH OF PEOPLE WITH DISABILITIES SO IT HAS A ADAPTIVE WHOLE SETTING AND SOCIAL REHAB OPTION YOU CAN JOIN A GROUP AND YOU CAN CHAT WITH YOUR GROUP AND THEN YOU CAN COMPETE WITH EACH OTHER. I DON'T THINK PEOPLE ARE USING THAT VERY MUCH RIGHT NOW BUT IT'S A NEAT OPTION AND WOULD BE A QUESTION HOW YOU CAN FACILITATE THIS SOCIAL INTERACTION USING THESE DEVICES. THEN THE LAST DEVICE IS THIS ONE TRULY MOBILE REHABILITATION. LIKE TO SAY AFTER A PERSON HAS A STROKE ABOUT 80% OF PEOPLE ARE IN A WHEELCHAIR WHEN THEY ARE SUBACUTE REHABILITATION. THEY ARE TAUGHT TO AMBULATE IN A COMPENSATORY WAY WITH GOOD ARM AND GOOD LEG. WHICH IS GREAT FOR GETTING AROUND BUT IT MEANS YOUR IMPAIR ARM IS NOT BEING USED. WE MADE THIS OBSERVATION WHICH IS WONDERFUL WHICH I'M NOT SURE PEOPLE OBSERVE BUT IF YOU GIVE A LITTLE LEVERAGE IN THAT ARMREST THAT HOLD THE ARM IN THE RIGHT CONFIGURATION, PEOPLE ARE IMPAIR ARMS CAN PROPEL THEMSELVES. SO WE CALL THIS LEVER ASSISTIVE REHABILITATION, SO THE IDEA IS NOW THAT YOUR WHEELCHAIR BECOME A WAY TO ARM REHABILITATION. THE LICENSE WE ARE DOING ELECTRICAL ACTIVITY HERE OF THE MUSCLES. WE COMPLETED A STUDY HERE. WE GIVE IT HERE IS THE SORT OF SBIR VERSION OF THE PRE-COMMERCIAL VERSION OF THE CHAIR WHICH IS -- WE HAD TO MAKE SO PEOPLE COULD BE MORE MOBILE, YOU HAVE THIS YO CLUTCHING THING TO BACK UP AND SPIN IN PLACE, IT'S REALLY COOL. IT'S MORE COMPLEX TO LEARN. PEOPLE -- AND WE ALSO HAVE A VIDEO GAMING MODE SENSORS ON CHAIR SO IF YOUR THERAPIST DOESN'T WANT YOU WANDERING THE HALLWAYS YOU CAN PLAY VIDEO GAMES BY PEOPLE IN THE CHAIR. WE SAW PEOPLE -- (LOST AUDIO) HAVE COOL IDEAS TO FIX THAT SO JUST TO KIND OF WRAP IT UP, THERE'S NEW OPPORTUNITIES FOR RESEARCH WITH THIS TECHNOLOGY, THERE'S OVER 50,000 USERS THERE'S 400 USERS, WE LOGGED ABOUT 75 MILLION PRACTICE MOVEMENTS NOW. SO THE WIDESPREAD USE OF CONSUMER STROKE PROVIDE A WAY TO ANSWER QUESTIONS LIKE WHAT FACTORS DETERMINE, WHO DOES HOME PRACTICE. SO WHAT EXTEND RECOVERY DEPEND ON COMMUNITY BASED UPPER EXTREMITY USE FOR EXAMPLE. THIS IS A ROBOTICS COMPETITION THEY RUN EACH YEAR AT JUNIOR LEVEL. THIS IS IMPLEMENTING THE STAR WARS AND SHOOTING DEATH STAR T. SOMEHOW IT'S A METAPHOR FOR -- HOW DO YOU FIND YOUR DIRECTION, ROBOTS USE THE COUNTER TO STEER, WITH THESE CONSUMER WEARABLES WHAT IS THE DIRECTION? YOU HAVE TO GET THROUGH THIS CHANNEL WITHOUT FALLING OVER AND TURN THE RIGHT DIRECTION. WHAT ARE BOTTLENECKS THAT ARE PREVENTING WIDESPREAD ADOPTION AND USE OF THIS TECHNOLOGY. I THINK REALLY INTERESTING QUESTIONS. SO THAT -- (INAUDIBLE) OKAY. THANK YOU VERY MUCH. [APPLAUSE] JUST MENTIONING NCMRR AND NIBIB, PARTICULARLY NCMRR A LOT OF THIS RESEARCH AS WELL AS NIDLER INVOLVED WITH. SO I DON'T KNOW IF I EEL HAVE TIME FOR QUESTIONS, BUT I LOVE COMMENTS OR QUESTIONS. >> THANKS SO MUCH. IT'S ALWAYS SO EXCITING TO SEE WHAT YOU ARE DOING. I HAVE MORE COMMENT I THINK. SOMETIMES I THINK THERE IS AN IMPRESSION THAT MORE SECONDNOLOGY IS BETTER. BUT -- MORE TECHNOLOGY IS BETTER BUT AT SHEPHERD CENTER WE HAVE SEVERAL MAYO SPRING DEVICES. I HAVE AN ARMEO IN OUR LAB WHEN I CAME TO THE LAB AND WE SOLD IT BACK. BECAUSE IN THE SPRING WHICH IS LOW TECH IS VERY USEFUL AND VALUABLE, THE POWER FOR EXAMPLE WHEN YOU WANT TO DO AN ARM MOVEMENT WE WANT TO USE IT TO MEASURE ARM MOVEMENT, A MOVEMENT LIKE THIS, THE POWER DOES IT LIKE THIS. THE POINT IS THAT VERY LOW TECH DEVICES CAN BE HELPFUL AND MORE TECH IS NOT ALWAYS BETTER. >> WE ARE SEEING THAT WITH THESE PUCKS WHICH IS MEASURE MOVEMENT, SIMPLE, VERY SIMPLE THING WE ARE SELLING FOR $250, ON AMAZON SO IT BECOMES A PROBLEM OF HOW DO YOU FIND -- IT BECOMES MARKETING PROBLEM HONESTLY, HOW DO YOU FIND THE PERSON AND IN MARYLAND THAT WANTS TO USE THIS DEVICE, I AGREE AND WE PUSH TOWARDS, THE MORE SOPHISTICATED STUFF IS GOOD FOR SCIENCE AND YOU ARE HOPING FOR A HOME RUN WITH WAY MAYBE YOU CAN DO SOME SORT OF THING THAT WILL BE REALLY GOOD BUT FROM PRAGMATIC STUFF THAT'S BEING USED IN CLINIC OR AT HOME, IT WILL BE SIMPLE, SIMPLE, SIMPLE. YEAH. >> I KNOW YOU ARE USING THE TERM CONSUMER TECH. WONDERING IF YOU CAN COMMENT ACROSS YOUR PRESENTATION. WONDERING IF YOU WERE INTENTIONALLY DESIGNING SOME OF THESE PRODUCTS WITH THE IDEA OF DIRECT TO CONSUMER TO FALL OUTSIDE THE SCOPE OF FDA AND CMS REGULATION AND IF THAT WAS PART O YOUR STRATEGY IN ADDITION TO MAKING THEM AFFORDABLE AND ACCESSIBLE. AND IF THAT WAS YOUR STRATEGY AND TO WHICH OF THE DEVICES YOU PRESENTED DID THAT APPLY. >> SO THEY ARE FDA LISTED DEVICES. BUT WE HAVEN'T WORKED WITH CMS SO I WAS INTERESTED TO HEAR THE PRESENTATION YESTERDAY SO OUR IDEA WAS LIKE OUR IDEA WAS TO TRY -- MOST REHABILITATION TECHNOLOGY COMPANIES HAVE EXPENSIVE EQUIPMENT AND THEY SELL FEW OF THEM. ARMY OF $60,000 THEY SOLD A THOUSAND SO A 60 MILLION-DOLLAR PRODUCT AND THE COMPANY SURVIVES. YOU HEAR A LOT OF IDEALISM LIKE I WANT TO MAKE IT CHEAP. THERE'S A LOT OF IDEALISM, I HEAR THAT A LOT. NOW I HAVE ENOUGH EXPERIENCE THE SAY IF THE COMPANY -- CAN'T PAY SALARIES OF THE PEOPLE, IT DOESN'T EXIST. IT'S GOOD LUCK MAKING IT CHEAP. LIKE I SAID, WE DID WANT TO MAKE I SO YOU CAN PAY OUT OF POCKET WITHOUT GETTING -- FEEL LIKE I HAD TO GET REIMBURSED AT LEAST CERTAIN PEOPLE COULD DO THAT, PEOPLE HAVE DONE LIKE GO FUND ME AND STUFF TO BUY IT. THEN LIKE I SAID, IT BECOMES A QUESTION OF HOW IN THE WORLD DO YOU SELL ENOUGH OF THESE TO PAY THE SALARY OF THE PERSON WHO NEEDS TO BE THERE, TO SUPPORT THE DEVICE. SO IT'S A NEW MODEL, WE ARE HOPEFULLY CRACKING IT. POTENTIALLY FOR STROKE YOU CAN 700,000 PEOPLE A YEAR, TAKE THAT MAYBE HALF -- SOLD 8,000 SO IT'S POTENTIALLY BIGGER MARKET. SO FDA, DEVICES AND THEN WE HAVEN'T PLAYED WITH CMS YET. IT'S APPROVED FOR PURCHASE IN THE VA SYSTEM. BUT REIMBURSEMENTS AN INTERESTING QUESTION. >> THERE'S CHICKEN OR THE EGG BECAUSE HOW DO YOU GET -- LIKE YOU LIKE TO GET DATA FROM THOUSANDS AND THOUSANDS AND THOUSANDS OF PEOPLE USING A DEVICE THAN TO SHOW IT MADE SOME SORT OF DIFFERENCE IN SOMETHING. HUGE SAMPLE SIZES WE WOULDN'T SUFFER FROM SMALL SAMPLE SIZE PROBLEM ANY MORE IF YOU CAN GET -- IF IT'S NOT -- I'M SORRY, IF IT'S NOT REIMBURSED HOW DO YOU GET THAT NUMBER OF DEVICES OUT THERE THAT'S KIND OF THE QUESTION. SO SEEMED LIKE CHICKEN OR EGGS BUT MENTION COUPLE OF MECHANISMS PERHAPS THAT YOU CAN DO THAT WITH. YES. >> THIS IS REALLY INTERESTING. IT TAKES SO MANY MAN HOURS AND WOMEN HOURS TO PUT TOGETHER A ROBOT. THAT WORKS AND EVENTUALLY WHEN YOU FIND SOME ASPECTS THAT WORK AND SOME ASPECTS THAT DO NOT WORK, JUST THE ADJUSTMENTS A LITTLE BIT TOO COME ABOUT, IT'S VERY DIFFICULT TO CHANGE ALGORITHMS OR CHANGE THE HARDWARE IN MIDSTREAM UNTIL YOU'RE DONE, RIGHT? >> YES. >> SO I GUESS MY QUESTION FOR YOU IS WHERE DO YOU GET THE SOURCE OF SUPPORT FOR DOING THAT. I'M LOOKING AT YOUR WHEELCHAIR WHEN YOU FOUND SO MANY WERE USERS COULD NOT MANAGE TO DRIVE IT. AND THEN AT SOME POINT THE -- THERE'S ANOTHER ONE DEVICE THAT YOU SHOWED THAT SOME -- THERE'S SOME FEATURES THAT YOU KNOW ARE DIFFICULT FOR THE USER. WHERE DO YOU GET FUNNELING TO SUPPORT REVISION FOR A BETTER -- OR DIFFERENT ALGORITHMS BECAUSE IN MOST CASES IF YOU ARE AWAKE WITH THE CONSUMER YOU NEED THAT RELATIONSHIP CONSUMER PLUS THE HARDWARE BUILDING AND ALGORITHM DEVELOPMENT AT THE SAME TIME. WHERE DO YOU GET THAT KIND OF FUNDING? >> THANK YOU FOR THE QUESTION. SO SOMETIMES WE ARE DOING -- WE ARE JUST GETTING STUDENT UNDERGRADUATE VOLUNTEERS TO COME IN AND DO STUFF. I MIGHT HAVE SELF-SUPPORTED MASTER STUDENTS OR Ph.D. STUDENTS WITH FELLOWSHIPS. THEY CAN COME IN AND START DOING STUFF. SO TRIED TO BUILD IT THAT WAY, SOME COME FROM SBIR FUNDING, SO WE TRY TO BE AS FRANK ADS AS POSSIBLE, THIS IS WHAT WE FOUND, THIS WORKED THIS DIDN'T WORK THIS IS WHAT WE WANT TO DO. THE LAURA THING WE HAD PHASE 2 SBIR AND NOW I WAS LIKE -- I WAS SAD PED BY THE FACT IT DIDN'T -- SADDENED BY THE FACT IT DIDN'T GET ADOPTED BY THE THERAPISTS, THEY LIKED THE CONCEPT BUT THE PRAGMATIC IMPLEMENTATION WASN'T THERE. WE TALKED A LOT WITH THERAPISTS AND NOW WE HAVE -- AND THEN I HAD A SELF-SUPPORTED VISITING PROFESSOR COME AND WORK OUT A NEW DESIGN FOR IT. SO NOW I HAVE A NEW DESIGN FOR IT AND I HAVE TO GET A FUNDING SOURCE TO MAKE THAT NEW DESIGN A REALITY. TAKING INTO ACCOUNT ALL FEEDBACK WE GOT FROM THE CLINICAL& TESTING. SO IT'S KIND OF I GUESS THAT'S THE MODEL WE USE. >> DAVE, THANK YOU FOR A VERY NICE PRESENTATION. ONE ASPECT RESONATED TO IS INTERDISCIPLINARY FOCUS THAT YOUR WORK MOVED IN. REHABILITATION SERVICE DELIVERY BY NATURE TENDS TO BE INTERDISCIPLINARY. REHABILITATION RESEARCH OFTEN TENDS TO BE MORE SINGLE DISCIPLINE. BACK IN THE DAYS WHEN YOU WERE AT RAC, CENTURY MOTOR PERFORMANCE PROGRAM GIVES MORE GADGET STUFF ON THE 14 FLOOR AND I WAS OFF SITE AND RAN MY SHOT. THERE WAS NOT A LOT OF INTERACTION IN THAT DAY. WONDERING WHAT STRATEGIES YOU FOUND HELPFUL TO HELP ENGINEERING STUDENTS THINK BEHAVIORALLY AND ENGAGE THE BEHAVIORAL SCIENTISTS IN THE WORK THAT YOU DO. >> THANK YOU FOR THAT QUESTION. GREAT POINT, WE NEED MORE OF IT. I'M INCREASINGLY CONVINCED OF THAT, WE NEED MORE OF THAT. I THINK LISTENING TO PEOPLE USING THE DEVICES WHETHER THEY BE THERAPIST OR PEOPLE WITH STROKE IN THIS CASE. IF YOU GO TO FLINT WEBSITE THERE'S REVIEWS POSTED OVER 300 NOW. OR MORE THAN THAT. YOU LOOK AND SEE WHAT PEOPLE ARE SAYING AND THERE'S A FACEBOOK GROUP FLINT STARTED, A STROKE SUPPORT GROUP AND IT HAS SIX, 7,000 PEOPLE ON IT AND THEY WILL TALK DID YOU TRY THAT OR THIS OR THAT. YOU CAN LOOK FOR A LOT OF INFO FOR THAT AS WELL. SO LISTENING AND THEN THE COLLABORATIONS, I THINK STEVE KRAMER HAS BEEN A GREAT COLLABORATOR FROM UC IRVINE AS UROLOGIST -- NEUROLOGIST BUT THINKS BROADLY AND CREATIVELY ABOUT THINGS. >> THAT WAS REALLY COOL. I WAS READING ABOUT -- WITH THERAPISTS HOW THERAPISTS, HOW DO THEY HIRE, DO THEY (INAUDIBLE) -- >> ARE THEY ALL FOR WHAT? >> ON BOARD WITH (INAUDIBLE) HOW TO A -- (INDISCERNIBLE) >> SO I THINK YOU SAID HOW DO THEY FEEL, ARE THEY FOR IT? AND HOW DO THEY RESPOND TO IT? >> YES. >> SO I THINK THERAPISTS ARE LOOKING FOR COOLS TO GIVE BETTER HOME WORK. RIGHT NOW IT'S PITIFUL. YOU GIVE A PERSON A SET OF APPRENTICE SHEET OF EXERCISE AND COMPLIANCE AND THE FEEDBACK IS NOTHING. SO THERAPISTS I THINK GENERALLY LIKE ANYTHING THAT MAKES THERAPY MORE INTERESTING. YOU DON'T HAVE TO PAY HUGE AMOUNT OF MONEY FOR SO THE FIT ME ONE BEST OF SHOW FOR AOTA. SO THERE'S BEEN PRETTY GOOD RESONANCE WITH IDEA OF LOWER COST STUFF THAT MAKES THERAPY MORE INTERESTING. IT'S NOT VIEWED AS A THREAT, IT'S NOTHING TO DO WITH -- UH-HUH. IT'S JUST A TOOL FOR THERAPISTS TO GIVE BETTER HOME WORK. YES. >> TO PA POINT TALKING ABOUT BEING A TOOL. ONE THING YOU OFTEN SEE THERAPISTS DOING IS TRYING TO CREATE THEIR OWN COMPUTER GAMES. COMPUTER GAME THERAPIST. I NOTICE YOU ARE USING GUITAR HERO. HOW MUCH AS YOU DEVELOP THINGS, ARE YOU A LOOKING FOR SPECIFIC NEEDS, ARE YOU B LOOKING TO RECAST THINGS OTHER PEOPLE DO, AND REFRAMEWORK THAT OR LOOKING AVAILABLE CONSUMER TECH PORE IT OVER, WHAT IS YOUR CONCEPTUAL PROCESS AS YOU ARE TAKING SHOWERS IN THE MORNING. >> THE VIDEO GAME IS A BREAK THROUGH, WE ARE DOING OUR OWN, LOOK AT TOP VIDEO GAMES, MOST ARE SHOOT EFFORT. P FIRST PERSON SHOOTERS ARE PRETTY VIOLENT, IT'S LIKE AT LEAST PROBABLY WHEN MY KIDS GREW UP IN REHAB, WHEN THEY ARE OLER THEY WILL PLAY SHOOTERS NO PROBLEM. THEIR GENERATION SO MUSIC IS ANOMALY SUPER POPULAR. REPURPOSING TECHNOLOGY IS VERY DIFFICULT TO DO THAT BECAUSE IT'S THE SIGN NOT FOR PEOPLE WITH DISABILITIES SO WE FIND IT DOESN'T WORK. WE COMPLETELY -- IT'S NOT EVEN -- WE COMPLETELY REWROTE GUITAR HERO. WE STARTED OPEN SOURCE VERSION AND HAD TO DO OUR OWN DEAL FOR IT. >> DO YOU PLAY WITH XBOX ADAPTIVE CONTROL IN >> I HAVE AN ARTICLE IN KUWAITING TO READ ABOUT THAT, WITH MICROSOFT, THEY'RE COMMITTED TO IT. THERE'S BEEN SOME COMMERCIALS SHOWING IT BEING USED. BACK TO KATHLEEN'S QUESTION BECAUSE I WANT TO BE FAIR ABOUT THERAPIST. SO IF PEOPLE CAN BUY THE FIT ME WITHOUT THERAPIST OVERSIGHT, SO THERAPISTS ARE I SHOULD BE PROVIDING OVERSIGHT BUT WHAT IF THEY ARE DOING EXERCISE WRONG? WHEN YOU GIVE HOW TO TRAIN BEFOREHAND T. AT LEAST THERAPIST VIDEO SHOWING YOU DO IT THIS WAY, DON'T DO THIS, DON'T SHRUG YOUR SHOULDER OR MOVE FORWARD. IT'S BETTER THAN WHAT'S CURRENTLY DONE SO ONCE YOU TALK THROUGH THAT PEOPLE ARE ACCEPT ING OF IT. >> ARE YOU USING THE FIT ME POTENTIALLY IN A THERAPEUTIC SENSE AS WELL AS MEASUREMENT SENSE AS WELL? >> WE HAVE ME GO AND MENUMETER BUT OUR GOAL IS SO GIVE GAME YOUR HONOR WRIST YOU'RE TRYING TO MAX OUT A SCORE AND EVEN WITH THE MENUMETER YOU CAN LOOK AT SCREEN AND MOVE YOUR HAND AS YOU PLAY IT, YOU HAVE EMOGE FEEDBACK THAT CHANGES EXPRESSION AND IT GIVES YOU A BAND HAND PUN WHEN YOU GET CERTAIN NUMBER OF MOVEMENTS LIKE I GOT TO HAND IT TO YOU OR SOMETHING. SO WE ARE VERY INTERESTED IN THE IDEA OF FEEDBACK AND GAMING, PUTTING GAMING ON YOUR BODY AS YOU GO THROUGH YOUR DAY TO GET YOU TO BE MORE ACTIVE. PERSONS WITH SIGNIFICANT WEAKNESS, THERE'S OFTEN TIMES CAREGIVERS THAT ARE DOING HOPE STRETCHING AND RANGE OF MOTION PROGRAMS, IF YOU -- HAVE YOU LOOKED AT TECHNOLOGY TO GIVE CAREGIVERS FEEDBACK OR ENGAGE CARE PROVIDERS TO TRY TO PREVENT SECONDARY COMPLICATIONS? AND SORT OF INDUCE -- >> NEAT IDEA. ARE YOU TALKING ABOUT -- ARE YOU SUGGESTING LIKE GAMEFY THE CARE GIVING EXPERIENCE? >> I MEAN OFTEN TIMES WITH PATIENTS AT RISK FOR CONTRACTURE FORMATION. THE INITIAL APPROACH IS NEED NOR PHYSICAL THERAPY BUT FOR PREVENTION CONTRACTURE NEEDS TO BE SORT OF DAILY LIFESTYLE TYPE OF ACTIVITY. THAT TO REALLY PREVENT THOSE COMPLICATIONS. >> HERE IS THE DEAL. YOU PROBABLY DON'T EVEN KNOW, HOW MUCH IT HAS TO BE. THERE'S AN EXAMPLE OF IT'S JUST INCREDIBLE WE DON'T KNOW THAT BUT WITH A WEARABLE TECHNOLOGY IF YOU HAD SOMEONE LOGGING IT ABOUT HOW MUCH STRETCHING YOU ARE DOING YOU CAN (OVERLAPPING SPEAKERS) YOU MEET THIS GOAL EVERY DAY FIVE DAYS A WEEK, WE KNOW IT BECAUSE WE MEASURE THIS IN 4,000 PEOPLE. >> THERE'S ALSO IN THE CONTEXT OF LET'S SAY YOU ARE INSTITUTING A THERAPEUTIC THAT MIGHT PREVENT CATTURES LIKE ANTI-FIEPOROTIC MEDICATION IN A POPULATION AND IN TERMS OF DESIGNING A CLINICAL TRIALS THERE'S ALWAYS THOSE CONFOUNDS OF STANDARD OF CARE AND HOW MUCH STANDARD OF CARE HOME PROGRAM OR HOW MUCH THERAPY IN COMMUNITY IS SOMEBODY GETTING. THESE ARE WAYS TO QUANTITATE THAT DOSING STANDARD OF CARE. SO YOU CAN PERHAPS EVALUATE THE TRUE EFFICACY OF THERAPEUTIC INTERVENTION. IN THE CONTEXT IN THE COMMUNITY PROGRAM. >> THAT'S GREAT. >> WHAT I LIKE ABOUT WHAT YOU ARE DOING IS THE ISSUE OF DOSING INCREASING THE TOTAL DOSE WHERE WE HAS BEEN FALLS SHORT IS FINITE, 45 MINUTESES IF WE ARE LUCKY. AS SOON AS REHAB ENDS THERE'S A CLIFF PEOPLE GO WACK TO WHERE MUCH LOWER STATE OF ACTIVITY OR WHATEVER IT IS. HAVING A CONTINUED THE ABILITY TO CONTINUE THAT OUT IS VERY INNOVATIVE AND IMPORTANT I THINK FOR THE FIELD OF REHABILITATION. OFTEN WHY THINGS END UP FAILING. >> THANK YOU. >> ANY OTHER QUESTIONS? ONE MORE. >> I'LL MAKE IT QUICK. IT'S A QUESTION OF VALIDATION OF DATA I NOTICE THAT YOU GAVE EXAMPLES WHERE YOU ARE USING FUNCTIONAL MEASURE LIKE THE FOGELMIRE TO LOOK AT OUTCOME. THERE IS DATA THAT COMES FROM TONS OF IT. HAVE YOU STARTED TO WORK ON VALIDATING THE DATA FROM THE SENSORS TO SEE IF INTERPRETABLE TO GIVE INFORMATION THAT WILL SAVE TIME? >> THANK YOU FOR THE QUESTION YOU ARE POINTING INSIGHTFUL EXCITING DIRECTION, HOW DO YOU USE THE DATA TO GET OUTCOMES. IT'S TRICKY BECAUSE PEOPLE ARE ADJUSTING THE PARAMETERS OF THE GAME AS THEY GO ALONG. IT'S IN THE HOME AND YOU ARE SHOT SURE DID THEY USE THEIR OTHER ARM THAT DAY OR DID THEIR GRAND KID USE IT SO IT'S TRICKY BUT WE ARE STARTING TO GET AT THAT. SO I'M VERY EXCITEDDED ABOUT THAT. IT'S PRELIMINARY AND I DIDN'T PUT ANYTHING IN THE TALK ABOUT IT. >> THANK YOU SO MUCH. >> NOW I WILL TURN IT OVER TO DR. TERESA CRUZ WHO WILL SHARE WITH YOU A CONCEPT CLEARANCE AS YOU REMEMBER, THE CONCEPT CLEARANCE PROCESS IN THE CONCEPT IS SELF--- ALAN SWITCHED -- AS YOU REMEMBER THE CONCEPT CLEARANCE PROCESS THE ONE WHICH INTRODUCE THE IDEA TO YOU IS A BOARD. NCMRR WILL PURSUE AS AN OPPORTUNITY OF SOME TYPE, WE TRY TO LIMIT THE AMOUNT OF INFORMATION THAT WE GIVE YOU ON PURPOSE SO THAT NO ONE HERE IS IN CONFLICT OF INTEREST SHOULD THEY APPLY FOR SAID OPPORTUNITY. I WILL TURN TO DR. CRUZ AND THEN OPEN FOR DISCUSSION. >> THANK YOU FOR THE OPPORTUNITY TO TALK TO YOU TODAY. I'M MOSTLY HERE BECAUSE I'M A SLOW LEARNER. IN DECEMBER I ASKED FOR FEEDBACK ON A CONCEPT FOR PEDIATRIC REHAB AND THAT RFA IS ON THE STREET DUE IN JUNE. THAT CREATED A LOT OF WORK FOR MYSELF AND HERE I AM AGAIN ASKING FOR PEED BACK TO PUT OUT ANOTHER. THIS TIME IT'S A FUNDING OPPORTUNITY ANNOUNCEMENT THAT DOESN'T HAVE MONEY ASSOCIATED WITH IT SO IT'S NOT REQUEST FOR APPLICATIONS. IT'S A PROGRAM ANNOUNCEMENT WITH REVIEW. WE HAVE A SPECIAL REVIEW FOR THIS. IT'S A RENEWAL, OUR EARLY CAREER RESEARCHER PROGRAM. WE HAD IT ON THE STREET THREE YEARS, WE HAD OUR THIRD RECEIPT DATE IN MARCH. NIH CHANGED ITS POLICY SO THAT ALL PROGRAM ANNOUNCEMENTS WITH REVIEW NEED CONCEPT CLEARANCE. WE HADN'T DONE THAT BEFORE, THIS IS A NEW POLICY, WHY THEY ARE SEEING IT FOR THE FIRST TIME THOUGH IT'S A RENEWAL. SO THE CRUX BECAUSE IT'S A RENEWAL YOU CAN SEE WHAT HAS ALREADY BEEN PUBLISHED SO IT'S NOT A SECRET. BUT THIS IS AN RO 3 MECHANISM SO THAT'S OUR SMALL GRANT MECHANISM, BUT WE INCREASED THE BUDGET. REHAB RESEARCHERS DO CLINICAL RESEARCH SO 50,000 DOESN'T GO VERY FAR. PER YEAR. SO THIS IS A LARGER BUDGET, 100K PER YEAR FOR TWO YEARS, RESEARCHERS WHO ARE LESS THAN SEVEN YEARS FROM THEIR FINAL DEGREE. SO THAT EARLY CAREER TIME, WE PICKED SEVEN YEARS BECAUSE THEN THEY'RE ELIGIBLE FOR EARLY STAGE INVESTIGATOR STATUS AT THE END WHEN COMING WITH RO1. WE GIVE THEM RO 3 TO COLLECT PRELIMINARY DATA AND COME IN WITH THAT RO1. ARE THERE QUESTIONS ABOUT IT? >> 'S MORE A PROCESS QUESTION THAT I SHOULD PERHAPS KNOW THE ANSWER TO BUT I DON'T SO WHEN YOU SAY SEVEN YEARS FROM FINAL DEGREE DOES THAT INCORPORATE ANY TRAINING LIKE RESIDENCY INTERNALSHIP OR ACTUAL CONFERRING DEGREE WITH LETTERS? >> WE TRY TO KEEP CONSISTENT WITH NIH POLICY FOR K AWARDS AND EARLY STAGE INVESTIGATORS STATUS. SO IT'S USUALLY THE Ph.D. BUT NOT POST DOC TIME. SORRY POST DOC TIME COUNTS TOWARDS THAT SEVEN YEARS, RESIDENCY AND CLINICAL TRAINING WE CAN MAKE EXCEPTIONS TO ADD TO THAT SEVEN YEAR WINDOW. ALSO PERSONAL TIME FOR RAISING FAMILIES AND THINGS. SO SEVEN YEARS IS A LITTLE FUNDABLE. FLEXIBLE. >> I THINK FLEXIBLE IS THE TERM. >> QUICK SEARCH IN REPORTER AND COULDN'T FIND APPLICANTS, PROBABLY SEARCHING WRONG, CAN YOU TALK HOW MANY APPLICATIONS YOU RECEIVE? >> THE RECENT DUE DATES, THIS IS ONCE A YEAR RECEIPT DATE, WE RECEIVED 73 APPLICATIONS ACROSS THE FIRST TWO, WE FUNDED 20%. >> I HAVE A PROCESS QUESTION TOO. NCMRR DOESN'T OFFER THE REGULAR RO 3s. THOSE ARE SMALLER. >> IT'S THE NICHD VERSION. >> OKAY. THANK YOU. >> ARE THERE OTHER RESTRICTIONS SUCH AS SOMEONE HAD BRIEF YOUS RO 3 R21 SORTS OF THINGS? >> YES. THEY SHOULDN'T HAVE HAD OTHER INDEPENDENT FUNDING OTHER THAN FELLOWSHIP. WE DO ASK THEY NOT HAVE NSF SIMILAR FUNDING ADS WELL SO REALLY NEWBIES. >> ACTIVES AWARE OF THIS FOR THE LAST THREE YEARS. WHAT I THINK IS REALLY NICE ABOUT IT IS THAT THIS RECOGNITION -- >> WHAT I REALLY THINK IS IMPORTANT ABOUT THIS RO 3 IS THEY RECOGNITION THAT CLINICAL RESEARCH IS VERY EXPENSIVE ESPECIALLY WHEN YOU HAVE PARTICIPANT, $100,000 IS MUCH MORE REALISTIC FOR PEOPLE TO MOVE SOMETHING TO RO1 LEVEL WHICH YOU DON'T GET WITH INTRAMURAL FUNDING AND DON'T GET WITH FOUNDATIONS. THEREFORE I'M A PROPONENT FOR THAT'S SPECIALLY IF WE WANT TO KEEP THE PIPELINE THAT WILL GET US TO THE NEXT LEVEL AS OPPOSED TO ONE PILOT AFTER ANOTHER. FOR $25,000 OR $50,000. I DEFINITELY SUPPORT THAT. >> I WAS ENTHUSIASTIC ABOUT THE RESPONSE AND SUSTAINED INTEREST FROM THE FIELD. >> AS YOU WERE TALKING EARLIER ABOUT THINGS WE CAN DO TO INCREASE PIPELINES, THIS IS THE EXACT THINKING. YOU CAN HAVE A REAL EFFECT ON. IN A WAY THAT FEW PEOPLE CAN T. SO IT'S TERRIFIC. >> ANY OTHER DISCUSSION? >> THERE'S NO FURTHER DISCUSSION. >> HAVE YOU CATALOGED DOMAINS THE 20 RECIPIENTS HIT UPON? >> YES, IT'S VERY BROAD. I HAD A LIST. REGENERATIVE REHAB, CHRONIC TBI POST STROKE MOTOR RECOVERY EXERCISE EXERCISE, PSYCHO METRIC VALIDATION OF MOBILE HEALTH TOOLS, PEDIATRICS. LOW BACK PAIN. IT WAS VERY BROAD. I WILL SAY THAT I DON'T EXPECT PEOPLE TO COME TO NCMRR FOR THE RO1s, THEY WILL END UP IN OTHER INSTITUTES AND I WILL TELL THEM THAT IS FINE. MAKE SURE YOU ARE HAVING CONVERSATIONS WITH THE OTHER PROGRAM OFFICER. >> THANK YOU. DO I HEAR A MOTION TO APPROVE RENEWAL AS DISCUSSED? ALL IN FAVOR? ANY OPPOSED IN THANK YOU SO MUCH. >> THANK YOU. >> AWESOME. THANK YOU, THERESA. SO I THINK WE HAVE COME TO THE SAD PART OF OUR SHOW, THIS IS WHERE WE SAY GOODBYE TO OUR COLLEAGUES WHO SERVED ON THIS BOARD. AND ARE NOW RETIRING AND MOVING ON TO GREENER PASTURES TO SPREAD THE WORD IN DIFFERENT WAYS. BUT WE DO WANT TO THANK THEM FOR THEIR SERVICE AND ALWAYS GIVE THE OPPORTUNITY FOR FOLKS TO SAY A FEW WORDS. WE ALWAYS DO THIS IN ALPHABETICAL ORDER SO MAYBE WE SHOULD LIKE EVERY OTHER YEAR DO ONE VERSE ALPHABETICAL ORDER SO WE DON'T DISCRIMINATE AGAINST PEOPLE WITH Z FOR THEIR LAST NAME. BUT THEN WE WILL START WITH KATHLEEN. KATHLEEN HAS BEEN A FANTASTIC AND ENERGETIC BOARD MEMBER, HAS HAD PROBABLY THE MOST ADVENTUROUS OF THE BOARD ATTENDANCE STORIES I THINK. HAS TAKEN INTERESTING DETOURS BUT WE VERY MUCH APPRECIATE YOUR SERVICE ON THE BOARD, KATHLEEN. >> THANK YOU SO MUCH. IT'S REALLY BEEN AN HONOR FOR ME TO SERVE ON THIS BOARD. AND I WILL CONTINUE TO WORK WITH ALL OF YOU TO ATTEND CONFERENCES AND I THINK I URGE US ALL TO REALLY LOVE THE RIGOROUS -- THERE'S SO MANY MEANINGFUL -- WE NEED TO DO THE BEST -- WE NEED TO HAVE WE NEED (INAUDIBLE) LIKE WE ARE ALL TRYING TO BE AND REALLY DEVELOP THERAPIES AND ULTIMATE CURES THAT WILL HELP PEOPLE IN THE FUTURE. IN THIS FIELD. THANK YOU ALL. [APPLAUSE] >> NEXT UP, DR. ALAN LINEMAN, ALAN HAS BEEN A FANTASTIC ADVOCATE FOR OUTCOMES AND ALSO HELPED US WITHIN WE DID RESEARCH PLAN BACK WHEN WE WERE DOING THE PUBLICATION MAKING SURE WE WERE GETTING THAT DISSEMINATED OUT TO PEOPLE, WE REALLY APPRECIATE HIS SERVICE AND HIS CONTINUED SUPPORT AND LOOK FORWARD TO PARTNERING WITH HIM IN THE FUTURE. ALAN. >> THANK YOU, ALLISON, IT'S A PRIVILEGE TO SERVE ON NCMRR ADVISORY BOARD. WHEN RALPH INVITED ME FOUR YEARS AGO AS TO COLLEAGUES WHAT THEIR EXPERIENCE WAS, TODD AND ZED WERE ENTHUSIASTIC AND ENCOURAGED ME TO VOLUNTEER. SO I DID. I WANT TO THANK RALPH. >> HE DOES EXTEND HIS APOLOGIES. HE HAD TO LEAVE BUT WANTED TO EXTEND TO ALL OF YOU HIS GRATITUDE. >> THANKS RALPH AND ALLISON FOR CONFIDENCE IN MY CAPACITY TO BRING DISTINCT PERSPECTIVE TO THE BOARD DISCUSSION AS REHABILITATION PSYCHOLOGIST MY WORK TO TO TO -- SERVICE ON NCMRR BOARD SHARE SIMILARITIES WITH OTHER BOARDS WHICH I HAVE SERVED AND ALSO DIFFERENCES. THE BOARD SHARES A PASSION FOR RESEARCH TO ADDRESS ISSUES OF DISABILITY AND ENVIRONMENT INTERACTIONS WITH FOUNDATION FOR REHABILITATION PSYCHOLOGY THIS, AND FOUNDATION FOR PMMR. QUALITY OF LIFE BROADLY DEFINED WITH SMALL CHURCH IN CHICAGO. AND CHICAGO P PRAY THEATER SEEKSES TO EXPAND OPERA AS A LIVING ART FORM. BUT NCMRR IS A FEDERAL AGENCY, THE BOARD ADVISES NCMRR, WE DON'T PROVIDE COUNSEL. WE HAVE A NATIONAL PERSPECTIVE, NCMR HAS A NATIONAL PERSPECTIVE AND INTERNATIONAL PARTNERS. THE BUDGET IS AT THE WHIM OF CONGRESS ITS SWISS TENSE IS STAMPTORAL THOUGH EXISTENCE IS STATUTORILY DEFINED AND WE DON'T HAVE TO WORRY ABOUT RAISING MONEY. IT'S LARGER THAN EACH OF US. I HAVE LEARNED FROM OTHER MEMBERS, RESEARCH ACTIVITIES PARTICULARLY DAVID TODAY THANK YOU. TY LEARNED CONCEPT CLEARANCE, DEVELOPMENT REVIEW OF THE REHABILITATION RESEARCH PLAN TO NCMR ROLE AND RELATIONSHIP WITH OTHER NIH ENTITIES FEDERAL PARTNERS PRIVATE ORGANIZATIONS, IT'S A SMALL CENTER WITH A LARGE MISSION, PRECIOUS RESOURCES, AND VERY EXPERIENCED AND THOUGHTFUL LEADERSHIP. I WANT TO TIP MY HAT FOR CLASS OF 19 ADVISORY BOARD SENIORS GRADUATING TODAY. ALL OF YOU ARE WORKING VERY HARD FOUR YEARS AGO BUT I DIDN'T KNOW YOU WELL, WE'RE AN AUGUST CLASS, WE PUBLISHED MORE THAN 1100 ARTICLES AND I DON'T THINK ANY OVERLAP IN AUTHORSHIP. WE GENERATED MORE THAN 22,000 CITATIONS. BUT MORE IMPORTANT THAN THOSE METRICS, WE SHARE PASSION FOR IMPROVING THE HEALTH AND QUALITY OF LIFE OF PEOPLE WITH DISABILITIES USING OUR DIFFERENT TRAINING AND EXPERIENCE AND WE HAVE THE CAPACITY TO WORK WITHIN THE STRUCTURE OF NCMRR NICHD AND NIH TO MAKE WHAT I HOPE IS AT LEAST A SMALL CONTRIBUTION. AN IMPORTANT BENEFIT OF BOARD SERVICE HAS BEEN TO HELP KEEP ME AT TOP OF MY GAME, I LEARNED A LOT ABOUT OTHERS WORK AND HOW TO ENTEREFFECT SECT AND INFORM MY OWN AND APPRECIATE MORE FULLY NEEDS OF PEOPLE WITH IMPAIRMENT AND DISABILITIES WHO WE SEEK TO ADDRESS THROUGH RESEARCH EDUCATION AND ADVOCACY. MOST IMPORTANT IS HELP ME FOCUS ON THE LEGACY OF THE WORK THAT I CHOOSE TO DO AND HOW TO USE LIMITED TIME AND RESOURCES TO MAXIMUM BENCH -- BENEFIT AND HOW TO REMAIN FOCUSED ON EXPERIENCE WITH PEOPLE LIVING WITH DISABILITY. SO FOR THOSE FRESHMEN SOPHOMORES AN JUNIORS, WISH YOU WELL IN YOUR THOUGHTFUL CONTRIBUTIONS IN YOUR ADVISORY ROLE LEADERSHIP OF NCMRR WELL AS IT CONTINUES TO FOSTER DEVELOPMENT OF SCIENTIFIC KNOWLEDGE, NEEDED TO ENHANCE THE HEALTH PRODUCTIVITY INDEPENDENCE AND QUALITY OF LIFE WITH PEOPLE WITH PHYSICAL DISABILITIES. THANK YOU. [APPLAUSE] >> NOW GREG HIX, I ESSENTIALLY PUT GREG ON THE BOARD A YEAR BEFORE HE WAS ON THE BOARD WHICH IS GREAT BECAUSE FOR WHATEVER REASON I HAVE DECIDED THAT GREG WAS ON THE BOARD FOR FIVE YEARS. BUT IT'S GOOD, ALL POSITIVE APPARENTLY FROM MY VANTAGE POINT SO I EXTENDED THE TERM IN MY HEAD. GREG HAS BEEN A REAL TOUCH STONE FOR ME AND PROVIDED HUMOR AND PERSPECTIVE, HE HIS SERVICE AS BOARD CHAIR IS VALUABLE IN TERMS OF ENGAGING PEOPLE DIFFERENTLY AND CARRYING ON THE THOUGHT OF MAKING SURE THE AGENDA WAS RESPONSIVE TO THE NEEDS OF THE BOARD AN WHAT THE BOARD DESIRES WERE SO I DO THANK HIM FOR MAKING SURE THAT THIS IS AN ENGAGEMENT, IT'S NOT US TALKING TO YOU, IT'S TALKING WITH YOU. AND WITH THE COMMUNITY AS A RESULT. SO GREG. >> THANK YOU, ALLISON, THOSE ARE REALLY KIND WORDS. IT'S HARD TO HAVE TO FOLLOW ALAN. PART OF ME -- PART OF ME WANTS TO SAY DITTO. I THINK WHERE I WANT TO START IS THANKING YOU, ALLISON AND RALPH,& THIS IS REALLY BEEN A GREAT EXPERIENCE FOR ME TO BE PART OF THIS BOARD. WE ARE ASKED TO DO THINGS ON A REGULAR BASIS AND YOU GO TO MEETINGS AND YOU FEEL OH BUT I NEVER FELT THAT WAY COMING TO THIS MEETING IT'S ALWAYS BEEN THIS THING OKAY WE GET TO GO TO THE BOARD MEETING. SO THAT IS A NICE THING TO HAVE IN YOUR LIFE. THINGS YOU ACTUALLY ENJOY DOING. I REALLY WANT TO THANK THE OTHER BOARD MEMBERS WHO HAVE HAD THE OPPORTUNITY TO INTERACT WITH& OVER THE PAST FOUR YEARS PEOPLE WHO RETIRED OR AS ALAN PUTS GRADUATED, AND ONES WHO ARE HERE. IT'S BEEN REALLY A GREAT EXPERIENCE TO LEARN MORE ABOUT THE REHABILITATION COMMUNITY IN A BROADER PERSPECTIVE. SO THAT'S BEEN BIG JOY FOR ME. I REALLY ENJOY COLLABORATIVE NATURE OF BEING ON THIS BOARD ALLISON AND RALPH WANT US TO ENGAGE THEY WANT TO HEAR FROM US WHAT ARE OUR THOUGHTS, WE GET TO PARTICIPATE IN THAT WAY THE STAFF HAS DONE A GREAT JOB I THINK OF BRINGING LOTS OF GOOD INFORMATION TO US WHICH WE THEN HAVE THE OPPORTUNITY TO TAKE BACK TO REHAB COMMUNITY, I WAS SENDING AN EMAIL TO I MY FACULTY LETTING THEM KNOW ABOUT THE NEXT THINGS COMING. SO I THINK THIS IS REALLY IMPORTANT FOR US TO ALL STAY ENGAGED TO CONTINUE TO PAY ATTENTION AND PARTICIPATE IN LIVE STREAMING OF MEETINGS BECAUSE THERE'S WORK TO BE DONE AS WE KNOW WE ARE ALL PART OF THE COMMUNITY AND WE HAVE THINGS TO DO NOT FUTURE SO LOOK FORWARD TO SEEING WHERE THINGS GO. SO THANK YOU. >> UPS AND DOWNS. GET EVERYBODY TO DO WALK UP MUSIC. OUR NEXT RETIRING BOARD MEMBER IS INDIRA, SHE'S ALSO SEARCHED AS BOARD CHAIR, BROUGHT A DIFFERENT PERSPECTIVE AND DEFINITELY PUSHED RALPH AND I TO THINK ABOUT HOW TO ENGAGE DIFFERENTLY. HOW TO THINK BROADLY ABOUT IMPACT. AND BETTER ENGAGE THE ADVOCACY COMMUNITY, INDIRA HAS SHOWN INCREDIBLE PATIENTS WITH US CATCHING TO HER THINKING. BUT I APPRECIATE HER SERVICE AS BOARD CHAIR ADS WELL AS SOME OF THE INCITES SHE BROUGHT TO THE BOARD. WITH THAT, INDIRA. >> I WANT TO START OUT ON MY REFLECTION BY THANKING YOU AND RALPH FOR YOUR INSIGHT DIRECTION AND RESPONSIVENESS NOT ONLY TO MY THE ENTIRE WORD -- BOARD, JUST AS GREG SHARED TO HAVE YOUR RESPONSIVENESS TO OUR INPUT U OUR ADVICE IDEAS AND SEEING MEANINGFUL INFLUENCE ACROSS NIP OVER TIME THE LAST FOUR YEARS HAS BEEN TRULY AN HONOR TO BE PART OF. TODAY'S CLOSING STATE OF THE SCIENCE CONFERENCE DISCUSSION IS A COALITION COALESCENCE OF EVERYTHING OVER THE LAST FOUR YEARS IN TERMS OF TAKING WHAT WE WERE TASKED WITH DOING AND HAVING A CONVERSATION ABOUT THE FUTURE WHICH IS VERY EXCITING AS WE CONTINUE TO MOVE FORWARD. THANK YOU VERY MUCH. [APPLAUSE] >> LAST BUT NOT LEAST, JUST IN THE Ks, WE DID THIS WRONG GOD BLESS AMERICA. I CAN'T ALPHABETIZE. I APOLOGIZE. K COMES BEFORE L. I WILL GET FIRED ONE DAY FOR THAT. YEAH. NOT LAST NOT LEAST YOU SHOULD HAVE BEEN SECOND TO LAST AND NOW IT'S JUST WE JUST KEEP GOING. KEN HAS BEEN A FANTASTIC PARTNER AND WE WILL GET TO CONTINUE TO PARTNER WITH HIM AS HE IS BEING SELECTED AS THE LEAD FOR THE LIMB LOSS PRESERVATION REGISTRY. I KNOW JOE AND I HAVE VERY MUCH APPRECIATED HIS PASSION FOR HIS WORK BUT ALSO INFLUENCES HE BROUGHT HERE TO THE BOARD THINKING ABOUT HOW TO BETTER USE INFORMATION COALESCE CHANGES IN THE SYSTEM TO MAKE A DIFFERENCE IN AN AREA WE REALLY FELT LIKE THERE WAS A GAP WHERE NCMRR COULD BE AN INFLUENCER WHICH IS SPECIFICALLY LIMB LOSS, DOESN'T FIT IN ONE INSTITUTE VERY WELL. AND IT ALSO HAS ASSISTIVE TECHNOLOGY PIECE TO IT THAT ISN'T ALSO INCREDIBLY WELL COVERED SPECIFICALLY IN ONE AREA. THE THINKING THAT HAS BEEN BROUGHT ESPECIALLY THROUGH THE REGISTERING OF WHAT WE HAVE SEEN SO FAR, I THINK WE'LL HAVE EFFECTS FOR YEARS TO COME. WE APPRECIATE YOUR SERVICE AND APOLOGIZE FOR MY LACK OF SKILL. KENT. >> THANK YOU. LAST WORD. MY EXPERIENCE HAS BEEN NOTHING BUT FANTASTIC NCMRR FORMED IN 1991, I WAS FORTUNATE TO GET A GRANT IN 1992, THE PROGRAM OFFICER WAS LOU -- I MET RALPH IN 199 #, THIS HAS BEEN MY HOME FOR RESEARCH ALL THOSE YEARS. I HAVE LIVED THROUGH THE BLUE RIB BOB PANEL DAYS AND I'M PLEASED TO SEE REVITALIZATION OF NCMR AND BASICALLY REHAB RESEARCH IN GENERAL AT NIH AND BEYOND. REHAB RESEARCH IS DIVERSE, NOT SINGLE DISEASE, NOT A SINGLE METHOD, NOT A SINGLE OUTCOME. THE STRENGTH OF THE PANEL IS DIVERSITY. I HAVE ENJOYED LISTENING TO THE DISCUSSIONS, I HAVE ENJOYED WHAT EVEN CONTRIBUTED. I CERTAINLY LEARN FROM THAT. I APPRECIATE EVERYBODY'S DIVERSE TRAINING, RESEARCH THEY DO, AND THE THOUGHT PROCESS THAT THEY BRING. THIS PANEL HAD A GREAT DISCUSSION, THE PEEP INDEPENDENT IN THOUGHT BUT UNITED IN VOICE. THAT'S THE STRENGTH OF WHAT ALLISON AND RALPH BROUGHT AND BEEN PLEASURE TO BE PART OF THAT. THANK YOU. >> MY LAST TASK IS JUST TO REMIND PEOPLE OUR NEXT MEETING IS IN DECEMBER ON THE 2ND AND THE 3RD. I WILL HAND THE AIR GAVEL. AND THIS MEETING IS ADJOURNED. >> THANK YOU ALL. [APPLAUSE]