The Problem We Solve

The COVID pandemic has overwhelmed our ability to provide rehabilitation to our patients. Over 1.3 million cases of COVID-19 have been reported worldwide and 32% of the diagnosed cases have required hospitalisation. Most rehabilitation doctors have been relocated to newly created COVID wards and rehabilitation gyms have been transformed into intensive care units, so we lack the resources to treat our COVID patients.

Post Intensive Care Syndrom (PICS) is an impairment in physical, cognitive, or mental health status arising after critical illness and COVID patients triple the average length of stay in intensive care untis. This drastically reduces their independence after the disease and delays their discharge. COVID seems also to be causing severe stroke in healthy adults in their 30s. Stroke is the leading cause of serious, long-term disability in Europe and the vast majority of these patients do not receive adequate treatment, as it usually lacks the recommended duration, intensity and specificity.

Traditional therapies are especially resource-intensive as they require individualized, long term rehabilitation by skilled multidisciplinary teams, that we are unable to provide during the pandemic.

We want to rebuild rehabilitation from the ground up to address all the challanges we are facing right now with our COVID patients

Our Inspiration

Rehabilitation is a key phase in the recovery from many illnesses. Although most medical efforts are currently focused on facing the pandemic, we must keep in mind that there are many patients with concomitant pathologies that require care. We see cases of PICS, stroke, hip or shoulder fractures being admited daily at the hospital, which require urgent rehabilitation. In many of these cases, postponing treatment is not an option since if deficits are not treated early they tend to become permanent.

Therefore, we have a large volume of patients who need attention for COVID and its complications without doctors to evaluate them, therapists to treat them or gyms to place them.

The Solution We Bring to the Table

Our goal is to rethink from scratch the model of rehabilitation care we can provide to these patients. The strategic lines that we have prepared during this hackathon would be the following:

• Treatment from the admission day of covid patients with rehabilitation videos.
• Provide Virtual Reality Telerehabilitation to patients with the most serious complications.
• Revamp hospital treatment protocols for early gym reopening to treat the patients that require therapy the most.
• Design of a monitoring and Follow up structure after discharge by the Primary Care Team.

From the hospital admission day

We have developed and implemented in our hospital a series of novel, evidence-backed video therapies so that the patient can safely and effectively start their rehabilitation treatment from the first day of admission. The initial assesment can be carried out by nurses with no prior rehabilitation knowledge. The videos are color-coded like a traffic light. The red exercises are those that require the least effort from the patient and can be performed by those who have not yet started sitting or walking. The yellow exercises increase the intensity and the green ones serve to reinforce those patients who are already able to stand up. The objective of this subdivision is to ensure that patients can perform the exercises in a safe and effective manner while providing an adequate level of difficulty that will allow them to speed up their functional recovery as much as possible. And we also provide them with a postdischarge treatment plan specifically adapted to our patients capabilities and needs.

This will allow us to reduce the average stay, ensure adequate independence of the patient after discharge and reduce the risk of co-morbidities such as accidents and falls.

To home based VR telerehabilitation solutions

For the more severe patients affected by PICS or stroke, we have developed cereVRal. CereVRal is an affordable virtual telerehabilitation platform that helps patients with neurological and physical deficits regain their independence. Using the patient’s smartphone we aim to provide evidence-backed, cost-effective virtual neurological telerehabilitation therapies.

We decided to design our own therapies from scratch to eliminate the adoption barriers of virtual rehabilitation and minimize our therapist workloads, testing these therapies daily to continuously iterate and improve them based on our patients' feedback.

Our platform improves the quantity and quality of the treatment received by our patients without overloading their carers and therapists, avoiding unnecessary trips to the hospital and improving our patients engagement, bringing us closer to that ideal treatment that we are unable to provide

Making sure we reach those who need us

One of the biggest challenges is to control and follow up the patients once they have been discharged. During their admission, patients are monitored by a multidisciplinary team and we have access to their progress data and clinical history. The problem lies in those patients who present functional impairment but who were never admitted, those who have been admitted to centres that do not have rehabilitation such as nursing homes, or patients who have presented a worsening after discharge.

We have realized that we do not have enough specialists to follow up all patients affected by COVID, so we need to establish a system that allows us to standarize the selection of those patients who need treatment the most. To this end, we are designing action protocols and training guidelines for the primary care team so that patients with deficits that are susceptible to urgent rehabilitation treatment can be referred to the hospital through existing fast-track channels.

This will allow us to avoid losing contact with those patients in a more vulnerable social situations and to optimize our follow-up capacity.

Reopening our rehabilitation gyms

Even if we were allowed to reopen the gym today it would be difficult to continue our activity as we have been doing until COVID. Traditional rehabilitation treatment requires high patient/therapist ratio and it is impossible to perform the therapies while maintaining a safe distance. Rehabilitation gyms and therapists have been a significant vector of infection within hospitals, so we must redesign gyms that ensure the safety of patients and workers. We have designed a plan that uses functional rehabilitation units formed by 4 therapists. 2 safe therapists, a risk therapist and a home therapist. The safe therapists are responsible for treating patients who have not had any symptoms or risk contacts. The risk therapist treats patients who have no symptoms but have some minor risk contacts. The home therapist provides treatment for patients who are isolated by high-risk contacts and will follow up on confirmed cases by telephone.

We have identified the protective elements that each member of the team must have, the protocols for the control of the patients' symptoms, the analytical controls of the therapists and the redistribution of the gym space.

Our system will allow the reopening of the gyms as early as possible, will minimize the risk of contagion between patients and therapists and will allow us to maximize the amount of therapy we may provide, which will prevent the appearance of sequelae and disability in our patients.

What We Have Done During the Weekend

Our virtual reality treatment videos are a project that our team leader, Dr Ezequiel Hidalgo, has has devoted the last 2 years. It is a project with a solid base and clinical experience, in a phase of commercial validation. Dr. Hidalgo has formed a starup, Eyegress, to transfer the technology to the market, and has obtained more than 100,000 euros in public and private investment. He currently has an MVP ready for the treatment of upper limb motor deficits, and several public and private clinics have shown interest in incorporating the treatment.

The treatment videos for COVID were an initiative that emerged in our rehabilitation department after the first days of the start of the pandemic. When we were told that our ward was going to be restructured and that we would probably lose the rehabilitation gym, so we started the planning, researching and recording the videos so that we could start using them with our patients before we were overwhelmed.

The great challenge of this hackathon was to try to unite all our treatment initiatives in order to provide a comprehensive solution that would allow us to treat our patients from the beginning of admission and continue with proper patient follow-up after discharge. Hector, our physiotherapist, has overseen the needs and requirements to provide rehabilitation treatment as soon as possible. Jorge, our specialist in preventive medicine, has been in charge of designing the followup scheme for patients after discharge and detecting the best channeling routes for the most serious patients. Diego, our innovation expert, has dedicated himself to seeking out European initiatives in the market that could benefit our platform as partners to ensure that we may implement our solution as quickly as possible. Finally, Beatriz, our entrepreneur, has been working on adapting our business plan to this new situation in order to maintain the viability of our proposal and while maximizing its social impact.

Our solution in a post - COVID world

We strongly believe in the tremendous potential of our platform and the incredible social impact it could have on those patients who cannot access traditional therapies but need treatment the most. In the future we would like any patient to be able to access all our treatments directly using their mobile phone. For less than the cost of 1 session of traditional physical therapy, the patiet may have a full month of home based virtual telerehabilitation.

We aim to create a "Rehabilitation Netflix" where patients can, regardless of their resources or location, access their treatment videos, ensuring universal accessibility to rehabilitation.

SUMMARY

Impact Potential

Most COVID patients admitted to hospitals need rehabilitation, but we have to face this demand without doctors to evaluate them, therapists to treat them or gyms to place them. Our solution will reduce the average hospital stay, ensure adequate independence of the patient after discharge and reduce the risk of co-morbidities such as accidents and falls. Our platform improves the quantity and quality of the treatment received by our patients without overloading their carers and therapists, avoiding unnecessary trips to the hospital and improving our patients engagement, bringing us closer to that ideal treatment that we are unable to provide to millions of people worldwide

Technical Complexity & Novelty

We provide a comprehensive 360º solution for our patients' rehabilitation needs. From the day of admission to the follow-up after discharge, we combine different solutions, including cutting edge virtual reality therapies, to cover all our patients deficits, specially those who need us the most.

Prototype Completion

We have developed and implemented in our hospital a series of novel, evidence-backed video therapies so that the patient can safely and effectively start their rehabilitation treatment from the first day of admission. CereVRal is an affordable virtual telerehabilitation platform with a MVP ready for motor deficts. Using the patient’s smartphone we aim to provide evidence-backed, cost-effective virtual neurological telerehabilitation therapies.

Business Plan

We build on existing traction as our solution relies heavily on IRL experience and research that has been built over several years. Dr Ezequiel Hidalgo, has devoted the last 2 years to this project, he founded a starup, Eyegress, to transfer the technology to the market, and has obtained more than 100,000 euros in public and private investment. He currently has an MVP ready for the treatment of upper limb motor deficits, and several public and private clinics have shown interest in incorporating the treatment.

Scalability

Introducing a digital solution reduces our scaling and distribution costs and our videos only need a voiceover to be exported to patients all around the world. We are looking for extra funding to increase our therapy range so we may include new therapy videos and upgrade existing ones for a better user experience and help prevent serious, long-term disability in Europe.