Episode 109 - Cadense: A Revolutionary Solution for Foot Drop and Mobility Issues

Foot drop - a difficulty in lifting the front part of the foot - is one of the most common issues I see with the people I work with. It can be caused by muscle weakness caused by muscular dystrophy, spinal muscular atrophy or motor neurone disease, or damage to the brain or spinal cord caused by a stroke, cerebral palsy, Parkinson's disease, or multiple sclerosis.

There are many ways to manage foot drop - ranging from physiotherapy to electrical nerve stimulation - but my guest today is here to present what his company describes as the world's first truly adaptive shoes.

Dr. Tyler Susco of Cadense shares his journey from being an engineer to developing a split treadmill for gait therapy at MIT, which eventually led to the creation of an innovative shoe. The shoe features a variable friction surface that helps users move more comfortably and confidently.

The shoe underwent a pilot study, where participants experienced significant improvements in their gait mechanics and overall mobility. Feedback from beta testers, including individuals with MS and recovering from strokes, was overwhelmingly positive, with many expressing newfound confidence and mobility. The shoe's impact on users' lives inspired Dr. Susco and his team to continue their work.

Discover the story behind this revolutionary shoe designed to help individuals with foot problems due to stroke, MS, rheumatoid arthritis, and more. Listen to the episode for insights into the creation process and the impact on mobility, and learn about the research, trials, and get a glimpse into the future of mobility aids.

DISCLAIMER
The information in this podcast is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions you may have regarding a medical condition or treatment.

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Transcript

0:02

Hello, I'm your host, Kathy Chester, and welcome to the Move It or Lose It podcast, a podcast about all things that move the mind, body, and soul. The Move It or Lose It podcast is for information, awareness, and inspirational purposes only. I am not a doctor and I don't even play one on TV. So please consult with your doctor before making any medical decisions. The views expressed by advertisers, guests, or contributors are their opinions and not necessarily the views of the Move It or Lose It podcast. Today, I'm very excited. You all know any company that is doing something for our stroke victims or autoimmune victims that makes our life easier, I always love to interview them. So I have been so excited about your product, what you've come up with and just your vision and what you're doing and getting in contact with you. And I want you just to talk about your vision and the shoe, which I've been talking to everybody about. I had a big women's support group and I was like, have you seen these? You got to get on Yeah, I'm really excited. And as I told you before, when we were talking before we started, that foot problems are such a big issue. And when I'm working with stroke victims or MS patients like myself, or even rheumatoid or diabetes, it's such a big thing. And it's like, doctors look at us like we're crazy. We're like, no, we actually, our feet hurt. Can you help? No. So talk Sure, sure. Well, thanks again for having me. My journey, I guess we go all the way back. It started when I was in high school and realized there was a population that had movement difficulties or disabilities that at the time I didn't know how to help. But as my career kind of grew, I became an engineer and I realized that I had a skill set that I could use for well, just about anything to create products and got into industry after I was an undergraduate designing power tools and all-terrain vehicles and golf carts for a company called Ingersoll Rand, which was an awesome job. But at the end of the day, I wanted something that I was more directly helping people. So then I went to do my PhD and I went to MIT and I spent five years there doing a PhD. And the cool thing was, is that there was a lab there that was doing specifically what I was interested in, which was Uh, at the time, stroke rehab, any neuro rehab, uh, but specifically with robots. Uh, so at the time, you know, I'm thinking of, I want to get into robotics. That sounds awesome. So I got into a lab that really pioneered the first robots that interface with people with stroke, uh, to recover from the stroke. So my advisor was the guy that I think he developed the first one of these, uh, in the eighties. And it took 30 years for this, this method to, to become approved by the American heart association. which was crazy for that amount of time and work that he had put into it. But, you know, there was a hole in gait therapy for stroke, specifically with robots at the time. There are devices out there, there are exoskeletons that people can walk in that allow you even to walk over ground. Exobionics is a company that spun out of Berkeley that does just that. They do a bunch of exoskeletons, pretty cool stuff. There's other companies that do treadmill based machines or even kind of like elliptical trainers. Uh, for this type of thing, but a lot of the literature was suggesting that these devices didn't necessarily outperform human interventions, body weight, supported terminal therapy, these kinds of things. So we started to just say, okay, well, what, what could be the problem there? And one of the things that we learned from upper extremity robots was the fact that you have to allow intention to happen and free motion to happen for that person to complete the neural circuitry. So you're trying to build this neural circuitry back together. And, you know, if you just have somebody close their eyes and you move them around, nothing happens. People have to be able to move to strengthen these neural connections. So we were trying to figure out what's the way that we can help people walk in the least disruptive method possible. And what we came up with was, uh, well, we'll have people walk on a treadmill, but anytime, if there, if there's somebody that suffers with foot drop, which is a big problem with the stroke community, with the MS community, with the cerebral palsy, um, they have trouble clearing the floor when they're coming forward for that next step. So what we did is we built a treadmill that could drop out of the way on one side. So there was two treadmills, one that was for your right foot, It was a split treadmill. Exactly. Split treadmill. We called it the Skywalker if anyone wanted to look it up, but I The name predated me. I got there and there was a name or a concept that somebody had come up with and it wasn't really a functional machine. Uh, so I had redeveloped the whole thing to be actually functional and do what it needed to do. So we found that, you know, removing the floor, I call it the floor constraint. It's a constraint in motion because it exists there and you don't want it to exist. You want to be able to move your foot forward, but the floor is there. So we get, but you need the floor when you stand, right? We can't stand and we can't push off and we can't move forward without the floor. But it gets to be a problem when you're trying to move that foot forward. So this treadmill was just dropping every time somebody took a step. So you can imagine these big treadmill tracks and every second, the thing is going down, up, down, up, down, up, down, up. And there was a vision system that was looking at the leg to know exactly where it was. And as soon as the person was making that step, we had an algorithm, a computer algorithm that was anticipating. participating when they were about to make the step. As soon as they were about to make the step, the track dropped away, the foot swing forward like a pendulum, nice and easy. And then it came in contact with the track to make another step. So we ran So this was like a study, like who was on your team? Did you have So it was pretty much just me and my advisor at the time. So my, my advisor, like I said, that he had done, he had done this for 30, 35 years at the point at that point, he's kind of, he was the pioneer in this area. So he had seen everything. Um, he put me in touch with medical collaborators. I met with chief medical officers of hospitals. I went to, um, I tested the machines that, that were currently on the market at Spalding rehab hospital, which is in Boston. Um, uh, really nice, uh, researcher. Let me actually get on the machine and had me do an hour long training on that machine. So I saw all of that. And, uh, we had a physical therapist come and we did a feasibility study and do assessments on, on the people that joined our study before and after everything was ethics board approved and stuff, but effectively the MIT way is kind of a, you do your work by yourself most of the time, and you have an advisor that knows what they're doing. But so I developed this whole machine and we did a feasibility study with three people over 40 sessions. So each person did 12 to 16 sessions for one month period to see what happens when we put people on this type of machine. And we were looking for rehabilitation outcomes. Um, and I had two people with cerebral palsy. One was stroke in that study. That was it. And we're just, um, you know, we did find some interesting findings afterwards, specifically with, with rhythmicity of walking, um, how Uh, symmetry, um, you know, there was some gait speed improvements. There was balance improvements. There was a lot of, and this was just one mode It was really neat, but the thing that hit me the most after the study was just the comment from one participant in the study who eventually ended up being my friend, and there's a long story there, but she said, it's just so easy to walk without having to worry about catching my toe every time I take a step. And for her, it was, my realization was, and she had cerebral palsy, and my realization was these people are having a hard time mentally with walking. because it's always the fear of every step is going to be a trip. And when you're walking out in the community, it's don't trip. There's, um, there's stigma associated with the way people are walking. There's also, um, people are self-conscious because they don't want to fall in front of others, uneven ground, uneven ground. It becomes this, um, this thing. And she said, it's so easy to walk. I can walk on this and not worry anymore. That's great. It is, it's a scary thing that I deal with a lot with clients. It's the fear of the floor, of the ground. And so a lot of that is teaching them to come up from the ground, because it is such a fear when you can't walk properly is what will happen. And what if I'm alone and I'm on the ground and You know, she just said to me in passing, like I kind of as a joke, oh man, it feels so good walking on that. I wish I could just take it with me when I walked outside. And I said, well, Why don't we work on that? And she's like, you would say that. And I'm like, well, we'll try it. So then at that point I graduated from MIT and I moved to UC Santa Barbara where I currently work. And at that point, that participant that was in our study also moved to Santa Barbara. It was just this weird happening of serendipity, right? We both were moving here. She was the one who was like, maybe you could do this for me outside. I said, well, why don't we try? So she started working with my students and we started to build stuff. So we started to do a robotic shoe, which makes sense because there was, we'd started with robots, but robotic shoes were just so, such a bad idea. Such No, they're terrible. Exactly. Actually, you bring up the best point, right? That people do not want to look like the Terminator or Robocop. I mean, it's like as an engineer. Yeah, that's cool. But generally nobody wants that. So after a couple of years or about a year of trying, we decided that this is a bad idea completely. The weight alone of putting stuff and motors and batteries underneath your foot is terrible. And where do you put that stuff? That's always a problem when you develop these devices is if you have weight and there's robots, like where do you put it? And there's not a really a great place in the body to put it like a fanny pack. Maybe I'm sure people love that too. So we're there and we're like, okay, well then I started working with more students at UCSB. We started doing projects on how do we turn this feeling into a shoe that we call passive, meaning there is no motors, no batteries, no software to deal with. And we came up with more and more prototypes and concepts. And after a year of doing that with a group of senior students, one of the students decided she wanted to take this into her master's. So she did a master's and we did an IRB, which is a ethics board approved study with five people using a passive shoe, which we called the cadence shoe at the time. With a C that time, we spelled our company with an S, cadence with an S. But at that time it was cadence shoe. And we were cutting holes in thick-soled shoes and we were putting in elements that were low friction with pieces of foam behind them that would spring them back out. So effectively what we were calling this was a variable friction shoe. It was low friction if people accidentally hit the floor. And it was high friction when they pushed down on it with their weight because there's little nubs of low friction material would get pressed up into the shoe and you would get the rubber back. And so we were like, okay, this in our opinions at the time, and still probably that this most closely approximated what I was able to do at MIT with a million dollar machine into something that could presumably be a $200 shoe. And so we're saying, okay, the impact of that is probably much greater. This is like the thing, I'd say my main job- I happen to know a few of you. Yeah. I know a few of you guys, so yeah. My main job at UCSB is effectively getting engineers to think as simple as Good luck with that. Everybody wants to design the next machine that has 27 different gear trains inside of it. And you're like, oh, okay, And for us, we wouldn't know what to do with that. You know, we're just like, what do we do with that? Cognitively, we'd be like, Too much complexity. So, you know, it's, it's, this is always, and you know, if you had talked to any of my students here, they'd all say the same thing. My, my message to everybody is always the same. It's, it's just keep it as simple as possible and the simplest solution you can possibly come up with wins. That's it always. So getting back into the shoes, we were cutting these holes in these shoes and we ran a five person pilot study at UCSB that was ethics board approved. When you go through the ethics board, it's IRB takes. years. So we did, we did that with five people. We had a physical therapist come to UCSB. We did this in collaboration with our local hospital here. It's called Cottage Hospital. There's a research grant. It was a very small amount, but it gave us access to the therapist and therapist time so they could come to campus. So we had five people walk with these variable friction shoes. Again, cutting holes in them. And we saw three out of the five people walked 20 to 60% faster in these shoes in two minutes with no instructions. So we just, we didn't know what we were doing with it at that time. We just, we just did this and gave it to people. The therapist came, they got two minutes to feel acclimated. We had a fall support harness because we didn't know what was going to happen at that point. And we just had them walk around our lab and then we had them go outside the lab and there was 10 meter walk test set up. And we said, okay, so walk 10 meters, you know, go forward, backward, forward with your shoes. And then we switched, you know, which order it was in and then walk in it with our shoes and then come back into the lab and let's look at your gait mechanics. So we had cameras set up, six cameras looking at the legs with a whole bunch of infrared markers. So we can tell what was going on with the, the, the foot. Sure. your shin and the upper leg, and we can see the motions. And what we found is the people that were improving came in with a circumduction type gait where they're flipping their leg out to the side to get that step because they're trying to avoid the floor. Sure, absolutely. They're trying to avoid this. Absolutely. And you think about gait patterns, gait patterns, uh, when they're abnormal are an adaptation that the body makes based on the constraints around this body. That's it. So, um, if, if anybody hurts their ankle or hurts their knee, they'll start limping. They limp because it's the most effective way to move forward with maybe less pain. There's something that's being optimized there. It's either pain. or it's easier to move that way. So your body actually is very quick at adapting to new surroundings, which is interesting. So the people that improved, we looked at their gait, what's happening. So in that two minutes, their body had figured out a new pattern where they weren't Circumducting as much anymore, the reductions in that angle started to go down by like 60% and people started just moving forward and relying on this low friction surface to move forward. So there was more knee flexion. There was more hip flexion. We're seeing, okay, well, something's happening here. And we, we kind of have an idea why, but there's five people there. You can't say too much. This is a pilot study. So we published that work. It was in, um, the engineering medicine and biology conference. It was in Munich that year in Germany. And we published that work and, um, that's in 2019. So after that we said, okay, this looks like it might be something that is going to work. So, um, we got another grant, uh, called a seed tech grant, uh, from the It depends on what you apply for, but for the one, the first one with Cottage Hospital was fairly quick, maybe six months. And then the second one was pretty quick too, maybe three or four months, maybe six, to get this next grant, which was effectively to take something you've done in the lab and now let's spin it out in the world. So it was a seed technology grant. $50,000 to do what you can to get this technology now moved out. We couldn't use what we had developed in the lab for out of the lab. It was only made for hard surfaces because they were little like plastic nubs that would get caught in every crack and crevice that you walked down the street with. You can't use that. So the next step was to get it to a manufacturable thing. So we started to explore and mind you, in between all of this, there was probably 30 to 40 attempts to get this right. It took a It's just, you, you experiment with something, you try it, something's wrong, you try something else. And so we got to the point with the CTEK grant where we were able to produce 26 pairs of shoes. We had three iterations with a factory that was making shoes. So they knew how to make shoes and we could iterate. So the first one was like a 3d printed, what we called it a puck on the front that was kind of like the shape of a ski, the front edge of a ski. Okay. We wanted it to be able to hit that crack that quarter inch crack or that nub or that uneven concrete or pavers that it would hit it and then get over it. So we made it. So it's like a ski. So you hit that and it goes over and we wanted to make sure, you know, it's not going to get caught in cracks. And so after that, that kind of round of development, which took. a couple of years, I think. So when you go to the shoe factory, it's not like what we were doing here, which was cutting the shoes. If I cut into a shoe, I can make a new prototype in an hour. If you go to the factory, it takes three months and then you get it back and then you mess with it. And then you ask for something else and it gets into a queue and three months later you have another one. And so this takes like a year. And so we got to a point where it was good. We said, okay, let's exhaust all the money we have left in that grant. Let's get as many pairs of shoes as we can. And that'll be the output of the grant. We also spent some money on things like a force plate to assess forces while people were walking with the shoes, which we're still doing. And so, okay. So at that point we had 26 pairs of shoes and pairs I'm curious. So they were for different issues. So if you had foot drop or you had like, I'm thinking of the clients that like do this and then the clients that just roll to the side. Yep. Yep. Like, you know, doing that, were you having to come up It was one shoe for that needed to work for everybody. So once you get in the manufacturing phase, each mold is very expensive. So that money essentially went to one size, one mold, one shoe, and now we can make 26 of them. That's essentially how it works. Yeah. So we got these 26, but your point's a good one. Like who actually is going to benefit from this and that at this time, we didn't really know. In our pilot study at UCSB, we did have two people with MS. We had people with brain tumors. We had cerebral palsy in that study. The first one we had cerebral palsy and stroke. And so we didn't know, but I said, okay, now that we have these shoes, we got 26 pairs. They were all size nine men's. That was all we had. And we, we contracted a shoe designer in that process to make it look like a real nice shoe. Right. And then I sent it out into the world. We, we found people through Facebook ads, essentially to join our, join our study or we called it a beta test because we weren't, this is going to be a product test. It wasn't going to be research. 14 people ended up completing our beta test, which was between one and six months, depending on how long they wanted to use it, uh, with people walking at least 10 minutes a day in the shoes for at least five days Gosh, I wish I would have known you. I would have done it. We are so excited about our new program. It is not about disrupting the status quo. It is about empowering you to lead a life filled with strength, resilience and joy. Join us on this exciting journey because disruption begins with you. Ready to make a positive change? Let's disrupt MS together. I can't wait to So we had people with MS, we had people with stroke, we had people with Parkinson's, we had people with cerebral palsy, we had peripheral neuropathy, we had people that were just older and having trouble moving their foot forward. And I mean, the number one point of that test was to try to assess safety. They'd never been released into the world before. We're sending them out into the world. And I closely oversaw that. So I would meet with the person beforehand to determine whether or not I thought they were going to be a good fit, explain to them the risks of what they were doing, that kind of stuff. Get the shoes on them, watch them walk, make sure they felt comfortable, check in with them after a week, make sure everything's good, record things. We were doing speed tests too. They were doing it independently. Some of these we were shipping away. And they were telling me, you know, what's going on with their speed. But really I was just looking for, are we okay? I'd ask any adverse events. Are you okay? Have you ever felt insecure? And that was my call. So I'd check in with a week and then a month and then every month after that to see what's going on. And we found that, you know, across the board there, there weren't any problems, which was the number one relief of all of that. I wanted to make sure that we weren't going to hurt That's never, that's like always what you want to assess. Right. And it still Is if somebody uses this and slips and that would be awful. Cause that's our purpose here is to do what we were talking about before that, before we started recording and, and empower mobility, you know, and, and help people. And, um, so anyway, that, that came back fairly positive. Uh, we had some other really great findings with that, that were internal for stroke patients. So there were improvements and assessments of how it was for them, uh, which then we could use for website and educating other people. And so things looked pretty good. So, uh, we raised some money so that we were able to then afford all of the different sizes in footwear. It's crazy. You think about other products I've made, it's like, you know, you, you make one thing and that's it for footwear. One thing is 20 sizes to start. And that sounds like a lot and it's not a lot. 20 sizes is six sizes for women, and then four sizes of wide for the women. And then the same for men, it's not much. So you only have a little bit in the bell curve. So people that started writing to us, we just told now to expand to 40 sizes, which again, sounds like a lot, and we're still excluding things. So we had to raise money to be able to do that. Every mold is expensive. Every size is a new mold and every size is a new upper with a new stitching pattern of how to actually stitch everything together. Oh yeah. Yeah. Yeah. So, so we, we got through it and I have a collaborator at UCSB and I've worked together forever on this. Uh, his name's Elliot Hawks. He's a, he's another robots guy, but he's a soft robot guy. So he's more material related. And a lot of our, our shoe comes down to the materials that we've chosen to, to go into it. I hope that it tells you a long history of where this came from. I love that. I think it explains so much of your heart and how the shoe is made and what the purpose is of the shoe. Because I know, you know, people seeing on Instagram, they're like, Oh, that looks kind of cool. But I don't really know, I don't understand, which is the reason I wanted you on the podcast, so that people could get an understanding. And I've been asked about it But really is it is as simple as possible. All it is is when you're using it, if you have trouble or worry about flipping the floor, when you move your foot forward or scuffing the ground, if you do that with a high friction shoe, it grabs. And that's a problem with this shoe. It's low friction. It will slide underneath your body when you place your weight on it. It's going to return your traction. That's it. And then you can step off normally. It's a little bit of my dad has Parkinson's he's been using the shoes ever Well, how good does that feel that you can help your dad? Yeah, that's It's really cool. It's really neat. Um, you know, a lot of our family members as they start aging too, are going to, are going to hit different types of, um, Yeah, it's such a neat concept. And it's so, so cool. Because like you said, there's so many people that can use this. And of course, like, I'm thinking of my clients that have so many issues and myself, you know, I can go a long time. I mean, I used to do marathons, and now my running is slowed down. And you know, then I'm walking, you know, my my dog, and I'm like, Are you kidding? I'm getting this drop foot. And so I'm like, I just need something. And You know, it's like you go in and they've got these braces that are so big and so cumbersome. And the ones that that would actually help you are never around or covered. And there are hundreds and hundreds or thousands of dollars. And it's like, all right, you know, you do know that most of the patients are on some kind of disability. So how would you expect them to afford this stuff? So it's always been confusing to me going into this, even when I didn't need anything. to see these patients in these very large things that didn't really help their drop foot or help what they were struggling with. So I loved your idea and what you were doing, because I'm like, that's something that people need, not these giant braces. And there are some people who honestly need those. Obviously, they need their devices, they need their AFO. However, so many of us are in that spot where we need a shoe, we need something, like you said, to give us that lift, to not trip on the curb and trip on that uneven, you know, round. And that's just such a great invention to think about. So what have you, as far as feedback from the different clients, what has been the biggest joy? What have you had like the most Yeah. So certainly, um, you know, going back to our beta test, when I was able to follow people and people would improve a lot and I'm talking with them weekly, it was awesome to see that. And I felt really good, um, since we've started to ship, which has been over a month now where we're shipping product, which is scary. It's like a prayer. This is the furthest I've ever gotten and actually shipping products that was my own. And then it's like, Oh my gosh, we had so many purchases before they even got to the port. We had 800 that we had to ship out. So they all get there once. And so you get blood back. Um, but we've gotten some awesome messages, uh, that, that really keep us going. Cause you know, any product people, some people are going to say, I don't like it. It's not for me, that kind of stuff. And that makes you feel terrible. And then you, you get these ones that are just like, I mean, I had one from somebody with MS and, uh, she, She'd said her husband is MS and he hadn't been outside in 10 years. He didn't want to walk anymore. And with these, he's able to get up and get out. And now he wants to go and, and, and do things again. And that makes you like, that was like tearjerker, you know, you're like, my, my, my wife's been helping with customer service. Cause we're getting so many inquiries. I'm a professor. I don't care. I don't have that many hours in the day. Um, we only have, uh, Johannes is our CEO. We only have him, me. And so we, I'm like, help. And so she's been jumping on, um, and helping with a lot of customers, but she's like in tears with this. And then, you I get my husband, I'm crying. I'm like, they walked today. And so I, Yeah. Oh, you know, exactly. Yeah. So, so they stood in the shower and I'm excited. I'm calling and crying. So I totally get it. So how would it amazing feeling that you created this So, yeah. So, you know, those are the. Yeah. And we've had probably, I don't know, 30 to 50 of those. And it kind of like, it lifts you up when you get that. And so I actually, some of them, that one specifically, I called them and I was just like, thank you so much for that message. That Those are the ones you want to put on the wall. So when that new stuff comes, you're Exactly. Exactly. And you know, the, the, the one thing that we're trying really hard to educate people on, cause this is a completely new experience. Like nobody has ever had this experience of walking with a low friction surface, because we're all attuned to, if you walked on an ice, we're all going to clench our muscles. We're going to be scared. Right. Because you're like, oh my God. you have to learn, uh, some people we found in our beta test that 30% of the people had to learn and take a week or so to get accustomed and comfortable. Um, after about a week, everybody in our test was like, okay, I got it now. Now I'm moving. Um, so in fact, the person that did the best in our beta test, he started the first week. He's like, I'm a little hesitant and I'm like, okay, well, we'll try this for him. He had trained for 11 years in a robot exoskeleton and his gait looked like a robot. I mean, it was like up, over, down, up, over, down, and very slow and very high ground clearance on swing to ensure he wasn't going to hit the ground. And these were completely different. And I'm telling him, let's walk to a rhythm. And for him, the best thing that helped him was let's think like we're, we're walking is dancing. We're going to have a beautiful rhythmic motion. And we're going to think about moving the same speed on the left, to the right, to the left, to the right. And for him that started to then blow him up. So we got a, we got a $2.3 million grant from the national institutes of health to do a clinical trial. So we're going to do, we're starting our clinical trial pilot. All of the participants are currently enrolled in this. It's, it's at Shirley Ryan ability lab, which isn't too far away from you in Chicago. And, uh, they're the number one stroke hospital. So we're starting with stroke there. Um, this next year, I'm going to start writing more grants probably to, to spill more into the MS space, but we're there with a clinical trial. Um, but we used that gentleman's data that was in our study because his improvement was so drastic that we're like, wow. So that's what I think maybe tip the scales with the national institutes of health to allow I mean, I can think of so many clients that need that. So it's just, it's Some people need time to acclimate. So, you know, the things that we're hearing back, um, you know, is just for some people, it feels slippery and they have to be able to their steps on our website that we send people as soon as they get the shoes on, here's some training, here's a tutorial on how to use it. And, um, this is what we want you to do. So we tell them to test the waters first, which is put your foot in, like putting it into some water, feel the low friction. Now step on it, feel the high friction. Now do the low friction tire trying on different surfaces, try to engage that high friction. Um, and if people then can get that and I'm sure that that is a lot of that is that first couple of days that they're like, Very, very neat. I love these. So tell me, I know that we're short on time because you've got to race to the other side to teach. Talk to me about like what you're looking forward to in this next like year to, you know, five years. What is something that you're like most excited about with the shoe and with everything that you're working Yeah. So, I mean, in the next five years, we will, this clinical trial Oh my God. Oh, I have three children too. One is a baby. Me too, but mine are older. Yeah. Yeah. I got you. Yeah. So we're doing, we're doing this and, uh, yeah, it's a lot. Um, but, uh, No, and the clinical trial will be done in four years. Um, that's going to be awesome. We're going to be able to see the data and something that's statistically meaningful. There's some statistical power. We have 50 people that are doing this test. They're walking in their shoes, um, for 12 weeks and then they're doing AFO training for 12 weeks. And we're looking specifically at. What the outcomes are from this shoe. And for that one, we're telling people to train at least 30 minutes a day for five days a week. And it doesn't have to be the same time. They can do 15 minutes, take a break if they can't handle it and then do another 15 minutes. Uh, but we're encouraging people 30 minutes a day, five days a week, and then they'll do the same thing with an AFL just so that we can have some, there's a placebo and then there's a. You know, uh, intervention. And so we'll be comparing the same person on both interventions to see what it did. And we'll have 25 people that start with our shoe and then 25 people that start with the AFL. So we flip flop them so that there's not an order of facts here to see what exactly what's happening, but I will be out of the clinical trial to ensure that there's no conflicted data. So that's going to be super cool. We already have, uh, six products in addition to the shoe that are starting to come. So that's really exciting too. Um, we have this one, this is a, this is a high friction mat. So effectively wherever this is located, we'll turn off the low friction because it'll stick to the bottom of the low friction stuff. So with that, if people, you know, we've had a couple of customers already respond to us, like it's hard for them to get out of their chair with it. And, um, I go over in the tutorials, how to do that, which is essentially you load the, load your feet first and then stand up. So you can do it for sure. But people that have trouble, we'll give them this mat that'll make it stick anytime you don't want it to slide. Um, so we'll have these mats available. We're going to have, uh, um, some other products available that will, will allow just more functionality with the shoes. We're also developing, uh, from the ground up, which we think is the first from the ground up shoe for people That's coming from the website. So the people are, that's awesome. Cause that is such an awkward thing to get your shoe with the Absolutely. So we're from the ground up the a hundred percent straight for AFOs, the same variable friction technology that's in our normal shoes. We're going to put in that. Yeah. And we found with AFOs that one of the people that I work with that was in our beta test, who's a good, good friend of mine. Now, um, he gave me all his old AFOs. I've been using I've got five, if you want some, none of them work, so you can have all of them. Yeah. So, We're doing that. We're going to come out with an app pretty soon. Um, that will allow people to train together, track their steps, track their mood and train as a group. So that one's coming, uh, within the next year. Um, there's other types of mobility devices I'm designing. So it's going to be a whole lot of things. Um, Yeah. Yeah. I'm super excited. Well, when It's a four-year trial. However, we're going to have data that will present like pilot data in, uh, probably in a couple of years. So we'll have like 10 or 20 people that have gone through it and in a couple of years, we'll probably present that at a conference or something, but we'll, we'll let people know about the results on our, on our website, but we're, we're not actually selling the shoe as a medical device. Yeah. And so they can get it now. Is it just a white shoe or are there different colors? I'm asking Oh, this was a big thing we learned in our beta test was we were given the men's shoes that looked like men's shoes and they're like, this is too ugly. So we've, we worked with two different shoe designers. We have really pretty shoes now we've got. For women, we have a black, which is our bestseller, 65% of people buy black. Uh, and then we have white, um, which is the second bestseller. And then we have a, like a light blue, uh, which is really pretty. And then there's a pink one, uh, which is nice too. So we have four colors for women. We have three colors for men. We're developing like a super Well, I know that I want to get some for sure. I love the concept. I love what you're doing. I definitely want to hear back, not in four years. I want to talk to you sooner than four years. I want to know how it's going. And I want to interview you more to see where you're at, because I am so excited about this. I just think it's so clever and such a great thing. I love the work that you put into it. I'm so excited. And I, I love things that, you know, there's things that are ideas and there are things that, that very obviously you're an engineer you're a doctor and it's you know goes into so much work and i don't think people get that often how much work goes into this and so i can tell you from the bottom of my heart i appreciate it so much and i know so many other stroke victims and all all of us that have you know these issues appreciate it so so much oh thank you thank you Well, thank you so much for joining us today on move it or lose it podcast, where you can again, find us wherever you like your podcast, whether it's Apple, Spotify, and join us on that. And we can't wait to see you again. We're going to have a lot of exciting guests and working together. And as always, you'll hear us say at the end of every podcast, we are stronger together. So let's do it. Let's become stronger together. Have a