Gait Training For Imbalance With Vizziq

Inventor, Katherine Haik, and Ashley Williams present a new medical-fitness exercise tool that helps people with imbalance learn to walk more confidently.

WHY GAIT TRAINING?

Falls are the leading cause of fatal and non-fatal injuries for older adults. They are expensive and can cause a spiral of decline, often leading to institutionalization. Neuromuscular re-education and gait training is an important, but often overlooked, modality for use in falls and balance therapy, as well as, brain injuries, musculoskeletal disorders, post-surgical therapy, and injury rehab.

How we walk is a complex phenomenon in which our whole body is performing a dance that has been ingeniously choreographed. Our visual, vestibular, and somatosensory systems are constantly adjusting and interacting. These are autonomic functions, like walking, where most of the time we don’t need to think about how these systems are working.

Gait speed is a vital sign that is described in the seven phases of the gait cycle, directly related to brain/body function. It is used as one of the measures for determining current health and independence.

Gait training is a specific form of therapy that can improve walking and stance by focusing on balance and posture while adjusting position and increasing endurance.

Gait rhythms and patterns can be retrained, improving gait efficiency, independence and confidence, which will decrease fear of falling and dynamic stability.

Vizziq Neuromuscular Trainer is an evidence-based mobility and gait training tool that can easily be adapted to user size and function levels. Vizziq is an effective gait training tool that can be utilized during both healthy times and after injury or illness, for faster recovery.

Speaker bios:

Katherine Haik, the inventor of Vizziq Neuromuscular Trainer is a pioneer in the space of exercise science; a member of the first class in her University to obtain a Bachelor's of Science in Exercise Science. Though they were considered undergraduate students, the majority of their coursework was spent with the graduate level programs learning physiology, kinesiology, cardiac rehabilitation, chronic disease management, 12 lead EKG Exercise Stress Testing, Athletic Training and Sports Injury Therapy Techniques, Nutrition for Athletes, and Adaptive Aquatics. Katherine studied and performed competencies that included various modalities from aquatic therapies, stress management and Feldenkrais, to the Pilates method. Her experience in these modalities led to her identification of a significant gap in the medical device industry, overground neuromuscular gait training devices.

Ashley Williams, CHPSE, PhD Candidate. Ashley started in healthcare as a CNA at 15 and became an EMT at 17, and a paramedic at 19. As a paramedic she worked in both pre-hospital and in-hospital critical care settings including the emergency department and intensive care units for over 10 years. Ashley was also an educator teaching life support courses for clinicians including physicians and other advanced care providers. Ashley has a Bachelor's of Science in Biology and Political Science, a Master's in healthcare ethics with a Catholic Healthcare Focus, and is a PhD Candidate in Healthcare Ethics and has several publications under journal review. She was 1 of 6 chosen for the first ASU/Mayo Clinic MedTech Accelerator program in which she began working with Mayo Clinic companies and as as a research affiliate with Mayo Clinic. Ashley now is a consultant for medical device/tech and healthcare companies (Ethos Healthcare Advisors) and a patient advocate (Ethos Healthcare Advocates).

This video is sponsored by Vizziq.

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Transcript

 Hello and welcome to Making Vestibular Visible. Today's educational event is called GATE Training for Imbalance. If you know anything about vestibular rehab, you're familiar with how important it is to restore a person's confidence and relaxation during walking or gait. People with vestibular symptoms feel challenged with walking normally, often widening their stance.

Slowing down or turning really carefully. Therapists use many techniques to help those with vestibular symptoms improve their balance, like improve, improve their walking speed, get their feet closer together, equalize their stride link, and normalize their body's rotation at the core. Today's episode is really an exciting topic for all those with vestibular symptoms.

It's brought to you by vis the developer and manufacturer of a new and novel gait training device. Our guests today will be telling us all about this, so stay tuned as this is. This episode is sure to be informative for both vestibular warriors and healthcare. Today we're joined by Katherine Hake. Hake, like Hake, who has a degree in exercise science and is the inventor of this new mobility and exercise device that syncs with your stride.

Also, joining us today is Ashley Williams, who is the Director of Operations and Quality at vix. So I'm gonna add them to. Chat, and we're going to begin today and hear them talk more about this amazing gate device. One second. Let me get us all in the right place. There you go. So welcome, welcome Catherine and Ashley.

Thank you, Kathleen for having us today. We're really happy to be here and excited. Thank you. You bet. So I think you brought a slide. People got to see in the intro reel about if you're watching on video and if you're listening on the podcast, know that the videos and the slides that'll be shown today will be available at the Vestibular Disorders Association in several places.

You can watch this video on replay on our Facebook page, our LinkedIn page, as well as our YouTube channel. So go to vestibular org to find those. And you can watch what is presented today, but we're gonna be explaining things in such great detail that even if you're just on audio, you're gonna be able to enjoy this conversation.

So you brought today some slides and that's gonna kind of guide the conversation. So let's just jump right in. Are you ready? Yes. Okay.

Tell us about vi, how'd you get this started and tell us about your company. Yeah, so Visic is a neuromuscular gate trainer and there'll be some, a little bit more in the story later on. But basically my background is exercise science and I worked in the aquatic area a lot of aquatic rehabilitation in general.

And worked a lot with physical therapy and that's where I learned about gait and saw the need. There was a huge need as I saw patients leave the aquatic environment on the mobility devices that they came in on. And I asked the therapist that I was working with, , isn't there anything else that we can do besides stoop over and shuffle or an asymmetrical gate pattern with a gain or whatever.

And he said there just isn't anything else. So that's kind of what got me on my journey. As an exercise scientist, I have had a lot of great Gosh, some amazing people that I've gotten to work with and learn from over the years, and we're just excited to get this new mobility device out that really.

Is a paradigm shift that's really needed in our, in our culture right now. That's great. Well, I got to see it at the International Conference for Vestibular Rehabilitation for the first time and actually used it. So it was certainly something I had never seen before, and so I'm excited to share it with this vestibular audience.

So let's see. Go ahead and continue. Sure. You can go to the next slide. Okay. So we are gonna start today by kind of just going over the foundation of gait and understanding a little bit about how it impacts the vestibular system impacts our gate.  So our first stages of gate actually begin when we start to.

So humans actually have the first reciprocal gate pattern from birth is the first sign of how our gate is gonna function as we begin to walk. So between 11 and 15 months is traditionally when individuals have the ability to walk on their own, and then by three to four years old actually is when you reach your reach, your maturity in your gate pattern.

So from a pretty early age, , we have our mature gate pattern set and then you know, when a trauma occurs or anything, even emotional traumas, things like that, you can have severe impacts in your gate. Next slide, please. It's, it's, let me jump in. It's incredible because all the things that a baby does from the moment that they're born are preparing.

For that automatic gate cycle, including crawling. You cannot walk normally with a normal gate pattern unless you crawled. Some people skip crawling, but it does come back and impact their gate pattern. So everything that happens to a baby from the very beginning will contribute towards the development of that automatic gate.

Yes, Catherine. And just to add to that I think it's the repetition as well. So when you're thinking about.  Infants do, and you know, the early stages of development, they're lifting their head, lifting their head. You put 'em on their tummies and then they lift and maybe lift the shoulder. Lift the shoulder.

So just the repetition that's required to develop all of that is really where we're gonna focus later on. So I'm glad you brought that up. Yes, absolutely. So like I kind of touched on previously, as our, as we age, we have emotional or physical trauma, our gait begins to decline. So this can occur as a symptom for many disorders, including vestibular disorders, which as  Our vestibular warriors know that's linked to your inner ear and your balance.

Neurological disorders, so that could be stroke, traumatic brain injury, parkinson's disorder, functional movement disorders, and many more. There's degenerative diseases like arthritis, Ms a L s or Alzheimer's disease.  and then others, including trauma, foot injuries, ill-fitting shoes or obesity. So there's a lot of things that impact our gait and things that you wouldn't necessarily even think would impact your gait have an impact on your gait.

It's true. And vestibular therapists or therapists trained in vestibular disorders see all kinds of patients with gait problems, balance problems that are related to the vest. System, but also other things. So anyone watching you might know other people who might benefit from this device. So stay tuned.

So a little bit more specifically on the vestibular system. So our vestibular system controls our balance and our walking as well as modulating our gate when we have impacts. Occurring between the signals of the vestibular system. That tends to cause people to take longer, slower steps, though they'll continue to maybe walk at a normal walking pace.

Sometimes that causes them to have a decline in their Gate cycle timing because they're trying to improve their posture. So all of these compensatory mechanisms lead to an altered gate pattern. So this kit, this is because of the way that our gate cycle works with our spatial and our temporal aspects, and the way the vestibular system links to our gate to be able to send those signals out for us to use our normal for US gate pattern.

So it's just important to. , keep your gait healthy throughout your entire life. Mm-hmm. . So your vestibular system can help you in, in case of falls. Absolutely. And the best way to keep it healthy is to keep doing it, keep practicing. Absolutely. Like Catherine said, repetition is, is key. Good point. Yeah, that's great.

Excellent. So this slide it's a.  confusing to look at, but once I explain it, I think it'll make a lot more sense. So gate speed can predict your disability and mortality risk. So every 0.1 meter per second, slower in your gate, that increases your risk to have a disability within three years by 30% every 1.1 meter per second, slower in your gate, that increases your risk for mortality within four years by 18 to 24.

So the slower the gate speed, the higher the risk for disability and potentially mortality to occur at a more rapid pace. So it's important to just keep, keep on your gait and repetition, repetition, keep walking, keep moving. It is connected to lifespan for sure, and I think the hard science supports that move more keep moving and live longer so that that's, there's the evidence for this device.

Okay. And one of the ways that we're trying to create more awareness around gate speed and the importance of paying attention to gate speed is actually implementing programs where you can an apparently healthy person can have their gate speed measured so that you know over time and have that done periodically.

 Something that I was trying to get going at the Y M C A, we're still working on that as well, trying to make that more accessible for people because I don't think gate speed measures are something that's done typically in a. Physical, right? It's your, yeah. You, you know, I wish they would be, but we, there is a outreach from Vita to work with primary care practitioners to do a more comprehensive vestibular and balanced sort of examination.

Physical therapists and occupational therapists who work in vestibular rehab do timed walking tests as part of it because we understand how that is a predictor of health falls and, and lifespan. So it is certainly  important measure. Mm-hmm.  that has predictive validity. Which is, which is good.

Good. That's right. I think we can go to the next slide cuz you pretty much just hit everything . Yeah. We covered that word, death, which is why we want to be healthy and move more. And listen, I wanna make sure I tell people we're gonna be telling you how you can get this device as we talk about it and stay tuned because there's a special offer for all of.

Who are watching or listening today. So we're gonna tell you how you can get the visit mobility device. So stay tuned. We have a special offer for all those watching and listening.

So this is where we're gonna just talk about the problem when we have falls that occurred to serious injuries, especially among older adults.  The vestibular related gate changes that occur are a serious risk for adults to fall, so it begins with decreased motor unit recruitment. Nerve condition, velocity and cross-section muscle fibers, all that to basically say your vestibular system starts to slow down in the firing of the nerves and neurons between your brain and the rest of your body.

So things like your sensory input resulting in improper neuromuscular control and decreased or abnormal balance can occur. You can have decreases in your gate.  increased in variability, in stance and swing time. So like Kathleen said at the beginning, when people start to spread their legs further apart, or they tend to, you know, walk a little bit faster, but with really short steps, those types of things, which increase your risk of falling or stumbling.

So these are just some statistics. We won't go over all of them, but basically every year one in four adults have a fall that leads to 800,000 hospitalizations every year and 3 million emergency department visits. So in those one in four adults who fall, one in five of them have very serious injuries.

And you know, part of our problem  in healthcare in America is we have to pay to get these services covered. So c m s, which is our Medicare and Medicaid services cover 75% of costs that occur in falls every year.  And those falls are extremely expensive. So in 2020 15, we had 50 billion spent in just falls alone.

By 2030, it's going to be nearly double or more than double, I should say, at $101 billion.  and that's just gonna continue to go up if we don't start implementing more fall risk reduction programs, whether that's through our hospital systems, you know, durable medical equipment stores, and even our, our patients being able to ask for devices like Visic that they need and that will help them with their balance in their gait and their posture.

 All that to say, you know, we're here to support gait and we want everyone's gate to be healthy, to impact your health in a positive way, as we talked about earlier, with health outcomes, you know, being predicted by your gait. So I'll let Catherine tell a little bit more of her story. So, Catherine, take it away.

So that's when, you know, when we end on that kind of negative note, the, the costs of. Also, I'd just like to add it's also cost of freedom and cost of, because that as we have falls and things happen over time all of those things start to cost us socially. When you have a fall, when you need to go to the hospital, there's a lot of things that happen in the community as well, whether it's your family community so the costs kind of are stagger.

in many ways. And it's interesting because when I, we talk about the falls expense monetary expense of the falls, when I got my degree in 1985 in exercise science from the University of Minnesota, we were the first graduating class. In non-teaching physical education, exercise science, that's not a exercise physiologist that does 12 lead EKG stress tests.

So it was a kind of a leap before wellness was really a around and back then they were saying by 2020, the falls are gonna cost in the billions. And now we're looking at hundreds of billions. And so in other words, this, this has gone the wrong direction and I feel responsible as an  scientist that we haven't been able to do more.

And so we can go to the next side that, that fall risk is a big, big part of, of, of what and why the visit is here. So basically my background again I did a lot of work in the aquatic environment at a wellness center that had Pilates. We did a lot of integrative things with physical therapy, cardiology on site.

We had spa and acupuncture, and. A restaurant that served wine. And so all of those things combined back in the early nineties was kind of a no-no. Right? And so what, but what we've learned in the process has been just really amazing. So when I talk about having people come out of the water and notice that they unfortunately had to.

Navigate against the effects of gravity. If they didn't come in on a mobility device, a slippery tile, or or if they did come in on a device, it was so important to figure out what can we do that's that's different, and how can we create dynamic stability in something that's supposed to keep you from falling down.

right? Mm-hmm. . So it's, in other words, it took a long time to develop the, the frame. We need knew it had to move over ground because parallel bars are very stationary, right? And so how can we do something that we're gonna be able to, again, repeat that good postural joint integration, all the things that need to go into place when we wanna.

Positive functional gate dynamics. Right? So it's repeat positive functional gate dynamics. Repeat positive functional gate dynamics. Say that five times. But that means just walk more. Walk better. Exactly. Walk easier, walk more confidently. I used to always say that if we can make someone.  restore their confidence in walking.

They're gonna move and they're gonna do more. And that's really important with the vestibular symptoms, is that they can take away your confidence mm-hmm.  to be able to move about. Mm-hmm. . Exactly. So Pilates and, and water are two of the, of the principles of those things are, are what really went into the design of the, of the visit.

. had gone through many prototypers and things like that, and we were actually, before I was married to my husband, I had invited him over for dinner and I had, of course, one of the prototypes sitting in my living room at the time, and he came in and he said, how much longer before dinner? And he ended up going home, getting his toolbox coming back.

And basically flipped it inside out. My father was a mechanical engineer and I've asked my husband, Chuck, if it's okay if I say this, but my, my dad died many years ago and I say that there was some kind of a, of a mentoring that went on in the living room that night because he was able to do what many brilliant scientists couldn't figure out.

And that was how do we create something? Stable, but yet dynamic. And so that's where the spring loaded resistance came in. And and the surround around frame, so just like the water creates that surround around stability for your somato sensory system, for the center of balance, for for, you know, the safety measure.

There's four wheels on it that allow it to glide. And those wheels are special in that. Are a wider tread and they also are a certain type of material that doesn't pick up all the junk on the ground. So I take my visit out five times a week or, or more even. And I live in Minnesota, so I'm in going over potholes and through puddles and through big piles of leaves on, on a lot of different pathways outside.

So that's what we wanted to integrate.  this, this dynamic stability within a safe tool for repetition. . So again, four patents later. About 14 prototypes is what it's taken because this thing is actually mimicking the human body. And so when I've done different when, when we go into different manufacturers and we let them know, you know, this thing looks very simple on the outside.

This is actually training. So three very important fall defense mechanisms in our bodies. And so this has to be carefully crafted. Each hole, the drilled has to be right on target because if it's off just a little bit, it's gonna throw it off. And it needs to be have that in order to create that safe.

dynamic stability. We need to have everything in place. And so we've got a fantastic manufacturer right now that's really incorporating this into their tooling. And le you know, it's, it's just taken a long time to get here because there were quite a few very precise manufacturers that couldn't do it.

Mm-hmm. . And so we're finally on our, on our winner. You know, I, yeah. Yeah. I think we underestimate. Complicated it is to design things like this because sensory feedback that we get when we're in the water, like you mentioned, or when we walk with a walker or in parallel barss, or when we walk with weights on our ankles or a cane in our hand.

I mean, those things drive the.  Fluidity and the coordination of our, of our motor system. So how we walk, how we move depends so much on feedback. So I can think, I mean, I walked in the visit and I thought, wow, this is so smooth and it's so coordinated with me. But if one little thing was off or if it jerked or hopped or felt off, it would, it would definitely impact me.

So you just, you just made me think about and appreciate how it being.  and sinking with the gate. Mm-hmm. , how, how hard that probably was to achieve, so, mm-hmm. . Well, and just the wheel alone, Catherine, I mean, , Catherine can tell you how many wheels that they have tried on these, the visit just to get the perfect wheel.

I mean, it's all the time and effort and studies and tests and like Catherine said, taking it out on the ice and in the snow and on the dirt and, you know, wow. Finding that perfect wheel. They can go through all the various. Ground that we're gonna cover, whether it's on asphalt or sidewalk or in the dirt.

I mean, it's just things that you don't think about when you're, you know, like you said, Kathleen, when you're, you're not inventing something like this. You don't really understand the complexity of it, and it's, it's very complex to mimic the human body in our gate pattern. And it's definitely something you can feel, like you said, when you're in the visit, you.

definitely the difference. Well, I'm eager for people to take a look at it, so let's keep going. Yes. So the, the science behind Visic is it's an over the ground neuromuscular trainer with a patented, progressive, spring loaded, resistive pivot, pivoting frame. So another one, say that five times fast . Right. So we have our three inherent fall defense mechanisms that Catherine mentioned before.

visit promotes the activation of these three systems together. So we don't want something that's just gonna promote one versus the other because we need to strengthen all of our defense mechanisms together. So our somatic sensory, which is our sensation, so sight, balance, pain, touch, pressure, that's gonna be what we feel with our somatic sensory system.

And then we have our vestibular system, which is our inner ear or our main center for balance. . And then we have our visual system, which is our seeing or our site. So without one of these systems working at its peak level, mm. We're gonna have impacts significantly on our gate, which is going to potentially lead to an increase in falls.

And even if you don't necessarily fall, we still don't want you to feel like you are going to fall and have the fear of falling, because that, as we know, leads to less walking and less mobility and decreasing in our health outcomes. So it's important to make sure that you feel comfortable and confident, and visic is a way that you can do that For sure.

Very well said. Thank you. So this slide just depicts how Visic works. So we have the upright handlebar placement, which allows you to look forward, have the upright posture, forward gaze, no stooping over, and shuffling or kyphotic posture. And then we also have the parallel bars basically, so somebody who doesn't feel as confident walking without holding onto something.

towards their waist so they can get that stability that they need to feel. That's something that we can also that you they can use. So it just allows them to be able to have the freedom, but also the security that they need, especially early in their gate journey. So also the parallel handle hand placements can have weights added to them for stability and maneuverability.

As well as sometimes we can add resistance bands to the visit, since it can be locked down into a stationary exercise device. You can use this for increased support, stability, alignment. You can do all of your, you know, heel strikes, toe push offs, and adding resistance as you need to, to build and strengthen yourself.

So it's not just about walking, but it's also. , making sure that you're performing those proper gate mechanics even before you're walking. So making sure that you're stable and doing those heel strikes and toe push offs to make sure you're functioning, you know, getting those muscles and those systems working together.

You can do that in your house while you're, you know, sitting on the, on the couch and using it to get up and do some exercises. So there's just a lot of.  functionality that you can use with vi Let me ask a question for clarification. So are you saying, I see the handlebars with the hand brakes, is that right?

Yeah. Can you said you can put your hands there or you can put them down on the side rails. So do you see the on the top of the. Handlebars, right on the brakes. Yeah. You see the ones that are forward, if you look where the brake cable goes, yes. Right down below. There's also padding right there. That's your parallel bar placement.

Ah. So you would just need to lower your handlebars a little bit to get that parallel bar placement, but you can do that right where that padding is on the visit. . And then it was interesting you mentioned that you could train in it without it rolling. Are there brakes on all the wheels or how do you use, how do you hold it steady?

The brake around are only on the rear wheels because the, the front wheels, it wouldn't, it would topple you forward. So the, what we do is we, you can push those brake handles forward and that locks the rear wheels. What we oftentimes say if you're, if there's instability to put it up pointed into a surface that's not gonna move like a wall or a couch.

Mm-hmm. Something, and, and then there you, it won't move at all, but you can put the brakes down and do exercises when you're outside walking. If you wanna take a break and you wanna do some spinal balance or some stretching or something like that, you can put the brakes on out in, on your course too. I love that idea.

Oh, the frame lost, so it doesn't the frame rotate. Yeah. Right. I love that idea because it's a safe place to do some standing balance exercises if you wanted to stand inside of it with the frame locked. Mm-hmm. , you could work on standing heel to toe or standing on one leg or standing with your eyes closed, and have that around you and lightly touch it so that it gives people that stability to practice some of those tough balance exercises at home.

So that's a bonus. Yeah, and locking the frame down just gives it that extra kind of support where the rear wheels are locked, so the frame's not gonna jerk forward when the frame is locked together. So that's why when we had to make sure the brakes were in the right spot so people didn't accidentally hurt themselves.

So the part of locking it down for extra stability would be locking that frame too, to make sure that people are, you know, completely level and feel. . Excellent. How do you use it in therapy and how do you teach people to use it? How, how are we teaching people? Yeah. Yeah. I was just, just segueing into therapy, like, how are you gonna have someone use it and what is the, what is the best way for someone who wants to use it to do it, and what do you teaching 'em to do?

Yeah. So as far as the clinician goes the therapy is I always tell the clinician, you, this is your tool, get creative with it. And you know all about gate cycle and gait patterning and repetition, and, and you also know your patient, so you. Bring your patient into the VI to start with and get them sized correctly.

And we have all of this on videos, little, little vignettes on our website, and we'll be doing more. We have more videos coming with some of the stationary things and, and movement things and vestibular specific modalities. But we have them stand inside. Stand them up nice and tall because the first, first thing we wanna do is get aligned.

We wanna make sure the handlebars are at the right place, so whether they're gonna be more confident in the upright handlebar first, or the lower hand grips, which allows their arms to kind of be down by their sides. And that is actually a more stable position, especially just following a joint replacement.

Or if your, if your balance feels a little more off that day, you may wanna go down to that lower handlebar position. If you need to unload just a little bit, that, that's another way to do it as well. And so here this woman is, is in her up.  Handlebar position and we get people just comfortable inside the frame.

And there's, there's ways where you can just see patients just they're, once they're in and they're holding on where the hand grips are most comfortable, you can just see their shoulders relax. You can position their head so that they're, they're elongating through the, the, the spinal column, especially up in the cervical area, dropping your shoulder blades down in, towards your back pockets.

It, it gives you that external input so that you're actually holding onto something. There's that somatosensory impact again, but it also allows for the, for your alignment and the joint integrity when you, are you. Walking with it. And so the, the clinician then takes that person. I remember one clinician was telling me they were working with an MS patient, and the MS patient had not been out of.

Out of her wheelchair for quite a lo, quite a long time. That's ma mainly how she gets around. She does have double cane that she uses for stability in her home when she has the strength, but mainly she was staying in her wheelchair and they brought the visit out to her. This was in 2019 when they first purchased.

And she literally looked at the therapist and laughed. She said, what do you want me to do with this? And, She now can walk. She's doing, she's doing one of our six week studies right now on the, on the pivoting mode because now she's using the frame in pivot mode and and so it just takes time and repetition.

But she was able, obviously with a two person assist. She was able to get up and in it and stand tall and actually start some of those movement patterns, and it's been, it's been really amazing to see how the therapists use it. And how creative they can get with it. You can put Thebans around it to strengthen internal or external muscle groups that need, that need, either more stability or flexibility.

There's, there's so much that a train a physical therapist at reactive out in out in California. I saw a clinician put a big football inside of it and push it up into, up against a, a bed where one of her patients was able to grasp onto the handlebars and then because it was, the ball was creating that resistance, she was able to stand.

I can see that. I can picture that. Yeah. So many different things we can do with it, you know, because it is a three dimensional tool, you know. . So basically I, Ashley, am I doing this? , do you want me to go into the evidence? Yeah, go ahead. Keep going. Okay. So I got to know the people at St. Catherine's University here in St.

Paul, university of St. Catherine, excuse me. And they have a women's health integrative research center and they I introduced them to the visit in 2015 and. So excited about it. And their, their PT students got so excited. So they have a six year program that goes three years exercise science, three years doctorate program for physical therapy.

And and those students were just on fire. So we did about six or seven different studies. They were comparing it to walking poles that we, we started out by just saying you know, does it create. Pivoting and rotation around the trunk and pelvis. And of course with the pivoting frame and the, and the spring loaded resistance, it gives that feedback and it allows for that important piece of the gate that isn't typically.

Exaggerated. If you watch people walk in an airport or wherever you see that there's not a lot of movement going on around the trunk unless you really practice it and, and really get people to do that. When we look at vestibular clients specifically, we define or describe how they turn and how they move their body as on block E N B L O C, meaning that it's one.

Brick like you, you know, you turn the whole thing at like that. And so I noticed when I watched your intro video on someone using the VI and when I felt it myself, that it sort of unlocks the hips and the trunk in a way that often. , the patient with vestibular symptoms locks it up just because they don't want to turn quickly or rotate or whatever.

So they just, they get locked up there. So that's a nice, a nice description of that. And I think I mentioned that, that we try in the vestibular clients in vestibular rehab to add some relaxation and some rotation.  and some, some, some wiggle, if you will, to the yes, to the pelvis and the body during gait.

That's, that's beauty's a normal rotation. Right? And the beauty of of it is that you can stand inside of the visit and you can be safe. While you kind of play with it. Yeah. It's just, it's a way for you to just kind of stand inside of it and play with it. And, and you'll see that when you, if you watch our, our vestibular exercises, you'll see Judy is our is our guru and she's gonna show a lot of different ways to, to utilize.

Do vestibular exercises that sometimes, as we know, are very challenging and especially in different circumstances. So you know, you, we, of course, we want safety always first, but it's a safe place to practice. And so to be able to actually practice the different stages and different different pieces of the gate cycle, heel and toe, push off, heel strike, toe push off, the extension that's needed through the front of your hip requires that rotation.

And sometimes I love that. Unlock it. You need to unlock it. And so that's what we found was. We there was a little learning curve in that the the, the lead investigators saw that we need a longitudinal study here. Because I'm seeing that as people use the visit a little bit more, they, they improve.

And so we did a three week study that showed that Catherine, can I interrupt you? Yeah. Can we go to the next slide real quick? So, so this was basically they, they talked about, you know, the decline that occurs and, and in our in the lit review, they were act actually finding studies that, that unfortunately show that there's actually.

With prolonged use of the devices that are out on the market now, they're actually a fall risk in certain circumstances because of how it impacts our gait dynamics. So I'm not saying this is supposed to replace what your doctor has told you you, you need to use, because that's very important to follow their orders.

but it's nice to know that there's a way to unlock that. I'm Kathleen, I'm gonna use that now. . Mm-hmm. . There's a way to unlock that rigidity mm-hmm. , that you need to keep, because it's, it's a, it's a, what do you call that? It's a, a juxtaposition in a way where you need to stay stable. But yet you also need that movement to keep those three systems in.

Our central nervous systems absolutely. Are, are all of those systems working efficiently? Because when one is down, the other two kind of compensate and come in. So it's, it's it's a way to work.  in a more equal way, right? Yeah. And so what they found was three 20 minutes, three times a week improved stride length, gate speed, trunk and pelvic rotation.

Mm, stride length. We had people say they felt so much more confident. I, I had a number of people. Call me after the study even six months later. Cuz remember we have a pretty severe winter here in Minnesota. Even though I take it out all the time in the winter. A lot of people don't walk and it's, there's ice and all kinds of reasons why you wouldn't.

But they would call me and say, I wanna go for walks, and I wa I, I really loved how I felt in the visit. And so 20 minutes, three times a week is the minimum. And then we we saw that not only were the people improving, , but they progressed to a point where that lasted with them. So there was muscle memory.

Right. So it continued  to advance them in their, in their gate training. So that's why it's, it's, even though I started out thinking I was gonna create this new kind of walker,  what I realized and what I see in where we are with falls risk reduction, where we are in our, in, in the world of, of being safe, how anxiety and depression and all the things that are happening in our culture and in our world is, Impacting us.

I see it in athletic training. Our, our, one of our head athletic trainers here in the, in the Twin Cities told me that his student athletes, this is collegiate level, are having such a hard time interpreting his queuing. He has to have external factors because they are so stressed out and anxious. And there's so much of that going on right now in our world that I think we can all relate to that, whether you're an.

or whether you're someone navigating through a vestibular disease or a, a memory loss disease, whatever it is, they're, they're, those anxiety issues are, are they, they take control of us, and so yeah, they, yeah. These are, this is just a new tool to, to you help people train and feel safe. You know, when I'm looking at this poster, this is a, this is a.

Study, it's impressive that you had people do this and the results that they found, and I just wanna point out to people listening and maybe those that can see this but if you can't go to the website and take a look at it, and this looks like a walker, but the people using it or the people who can benefit from it are not those who you would typically.

Say are disabled to the point that they need a walker. Mm-hmm. , I hear you saying that the visit is an exercise device. It looks like a walker, but don't think it's for the severely disabled or those who might use a traditional walker. It's an exercise trainer for those who probably walk alone already and those who don't use an assistive device like a cane or.

Walking sticks or two canes or a quad cane or any kind of thing. You know, these are people who, who walk alone and this device, this walking device is an exercise device to help them walk better. And so I just don't, I wanna make sure that if you're looking at it, you don't think, wow, this is a walker. I'm, I walk too.

Well, for a walker, this is really an exercise device that happens to look like, Would you agree? Absolutely. And, and I have a perfect example of that right now. I have a person who has been using this for 10 years and she recently had a heart incident. And her, her ability to, she, she had a a, a tapper, so an aortic valve replacement and she was able to walk with the visic throughout this whole situation.

And she just looked at me and she said, I'm so glad I already knew how to use. I said this is exactly it. And she's been super healthy for 10 years or for a long of time, but stuff happens, right? And so that's why it's so nice to already know how to use it because we all need work on, on that repetition and that good alignment and our postural awareness and just making sure that we're mindfully aware of how we walk because our gate is so.

And we know how now we spend so much time on a computer and we're do on our cell phones all the time. So we're, we're in that, that kyphotic mode, we're going back into that fetal position again. You know, and we need to stay open and, and aligned, and that's what this helps us do. So now we got off track with our little PowerPoints, , let's see, where we're, I think you, you talked about how you can use it for exercise and stretches both in a, when it's stable.

Well, can I add real quick to what you guys were saying before? Yeah. I think it's, you know, it's key to know that this is for most stages of people's walking and gate pattern. Whether that be somebody who, like Catherine said, we have people who are wheelchair bound that use it. And of course you need to be safe and listen to your healthcare professionals.

They're not gonna steer you wrong in how to use it, you know, but make sure that people. Are able to walk like Parkinson's disease, you can use Visic in a lockdown frame and be able to use it and keep that upright posture instead of having to use maybe a traditional walker or the walker with the laser that can potentially lead to more fall risks.

So, you know, there's, it's accessible for anyone who has the appropriate support. And the key is this segues into. So this is where, you know, we work with clinicians and consumers for both sides of the coin because this needs to be used in clinic, but also at home.

Because if you're in clinic twice a week and evidence suggests three times a week for at least 20 minutes, You know, how are you gonna be able to get that extra time in? So we have our Success Coach program to work with clinicians and consumers. So we provide the support on technical issues, setting up and sizing showing the institutions how to demonstrate themselves, right?

So we teach people how to properly use vi, we can help with the person's care team to provide them a custom exercise program. We train your trainers, so whoever you know purchases a visit. They get the Success Coach program. With the visit to ask us questions whenever they have questions, you know, we wanna be there to support.

So we're not just gonna sell you a device and say, good luck and, and see you later. We want you to be successful and that's the key. So we have our Success Coach program and then we also offer support to our clinic. Specifically.  So we have programs that we've worked with different clinicians in how to increase their return on investment with purchase of visits.

they can reimburse for c p t codes, for neuromuscular reeducation with viic. People are going to the clinics and paying to use VI in the Twin cities $10 per use, or they buy a card of so many visits and they can use the visit for 20 or 30 minutes, whatever the clinic decides. And then, you know, they, they get that time without taking away from the clinic.

Billing ability, so they can still work with the visit when they need to, and not necessarily if, you know, they can't have one for their home, they can use it at their clinic. There's also the rental option. We work with local DMEs and, you know, the clinicians' area to help them set up their program and things like that.

And then also being able to prove your better outcomes for your patients. To get those MIPS and macro incentive payments, it's key to show that you're actually provid. Good care, quality care, value-based care, as opposed to, you know, the way that our system is now, we're transitioning to value-based care.

So being able to show these better ins, these better outcomes is essential for clinicians. Catherine talked about this a little bit about one of our people doing our case studies. So we work with clinicians to build case studies. We have our. And if we need to tailor something based on your patient, we're happy to do so.

So we have some that we've used that were MS patients. We have some Parkinson's patients. There's been, you know, ortho patients people with ataxia, those all different conditions. So, When it's specific to learning what your patient can do better on the case study, we're happy to tailor those things and add in maybe some extra tests that might help you identify how your patient's progressing and things like that.

So if you wanna go to visit.com and contact us or contact us@infoatvisit.com, we're happy to provide our case study information and our, the slides for today as well, if anyone's interested. Feel free to reach out to us and we're happy to talk and educate and we want people to just be healthy so you can tell people where they could find a visit in their area or how they could ask their clinic to get one lots of different ways for a person to experience it.

Working in conjunction with your physical therapist or your vestibular rehab program or directly with the company. That's great. Absolutely. So this is our results section. So as you can see, the difference in the way this individual is standing from h Keen to the visit, it's just there's no, we don't even have to say words.

I mean, it's just right there. You can see the difference in her posture and, and how her gaze is upright and forward. And she's looking in a totally, you know, not kyphotic and she felt good in visit. . We love being able to show that our evidence actually, you know, shows that we have the results that make this beneficial.

Nice.

So, like Catherine mentioned before, we had our evidence suggested improvements in gate speed, trunk rotation, posture, confidence, pelvic rotations, stride lengths, balance, and decreasing in fears of false. It's just there's so many things that we can do to impact our gate while using VI and be able to help our health in general.

So this is a video of one of our case studies. He's walking side by side, so I'm gonna play this now. Let's see. Kathleen, I'd like you to talk us through. It . Well, when we watched this, I, I watched this a few times and you said, can, can you see, you know, the difference between this guy walking and, you know, I look at the, the base of support that he has on the left versus on the right.

So he has a wider base on the left, on the right. He, you know, maybe is walking with some more confidence. He's walking and turning his head to look at things.  and you can see that, you know, he's ambulatory independently on the left, but after training with the visit, there's a little bit more dynamic movement through the trunk.

And I think that's what we were talking about. Looks like he's engaging his core a little bit more and he's able to walk with a little bit more confidence. So I, I think that what's important is in some clients, I'm sure that you. See a huge physical change, but in others you're gonna have someone just say, I just feel better.

I feel more steady. And you know what this video I liked about it when you suggested that we show it, is because a vestibular disorder is an invisible illness. And a lot of people say, you know, they don't, no one can see it. No one knows how I feel. So in this, if you said, You know, he doesn't look a lot different, but he probably feels different.

And for those with vestibular problems, they're getting from point A to point B a lot of times and their symptoms are invisible to others. And so you know, changing how confident you feel, how directed you feel when you walk across the street. Not worried about looking around for a car or.  through the grocery store or what lots of things just really can make a big, a big impact.

Mm-hmm. , and that's exactly what he said was, you know, Hmm, my, even my neighbor noticed my posture. I'm a, a hunter is what he called himself. I'm a hunter, right. I always sit down and I hunch over. I don't have good posture. And you know, again, we're happy to share this case study so anyone can read it, so feel free to contact us if you're interested.

He basically just said, I feel better. I feel like my posture's. And I am more confident when I walk, and he actually had a decrease in his fear of false for from initial pre-vis use to the six week post-vis use. So to be able to show an apparently healthy male. Who had a fear of falls pre-vis who doesn't anymore.

That's, you know, that's such an amazing feeling. To go from a, a medium fall risk to a moderate or a, a minor fall risk is really very exciting for us to see. Mm-hmm. . Mm-hmm.  it is, I think even the changed his stride probably in the way his legs are so externally rotated in the picture on the left and during swing phase to having his hips function better in a more forward.

positioning. So, I mean, there's a lot of technical things that potentially you could point out by looking at that, that may or may not be a, you know, noticeable to the naked eye. But good for him that he used it, that he was disciplined, that he enjoyed it, he felt good. He probably even got a little fitter mm-hmm.

you know, maybe dropped some pounds or felt a little stronger. So it's great. Great. And we have.  in the case study we have like the measurements of how his hips were moving and this, this difference between his stride lengths even when he was walking. So yeah, if anybody wants to see the, the case study, we're happy to share it.

Next slide please. I think these are just our patient testimonials, which talk a little bit about some of the different patients that we've seen. Just like you said, Kathleen, we have literally a quote of one of our Parkinson's disease patients who said, I just feel better on the days I use viic. Hmm.

So it's just really, it makes you feel good knowing that this is something that you know, you can help somebody in their gate and have better healthy life and happier days. , when I first saw it, it reminded me of the technique. Vestibular therapists have all kinds of different techniques, and I think you mentioned it before, it's important to mention this is not a, you know, cure-all for everything.

Mm-hmm. , but it's another tool that your therapist might try and if you brought it to their attention, they might find it useful. I personally have not used it with a client yet, but I'm eager to try that in the future. But when I tried it at the conference, I thought it was important to bring to this audience.

When I see that the person gets. , hold onto something. It's like when we put two canes in someone's hand. Mm-hmm. , it's like putting your hands on the floor. So for the vestibular patient, just having that extra stability, like putting your hands on the floor and then walking, and you can't see it in a stable slide, but in the video you could, when you walk with that normal walk, I think the, that the the science is there to support.

Why? Feel better to people to walk in it. And it goes along with what we know about neuroplasticity of the brain and the, the the system and the way it works. Mm-hmm. ? Yeah. Very good. Mm-hmm. . Excellent. So these are just some of what our clinicians say. So we're not gonna read this out loud, but we just have mm-hmm.

you know, some really great clinicians that we're working with that enjoy working with Visc and have seen such a difference in their patients. It's. You know, like it says down below, we've heard it's a great training tool, a wonderful therapeutic device, and that it, we just wish we had it sooner, is pretty much what we hear from our clinicians.

So . We're getting to the, almost the really important part, which is yeah. Moving . Yep. Moving. So making sure that you're joining our movement. Movement. So continue to move, keep yourself healthy. , like Catherine said, it's a paradigm shift, so we wanna help everyone with their moving and getting up and going.

So we're making a special offer for anyone who watched the webinar today, 10% off of the visit purchase for anyone who watched, and then the 25th person to pre-order their visit. Today, we'll get 25% off their visit unit. Make sure you go to visit.com and reach out to us. And then the next page is our contact page.

So this just has our sales information, our support information, clinical information, and then our phone number. So feel free to, let me go ahead and lemme go ahead and have you read those, Ashley, because we do have a, a podcast audience that we'll want to see that. So I'm gonna back up and have you repeat again the special offer and then we'll go to the contact page and have you read that out for.

you got it. So our special offer again, is 10% off for anyone who was able to attend our live webinar today. So you just have to let us know you attended and we'll give you your 10% off and then 25% off for the 25th person to pre-order their visit. So get your orders in. Contact us at sales visit dot.

or if you need support, if you're one of our customers already and you need support, it's support@vi.com and VI is V. Spell that. Yep. V I Z Z I Q. So v i Z as in zebra, Z as in zebra, i Q. So support@vi.com. Sales visit.com or info visit.com. Or you can just simply go to our website and click contact. Or you can call us at (763) 333-9646.

One more time. Seven, six. Three. 3, 3 3. Nine six. Four six. That's a United States phone number. Dial plus one if out of the us. That's great. I think this has been a wonderful opportunity for you to share what you've, you've got going on and I really like the emphasis on research, this particular slide presentation.

Listening. You can find it on video with through the Vestibular Disorders Association, and if you want references to support. Was presented today by Ashley and Catherine. You can contact VIS at info vi z z iq.com and they'll send you a whole list of references for all the really encouraging scientific research that's being done by clinicians around to support this new end dynamic kind of thing.

I really, really appreciate you guys today coming. Sharing with us all this information that you did, what a labor of love to have invented something and worked so many, many years on it. And so congratulations to you, Katherine, and the patents that you have. And I'm excited to see how this makes its way through the vestibular rehab community and in the clinics.

And I hope that those watching will ask for it or contact you and see how they can demo, demo one of them, Dr. Demo Drive it. What do you call it? Test. Yes, sir. I also just wanna say thank you so much to all the viewers because you're the reason we did it . So bless you and I hope you all do very well as you navigate through life.

Well, it is our pleasure. And remember, the Vestibular Disorders Association exists to provide you information and support to help you find your journey back to balance. And so look for more information on vestibular.org. And until next time, we thank pH very much for sponsoring this episode, and we look forward to seeing you again.

Take care.