The neuromodulation market is growing rapidly – it’s expected to double in revenue between 2023 and 2028 from US$6.2 billion to US$11.0 billion – and the related technology is evolving apace. Encompassing electrical, chemical and mechanical processes, neuromodulation can be used to treat a broad range of neurological conditions, including chronic pain, Parkinson’s disease and epilepsy, which affect millions of people. Emovo Care, a medical device company based at Biopôle, is developing wearable robotics to support people with neurological injuries. CEO and engineer Luca Randazzo explained to us how Emovo Care’s accessible, non-invasive neuromodulation technology could be used to help patients increase mobility in their hands after a stroke.

What inspired you to develop a robotic rehabilitation device?

My sister has cerebral palsy with both motor and cognitive disorders, so I’ve seen how deeply limited motor functions can affect someone’s life – for example their ability to eat and wash independently.

I studied engineering and computer science because I dreamed of building an intelligent house that could react to someone’s needs – robots that fed you, doors that opened themselves – but then I fell in love with wearable robotics. Instead of putting the autonomy into a building outside the body, I realised you could use technology to develop your own ability to move, working with your nervous system. It became my mission to develop a non-invasive, wearable, affordable device that could support people to restore lost motor function in their hands to improve their daily lives.

Could you give me a simple overview of how your device works? How does it help patients?

In our first product, Emovo Clinic, the core technology is mechanical: motorised silicone exoskeletal fingers go on top of your hand and can be moved by a remote-controlled box. When buttons on the box are pressed, the fingers on the hand wearing the device open and close. This can help the patient in three ways: first it allows them to practice hand movements, exercising muscles and stimulating nerve signals; second, it enables them to practise simple daily living tasks, such as holding a glass of water; and finally, it limits secondary conditions linked to immobilisation, such as joint contractures, which could restrict the hand’s long-term range of motion.

For now, we foresee it being used primarily in rehabilitation and clinical settings for occupational therapy, but my dream for the future is to develop systems that can be used at home. Most of the time, patients attend therapy sessions once a week or fortnight, but they’re typically not motivated to sit down and do their exercises the rest of the time. Intensive rehabilitation in relevant tasks (for example, daily living activities) is important for recovery. We would love to build devices that can integrate rehabilitative exercise into day-to-day tasks, which patients are more motivated to perform. We call it ‘therapy while living’.

Looking forward, we’re developing products to work more directly with the nervous system, for example algorithms for a bracelet to read muscular signals. In the long term, we plan to pair our exoskeleton with this electromyographic (EMG) technique, enabling patients to control movement in their hand through brain activity. These approaches have been shown to have positive results in stimulating brain plasticity and recovery, acting as a closed-loop mechanism that helps reconnect the impaired brain to the body. The process can ‘reward’ the patient with hand movement when the ‘correct’ muscular signals are given. When repeated over and over again, this practice could have major beneficial effects on recovery.

How does your technology differ from other neurorehabilitation tools on the market?

Existing rehabilitation devices can be great, but they are often large, complex machines that work different parts of the body, perform many different functions and therefore have to stay in clinics. But the diminutive size of our device means you could take it home and use it daily for rehabilitation exercises.

Emovo Clinic uses soft robotics. It has a light structure that can adapt to different patients, so it’s pretty comfortable and can be set up autonomously with only one hand, even for stroke patients, who are typically hemiparetic. Other similar devices use gloves, but it can be very hard for people who have experienced strokes to open their hands and put them on.

In the future, we’re also hoping to differentiate through software, making statistics and insights available on a smartphone so that users can measure and track their rehabilitation. This offers patients the opportunity to gamify recovery, which can be really motivating.

Some technologies, like Neuralink, implant chips in the brain, which is an incredible approach. Research shows that you can work with patients to perform pretty complex tasks using this technique. However, one limitation is that many people may be unwilling to undergo surgery. By contrast, the EMG-based techniques that we’re developing are non-invasive and can be set up in a matter of minutes. The aim is to offer a controller that, once set up by a clinician, can be taken home and used independently by a patient.

How can technologies such as yours be made accessible and affordable?

Some rehabilitation devices are expensive and complex, typically designed to be used in clinics. Making new technology more accessible requires a thorough understanding of the patients’ needs, for example through extensive testing and cutting back as many features as possible to really tailor a device around those needs, which is simpler and therefore more affordable to reproduce.

However, it’s still complicated to bring a medical device to market, as regulation is understandably complex. There may be space to simplify these procedures and reduce the barriers to innovation, which could potentially bring costs down.

How closely do you work with patients while developing your product? 
 
As an engineer, I enjoy the technical development of a product and I always keep in mind that someone will be using it in their own particular context – this awareness is a fundamental part of creating a product, beyond being basic ‘tech’. This is why, despite our first product not yet being commercial, we’ve already tested it with many patients during our research. One of the greatest moments for me was when it was used by a man who had experienced a stroke seven years earlier. He was an engineer, so he was interested in the technology and motivated to try it. He enjoyed moving his hand with the exoskeleton, but the magic moment was the next morning, when he moved his finger independently for the first time since he lost mobility. Although this wasn’t a formal clinical trial and it was minimal movement of only a couple of millimetres, it was a significant moment for him and definitely very motivating for our team.

Another notable experience for us was when we were trialling the EMG bracelet. We fitted it to a patient and created a model of the algorithm for him. Within minutes he was controlling the exoskeleton, sending muscular signals to open and close his hand. His reaction was beautiful to see. He was empowered by having a device that reacted to his will, rather than the push of a button. It’s a different sensation to control the movement yourself and it offers great potential for rehabilitation.

Are there other applications for the device or the technology in general?

Emovo Care has focused on stroke patients, but there is potential to work with other people who experience impaired hand function, such as those with cerebral palsy, multiple sclerosis or spinal cord injuries. Our products could also be valuable tools in orthopaedics recovery, for example to enable continuous mobilisation at home following surgery for a traumatic finger injury. These could all be potential avenues for future developments.

And, of course, we’re excited to explore the different ways Emovo Clinic can be used in patients’ homes to bring them more independence and improve their quality of life. I still fantasise about an intelligent house with robot servants, but my main focus today is to see how our device can serve patients more intuitively and unlock the homes and bodies they already have.