In this episode of Raising Tech, our host, Patrick Leonard, has a thought-provoking conversation with Craig Hillman, the Senior Vice President of US Operations for GaitBetter, about how GaitBetter's cognitive and mobility training solution are preventing falls in Senior Living communities.
Discover how GaitBetter is being used to reduce the risk of Senior Living residents falling by 70%, according to their studies, and how it's boosting seniors' confidence and physical strength in Senior Living communities.
Raising Tech is powered by Parasol Alliance, The Strategic Planning & Full-Service IT Partner exclusively serving Senior Living Communities.
Welcome back to Raising Tech, a podcast about all things technology and senior living. I'm your host, Patrick Leonard. So today we're gonna talk about a very interesting solution for gait training, mobility and falls prevention, which is always a hot topic for senior living communities and I'm excited to welcome and introduce our guests to the listeners today, who's Craig Hillman from GaitBetter. Craig, welcome to the show.Craig Hillman:
Thanks, Patrick, glad to be here.Patrick Leonard:
Awesome, we're happy to have you. So Craig, we've met a few weeks ago at one of the LeadingAge conferences out in Maryland and you know, you're immediately struck by the GaitBetter team as you walk by the booth, as you know they have the treadmill going and kinda the virtual reality experience, which of course we'll dive in more today. But can you start things off before we get too far into it by giving our listeners a little bit of background about yourself and GaitBetter?Craig Hillman:
Sure, happy to. So I actually, I'm relatively new to senior living and I would say kind of health tech in general. My background actually is engineering. I actually was in what's called the software simulation space for a long time. That way to describe it is reliability of electronics, making sure that that iPhone in your pocket doesn't fail when you don't want it to. But I had a great time in that space. Actually founded a company, sold it just before Covid, God bless, and right around the same time met the CEO and founder of GaitBetter, Hilik Harari. And kind of initially he was starting his company. I had just stopped running my own company and kind of offered to be just an informal advisor, help him kind of reach for the stars so to speak. And really over the 18 months I had a chance to talk to Hilik. I was really inspired by him and really inspired by the technology and what it was doing in Israel. All the amazing things, the outcomes, the embrace of the technology. He would share with me really just emotional inspiring letters from spouses of people who had been on GaitBetter spouses who had not left the couch in six months, who were worried who wouldn't leave the apartment because they were worried about falls, they were worried about walking and really just having a transformational outcome. You know, without pills or without taking a class for like 12 months or longer. After kind of talking to Hilik for 18 months, I kind of looked around and said, you know what? I'm in a time of my life. I really would like to be inspired to help people to do good things. So I literally begged him to let me on to GaitBetter and bring that technology here to the US and that was about two years ago.Patrick Leonard:
Wow, that's awesome! Thanks for providing that background. It's always fascinating to me to hear how people get into this crazy senior living space and where they've come from and what they've kind of built and worked on before. So thanks for providing that background. So for those who aren't as familiar with the concept, can you educate our listeners a little bit more about what is gait training? Why is it so important? Specifically in the use case of senior living communities?Craig Hillman:
I'll take a step back and what's been really inspiring is so, I have a PhD and I'm not doing that to be a humble brag, but really to kind of give you just a little bit of insight, I was trained for a brief moment to kind of do research and so joining GaitBetter you know, it was inspired by a lot of research coming out of Tel Aviv University and other institutions around the world. So you know, in my free time late at night, I would kind of read some of these publications and really became kind of inspired by what I learned, not just for GaitBetter but really in for my own health and hopefully as I describe it, for the people living in senior living communities and people helping those seniors in living communities. And what I found was the best way to describe it is walking is one of the best cognitive tasks you can do. So it turns out that walking in the real world is very cognitively demanding and the way they explained it when they explained it, it kind of made sense, right? Which is you are multitasking like crazy when you are walking, you know that whole thing Mom says "don't chew gum and walk at the same time." That's because you're thinking about all these other things while you're walking. You're going to distract yourself when you're chewing gum. But when we just normally walk in the real world, let's say you're going, I don't know, you are gonna take your kid for an ice cream cone. They've been really good that day. They ate all their dinner, even if they had Brussels sprouts, you're going to take them for an ice cream cone on that walk. What are you thinking about? So you're walking, you're already doing motor planning, you're thinking about where you're putting that feet, you're thinking about where your son is in 3D space. There's somebody approaching you, you're actually doing a mental prediction because you're seeing where that person's walking and where they will be in the future. So you don't run into them. There's audible distractions around you all the time . You're thinking about how to get to that ice cream store. So you're using working memory and what you're going to buy when you get there. It's an amazing amount of mental energy and because it's multitasking, it pushes all that activity to the front of the brain and so what ends up happening is as we age, unfortunately the part of the brain that ages the most is that same part that handles what they call executive function or really that multitasking capability. We lose that ability to multitask as we age. And this is why we struggle with gait, and this is why we fall because when we get into a situation where we cannot handle all these kind of motor and cognitive tasks simultaneously, the brain will, for lack of better description, shut down. It will decide not to do certain things. So you might forget where you're going, right? The working memory might fall away, you may run into somebody, right, because you weren't predicting where they would be accurately. But also you can lose that motor planning. So you plant your foot incorrectly and then you will fall. In fact if you ask an older adult. So, two things, are really fascinating: one is the overwhelming majority of falls in otherwise I would say healthy, older adults. A. They fall while they're moving, they fall walking up the stairs, down the stairs, walking on flat ground , but they're typically moving or walking. And if you ask them why they fell , they'll tell you I wasn't paying attention. But it's not their fault, it's what's happening in the brain. So realizing that walking is really a success of walking is really a cognitive task. That was the inspiration behind GaitBetter. How do I retrain the brain so I can reduce fall, I can become more confident and stay mobile for a longer portion of my older adult life. That was kind of the genesis of GaitBetter.Patrick Leonard:
Amazing, thanks! That's really interesting. And the way you kind of walked us through that journey from start to finish really kind of clicks and I think it makes sense to a lot of people at the same time. I don't think I ever wanted brussels sprouts and ice cream at the same time as much. So thank you for <laugh> . Thank you for triggering my hunger as well, right <laugh> . So that makes sense from a conceptual standpoint now. So going back a little bit into the the GaitBetter solution, can you tell me a little bit more how you bring those concepts and kind of the science behind everything you just described to life through a tangible product and solution for communities?Craig Hillman:
100%! So, imagine you're this researcher so figured out that, I mean again this , it's more than just them, right? It is I think a pervasive awareness understanding among people who are experts in this area. So we know walking is a cognitive task. So how do I create something that's gonna be useful to older adults? So what's great about this team, they're gerontologists, they're neurologists, they're physical therapists and they all kind of got together in the room and they brainstorm. You know, we used to brainstorm in the same room before Covid for antiquated idea. So they all brainstorm, right? And they also, the neurologist came the table with an awareness of kind of what they call the neuroscience of aging. So if I'm going to retrain the brain, if I need a brain exercise, what are some important key aspects in order to retrain the brain successfully? And so it's quite fascinating Patrick. So the first is as we get older and it has to do partially with like how are the connectivity between the different parts of the brain, we are less able to skill transfer or to transfer skills from one activity to another. And the best example I'll give you is, let's go back to your son who likes to eat brussel sprouts and ice cream. So your son's gonna be the next Mike Trout , amazing baseball player. So his coach is most likely teaching him certain skills that your son will be able to transfer onto the field, like how to catch or hit or whatever it is . As we get older, we lose that ability. And a good example of that is they did a big study about how, you know, older adults are supposed to do crossword puzzles to stay cognitively sharp. Well they found out if you have an older person, you have them do lots of crossword puzzles, they get really good at crossword puzzles . That's it. So number one, if I want to retrain the brain, I have to put it through an activity that is similar to what experiences in the real world. That means I need to be walking and I need to have cognitive challenges that are almost exactly the same as the cognitive challenges I experienced in the real world. I have to do motor planning , I have to hear sounds, I have to see things coming towards me, I have to have a destination. So that's really important. The second is they find out that neuroplasticity, which is, I will admit an overused word unfortunately in a lot of health tech , but in order to really form those new connections I need to have an elevated heart rate. I won't get into the whole physiology, but when I elevate my heart rate, there's actually a synergistic almost effect in terms of neuroplasticity. If I am sitting on my rear end, you will not see as much of a neuroplasticity even if you're doing the exact same thing that if you were walking or even just kind of at elevate heart rate. So there's a couple other kind of key things, but those are the two important things. So realizing that they came together and decided to utilize kind of we'll call semi-immersive virtual reality in front of a treadmill. So what does that mean? So GaitBetter works with any existing treadmill. It is not a treadmill, it just works with any existing treadmill and what they do is they have a camera. They put a camera in front of a treadmill and it watches your feet as you walk on that treadmill. And then it presents these disembodied feet that represent the movement, your gait movement onto a TV screen in front of you. So if you lift your left foot, the left foot on the TV screen moves, you move your right foot, the right foot on the TV screen moves. And so these disability feet are in a virtual reality environment. And so they, as they walk through this environment, we give them a number of motor and cognitive challenges that very much are applicable to real world . So you start off with a map, you're going to that ice cream parlor. So you have to remember how am I going to get there? Is it two lefts and a right? Is it two rights and a left? You have to remember that, and as I'm walking through this environment, it can be a crowded, noisy environment, it can be a gentle quiet environment. We actually adjust it based upon people's cognitive capabilities. For example, it's like wait, look you don't give somebody who's lifted weights for years a 200 pound bench press. We start them off slowly. We do a very similar thing here. And then again we give them these kind of cognitive challenges. They have to see people coming, they have to overcome herbs and puddles. They have to, they hear noises like planes and birds and cats and dogs and people, all the stuff you would see and we do it in a very methodical and structured way. So it's almost like strength training. Again, I'll go back to that analogy. By the time they've gone through well 15 sessions, those new neural connections have formed and they're much more confident walking in these real world environment.Patrick Leonard:
That's amazing. You're hearing more and seeing more about virtual reality. You know, the more I talk to people about virtual reality, the more you experience and you know, go to conferences and read about it. There's so many different use cases for it now than we just kind of typically think of, or at least I did had a bias towards what virtual reality meant . And there's the gaming experience side of it, right? There's the educational side of it, there's the experiential side of it and this is a whole new for me concept and use case for it that just seems so advanced in so many different nuances from a technology standpoint. How did we get here? What's kind of the background of where we came and how we got to this point where we can actually use this in the way that you just described as an end user to experience all those different things .Craig Hillman:
GaitBetter concept really has been about 15 years in the making, right? Wow. And so it , that kind of speaks to there's all these different use cases of VR but if we really think about it, the idea of VR has been around now for probably over 20 years, but it takes a while to kind of launch. And so I want to say really going back as far as like 2008, 2007, the team that eventually would develop the predecessor for GaitBetter was already thinking about this whole neuroplasticity and you know, what is the best tool to drive these new neural connections and deciding that virtual reality was the best approach. They actually tried a fully immersive approach first rather than the TV screen which we call semi immersive. They actually tried using the goggles, but goggles don't work really well if you're trying to hit some of those key neuroscience facts about aging. Number one is I need to be walking, I need to be walking because I need to be doing the same thing I do in the real world, right? We struggle with skill transfer and I need an elevated heart rate. I need to be moving somehow. I need to be maybe breathing hard a little bit. So when they tried kind of virtual reality, they're ran into two big problems. The one is, if you wanna laugh, type in "VR walking" into YouTube and watch the thousands of people running into their children into the wall, into the kitchen counter. So, if you can't see where you're going, you're not going to be very good at walking. But also older adults really struggle with that single focal plane that you're forced into when you have VR goggles. So VR goggles definitely have, there's some amazing research out there on what they can do, especially from like a pain management. But most of that is geared towards younger adults. When you move into older adults, after about 10, 15, maybe at most 20 minutes older adults start getting nauseous. They get dizzy because again the eye is not used to just looking at a single focal plane and it's forced into that situation with the VR goggle. So we looked at the VR goggles but eventually kind of knowing some of the limitations, that's how we chose the semi immersive instead.Patrick Leonard:
Yeah, and it makes a lot of sense because even if you're on a treadmill and walking and not using this solution just simply looking at a television screen or you know, whatever it might be in front of you, it seems to be a similar experience from its simplest form that someone would be accustomed to or used to. It's just doing a lot more obviously for the person.Craig Hillman:
It's a great point. Who has not seen a TV in front of a treadmill, right? Right . This is not a scary new thing. You're gonna be very familiar. Now, most older adults aren't typically on a treadmill or not really walking at all. This is part of the problem. So we also provide small safety system. It helps in two ways. So one, we find that senior living staff that are worried about putting, it's, I guess I'm thinking everyone would find understand this is kind of amusing. On the one hand a lot of these new senior living communities have these amazing gyms. We've all seen them. They're gorgeous, they have the latest technology. At the same time senior staff are very nervous about senior living residents as being on that same treadmill. So we have a very simple little safety system in place. So when the person gets on there, I mean we're going to challenge them, right? We're asking them to do things beyond what they normally do that's intentional. Just like you get stronger and weightlifting because you're lifting weights that are heavier than you would lift in the real world. Same basic idea. We're going to give you cognitive challenges that are heavier than what you experienced in the real world. And so in case you're worried about like stumbling or something like that, while you're on this treadmill, we have a little safety system to keep everybody safe and confident in terms of that training activity.Patrick Leonard:
Yeah, that's fantastic, and obviously a really crucial piece I imagine of the considerations that were taken in implementing this. And so as I think about this, I think about at the community level, how is this being spearheaded? Who's kind of taking it upon themselves to work? Is it in more like the rehab, physical therapy side of things? Um , or where does this tangibly happen in the senior living community? And then build upon that, not to ask too many questions at once, but as my mind keeps racing, I imagine there's a whole lot of data and insights that you're able to collect from what is actually being experienced for each individual person during this process. Can you talk a little bit about those two things and how that all ties together is being used to kind of ensure healthy and safe residents are patients who are utilizing this?Craig Hillman:
So it's a great question. I think we're still figuring out Patrick, what is really the most effective implementation for our senior living customers. We definitely have those that place it within a rehab gym and it's being supervised by trained clinicians like physical therapists or physical therapy assistants, and that's been very effective. There are limitations there. Not every senior living resident is going to physical therapy. If they're going to physical therapy, typically they need or they're looking for a doctor's referral. Some rehab gyms are relatively small in some of the communities some don't have at a treadmill, and then there's obviously you get into the whole like cost and reimbursement kind of situation. They can't use, you know, they can only use GaitBetter for a certain amount of time or a certain number of sessions. There's some restriction and it tends to be reactionary. Somebody maybe has fallen or maybe has had a stroke, then they'll get access to the GaitBetter system. You know, in some senior communities it's more on the fitness side especially what we've been hearing is a lot of operators have these gorgeous gyms. They're great about attracting new residents, but once they're in, they don't really get utilized too much except for maybe a couple operators here and there. And so they, you have this under utilize asset, you've spent a ton of money on these wonderful pieces of equipment, nobody's going in to use them, and it goes to speak a little bit, you go back to that whole gamification, it is the other real strength about GaitBetter. I mean you have the clinical aspect which is really just really powerful in terms of the numbers that come out. But there's also the gamification side of things. It's fun. You can watch yourself improve your score. It's a game very much geared towards older adults. There's no explosions or space aliens or gore. It's really right at their speed. And we've seen, especially for certain residents who are not joiners, they don't wanna really do anything get attracted and they come back. They really utilize this facility. So it's a long way of saying, I don't really know. Sometimes it's the rehab gym, sometimes it's the fitness gym. They can go in either location. We make a small change to the operator screen so it's a little more push button for the fitness gym because nobody's really there just the resident or the gym supervisor. We're in the rehab environment. We make it a little more, they have a lot more levers they can pull because they're clinical experts. And then you're right. What's really also nice about this intervention, let's say compared to classes is, we really can track each person's progress. So it's great. We have table, we have graphs that really show, I did this actually my, one of my motivations for joining GaitBetter was my father-in-law, a Vietnam veteran had a massive stroke four years ago and then in , unfortunately it's now also on medication that increases his risk for falls . So we decided to put him on GaitBetter and you know, after 3, 4, 5 sessions really got into the score how far he had walked, whether he was walking farther than the time before, whether he was walking faster and he really could see it. It was all being displayed in front of him and it was all something that me and him would review once his session was done, how much better he had done compared to the previous time period. So, it's right, the gamification really provides a wonderful motivational aspect to it.Patrick Leonard:
Yeah, I love that and I'm glad you touched on there is a gamification side of it in addition to the clinical side as well. Being able to tie in something that's both mutually beneficial as from a clinical perspective as well as something that even socially and just fun and engaging in that sense. You can do both those things at the same time, especially in the senior living setting. I mean that's the ultimate goal. So that's fantastic. Thanks for touching on that. So from a curiosity standpoint, are there a lot of other solutions like this in this space? I mean I know we talk about all these different things maybe and I can think of some solutions that are trying to combat some of the false prevention, of course, is a hot topic. There's different solutions but as far as tying it all together in this sense, is there anything else out there that you all are aware of or coming against in this space?Craig Hillman:
Oh, 100%. What's interesting, of course, is what does fall prevention mean? How do you initiate fall prevention? So it's really quite fascinating. I would say most of the efforts in the technology space around fall prevention is around what I'll more describe as fall detection or fall prediction. So, for example, there's a wonderful company that has a scale that you stand on the scale and based upon I think how you balance, they'll predict whether or not you're at risk for falls. There's a couple of camera systems they'll put in somebody's room and kind of observe how they move or whether they're moving in a certain way. In fact, I was just on a call with somebody, there's even like a mattress or almost like a pad you can put on a bed and depending on how somebody is rolling, you can predict where they're fall. We don't see a lot on the fall treatment side in technology really kind of obviously the detection or prediction, but not so much on the treatment side. And those that are on the treatment side, they have some value. But it , from what I've seen in literature, right, they provide a similar value to existing interventions. So how do senior living communities deal with falls? They really deal with them in one of three ways. They offer classes that's typically for the more from like independent living typically maybe a little assisted living. So you're talking about like Tai chi or Steady or these group classes where they work on balance for example, a lot, there's what's called multifactorial interventions. So they'll look at the resident and look at their medication, whether they need glasses, so their eyesight, their hearing, making sure there's no rugs, making sure the room is well lighted, those kind of things. And then there's physical therapy. But we find, and again it goes back to that whole neuroscience of aging. What you find is because all those interventions typically A. are not really hitting the cognitive, not really acknowledging that cognitive is really a key, if not the key aspect of successful walking and the skills or the activity they're introducing does not really correlate with real world . Again, a great example is Tai chi . Tai chi , wonderful exercise, but again you're kind of standing still, you're not really walking these what are called meta-analysis or these studies of studies, there's one that comes out every three years, has hundreds and hundreds of studies on fall prevention. They find it actually doesn't really matter what it is, physical therapy , multi-fold, factorial, these different types of fall prevention classes, they all have a fall reduction rate of about 25% across the board. Whereas GaitBetter approaches close to 70%. I mean this is why I'm so inspired to where for GaitBetter, why I'm so inspired to reach out to these senior livings because I really do think it's going to be a game changer. And the game changer is that it's really based upon the fundamental whys of why do we fall.Patrick Leonard:
I love that and you , you simplified it for me in my mind because again I think you put it great when you said there's fall prevention, there's fault detection. This is really fault treatment because you're doing something physically and cognitively to help prevent this in the long run that isn't just simply, okay, walk more or work out more or do this specific activity. This is combining everything in one to really address the root issue. So I really appreciate that perspective. I think that's a great thing to kind of end on. But before we wrap up, I do want to give you an opportunity, I think this was such a really educational session for me. I think our listeners are really gonna enjoy it as well. I think you speak very well to this solution and the impact it has on your living communities. But before we wrap up today, is there any other final thoughts that you want to make sure that you share with our listeners or any other types of words of wisdom that you might have before we part ways today?Craig Hillman:
Maybe one, and I hope no one takes offense, I'll apologize ahead of time .Patrick Leonard:
Uh ohj , here we go!Craig Hillman:
So, GaitBetter has been very successful in Israel, but something like 90 plus percent of the Israeli population have access to GaitBetter. It's really become the standard of care. If somebody's at considered a risk of falls or they themselves can kind of self-refer, they can go almost anywhere in Israeli society to experience GaitBetter. It can be in a hospital, in an outpatient clinic at a senior center in a senior living community gym all over the place, and we do, to be very transparent, we hear some concerns from the senior community here in the US. They find it potentially maybe too risky or a little scary to put one of the residents on a treadmill to force that resident to do some challenging physical and cognitive tasks. It could be just we're litigation kind of nervous here in the US possibly, and so I tell them it's that, listen, the risk is far lower than you might expect and the benefit is so much better. One thing my Israeli colleagues like to talk to me about in the US is we need to be a little more willing to make that jump, make that leap and we'll see really significant benefit. So that's what I would tell you. I'm getting old or I'm hope , I think I'm still young, but you know, I feel those aches in the morning and then I'm sure they'll just get worse as I get older. So right, they're handling people, they're handling our parents and our grandparents and they , those who want to know that those parents and grandparents are being kept safe, and I think the mentality because is, well, keep them safe, I don't want them to do anything that looks scary. I'm going to kind of almost put them in a cocoon. But you also have to realize there's this use it or lose it aspect to our bodies and our mind. We have to challenge ourselves on a daily basis when we really kind of end going in the wrong direction, and so I think GaitBetter is a very effective way of challenging. It doesn't take too long 15 sessions and they're done. So I'm not asking, we're not going do it every day , but when you see that leap and you see those results, I think it'll be just an overall benefit to the community and and to the staff as well.Patrick Leonard:
Awesome. Well that's what it's all about. Well Craig, thanks so much for the conversation today. I personally learned a lot. I think our listeners will too. So thanks for taking the time out of your day to tell us a little bit more about your story and about GaitBetter.Craig Hillman:
My pleasure. Hey, thanks for having me!Patrick Leonard:
Absolutely. And listeners, thanks for tuning into another episode of Raising Tech. Hope you picked up some valuable information you can take back to your organization today, and if there are any topics you want to hear about in particular or want to be on an episode yourself , please feel free to reach out on our website at www.ParasolAlliance.com. Have a good one!