ADAMO has developed the most innovative robotic technology within the medical-rehabilitation area. A solution that is born from the hands of a physiotherapist and uses robotic technology for the treatment of musculoskeletal pathologies. The collaborative robot (100% safe) of ADAMO is an automaton that uses compressed air to perform pressure of between 4 to 8 bars, which produces the desired effects on the patient’s back.
We have developed two fully functional prototypes of ADAMO – TRL7/8. The robot has been tested by 175 patients throughout the development stags since 2017 to assure the applied compressed air treatment methodology was beneficial to treat myofascial trigger points (MTP), which are sensitive spots in the soft tissue that produce pain. ADAMO has been certified with the CE marking (medical electrical equipment). A clinical study early this year was started by the CIBIR Biomedical Research Centre and Hospital San Pedro (Logroño, Spain) with 200 patients to avail the impact of ADAMO on pathologies and the clinical outcome, however it was stopped due to the COVID-19 breakout. The ethical committee approval was obtained. The application for Medical Device Class IIa certification has been filed and is expected in November/December 2020. Unlike competitors, ADAMO will be the first physiotherapy robot to be certified as a medical device. A preliminary freedom-to-operate analysis has been conducted.
The global physiotherapy equipment market size was valued at USD 16.3 billion in 2016 and is expected to grow at a CAGR of 7.1% through 2022, but from this equipment around the 80% corresponds to MSDs devices.
The current pandemic situation (COVID-19) with more of 2,5 Million contagious continuously extends such market estimations, being our main short term goal to treat COVID patients.
Our target clients include private and public hospitals, mutual funds, insurance companies, physiotherapy centres and others (hotels, wellness centres, etc.). The end users are the physicians in hospitals and specialized centres that needs to treat patients with MSDs back illnesses.
Private Hospitals have the largest share of the market due to the high cost invested in medical equipment. While public hospitals tend to outsource treatments to specialized therapy centres to free up resources and cutting down waiting times. This will also give specialized physiotherapy centres the opportunity to offer more services and increase their physiotherapeutic capacity. This relationship will impact the number of patients that can be treated, thus increasing the wellbeing of society while also increasing efficiency on the management of the growing number of patients with MSDs. We will also target mutual funds and insurance companies since back illnesses associated to MSDs are categorized as occupational diseases.
Problem or Opportunity
Back pain is an illness associated to Musculoskeletal Disorders (MSDs). The most common illness in the world. Cause of disability worldwide affecting 80% of the population. 540 million people around the world are suffering from lower back pain at any one time.
In case of COVID-19 patients: Intensive Care Unit Acquired Weakness (ICUAW) is the acute onset of neuromuscular and/or functional impairment in the critically ill for which there is no alternative etiology other than critical illness. ICUAW is a common condition in critically ill patients who are mechanically ventilated for prolonged periods of time. Mechanistic studies have shown only recently that muscle atrophy and loss of muscle mass develop rapidly during critical illness – within hours of the patient being intubated and mechanically ventilated. Physiotherapists play an integral role in the prevention and treatment of ICUAW within the intensive care unit (ICU), with studies showing benefit from early mobilisation and inspiratory muscle training for patients in the ICU to improve duration of weaning and functional independence at hospital discharge. Most importantly, as survival from ICU increases, physiotherapists will have a greater role in the management of ICUAW after discharge from ICU and hospital.
Healthcare professionals: nursing personal is currently facing heavy physical workloads that will eventually lead to the presence of musculoskeletal risk factors and the incidence of low back pain among nursing professionals of a hospital. Statistically, female workers suffer have a higher prevalence of back pain and impaired work capacity due to physical workloads at a hospital. Nowadays, around 69.5% of nursing personal suffers from lower back pain due to daily patient-handling routines (source: Effects of patient-handling and individual factors on the prevalence of low back pain among nursing personnel). The actual COVID-19 situation forces to treat more patients and will eventually lead to a higher prevalence of lower back pain incidents. There is a need to reduce the future heavy professional and social impact by offering treatment to ensure the reduction of the prevalence and the impact of lower back pain, which can eventually lead to become a disabling disease.
Solution (product or service)
ADAMO robot is designed to provide safe, contactless, hygienic and personalized treatment to patients regardless of the severity of the muscle injury, cause of pain, or treatment plan. Our leitmotif is precision and consistency to monitor the real-time evolution of the healing process providing valuable traceability information for the physiotherapists to assure the best therapy outcomes and the shortest possible treatment for each individual.
ADAMO will help taking off the burden of medical staff involved in physiotherapy treatments of COVID-19 patients. It offers +60% higher productivity as manual work is streamlined, and physiotherapists will be able to treat several patients at the same time without having direct contact. They will be able to focus on respiratory physiotherapy rather than the Intensive Care Unit (ICU)-acquired muscle weakness (AMW), which can be treated by ADAMO. We have been able to prove in previous trials that the session time can be lowered to 20 minutes and recovery time can be reduced from 7 to 3 weeks. ADAMO will also provide treatment sessions to caregivers and health care workers to lower chances of lower back pain prevalence and help them stay strong.
ADAMO robot consists of a six-axis robotic arm capable of highly articulated movements to provide precise therapeutic treatment by applying compressed air, this innovative approach has been proved to produces the same effects on the patient’s back as manual therapies in an efficient way reducing treatment time unlike current solutions.
ADAMO robot highly innovates by applying Artificial Intelligence to help therapist identify all the trigger points, suggest the best treatment base on medical data, reproduce the treatment automatically, and track the evolution. To do so, before each session, ADAMO explores the patient body with a 3D volumetric scan and thermal vision to identify these knots (hot spots), which appear in strong red colour, and locate their position. After exploring the patient’s back pain, ADAMO robot defines the positions of the MTPs and treatment properties (pressure, temperature, etc.) and monitors evolution by comparing the thermal vision from different sessions. This unique approach enables therapists to decide the duration and number of sessions based on medical data. All data is securely stored in a distributed cloud system allowing full treatment track for patients to receive subsequent sessions anywhere.
ADAMO will enable a robot assisted therapy with reduced times and accuracy of 100% supporting the physiotherapist to treat several patients at the same time and to store in the cloud patient and treatment information to be accessed for other physiotherapists anywhere once the patient has been finally discharged.
Manual therapy and messages are key components in MSDs treatment and they are meant to relax your muscles, reduce painful muscle tension, and increase your general sense of wellbeing. The main share in the physiotherapy market relies on support tools for physiotherapist to apply their manual massages. Support tools includes the extended electrotherapeutical technologies where the transcutaneous Electrical Nerve Stimulation (TENS) is the most common. TENS triggers electrical impulses in the nervous system and is done to stop pain signals being sent to the brain and to stimulate the production of endorphins, the body's own pain-relieving hormones. Lately, some innovative companies such as Aitreat Robotics and Massage Robotics have also developed robotic solutions for the personalized treatment of soft tissue but having direct contact with the patient, being it a driver for the virus transmission. The first includes a camera-based solution for body mapping and an ICT system to apply the treatment while the latter technology is more focused to the wellness market. Apart from our competitors, the ADAMO robot is the only European solution, and the only one in the world, that provides a unique technology and treatment technique with compressed air that produces safe, contactless, hygienic and personalized treatment to patients with proven results (by more than 155 patients) by autonomously healing MTP. The provision of robotic healthcare is an attractive goal on a global level, especially in relation to physiotherapy. To ensure that this technology can be successfully exploited by global healthcare providers, creating wealth, employment, societal benefits and cost efficiency, requires rapid and focussed development to deliver ahead of potential overseas competitors. Validation of the functionality of the robotic massage capability will allow engagement with a wider section of the medical robotics industry, opening yet wider opportunities, as the actual pandemic scenario.
Advantages or differentiators
The main advantage considering the recent pandemic scenario is the capability to safely treat Covid patients and professional healthcare providers.
However, the system brings the following advantages:
▪ Treatment: The system provides a personalized and safe treatment healing MTPs with a sustained and constant pressure (between 4 to 7 bar). ▪ Consistency: The MTPs and its treatment is defined by a physiotherapist and customized for each patient. By means of our 3D volumetric body scan system the robot reproduces the treatment in the same MTPs and with the same defined pressure.
▪ Efficiency: Reduces waiting lists given that we increase the amount of repetitive treatments improving the results of the rehabilitation up to 60%. The patient can receive the same treatment in any ADAMO Robot unit anywhere in the world.
▪ Proven results: Each treatment documented and stored in the cloud where you can trace in real time the evolution, improvement and the result of the treatment from any ADAMO Robot unit or by any device connected to the internet. In fact, the Eurobarometer of 2017 says that the 52% of the patients would like to have access to their clinic history but only 9% of the hospitals share them. Also 70% of patients are likely to share their clinical data if the data transmission is safe.
We have projected the market performance of the outputs of this product during the commercialization phase.
We expect that by year 5 we will generate €2.7 million in revenues, cumulated profits of €4.17 million and hire at least 17. Altogether, we expect a pay back from the investment in this project after 4 years in the market. This financial projection corresponds to the most conservative sells estimation, but we expect to double these sales with payback return of 2 years. We will invest part of the expenses in a continuous development of the solution which will help us maintain the competitive advantage over our potential competitors.
The first commercial phase we estimate a very competitive selling price for the ADAMO at 85.000€. The foreseen business model relies in two main channels:
• Sell: In this case we would sell the full package of the ADAMO robot that will include the access to the cloud-based services. If this option is selected, we will charge an annual support and maintenance fee between 6 to 12% from the total cost of the product (first year free). This includes the mechanical tuning, the software updates and of the cloud-based services. We have valued that the session made by ADAMO robot could be like the ones made by two full-time trained physiotherapists. Depending on the economic level of the country, centre could have a payback in 2 years in countries of southern Europe (Spain, Portugal, Italy, etc.) countries and in 1 year in northern Europe (Germany, France, Austria, and Nordics, etc.).
• Rent: We consider the rent model to be very attractive to customers and must be arranged through financial partners (framework agreements) and will not affect our income. According to the rent plan made through an external leasing company, the ADAMO solution must be sold with the additional support and maintenance fee and the access to the cloud services. We expect to have sufficient product buffer to reach a potential attractive financial agreement with financial companies (banks or leasing companies) to reduce CAPEX.
• Others: other sources of revenues will come from maintenance, SW updates, cloud platform and sales of accessories and spare parts.
We consider that these two main models plus the maintenance and technical support will give a very strong and steady growth margin and business scale-up opportunities.
Money will be spent on
-Finalize medical certification (CE class IIa) process.
-Reinforce the team.
-Marketing and dissemination activities.
We consider that the benefits of the ADAMO Robot for the wellbeing of society and for private and public health institutions are solid.
The solutions that we have conceived are focused on safety and easiness for the users, even though it has some unique properties (e.g. mixed air treatment), they are based on proven concepts and techniques.
Technically speaking one of the main challenges is to increase repeatability in the reproduction of the sessions based on artificial vision systems.
On the other hand, we are fully aware the conservative nature of the healthcare market might rise barriers to entry and adoption of novel concepts.