Transcript: Milos Popovic: Regaining Movement, Restoring Dignity | Nov 05, 2015

Steve sits in the studio. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a black suit, lilac shirt, and white plaid tie, as well as a red flower on his lapel.
Behind him, a wall screen reads “The Agenda, with Steve Paikin.”

Steve says STROKES AND SPINAL
CORD INJURIES WERE ONCE THOUGHT
TO HAVE LITTLE OR NO POSSIBILITY
FOR SIGNIFICANT RECOVERY.
BUT A TECHNIQUE KNOWN AS
FUNCTIONAL ELECTRICAL
STIMULATION -- F.E.S. -- IS
SHOWING THAT THE BRAIN CAN LEARN
NEW PATHWAYS TO A PATIENT'S
MUSCLES.
JOINING US NOW FOR MORE ON THESE
DEVELOPMENTS:
DR. MILOS POPOVIC, ASSOCIATE
DIRECTOR OF RESEARCH AT THE
TORONTO REHABILITATION INSTITUTE
AND TORONTO REHAB CHAIR IN
SPINAL CORD INJURY RESEARCH.

Milos appears on screen. He’s in his late forties, clean-shaven, with short gray hair. He’s wearing rimless glasses, a gray suit, white shirt, and striped blue and red tie, as well as a red flower on his lapel.

Steve continues WE WELCOME YOU TO TVO TONIGHT.

Milos says THANK YOU.

Steve says CAN YOU GIVE US A
SENSE OFF THE TOP, HOW MANY
PEOPLE SUFFER THE AFTER EFFECTS
OF HAVING HAD A STROKE.

Milos says IN THE U.S.
AND CANADA COMBINED, IT'S ALMOST
1.9 MILLION PEOPLE.

Steve says 1.9.
HOW MUCH MONEY DO WE SPEND
TENDING TO THE NEEDS OF
1.9 MILLION PEOPLE?

A caption appears on screen. It reads "Milos Popovic. Toronto Rehabilitation Institute. University of Toronto."

Milos says IN THE U.S.
THE ESTIMATE IS 34 BILLION dollars AND
IN CANADA WE ARE LOOKING AT
ABOUT A TENTH OF THAT, SO
3.5 BILLION dollars.

The caption changes to "Regaining movement, restoring dignity. By the numbers."

Steve says YOU HAVE CREATED A
GRAPHIC THAT MAPS THE JOURNEY
YOU TOOK IN CREATING THIS DEVICE
THAT IS ON THE TABLE BESIDE YOU,
IT'S CALLED MYND MOVE, I PRESUME
BECAUSE IT'S --

A slate appears on screen, showing a complex flowchart titled “The journey.” There are 20 boxes in the chart, that go from “Technology creation” in 1997-2991, to “Product launch” in 2014.

Milos says WE SPENT
QUITE SOME TIME TRYING TO PUT
THE NAME TOGETHER, AND THIS “Y.”
IS DELIBERATELY THERE, THEY
EXPECT IT'S MIND AND MOVE, BUT
THIS WRONG SPELLING KIND OF
FOCUSES YOU TO PAY ATTENTION.

Steve says IT WORKED.
BECAUSE THAT WORKED ON ME.
THE MYND MOVE TECHNOLOGY, IT
SHOWS THE PROCESS OF GETTING
UNDERWAY IN 1997 -- IF YOU GO TO
THE TOP LEFT-HAND CORNER OF THAT
GRAPHIC.
CAN YOU JUST SORT OF WALK US
THROUGH FROM THAT STARTING POINT
THROUGH TO WHAT YOU HAVE
LABELLED THE A-HA MOMENT IN 2001?
YOU SEE THAT ON THE TOP, RIGHT?

A new slate shows a man in a wheelchair receiving treatment on his right arm. A title reads “FES Therapy. How does it work?”

Milos says RIGHT.
ESSENTIALLY WHEN I STARTED
WORKING IN THIS FIELD WITH MY
TEAM, WE WERE DEVELOPING
PROSTHETIC SYSTEMS.
THEY'RE NOT OFF THE SHELF
DEVICES.
YOU CAN'T SIMPLY GO AND PURCHASE
THEM.
WE SPENT A LOT OF TIME PUTTING
THE TECHNOLOGY TOGETHER AND
TRYING TO ACTUALLY DEMONSTRATE
THAT YOU CAN DELIVER ARTIFICIAL
MOVEMENTS TO THE LIMBS AND
THEY'RE REPEATABLE, THEY'RE
RELIABLE, AND THAT PATIENTS
RESPOND TO THEM FAVOURABLY.
AND ONE OF THE FUNDAMENTAL
CONCEPTS AT THE TIME IN 1997-98
IS THAT THE PATIENTS WILL NOT
IMPROVE.
SO YOU WILL NEED A TECHNOLOGY
THAT WILL SUBSTITUTE THE
FUNCTION THAT THEY HAVE LOST DUE
TO STROKE OR PARALYSIS.
WE WERE TO DESIGN A SYSTEM THAT
WOULD REPLICATE THE DIFFERENT
MOVEMENTS OF THE HAND THAT THE
PATIENT WILL USE EVERY DAY.
THE PATIENT WILL HAVE THIS
PROSTHESIS ON THE BODY EVERY DAY
AND THE DEVICE WILL FIRE THE
MUSCLES IN A COORDINATED MANNER
TO PROVIDE THAT MOVEMENT.
SO THAT WAS THE FOCUS OF THE
EFFORT, AND WE WERE FORTUNATE TO
BUILD A SYSTEM, WHICH WAS FAIRLY
RELIABLE, AND WE COULD APPLY IT
TO MULTIPLE PATIENTS TO SEE HOW
IT ACTUALLY WORKED.

Steve says WHAT WAS THE A-HA MOMENT?

Milos says AS WE WERE
DELIVERING THESE SYSTEMS TO OUR
PATIENTS TO TAKE HOME, WE HAD
CLEAR ANTICIPATION THAT THEY
WOULD USE IT EVERY DAY AS AN
ASSISTIVE DEVICE AND THEY WILL
COME BACK FOR REPAIRS AND
MAINTENANCE, WHATEVER.
WE STARTED GETTING PATIENTS
COMING BACK AND SAYING, WE DON'T
NEED THIS DEVICE ANYMORE.
AND IF YOU WORK IN ASSISTIVE
TECHNOLOGY FIELD, THIS IS NOT AN
UNUSUAL EVENT BECAUSE PEOPLE
RETURN DEVICES BECAUSE THEY
DON'T LIKE THE COLOUR, THEY
DON'T LIKE THE FUNCTION, IT'S
VERY DIFFICULT TO USE IT BECAUSE
A NURSE OR FAMILY MEMBER DOESN'T
WANT TO PUT IT.
SO WE EXPECTED ONE OF THOSE
THINGS TO HAPPEN TO OUR DEVICE.

Steve says THEY DON'T NORMALLY
RETURN IT BECAUSE THEY DON'T
NEED IT ANYMORE.

Milos says EXACTLY.
THAT WAS A SURPRISE BECAUSE THE
PATIENTS STARTED TELLING US
ESSENTIALLY THAT WE DON'T NEED
IT ANYMORE.
I CAN DO IT WITHOUT A DEVICE.

Steve says EARLIER THIS YEAR,
THE UNIVERSITY OF CALIFORNIA AT
IRVINE RELEASED A VIDEO OF A
PARAPLEGIC MAN USING F.E.S. TO WALK.
LET'S ROLL SOME OF THAT VIDEO
AND WE'LL TAKE A LOOK AT THAT
RIGHT NOW, AND THIS IS REALLY --

A clip plays on screen of a man walking with great difficulty, aided by a device that supports his body from the ceiling of a rehab room.

Steve says WELL, LOOK AT THIS.
TELL US WHAT WE'RE WATCHING
RIGHT NOW INSOFAR AS THE
FUNCTIONAL ELECTRICAL
STIMULATION DEVICE IS DOING
SOMETHING THAT APPARENTLY IS
ALLOWING THIS PERSON TO WALK?

Milos says SO WHAT IS
REALLY EXCITING ABOUT THIS
TECHNOLOGY, THE WALKING PER SE
HAS BEEN DONE AND IT'S BEEN
AVAILABLE FOR MANY YEARS, SO YOU
CAN FIRE DIFFERENT MUSCLE GROUPS
AND IN THIS PARTICULAR CASE A
NERVE TO GENERATE REFLEX,
MEANING THE SYSTEM ALLOWS THE
LIFTING OF THE FOOT AND
GENERATES WALKING-LIKE SEQUENCE.
BUT WHAT THEY HAVE DONE
ESSENTIALLY IS THEY HAVE
CONNECTED IT TO THE BRAIN.
SO THEY HAVE USED THE SIGNALS IN
THE BRAIN TO TRIGGER THE
MOVEMENT OF THE FUNCTIONAL
ELECTRICAL STIMULATION.
THAT IS WHAT IS DIFFERENT AND
UNIQUE ABOUT --

Steve says THE HARNESS, WHAT'S
THE STORY WITH THAT?

Milos says THE HARNESS
IS ACTUALLY SUPPORTING THE
WEIGHT OF THE SUBJECT AS HE'S
WALKING.
SO IT'S FOR SAFETY AND SOMETIMES
IT'S USED TO OFFLOAD THE WEIGHT
OF THE PATIENT BECAUSE SOMETIMES
PATIENTS ARE NOT ABLE TO SUSTAIN
THE ENTIRE WEIGHT OF THE BODY.

Steve says NOW, THAT'S
UNIVERSITY OF CALIFORNIA IRVINE.
YOU ON THE OTHER HAND ARE
CONCENTRATING I GATHER ON ARM
AND HAND MOBILITY RATHER THAN
WALKING.
HOW COME?

The caption changes to "Hands-down winner."

Milos says ACTUALLY, WE
HAVE BEEN WORKING WITH
LOCOMOTION SYSTEMS.
HOWEVER, WE BELIEVE VERY
STRONGLY THAT THE PRIORITY FOR
PATIENTS IS THE UPPER LIMB
FUNCTION.
THE REASON FOR THAT IS WHEN
PEOPLE DON'T HAVE AN UPPER LIMB
FUNCTION AVAILABLE, HAND AND
ARM, THEY ESSENTIALLY RELY ON
OTHERS TO PERFORM ACTIVITIES OF
DAILY LIVING.
WE THINK IT'S WALKING THAT'S
RELEVANT FOR THE PATIENT.
BUT THE PATIENT WILL TELL YOU,
NO, NO, I REALLY NEED UPPER LIMB
FUNCTION BECAUSE THEN I CAN DO
THINGS ON MY OWN, I CAN PERFORM
TASKS INDEPENDENTLY, AND BY
DOING THAT, I GET MY DIGNITY
BACK AND I GET MY INDEPENDENCE.
AND BY GETTING INDEPENDENCE BACK
AND GETTING DIGNITY BACK,
AUTOMATICALLY THE NUMBER OF
PEOPLE THAT NEED TO ATTEND TO
THIS PERSON EVERY DAY GOES DOWN
SUBSTANTIALLY, WHICH REDUCES THE
COSTS, MAKES PEOPLE INDEPENDENT,
AND THEY CAN ACTUALLY GO BACK TO
WORK.
LOCOMOTION IS NOT CRITICAL FOR
GOING BACK TO WORK.
HAND FUNCTION IS.
OR GOING BACK TO THE COMMUNITY
AND BEING ABLE TO PARTICIPATE IN
YOUR COMMUNITY.

Steve says INTERESTING.
SO YOU'VE GOT THAT, YOU CHOSE
THAT APPROACH BECAUSE YOU
LISTENED TO YOUR CLIENTS.

Milos says EXACTLY.

Steve says GOTCHA.
WE'VE GOT ANOTHER VIDEO TO SHOW.
THIS TIME ONE OF YOUR PATIENTS.
THIS IS ANDREW GENGE, SUFFERED A
STROKE, SERIOUS RUGBY INJURY.
LET'S ROLL THE CLIP AND SEE
WHAT'S UP.
GO AHEAD, PLEASE.

A clip plays on screen with the title "Dr. Milos Popovic. Toronto Rehab Chair in Spinal Cord Injury Research. Professor, University of Toronto."
In the clip, Milos talks to the screen during an interview.

He says IF SOMEBODY HAS A HIGH-LEVEL
STROKE INJURY, PROBABILITY OF
IMPROVEMENT IS LESS THAN 10 percent.

A teenager trains his right arm to try to grab a book.

A female voice says HIS RIGHT ARM AND RIGHT HAND
WERE MOST SLOW IN RECOVERY.

Milos says IF ANDREW WENT TO REHAB TEN,
FIFTEEN YEARS AGO, EXPECTATIONS
WOULD BE THAT MOST LIKELY HIS
HAND AND ARM FUNCTION WOULD NOT
IMPROVE.

An older Andrew is shown grabbing an object with his right hand and says
I WENT FROM PARALYSIS IN MY
RIGHT ARM TO MOVING MY FINGER
AND I WAS COMPLETELY AMAZED BY IT.
IT DID WONDERS FOR ME.
IT PRETTY MUCH GAVE ME BACK MY ARM.

A clip shows Andrew jogging on a cold winter day.

He narrates I WOULD DESCRIBE MYSELF AS
HAVING 90 percent MOVEMENT IN MY HAND
AND ARM THANKS TO F.E.S.

He’s shown working out at a gym

The clip ends.

Steve says THAT'S UNREAL.
HE'S IN HIS 20s.
HE HAD A STROKE IN HIS 20s.

Milos says YES.
ACTUALLY, HE WAS 17 OR 18 OR
SOMETHING AROUND THAT.

Steve says AND NOW LOOK AT HIM
PUMPING IRON.

Milos says EXACTLY.

Steve says WHAT DID YOU DO?

Milos says WHAT WE
ACTUALLY HAVE DONE, WE HAVE
TRAINED HIM -- SO THE WAY THE
TECHNOLOGY ESSENTIALLY WORKS IS
YOU ASK THE PATIENT TO DO
REACHING OR GRASPING AND HE IS
STRUGGLING TO PERFORM THE TASK,
WE ARTIFICIALLY FIRE THE MUSCLES
TO ACTUALLY GENERATE THE
MOVEMENT THE PATIENT IS TRYING TO DO.
AS THE MOVEMENT IS GENERATED,
YOU PROVIDE ALL THE SENSORY
FEEDBACK TO THE CENTRAL NERVOUS
SYSTEM, THE DESIRE TO MOVE AND
THE IMAGERY OF THE MOVEMENT HELP
THE PARTS OF THE BRAIN THAT WERE
NOT DAMAGED BY THE STROKE TO
RELEARN HOW TO DO THIS STUFF.

Steve says AND HOW TYPICAL IS
HIS RECOVERY COMPARED TO OTHERS?

Milos says SO WE HAD A
NUMBER OF -- I MEAN, HIS
RECOVERY, AS YOU SAW FROM THE
BEGINNING OF TREATMENT TO THE
END OF TREATMENT WAS VERY TYPICAL.
WHAT WAS EXCITING FOR US BECAUSE
WE HADN'T SEEN HIM FOR SEVEN TO
NINE YEARS, IS WHEN THEY FILMED
HIM FOR THIS CLIP, HE ACTUALLY
DRAMATICALLY FURTHER IMPROVED
AND GAINED STRENGTH AND HE WAS
ABLE TO DO CHINUPS AND PUSHUPS,
WHICH I DIDN'T THINK HE WOULD BE
DOING.

Steve says BECAUSE HE'S SHOWING
OFF FOR THE CAMERA?

Milos says PROBABLY.

Steve says I HATE TO BE A
KILLJOY HERE, BUT WHAT ABOUT THE
PROSPECT OF A RELAPSE?
IS THAT POSSIBLE?

Milos says ACTUALLY,
ALL THE PATIENTS THAT HAVE
PARTICIPATED IN OUR PROGRAM AND
USED THE TECHNOLOGY ESSENTIALLY
EITHER KEPT THE FUNCTION WHICH
THEY GAINED OR THEY IMPROVED.

Steve says DO YOU HAVE TO DO
WHAT YOU DO IMMEDIATELY AFTER
THE INJURY TAKES PLACE, OR IS IT
BETTER TO WAIT SOME TIME?
HOW DOES IT WORK?

Milos says WE BELIEVE
IT'S BENEFICIAL TO DO IT EARLY
AFTER THE INJURY -- NOT
IMMEDIATELY, BUT A COUPLE OF
WEEKS UNTIL THE PATIENT STABILIZES.
BASED ON THE LITERATURE AND OUR
EXPERIENCE, THIS IS THE TIME
THAT THE PATIENT IS MOST PRONE
TO RECOVER AND TO ACCOMPLISH
SOME SIGNIFICANT GAINS.
WE HAVE HAD CHRONIC PATIENTS WHO
ARE 19 PLUS YEARS AFTER STROKE
WHO CAME AND TOOK PART IN A
STUDY AND -- NOT IN A STUDY, BUT
THERAPY, THEY ACTUALLY IMPROVED
19 YEARS AFTER AND QUITE
SUBSTANTIALLY, ACTUALLY.
SO APPARENTLY YOU CAN HAVE
SOMEBODY WHO IS QUITE CHRONIC --
I MEAN, 19 YEARS --

Steve says IS QUITE CHRONIC.

Milos says YES.
BUT WE BELIEVE GETTING PATIENTS
EARLY IN THE GAME IS MORE
BENEFICIAL FOR THE PATIENT AND
YOU CAN HAVE LARGER GAINS AND FASTER.

Steve says NORMAN DOIDGE HAS
BEEN A GUEST ON THIS PROGRAM
MANY TIMES SO WE KNOW ABOUT
BRAIN PLASTICITY AND THE BRAIN
THAT CHANGES ITSELF.
WHAT ROLE DOES THAT PLAY IN F.E.S.?

Milos says THAT'S IT.
THIS IS ESSENTIALLY THE METHOD
WHICH ALLOWS TO REPROGRAM THE
BRAIN BY PROVIDING WHAT THE
PATIENT WOULD LIKE TO DO AND
PROVIDING PROPER MOVEMENT OF THE
ARM AND FEEDBACK TO THE SYSTEM
SO HE CAN RETRAIN THE SYSTEM.

Steve says LET'S TAKE A LOOK AT
ANOTHER GRAPHIC, IF WE COULD.

The picture of the man receiving treatment in his arm reappears. There are four electrodes connected to his skin. An assistant helps him grab an object.

Steve continues LORRAINE IS DIRECTING TODAY.
THIS IS AN EARLY PICTURE OF YOUR
EQUIPMENT.
TELL ME HOW PLASTICITY WAS
INVOLVED IN THE DEVELOPMENT OF
THIS EQUIPMENT?

Milos says THIS IS
GENERATION NUMBER TWO OF THE DEVICE.
WE ACTUALLY BUILT A DEVICE WHICH
IS A LABORATORY-GRADE SYSTEM.
SO MANY OF THE PROTOCOLS AND THE
WAYS WE STIMULATE THE PATIENT
WHICH IS PART OF THE MYND MOVE
STIMULATOR.
WE USED A CONVENTIONAL
STIMULATOR LIKE THAT THAT YOU
SEE IN THE VIDEO, ON THE IMAGE,
ACTUALLY.
THEY'RE NOT VERY PLEASANT.
SO WHEN YOU STIMULATE THE
PATIENT, THE PATIENT FEELS
DISCOMFORT, AND SOME PEOPLE EVEN
FEEL PAIN.
SO WE NEEDED TO GO AND DESIGN A
SYSTEM THAT IS MORE COMFORTABLE
FOR THE PATIENT AND NOW THIS IS
THE PART OF THE NEW DEVICE.
YOU'RE LOOKING AT ABOUT FOUR
GENERATIONS OF HARDWARE AND
SOFTWARE BEFORE WE WERE READY TO
GO -- SO THIS IS GENERATION FIVE.

Steve says THIS IS 5.0.
CAN WE BRING THAT SHOT UP ONE
MORE TIME, LORRAINE, BECAUSE I
JUST WANT TO LOOK AT -- ONE,
TWO, THREE.
IT LOOKS LIKE FOUR ELECTRODES ON
EACH ARM.
IS THAT ENOUGH TO REALLY GIVE IT
THE JOLT YOU NEED?

Milos says IT DEPENDS
WHAT YOU'RE DOING.
IF ONE IS JUST DOING HAND
OPENING AND CLOSING, THAT'S
SUFFICIENT.
BUT IF ONE WANTS TO GET REACHING
AND HAND-OPENING, THEN YOU NEED
UP TO 8 CHANNELS.
SO THIS DEVICE HAS 8 CHANNELS
AND WE WILL FIRE 8 DIFFERENT
MUSCLES GROUPS OR MUSCLES TO
GENERATE THESE MOVEMENTS.
SO THE MOVEMENTS CAN BE TOUCHING
YOUR CHIN, THAT'S FAIRLY SIMPLE,
BUT REACHING FORWARD, GRABBING
AN OBJECT, RETRIEVING IT, IS
FAIRLY COMPLEX, AND YOU WILL
NEED 8 MUSCLE GROUPS TO WORK IN
SYNERGY TO DO THAT.

Steve says LET'S UNDERSTAND HOW
YOU GOT TO DEVICE 5.0.

Milos says RIGHT.

Steve says HOW MUCH DID IT COST
FROM ORIGINAL IDEA TO THAT
PROTOTYPE?

Milos says THAT'S AN
EXPENSIVE EXERCISE FOR VARIOUS
REASONS.
FIRST, TECHNOLOGY DEVELOPMENT OF
GENERATION 1 AND GENERATION 2
PROBABLY WERE IN THE RANGE OF A
MILLION, MILLION and a half TO DO THAT.

Steve says DOLLARS, I ASSUME.
CANADIAN DOLLARS.

Milos says CANADIAN
DOLLARS.
THEN WE NEEDED TO DO CLINICAL
TRIALS.
SO WHEN YOU DO SMALL PILOT
PRICE, YOU KNOW, FIVE, SIX,
SEVEN PATIENTS, THAT'S ABOUT
100,000, 150,000 dollars A POP.
AND WHEN YOU DO RANDOMIZED
CONTROL TRIAL, YOU'RE LOOKING AT
A MUCH LARGER PRICE.
IF YOU DO A TRIAL WITH 60, 70
PATIENTS OR 80 PATIENTS, YOU'RE
LOOKING AT ALMOST 1.5 TO
2 MILLION dollars IN COSTS TODAY.
SO NOT ONLY DO YOU NEED TO
DEVELOP TECHNOLOGY BUT YOU NEED
A RANDOMIZED TRIAL.
IT'S MEANINGLESS UNLESS YOU CAN
DEMONSTRATE IT WORKS ROBUSTLY ON
MULTIPLE PATIENTS AND IT'S
BETTER THAN THE CONVENTIONAL
THERAPY OR THE THERAPY YOU ARE
TESTING AGAIN.

Steve says LET'S BRING THIS UP.
WE HAVE ANOTHER GRAPHIC HERE
INDICATING THE COST -- THERE WE GO.

The flowchart pops up again.

Steve continues WE SAW THIS BEFORE.
ALL THE WAY FROM TECHNOLOGY
CREATION, TOP LEFT CORNER,
MOVING TO THE A-HA MOMENT IN 2001.
PRODUCT LAUNCH, BOTTOM
RIGHT-HAND CORNER.
YOU'RE ALMOST THERE.
TELL US AGAIN: WHERE DID THE
MONEY COME FROM THAT ALLOWED YOU
TO COMMERCIALIZE WHERE YOU ARE TODAY?

The caption changes to "Costs and timelines."

Milos says RIGHT.
SO A COUPLE OF ELEMENTS THAT
HAPPENED WHICH WAS VERY
IMPORTANT FOR US.
IN THE PROCESS -- WHENEVER WE
WANTED TO DO A CRITICAL STUDY,
RIGHT, OR CRITICAL DEVELOPMENT,
IT WAS USUALLY THE FOUNDATION,
FOR EXAMPLE, TORONTO REHAB
FOUNDATION WOULD COME FORWARD
AND PROVIDE US WITH THOSE FUNDS
THAT ALLOW US TO DO HIGH-RISK
TYPE OF PROJECTS.
SO FOR US, THE TORONTO
FOUNDATION HAS PLAYED A PIVOTAL
ROLE IN BRINGING THOSE FUNDS
THAT ALLOW US TO -- THEN WHAT
WAS VERY IMPORTANT INTO
LAUNCHING THE PRODUCT, THE
PRESIDENT OF THE COMPANY AND
MYSELF, WE ACTUALLY WENT TO THE
CENTRE OF EXCELLENCE.
THE CENTRE OF EXCELLENCE WAS
VERY KIND TO US AND RECOGNIZED
THE POTENTIAL AND THEY HELPED US
FINANCIALLY TO ACTUALLY ENGAGE
PROPER PEOPLE SO WE CAN ACTUALLY
PUT THE BUSINESS PLAN AND WHAT
WE WANTED TO DO WITH THE
COMPANY.
AND THE NEXT PHASE WAS
ESSENTIALLY ANGEL INVESTORS.
SO WE WERE VERY FORTUNATE THAT
IN ONTARIO WE HAD 20 INDIVIDUALS
IN 2012 WHO TRUSTED THE
TECHNOLOGY, TRUSTED THE TEAM --

Steve says HOW MUCH DID THEY GIVE?

Milos says THEY GAVE US
ABOUT 2 MILLION dollars.

Steve says THE ANGEL INVESTORS.

Milos says THE ANGEL INVESTORS.
IT WAS ABSOLUTELY FANTASTIC AND
I THINK AT THAT TIME IT WAS ONE
OF THE LARGEST ANGEL INVESTMENTS
THAT HAS HAPPENED.

Steve says WOULD WE KNOW THE
NAMES OF SOME OF THESE PEOPLE?

Milos says NO, THESE
ARE -- I MEAN, I DON'T WANT TO
GO THROUGH THE NAMES BUT THEY
ARE INDIVIDUALS WHO WERE IN A
POSITION TO HELP US AND THEY'RE
NOT PARTICULARLY FAMOUS.
I MEAN, THEY'RE VERY WELL-KNOWN
IN THEIR FIELD, THEY'RE
EXCELLENT INVESTORS AND THEY'RE
VERY COMPETENT INDIVIDUALS AND
WE'RE VERY GRATEFUL TO THEM, BUT
IT'S NOT LIKE A SINGLE
INDIVIDUAL.

Steve says BECAUSE WE DO HEAR
IN THIS COUNTRY THAT THERE'S NO
VENTURE CAPITAL SECTOR TO SPEAK
OF, RIGHT?
IT'S EXTREMELY DIFFICULT TO GET
PEOPLE TO -- YEAH, WHO, IN
ESSENCE, THROW SOME MONEY INTO
THE KITTY AND LET'S SEE WHERE IT
GOES, RIGHT?

Milos says RIGHT.

Steve says DID YOU FIND THAT TO
BE DIFFICULT IN THIS CASE?

Milos says I THINK WHAT
WAS VERY IMPORTANT, WE HAD
REALLY THE PRIVILEGE TO MEET THE
EXCEPTIONAL PEOPLE WHO
IMMEDIATELY UNDERSTOOD WHAT WE
WERE TRYING TO DO, AND I THINK
BESIDES TRYING TO MAKE A GOOD
INVESTMENT FROM A FINANCIAL
POINT OF VIEW, I THINK ALMOST
ALL OF THEM ARE ALTRUISTIC.
THEY BELIEVED THAT THIS
TECHNOLOGY COULD HELP A LOT OF
PEOPLE, SO WE ARE READY TO TAKE
A RISK.
SO OUR INVESTORS WERE IN THAT
WAY EXTRAORDINARY BECAUSE THEY
FELT STRONGLY THAT THIS IS GOING
TO CHANGE THE LIVES OF MANY
PEOPLE AND THEN THEY THOUGHT
THAT IT IS WORTH TAKING THE
RISK, NOT JUST FOR FINANCIAL
PURPOSES BUT ALSO FOR THE
PURPOSES OF HELPING PEOPLE, AND
THEY'VE BEEN WITH US EVER SINCE.

Steve says THE ONTARIO HEALTH
CARE SYSTEM IS A 50 BILLION dollar A
YEAR ENTERPRISE, AND OBVIOUSLY
SOMETIMES YOU HAVE TO SPEND
MONEY IN ORDER TO SAVE MONEY.
SO WITH THE INVESTMENT IN YOUR
PROGRAM HERE, HOW MUCH DO YOU
HOPE TO ULTIMATELY SAVE
TAXPAYERS OF ONTARIO, GOVERNMENT
OF ONTARIO BECAUSE THE VERY
EXPENSIVE PROSPECT OF TAKING
CARE OF PEOPLE WHO HAVE STROKES
AND INJURIES OF THIS KIND MIGHT
BE ALLEVIATED?

Milos says LET ME GIVE
YOU AN EXTREME EXAMPLE.
IF SOMEBODY HAS A SPINAL CORD
INJURY -- I REFER TO SPINAL CORD
INJURY BECAUSE I HAVE THE
NUMBERS AVAILABLE.
IF IT'S A CERVICAL LEVEL, WITH I
MEANS THEY'RE NOT ABLE TO USE
THEIR HANDS, YOU'RE LOOKING AT A
LIFETIME COST WHICH IS EASILY
MORE THAN 1.8 MILLION dollars.

Steve says PER PERSON.

Milos says PER PERSON.
IF THAT PERSON HAS THEIR HAND
FUNCTION BACK, WHICH MEANS
THEY'RE A HIGH LEVEL PARAPLEGIC
INDIVIDUAL, CAN YOU ROUGHLY
SHAVE ABOUT .8 MILLION.

Steve says SO WE'RE DOWN TO A
MILLION NOW.

Milos says RIGHT.
SO THIS .8 IS EXACTLY WHAT YOU
GET WITH THIS DEVICE.
SO IF YOU DELIVER THE THERAPY
EARLY IN THE GAME FOR SPINAL
CORD-INJURED PATIENTS, YOU
SHOULD BE ABLE TO MOVE THEM FROM
QUADRIPLEGIC PATIENTS TO
PARAPLEGIC PATIENTS AND GIVE
THEM THE HAND FUNCTION BACK,
THAT WILL PROBABLY REDUCE COSTS.

Steve says AND WHAT'S THE COST
OF THE TREATMENT?

Milos says THE COST OF
THE TREATMENT RIGHT NOW, THERE'S
A COMPONENT OF THE THERAPIST AND
THERE'S THE COMPONENT OF THE
DEVICE, 20 HOURS OF THE
THERAPIST IS ABOUT 3,700 dollars, AND
WE WOULD RECOMMEND PEOPLE TO
HAVE 40 HOURS OF -- THEY CAN
HAVE MORE THAN THAT, BUT 40
HOURS OF THERAPY WE HAVE FOUND
PRODUCED EXCELLENT OUTCOMES.

Steve says SO THE 3700 COVERS
HOW MUCH?

Milos says IT COVERS 20
HOURS.

Steve says 20 HOURS.
DOUBLE THAT, YOU'RE TALKING 7400 dollars.
SO YOU SPEND 7,400 dollars AND YOU
COULD SAVE 800,000 dollars.

Milos says THAT'S CORRECT.

Steve says PER PERSON.
SO MULTIPLY THAT BY...

Milos says BY THE
NUMBER OF INDIVIDUALS.

Steve says THE NUMBER OF
INDIVIDUALS SUFFERING FROM THIS.
SO THIS PAYS FOR ITSELF NUMEROUS
TIMES OVER.

Milos says IN THE FIRST YEAR.

Steve says IN THE FIRST YEAR.

Milos says RIGHT.

Steve says WHAT ARE WE WAITING FOR?

Milos says THERE ARE A
LOT OF PEOPLE COME TO O.H.I.P.
AND SUGGEST THIS IS THE MOST
WONDERFUL THING THAT EVER EXISTED.
SO WANT TO HAVE THE EVIDENCE,
CLINICAL EVIDENCE THAT SUGGESTS
THAT THIS WORKS VERY WELL.
BUT THEY ALSO WANT TO HAVE THE
EVIDENCE THAT FINANCIALLY THIS
MAKES A DIFFERENCE.
SO WE'VE BEEN VERY FORTUNATE TO
BE ENGAGED WITH A PROGRAM WHICH
EVALUATES TECHNOLOGIES LIKE THIS
AND IT'S RUNNING THE RANDOMIZED
CONTROL TRIALS IN MULTIPLE SITES
AND WITH A CENTRE FROM HAMILTON
WHICH IS ACTUALLY RUNNING THE
TRIAL AND DR. MARK BAILEY WHO IS
THE PRINCIPAL INVESTIGATOR OF
THE TRIAL, WE WILL TEST THIS IN
90-PLUS STROKE PATIENTS AND LOOK
AT NOT ONLY THE CLINICAL
OUTCOMES BUT ALSO THE EXPENSES
AND COSTS AND SAVINGS TO THE
SYSTEM.
AND IF THAT TRIAL DEMONSTRATES
THE SUCCESS OF THE SYSTEM, NOT
JUST CLINICALLY, THAT WILL BE A
LOVELY segue FOR O.H.I.P. TO
CONSIDER THAT SERIOUSLY FOR
FUNDING.

Steve says THAT WAS GOING TO BE
THE NEXT QUESTION.
I PRESUME SOMEBODY FROM YOUR
TEAM HAS HAD MEETINGS WITH, IF
NOT THE MINISTER OF HEALTH, THEN
SOMEONE ON HIS TEAM, AND SAID:
LOOK WHAT WE'RE DOING HERE.
WE CAN SAVE YOU A LOT OF MONEY.
YOUR GOVERNMENT NEEDS TO SAVE MONEY.

Milos says RIGHT.

Steve says HOW ABOUT IT?
HAVE YOU HAD THOSE MEETINGS YET?

Milos says ACTUALLY,
OUR MEETINGS HAVE BEEN THROUGH
THE EXCITE PROGRAM AND THAT IS
THE FUNNEL WE USE FOR THESE TYPE
OF COMMUNICATIONS, TO THE BEST
OF MY KNOWLEDGE.
I'M NOT RUNNING THE COMPANY, SO
I CAN TELL YOU WHAT I KNOW.
FUNDAMENTALLY WE ARE TRYING TO
DO THAT, AND SO WE WELCOME
ENGAGEMENT FROM THE MINISTRY TO
TALK TO US AND TO LOOK AT THIS
TECHNOLOGY MORE CAREFULLY.

Steve says BECAUSE I PRESUME AT
THE END OF THE DAY, AND YOU CAN
TELL ME WHEN THAT IS, AT THE END
OF THE DAY YOU WOULD LIKE TO SEE
THIS TREATMENT COVERED BY THE
ONTARIO HEALTH INSURANCE PLAN.

Milos says ABSOLUTELY.

Steve says SO THAT IT IS LIKE
ANY OTHER TREATMENT?

Milos says ABSOLUTELY.

Steve says THAT SOMEBODY WOULD
GO TO GET COVERED FOR?

Milos says THE REASON
FOR THAT IS BECAUSE RIGHT NOW
THIS IS ESSENTIALLY PRIVATE AND
PEOPLE HAVE TO GO TO DESIGNATED
PHYSIOTHERAPY CLINICS OR
OCCUPATIONAL THERAPY CLINICS TO
HAVE ACCESS TO THIS TECHNOLOGY,
AND NOT EVERY INDIVIDUAL IS ABLE
TO AFFORD THIS TYPE OF
TREATMENT, ALTHOUGH WE FEEL
STRONGLY THAT IT IS MORE THAN
WORTHWHILE, BUT SOME PEOPLE ARE
NOT ABLE TO AFFORD IT.
BY HAVING IT COVERED THROUGH
O.H.I.P. OR IN U.S. MEDICARE AND
EQUIVALENT --

Steve says ANYBODY CAN GET IT THEN.

Milos says THEN
EVERYBODY CAN GET IT AND WE CAN
HELP A TREMENDOUS NUMBER OF
PEOPLE.
FOR EXAMPLE, EVERY YEAR IN THE
U.S. AND EUROPE ALONE, WE SHOULD
BE ABLE TO ADDRESS AT LEAST
800,000 INDIVIDUALS, WHICH IS --

Steve says AMAZING.

Milos says IT'S AMAZING.
SO WE ARE LOOKING FORWARD TO
THAT MOMENT IN TIME WHEN
O.H.I.P. AND MEDICARE-MEDICAID
WILL ESSENTIALLY PAY FOR IT.
WHAT IS GOOD NEWS, AND WE ARE
VERY EXCITED ABOUT IT, IS
INSURANCE COMPANIES SEE THE
VALUE IN THAT, SO SOMEONE WHO
HAS A CAR ACCIDENT AND HAS A
SPINAL CORD INJURY OR TRAUMATIC
BRAIN INJURY, PRIVATE INSURANCE
COMPANIES ARE PAYING FOR IT
RIGHT NOW.

The caption changes to "Produced by Gregg Thurlbeck, @greggthurlbeck."

Steve says MILOS POPOVIC, THANK
YOU FOR VISITING US AT TVO TONIGHT.
FANTASTIC WORK.

Milos says Thank you very much.

Watch: Milos Popovic: Regaining Movement, Restoring Dignity