Helping Paralyzed People Walk with Achilleas Dorotheou, Head of Human Motion & Control at Parker Hannifin

(Joel Beasley at 00:00:04) Hello, my friends. Today we're talking to Achilleas, the Head of Human Motion and Control at Parker Hannifin. And we discuss how Achilleas and his team are building exoskeletons that help paralyzed people walk, how they worked with Apex Ridge Reliability to make sure these exoskeletons don't fail in the field, and the future of the medical exoskeleton industry. All of this right here, right now on the Modern CTO Podcast.

(Joel Beasley at 00:00:38) Here we go. This is the Modern CTO Podcast.

(Joel Beasley at 00:00:50) Tell me a little bit about your origin story. How did your career kind of start?

(Achilleas at 00:00:56) I was born and raised in Cyprus, which is a little island half the size of New Jersey in the eastern Mediterranean, by the way. And thanks to a scholarship program called Fulbright, the first time I flew out of Cyprus was to Manhattan, New York.

(Joel Beasley at 00:01:18) That's a long flight.

(Achilleas at 00:01:20) Yeah, long flight. And, you know, can you imagine the culture shock from this little—Cyprus has less than a million people, by the way. That's it. So you imagine Sicily. It's very similar. And so New York, Columbia, and started engineering there. I ended up with a master's in robotics and control systems. Those are kind of my passions. And I ended up applying that to the Middle East. Basically, my first job was building air bases in Saudi Arabia for some new aircraft they bought. Did that for a couple of years. Then came back to New York, which became kind of a home for me, Columbia again, and did my MBA. And at that point, the venerable old technology and strategy firm called Arthur D. Little—they're famous for creating silk out of a sow's ear, as the saying goes. So they are behind a number of innovations, everything from like Bluetooth to things like that. They kind of innovated the whole field of consulting in many ways. Boston Consulting Group was a spinoff. So it's an interesting group of people. And so they somehow discovered me in New York, you know. Basically, career services called me one day and said, you know, this firm in Boston wants to talk to you.

(Achilleas at 00:02:43) And that was because they kind of combined, apparently—and I don't even know how they triangulated that—but that I combined kind of business skills that I got from Columbia with familiarity of the Middle East environment, specifically Saudi Arabia at the time. And it turned out that they had a long history with the region, everything from helping found a lot of the ministries there of the country to developing literally the five-year plan of Saudi Arabia every five years.

(Joel Beasley at 00:03:12) The government plan?

(Achilleas at 00:03:13) Country plan. Wow. Right. It was done by economists in Boston. And so anyway, I joined the strategic consulting side of them and ended up doing some, you know, quite a few—well, similar to your position, right. I ended up, you know, like a deer in the headlights. I had all these cool projects, you know, everything from leading the feasibility study for a new skyscraper, the first skyscraper of an academy that also got built, then designing the innovation campaign of the National Oil Company of Saudi Arabia, Saudi Aramco. I did a variety of restructuring and strategy cases and ended up my career in the Middle East and consulting in the Middle East with actually leading this large project of merging the four regional power utilities of Saudi Arabia into one, so one national company.

(Achilleas at 00:04:21) So after that, I basically requested to start doing American work. At that point, I decided I was more American than European. And then I came to the U.S., and I started doing work with corporate clients, typically around business portfolio work, corporate portfolio. And I was helping corporates in the U.S. figure out which businesses to keep, which businesses to grow, which businesses to divest, that kind of thing, but also working with general managers, so established businesses in turning around their businesses, you know, that kind of thing. So that's basically how I started doing work in the U.S. So that's kind of my story in consulting. And then, you know, one of those clients, Parker Hannifin, basically hired me in their executive branch.

(Joel Beasley at 00:05:12) Oh, nice. So you came into Parker through consulting them on corporate strategy?

(Achilleas at 00:05:18) Consulting engagement. Nice. Yes. And that's kind of a theme for me. It's kind of—I am, I would say, an ambivert as I call it. Kind of like, you know, the way that people—I'm not very good at selling myself in a way. So it's—I think—but kind of I grow on people by working with them. And after a while, they're like, "Okay, I guess I like this guy. I like the results." You know? So let's continue to work with him. And that has been really a theme, you know, throughout my career. So that's how I always get my next job, is kind of an interaction I had from before.

(Joel Beasley at 00:05:58) Nice. And so today, I know you're working on some really cool stuff at Parker Hannifin doing exoskeletons to help people move. How did that get started?

(Achilleas at 00:06:11) Right. Exactly. So as I said, I joined Parker as a corporate guy first. By the way, this is my seventeenth year at Parker.

(Joel Beasley at 00:06:19) So it's...

(Achilleas at 00:06:19) Been—I've been here for a while. And but I had three different careers at Parker itself. You know? So the first was being more kind of a corporate strategy guy along the lines of what I was doing before. And then kind of the second stage of that was I worked with the president of one of the major businesses here to develop his strategy along with his team and take it to the board. And then he asked me to join his team to kind of grow the business. That was the Engineered Materials Group of Parker. So the big thrust of that strategy was to move kind of elastomeric, polymeric capabilities that that group had into the medical space and then also the oil and gas space. And so through the first bit, the medical bit, I was exposed to—I worked with the Cleveland Clinic, which is another institution in the Cleveland area where Parker is based, right, to basically bring together surgeons of the Cleveland Clinic and engineers of Parker. And then we kind of ran a joint stage-gate process where we had ideation sessions literally watching surgeries being performed and asking the surgeons what could you do better here or what would you need, you know.

(Achilleas at 00:07:38) And then device ideas came out of that, and then we basically would develop prototypes, test them, and kind of run them through. So through that program, I commercialized a couple of devices. One was a drug delivery device for cancer therapy in the brain. And the other was, you know, it sounds simpler than it is, but it's kind of like a sheath for endoscopes. Both were commercialized, you know, licensed, or spinoffs were created around them. And so at the same time, while I was doing that, at corporate—it sounds like there was a team at corporate, at Parker, that was watching carefully technology developments around kind of applying Parker's strength for capabilities, which is we call them motion and control. You know, Parker prides itself—Parker, just for—it's kind of a quiet company. It's in our culture. We don't like to kind of be very glamorous. We like to be behind our customers. And so it's actually a $14 billion in sales company and probably $40 billion in market capitalization at the moment, doing very well. But basically, it moves and controls things. So we have technologies that, you know, appear all over the plane, an airplane, and we serve everyone. You know, Airbus and Boeing. Boeing is a 100-year-old customer of Parker, so long relationship. John Deere, the same. Caterpillar, the same. So basically, under Caterpillar and John Deere, you see a lot of assemblies of Parker, basically. And so, again, we move and control things.

(Achilleas at 00:09:18) And so it was an aspiration of our leadership team to try to move the technology into the human space. They felt that that area was unexplored, and they had a team of PhDs looking at things that would make that happen. So they noticed, for example, in the early 2000s, you know, with the advent of cell phones that all of a sudden batteries actually started to become more and more powerful. And so the—any devices that people imagined before to try to help impaired people move or augment the motion of people, right, that make them stronger, you know, imagine, you know, Superman of sorts, you know, that before the limitation was that they had to be tethered. Right?

(Joel Beasley at 00:10:03) Right.

(Achilleas at 00:10:03) All of a sudden with batteries, you know, and actually really was electric cars and cell phones really led to that development, made it possible to untether these devices. Right? Then you had advances in materials. You had like titanium, carbon fiber, and, you know, aerospace-grade aluminum that made them lighter, a lot of them. Actually, you have also fancy polymeric, thermoplastic, elastomeric pieces that are very sophisticated nowadays that make the device kind of comply to the human physiology and motors that are flatter and quieter and, you know, energy efficient. And so they basically felt that, you know, that may be an area of interest right now. We can actually make that happen. Right? And so they looked around. There were several technologies. In fact, they found there were a couple of startups already that were publicly funded that were dealing in exoskeletons—exoskeletons, one for military and one for kind of medical purposes already. And they basically identified this technology at Vanderbilt University, which we ended up naming Indigo, Independence and Go. Nice. Right? Indigo. Right? And then because the—so this is an exoskeleton. This is for people that are fully paralyzed, basically, you know, because of an injury, typically spinal cord injury, you know, that leaves people paralyzed.

(Achilleas at 00:11:29) So typically, at the point of injury, you—signal does not go through the spine to the lower parts of the body. Right? So they may not sense anything, and they may not control anything. So the exoskeletons that we talked about and we developed are meant to be worn, put together on an individual by themselves, that can enable them to get up and walk, you know, with the aid of, you know, crutches or some other stability aid. And pretty much, the person interacts with the device themselves. So there's no, you know, anybody else. So basically, that's what that is. And so basically, the technology was—lies—was at Vanderbilt University. And because of my medical experience, again, going back to my experience, corporate asked me to help negotiate the potential license from Vanderbilt University for this technology. Right? And it turned out that the young co-inventor of the technology that we also hired, after we licensed the technology, they asked him apparently, "Who do you want to work with from all the people you met at Parker?" And he said, "This guy."

(Joel Beasley at 00:12:40) Nice.

(Achilleas at 00:12:41) So I was chosen by the inventor, I guess, to—and so, basically, I was, you know, offered the opportunity to build a new business from scratch at Parker to commercialize this particular technology, but also to define what human motion and control means for Parker. In other words, right? So it's an interesting concept, but, you know, you have to break it down. Right? You know, what does that mean exactly? What kind of devices are we talking about? What more importantly, you know, what devices are we not including in the space? And so we actually discovered that, you know, if you talk about—there are already mechatronic human mechatronic devices that we call—that's what the field we call it, human mechatronics. There are already devices out there, you know, that are commercialized, and there is a whole industry. The orthotics and prosthetics industry in the U.S. and Europe is probably, you know, a $3 or $4 billion market. And there are, you know, for people who are amputees especially, you know, people who lose their limbs, there are devices that have a very sophisticated logic. They have the mechanics that basically replicate the motion of a good leg and enable these people to live fuller, if not, you know, more full lives than they had before. You know?

(Joel Beasley at 00:14:01) Yeah. I actually, one of my best friends—I live with him currently—lost his leg like about a year ago. Although luckily, it was below knee. There's actually, like, a huge, like, medical drama around it where doctors were fighting with each other between above knee or below knee. Ended up getting to keep his knee. So he has a, like, a much less sophisticated prosthetic. But I've picked, like, picked him up from—are you familiar with Hanger Prosthetics?

(Achilleas at 00:14:35) Yes. Very much. In fact, we are actually—yes. We are very familiar with Hanger.

(Joel Beasley at 00:14:41) Oh, that's awesome. Yeah. Because I've, like, gone to pick him up from Hanger from his appointments before, and like, it's crazy seeing all the people just walking around outside with the incredibly sophisticated prosthetics, and like their walking gait just looks normal, you know. Like, it's really, really cool to see.

(Achilleas at 00:15:03) Yeah. So what we discovered is that there is already a pretty neat industry there already. But somehow we felt that kind of the powered orthotics area was underserved. So that's kind of the conclusion of that analysis is that, you know, in a way, if you think about Indigo, the formal description of it is really a powered orthotic. Orthotic means that you have your limb, like, but they don't work right, just to simplify. There is some kind of weakness, some kind of neurological impairment that, you know, prohibits you from using your legs, you know, to move around, you know, normally. And therefore, you need some kind of an orthosis that basically is fitted on top of your existing limbs. And the idea is our specific expertise, and we built a world-class engineering team here to do that, is really about applying power to move the human body. You know? So in cases where people have their limbs, but some neurological impairment doesn't enable them to use them at all or use them partially.

(Achilleas at 00:16:11) So that's kind of really our product trajectory since we launched the first—so basically, yeah, we launched the business. I was asked to create a business. We launched it, you know, 2013. We formed the business unit. By end of 2015, we got regulatory clearances from the U.S. and Europe and then beginning of 2016 in the U.S. to start selling our full—so the first market was really using the full-powered exoskeleton for fully impaired people, fully paralyzed people. So basically, you're supporting four joints, knees and hips. Right? And in the clinic, that was the first use case for rehabilitation purposes. So it's people—so the clinicians do have different programs for clinicians to use this device to fit people in it and teach them how to walk again or give—or using kind of the exercise that the exoskeleton gives to actually improve their health. So that's kind of the first use case. That first...

(Joel Beasley at 00:17:11) So yeah. So that first one was for, like, helping people—they would use it so that they could walk without one? Like, they'd use it for training? Okay.

(Achilleas at 00:17:21) If they have the potential for recovery, it's called. Yeah. Right? The idea is to retrain the body to basically learn how to walk again. For example, a key example there is stroke. Right? So stroke, what happens is an injury is in the brain. Right? And what happens, it kind of kills the neural connections that, you know, enable you to walk. And the idea there is that with these devices, we have several programs that our engineers developed, you know, that the clinicians can use to basically help the person learn how to walk again.

(Joel Beasley at 00:17:56) Right? Like, reestablish those neural connections?

(Achilleas at 00:17:59) Reestablish those neural connections. And, you know, sometimes it's 100% and sometimes it's not. Sometimes it can only get to a certain stage. They may be left with a certain residual impairment, but they're still largely functional. Right?

(Achilleas at 00:18:16) So that's the first use case: using it in the clinic. Right? Then there's a second use case, which is really allowing the device to go home with people for use. This is, again, fully paralyzed people. In fact, the approval from the FDA is they have to be spinal cord injured individuals with injury almost like from the high chest and below. So basically, they have to have function of their arms, but they don't have to have any other function. So basically, they're below the high chest. Indigo Personal, as we call it, can be prescribed to them, and they can buy it and take it home after a prescribed training program, around 40 hours of training, to know how to use the device and interact with the device, to take it home and use it in the home or the community. That's kind of the second case.

(Achilleas at 00:19:10) And then our new product, which is about to be released later this year in a limited way with some partners you mentioned before, is—we found that there is actually a much larger market for partially impaired people. It's the people who are not fully paralyzed, but they have an impairment in the knee, a weakness in the quads, or something that prohibits them from living full lives. Right? And the idea here is that we actually take Indigo technology, our ability and knowledge of how to power and control the systems to the body, to basically erase existing impairments. Right?

(Achilleas at 00:19:52) And so that's the goal. We think it's a much larger opportunity than helping the fully paralyzed people. We think there are 2.6 million people in the US that could benefit from this device. And that's kind of our next frontier. Now if you look at the use cases—and that's where, you know, reliability comes in, and I know we'd like to talk about that—the clinical space, both in terms of safety, patient safety, and reliability, is probably the most forgiving case. Because you have doctors around, you're supervised. Right? Even if the person falls and injures themselves, you are in a clinical space. You can get very quickly care to them.

(Achilleas at 00:20:32) Right? So even the FDA didn't have a lot of issues with approving us for clinical use. Right? And also, rehab centers, especially the notable big rehab centers in the country, they've dealt with so much modern technology that they're kind of more forgiving if it has a few quirks and things don't work a little bit. They may complain, but they're used to it. Right?

(Achilleas at 00:20:57) But once the thing goes home, now you have a person that is not supervised by a clinician. So any injury could be really serious. You have to be really careful, and you really don't know how the people are gonna use it. Even though, you know, they may try to do crazy things that people tend to do. By the way, that's actually a phenomenon that a lot of people who are out there, amputees or impaired in some way—they use modern technology, and it's almost as if they want to prove to themselves and to their peers and to whoever that they are as active or more active than they were before.

(Achilleas at 00:21:36) So they go absolutely berserk in terms of challenging the limits. They want to be athletes and, you know, track the Appalachian Trail and all kinds of things like that. So, you know, they really put these devices through their paces. So the use case of the full exoskeleton going home is our second case. And then the third one, which I just talked about—the partial impairment—that's probably the most stringent one. Because, you know, with the exoskeletons, the full exoskeletons, we expect people to use it, I don't know, three or four times a week.

(Achilleas at 00:22:12) Right? For maybe a couple of hours each, just to get themselves up and walking and getting some exercise, walking around, et cetera, et cetera. But we don't expect them to be using it from morning to night. But with the powered knee ankle-foot orthosis, as we call it, which is that partial impairment thing, those people are already active. They're already working. So all you're doing is eliminating the cane or whatever assistive device they had. You want to eliminate them from having to use that. Right?

(Achilleas at 00:22:35) And so, but those people, now you're dealing—that's their leg. So basically, they get up, they're gonna wear their powered orthotic device, and they're gonna keep it on until they go to bed. And then they will go with it everywhere they go. And we, in fact, when we designed our new product, we talked about these scenarios, these personas, where we're saying, like, I don't know, Jack in Minneapolis in the winter. Right? He's a student. You know? He likes to hike or whatever. Or, you know, somebody in Arizona or somebody in New York having to go through the subway and, you know?

(Achilleas at 00:23:14) And so, basically, just to challenge ourselves that this thing needs to operate—first of all, it has to be bulletproof in terms of reliability. But also, it has to almost disappear from the person. What I meant by that is that the idea is that it has to be fully reliable and live with the person from day to night. Right? And that's the most stringent kind of use case in terms of reliability, durability, et cetera, et cetera. Right?

(Joel Beasley at 00:23:59) Yeah. So, yeah, we were originally introduced through Adam Barrett of Apex Ridge. And, yeah, I really enjoyed his episode of the podcast just because his resume of the different companies he's worked with, you included, as well as Boston Dynamics and all the other really cool projects he's worked on. How did you find him and decide to work with him on the reliability engineering of the exoskeletons?

(Achilleas at 00:24:32) So, as I mentioned, it's important that I'm glad that we kind of set up those three different markets that we are targeting with our products. Right? When we first hit the first market, it was really the clinical market. Right? That was most of our sales. By the way, since that time, I won't go into financials—we're a public company—but we have sold 280 devices. There are 280 devices in the field. Seventy of which are personal. So basically, people walking around in Indigos in the US and Europe. Right? And each one, by the way, the clinical device is around $130,000, and the personal device is around $100,000. So we're really selling Teslas, in a way, with this thing.

(Achilleas at 00:25:18) So when we first hit the clinical market, we started actually having some issues in the field. And we started tracking those very carefully, as you do with medical devices. And I recognized that we had a blind spot. And the blind spot was, you know, we were very careful in recruiting our engineering team. As I mentioned, this is kind of a new emerging field of human mechatronics. It combines control systems—very sophisticated control software—with inventive mechanical design and materials, and then understanding of the disease. Right? Basically, really understanding how the impaired body functions, and depending on what disease. So we have PhDs whose PhD was really on a controller for stroke rehabilitation.

(Achilleas at 00:26:15) Right? Using an individual device. So that's how specific it was. Right? So we have these whiz kids of sorts, young, 20, maybe 30, with PhD programs from notable universities around the country.

(Achilleas at 00:26:32) But, of course, they don't have the scars of having commercialized real product. This is a new field too, by the way. There are no established standards. It's not like automotive. You don't have a history of 100 years. There are no standards to say what's reliable and what's not yet. There is no precedent. So—and the FDA, by the way, when they gave us clearance, their screen was safety. Are you harming the person? How likely are you to harm anyone?

(Achilleas at 00:27:00) Right? But it's not exactly reliability. Right? So when we started seeing some of those issues, we started addressing them very carefully. We stayed on top of them, but I recognized that we had a blind spot with that team. Their obsession was really functional performance. I call it—it was the Ferrari. Right? They wanted the thing to be a Ferrari. They wanted the interaction with the individual to be user-friendly and seamless, and they wanted the software to be exactly the right software to actually treat the impairment in the fastest way possible.

(Achilleas at 00:27:34) Right? But the question of doing that every single time was a boring aspect that kind of escaped them, and they were not as passionate about it.

(Joel Beasley at 00:27:44) Right? Like the consistency.

(Achilleas at 00:27:46) The consistency or the reliability of the device operating well every single time without bugs. Basically. Right? And so, but I recognized—I was a business guy, so from the business model standpoint, that could be an issue, especially if I knew that that trajectory was that we started from the easier market. We are starting to go now in the personal field. A reliability incident could be dangerous if somebody is not supervised and they are on their own with a companion at home. Right? No medical supervision around there.

(Achilleas at 00:28:20) So it's like, uh-oh. That's an issue. And then definitely with the last market, which is basically a product that will be used in any setting from mountains to snow to the desert to, I don't know, wherever they will use it, from morning to night, that scared me the most. And I said, okay, we have a blind spot. We need to understand that and fill it, basically. And so we did some search, found Adam, and then started to work with him. And I knew that in building this business, this needed to be more than just lip service. Right? I knew from my consulting experience in talking about culture and all of that, that I wanted to somehow embed reliability as something that was a basic value, a basic assumption.

(Achilleas at 00:29:14) In other words, yes, we want superior functional performance. We want to be the most advanced device out there, but I want that to be a Toyota in there. That basically, you know, every time you wanted to use that superior functionality, it was available to be used, and that it didn't have any quirks to it. Right? And so I would say that Adam was very good at—in the beginning, working with—he had to first earn his stripes with the engineers. Can you imagine? Right? You're coming in to address them with this boring topic to them about reliability. And they will, of course, challenge him on his understanding of functional performance. But, of course, he's shown there. That's how he earned the right to talk to them about reliability. He talked to them about Boston Dynamics and all the cool stuff that he worked on.

(Achilleas at 00:29:54) And so we made an opening, basically creating some reliability plans and testing and all of that, and then introducing a new language to our engineers. But I knew that, again, for me, I needed to see that that was for them a fundamental assumption that I didn't have to chase and oversee or make sure that they did the plan or implement the plan, that they did it because, of course, that's how you do it. And as there was some changeover in the team, I actually made it a hiring criterion that people had to have experience or at least a demonstrated passion for reliability in the field. So when we started hiring new engineers and new leaders, we made sure that that was part of the selection process because I, again, wanted that to be an assumption.

(Joel Beasley at 00:30:59) Yeah. That's cool. So did you work more with Apex Ridge on actually beating up your exoskeletons and the engineering of it, or more on the reliability culture built into the company, or kind of both?

(Achilleas at 00:31:16) Right. Kind of both. In a way, you know, how you do culture, how you influence culture, is in many ways—it was good that we did it as this little business was growing. Because to change culture once it's formed is actually a dangerous project. And typically, you don't impact culture directly. Typically, the impact on culture is indirect. The best way to actually impact culture is to create a visible project, and then in the process of working on the project, introduce these new values and principles. Right?

(Achilleas at 00:32:01) So for us—and actually, that was something I cared about from the beginning—I didn't want to have a reliability values training. That would not, to me, be helpful. Right? What I instead wanted—what we organized with Adam—was working on the new Nomad product, the one that we're about to launch. Right? And we didn't worry as much about the existing product because we're already in the field. That was kind of containing the issue as opposed to—but I cared more about the new product because it would be in the most demanding use case, and I wanted that to be designed from the beginning with reliability in mind.

(Achilleas at 00:32:36) Right? And that's where I asked Adam to focus, work with our team that in the design process for this new Nomad product, that they consider reliability. Right? And so he was part of actually the design, but he represented reliability. If you know what I mean. Right? So there was part of the design workshops. And then he, of course, brought in some tools, which are some statistical tools. He brought some testing approaches. He has his own testing facilities as well. He helped us design testing rigs and testing approaches, and so as well to put the Nomad through its paces. And he's actually now our—when we do design reviews, they're a big deal for a company like Parker, but also for the FDA and the medical regulators. And Adam is our kind of external expert contributor, representing reliability in these meetings.

(Achilleas at 00:33:34) So when we review different stage gates of the design, he can look at it. Okay. Have we captured everything from a reliability standpoint? Do we need more testing? Are we ready to launch? Are we ready to transfer from design to production? He has an opinion, basically, as an external advisor to us.

(Joel Beasley at 00:33:52) That's really cool.

(Achilleas at 00:33:53) In that process. So that's how we're kind of working with him.

(Joel Beasley at 00:33:57) So what are some of the most extreme things that you've put your product through to test it for those mountainous conditions or whatever it's gonna be?

(Achilleas at 00:34:08) So, yeah, looking for dramatic failures. I would say the one that I like the most is that we actually have a squat device—a squat-like device rack—for the big exoskeleton. So literally, we load up a contraption here with weight, and the exoskeleton has to literally do squats up and down.

(Joel Beasley at 00:34:32) With the person in it or on its own?

(Achilleas at 00:34:35) On its own, basically. Just to sort of make sure that it can hold the weight. So what else?

(Achilleas at 00:34:43) I think, yeah, another one was we had an issue with batteries popping out in the first iteration of the product. And so our engineering team redesigned it. And then what they did is that they basically fixed the exoskeleton, you know, on the ground, and then had a truck try to pull the battery away, you know, so just to make sure that it wasn't going anywhere. So it was a bunch of—there's always something going on.

(Achilleas at 00:35:15) We have actually a kind of glassed area with different contraptions in there where we test these things to, like, I don't know, 2 million cycles. Right? So for example, the Nomad device, you know, we want it to last to go for at least three years without a single maintenance, you know, to it. So basically—that's amazing, you know?

(Achilleas at 00:35:41) It's—yeah. Because the idea is, that's disruption, right? Yeah. Because every time you—if the device doesn't work, it has to go back to the office. It has to come back to us. The person has to get the loaner. It's a big deal, a disruption to them. Again, it's their leg, so they hate that.

(Joel Beasley at 00:35:59) Yeah. Then all—

(Achilleas at 00:35:59) of a sudden, you would have—no, I'm not gonna go back to my walker, you know?

(Joel Beasley at 00:36:03) Yeah. With prosthetics, I know you need maintenance much more often than every three years.

(Achilleas at 00:36:08) Right. Well, we set a high standard there just to make sure that we don't have to. And so we have always back there—in fact, we have a device that literally walks, you know? So literally, it goes through the walking motions of the foot, and they would put devices there. And we have them do like 2 million cycles just to see if the orthotic underneath breaks or not, whether it shows fractures on the carbon fiber or not and stuff like that. I don't know, it may not be that extreme, but that's basically how it's done.

(Joel Beasley at 00:36:38) Robotic legs simulating walking inside the orthotic?

(Achilleas at 00:36:44) Exactly.

(Joel Beasley at 00:36:45) That's really cool.

(Achilleas at 00:36:47) Yes. Exactly. So yeah, that's how we kind of work with Adam. I think it was a—and I'm very happy where we are now, because, you know, you feel much more confident. If you see from the business side, if you don't have reliability dialed in, I guess, you know, you always have to watch your back because, you know, an incident in the field, especially when you start to scale, right, can be really, really detrimental to you building your brand, building your business, and all of that. Right?

(Achilleas at 00:37:20) So that's what I'm trying to basically tell the engineers is that I know it may be boring to do all these tests and things, but, you know, if you want to continue to have the opportunity to develop new functionalities and new products, we need to make sure that the product in the field does well. Yeah. Because if it doesn't, we can't build a business, which basically means we can't fund new programs for you to work on. And so you have to kind of teach them the full cycle, right? And kind of rationalize the need for them to spend time on reliability, right?

(Joel Beasley at 00:37:55) Are you able to share what kind of time frame you're looking at for the product for partial impairments getting out to market?

(Achilleas at 00:38:02) Right. So, you know, later this year, we are partnering with a major network of orthotic clinics in the country, right? To basically—there are some 3,000 clinics in the U.S. that fit orthotics and prosthetics, basically. So there is one company that owns over 800 of them, right? So it's a major channel. And so we have an agreement with them to basically help us clinically test kind of the last set of clinical tests before we go into commercial release. So those are happening this summer. Basically, June is right now the timeline.

(Achilleas at 00:38:49) COVID was not helpful because it kind of delayed some of our development. We couldn't recruit patients, you know? And if you can't put devices on people, you can't really test them, you know? It doesn't work. Human mechatronics need a human to keep developing, right?

(Achilleas at 00:39:05) And so we hope this summer to go into that. If those go well, we expect in 2023 to go in limited release, which basically means we're starting to deploy devices that stay home with people, right? And so we see—we're very careful because these devices don't have precedence, right? So you want to be really careful when you put them in the wild. So we're going through very careful steps. You know, we think the device is pretty much done right now, but we would like to first bring in the orthotists, work with the orthotists, fit it, you know, train the individuals who are gonna wear it, take it home for a month, watch it remotely. All of this, by the way, is connected, cloud. We can monitor these devices remotely, right?

(Achilleas at 00:39:52) To see, you know, this device performs well for a month, take the device back, see if there are any tweaks to it. Next year, we're releasing it to the wild in a limited way. Kind of, you know, maybe, I don't know, 50 devices will go home next year, right? But after that, you know, you're off to the races—major commercial release with a commercial partner, basically.

(Joel Beasley at 00:40:13) That's amazing. So I do wanna—since I have you on the call here, I do wanna ask you about some fun kind of futuristic stuff, if that's cool.

(Achilleas at 00:40:21) Sure.

(Joel Beasley at 00:40:21) So you did mention earlier in the call that a use case for this is to make, like, superhuman strength possible. Is that in the plans for the distant future?

(Achilleas at 00:40:37) Right. So here it is, right? In the beginning of this project, we recognized there were actually three different big domains where exoskeletons could be applied, you know? So there was a military domain. And in fact, one of our main competitors, Ekso Bionics, which is a NASDAQ-listed company based in California—that's where their origins are. It's, uh, Lockheed, I believe, if I'm not mistaken, had an exoskeleton program funded by some government agency to literally do this superhuman soldier, right? That was kind of the idea, right? So that's military.

(Achilleas at 00:41:12) Then the industrial folks have been trying to do something that workers can wear for material handling in warehouses, in the shop, to basically be able to lift bigger loads and to also prevent injuries for people, right? So that's kind of the industrial space. And both of those spaces—you're dealing with able-bodied people, right? But you're somehow augmenting the capabilities. They lift heavier and they go more distances, you know, right?

(Achilleas at 00:41:54) So in the beginning of this project, we decided that we needed to focus, you know. With startups, even if they're internal, you know, you really need to kind of focus on an area, make some headway, convince the sponsors or investors that you have a successful business, and then continue building on that as opposed to having a wide front, right? So the exoskeleton, you know, for us was developed really for impaired individuals. And interestingly, that, the—counterintuitively, even though it had regulatory barriers and all of that, it was the first field of exoskeletons to become commercial, right?

(Achilleas at 00:42:35) So we could sell immediately, and that mattered to Parker, right? Whereas it wasn't clear that the military—still now, now nine years after, I don't believe they have any sales, right? It was still a lab thing. And even though there's still activity, there are several companies that work on military-oriented exoskeletons. The Chinese are working on one. The Russians are working on one. You know, everybody's working on a military exoskeleton.

(Achilleas at 00:42:58) And then there is—actually the past three or four years, there's been a lot of interest in industrial exoskeletons, which are used again for material handling. Some of them are more passive, meaning passive means they are not motorized.

(Joel Beasley at 00:43:13) Yeah.

(Achilleas at 00:43:13) But they are in a way protecting the human from load or enabling the human to lift for longer or, again, protecting from injury. And there's some with sensing capability or even some power capability. I mean, I think that's really still a new field, not quite there yet. We tried to focus on the medical piece, which is really about impaired individuals. So I believe augmentation is coming, you know. I think it will happen. But I feel it lags behind the impaired, you know.

(Joel Beasley at 00:43:52) It's not needed. It's, you know— Yeah. Yeah. This is a direct huge impact on people's lives right now.

(Achilleas at 00:44:01) Exactly. Exactly. Exactly. Exactly. Right. So that's—but I think it's gonna happen. I mean, I think these are not going away. There's a lot of interest. I mean, we developed the business on a budget being under a disciplined corporate entity, right? But our two competitors, you know, I would say by now, they raised $250 to $300 million each in commercializing their exoskeletons. You know, there's a lot of—yeah—funds out there for these kinds of technologies right now.

(Joel Beasley at 00:44:33) So how much do you guys do with, like, neural implants to be able to control the exoskeletons with your brain and, like, no buttons or anything?

(Achilleas at 00:44:46) That's a great question. So that's kind of intent recognition, as we call it, right? So that's another debate we had in the beginning of this project. And you have to take some risks as to and make some judgments as to the readiness of the different technologies, right? So there are a few different technologies. How do you read intent? In other words, you can obviously power somebody's legs, right? But the question is, how do you connect the person to read their intent, basically, right, as to what they want to do? They want to get up. They want to walk. They want to stop. You know what they want to do.

(Achilleas at 00:45:26) So at the time when we began, and I still believe it's still the case now, even though there were several—no, it's easy to create hype on the net about these things, you know. They're very exciting. But to be able to read brain states, you know, you can probably—I'm told by our experts—maybe two or three, you know? In other words, on, off, and maybe something else, right? So maybe you can initiate a sequence by having some kind of contraption reading your brain signals, right? You know?

(Achilleas at 00:45:59) And that happened. You can—we are able to turn on and off maybe one more state, but that's about it, you know? But the control of the whole body with all the different modalities you need to have to keep a person safe, right? It's almost impossible to do right now, I believe, just by reading neural signals, right? Now you can then tap on internally on signals, right? And then use those to drive the machine.

(Achilleas at 00:46:30) But even that has been rather unreliable. It's called EMG, right? You know, and there are several devices that tried that. We felt that that was kind of not reliable because every person's signal is kind of weaker or stronger, and it requires specific fitting. And, you know, imagine now every time you wear the device, you know, you have to hit exactly the right spot to read the signal.

(Achilleas at 00:46:53) So we chose actually to go from more—not haptic, but we have a—you know, our device reads intent by looking at the angles of the thigh. So that, well, it is kind of the natural way that the person positions themselves to move. So by actually setting almost like a—we call our device a legged Segway, you know? In other words, if the person leans forward, it basically tells the device I want to advance. If it leans back, it tells the device I want to stop or pause, right?

(Achilleas at 00:47:24) And then the other thing we have is that we have vibrations, you know, that the person can feel even though they can't feel anything else. The vibrations go through their bones, right? So to basically, you know, if the person wants to move, they lean forward, you know, then the device will vibrate, right? And basically—and then it'll stop counting. And then basically, the person maintains the posture that basically tells the device I want to advance, right? Then you can set all those adjustments so that basically the device communicates with the person through vibration, right?

(Joel Beasley at 00:48:04) Got it.

(Achilleas at 00:48:04) So we found neat tricks like that to be able to avoid what we call unreliable ways of, you know, tapping into your brain or signals on the device to basically have a reliable signal of intent to the device, right? But I would say that's probably coming. Already you hear of—now, then there is stimulus. This is about reading intent. I would say reading intent directly from the brain or from other nerves is coming, right? There are—especially for prosthetics, there's some work that was done by Alfred Mann Foundation. I don't know if you're familiar with them. I understand one of the major prosthetics manufacturers also bought the technology.

(Achilleas at 00:48:46) And it's that—that basically is kind of implanting kind of a rice-sized, you know, device that somehow processes the signals of your brain, right, and then directs those to control a prosthetic, right? So it's coming. It's not yet commercial, but it's coming. I would say maybe a decade or two, it'll probably be there. Now, for stimulation though, that's another field. Now you are stimulating the nerves, right? So the holy grail of these is actually a convergence of pharma, you know, exoskeleton-type devices, and then stimulation on the nerves.

(Joel Beasley at 00:49:30) That's like a spinal ultrasound.

(Achilleas at 00:49:32) Three. So yes. So basically, right now, what you see—they, in fact, we're invited by the VA to participate in the study using Indigo, which they're basically implanting these stimulators on the spine of these veterans, you know, that are paralyzed. And what happens is by stimulating the spine, you're now opening—you're opening it again to learning. You're basically somehow opening up the signal.

(Achilleas at 00:50:01) Interesting. And so now you can use exoskeletons to teach people something. And you can even maybe use stem cell or other pharma interventions to, you know, basically encourage the growth of those cells, their spine cells and stuff like that, and accelerate the learning too. So we think going forward, people that are deemed now to be having no potential for recovery will have a chance of opening up a potential using stimulation, right? Neurostimulation. And then in conjunction with—and then the exoskeletons then become a teaching tool, right?

(Achilleas at 00:50:34) So basically, the idea is that you wear the exoskeletons until you're at the point where you don't need them anymore, right? You know, because you now started, you know, to recover. In all likelihood, you'll probably improve your situation. So you'll be more mobile, but at least need some degree of assistance from exoskeletons. We think our third devices that are intelligent and powered are here to stay, right? But definitely, there will be advances in pharma, stem cell research, and neurostimulation that will open up the possibility of recovery to more individuals that are now, you know, impaired, basically. That's what we think the whole thing is going.

(Joel Beasley at 00:51:07) That's super exciting.

(Achilleas at 00:51:08) Yeah. I agree.

(Joel Beasley at 00:51:29) Before we wrap up, is there anything else that you wanna call an extra shout out or attention to about, like, just the exoskeleton industry or about Indego?

(Achilleas at 00:51:40) Right. So I just wanted to say it was a privilege to work in this. I would say it's kind of the first time in my career that, you know, what I worked on had a true purpose, right? And it was really tangible.

(Achilles at 00:51:55) You know, you see these stories of the people and being able to impact them a little bit, you know, to make them a little bit more mobile, a little bit more, you know, improving their quality of life somehow, gives real meaning to tech. You know, it's not just cool for its own sake, but actually impacts people's lives. And for me on the business side, what I felt was necessary was to make this effect sustainable, you know, in America, in, you know, modern, you know, capitalistic societies. Right? So if you don't make sure that there is a viable business model around the technology, then the technology and the impact it has on people is not sustainable.

(Achilles at 00:52:37) So basically, the way I kind of justify my existence and my contribution was to make sure that we make—I fought hard the past nine years to try to, you know, pass on the baton to the next generation of business people and engineers to continue developing this technology. Right? Yeah. So.

(Joel Beasley at 00:53:00) Thank you so much for listening. And if you found this episode useful, please share it with a friend or colleague who you think would get value from it. And if you have topics that you'd like to hear discussed on the podcast, either add me on LinkedIn or send me an email: [email protected]. Every time I get an email or LinkedIn message, it absolutely makes my day and inspires me to keep going.