In this episode of HealthIMPACT Live Digital Health Talks, we spotlight Kristin Nuckols, OTD, MOT, OTR, a pioneering female founder in digital health. As the Co-Founder and Chief Clinical Officer of Imago Rehab, Kristin shares her journey from traditional occupational therapy to developing cutting-edge telerehabilitation solutions for stroke survivors. Learn how Imago Rehab is leveraging telehealth and soft robotic technology to achieve unprecedented outcomes in neurological rehabilitation.
Five Benefit-Driven Takeaways:
Kristin Nuckols, Co-Founder & Chief Clinical Officer, Imago Rehab
Megan Antonelli, Chief Executive Officer, HealthIMPACT
Intro 0:01 Welcome to Digital Health Talks. Each week we meet with healthcare leaders making an immeasurable difference in equity, access and quality. Hear about what tech is worth investing in and what isn't. As we focus on the innovations that deliver. Join Megan Antonelli, Janae sharp and Shahid Shah for a weekly no BS, deep dive on what's really making an impact in healthcare.
Megan Antonelli 0:30 Welcome to HealthIMPACT Live digital health talks. I'm your host, Megan Antonelli, and I have the privilege of speaking with a true innovator in the field of stroke rehab, our guest, Kristen knuckles, the co founder and Chief Clinical Officer of Imago rehab, Kristin has dedicated her career to improving the lives of stroke survivors through clinical excellence and innovation. Her groundbreaking work has recently earned her the 2024 Innovation Award from the National Board for certification in occupational therapy. Kristin, thank you for joining us. How are you?
Kristin Nuckols 1:01 Thank you so much for having me
Megan Antonelli 1:03 absolutely. Well, it's exciting to learn about this. I know we've been working a lot with the American Heart Association, and you guys have been involved with their work as well, but tell me a little bit about your founding story and how you started the organization and got started in occupational therapy,
Kristin Nuckols 1:22 sure, so I decided to become an OT when I was 13, and I had a hand injury, and went to occupational therapist, and she made me a splint and did some fun activities with me, and I got better, and I thought, well, that sounds like a good job. And then when I was in school, I began to learn about stroke rehab, and that really became my passion. And for the last almost 18 years, I've been working in this space and trying to make stroke rehab better,
Megan Antonelli 1:52 amazing.
Kristin Nuckols 1:53 So yeah, so Imago rehab was founded out of a Harvard engineering lab. I was working there as a researcher, we were creating wearable robots, which we'll talk about some more in the rest of this conversation. Creating wearable robots, looking at the idea of connected health. What does that mean? Connected healthcare? How do we help people? How do we know what they're doing? How do we tell them what to do when we're not with them? So that kind of technical side from Harvard. And then also I completed my post professional OTD, which is a doctorate in occupational therapy. And I did that, wrote a thesis about how can we serve people with stroke using a telehealth model, and that was written before COVID happened. But then COVID kind of enabled the billing structure, and so we just put everything together and launched a telehealth service with a technology development side.
Megan Antonelli 2:50 Wow. So what inspired that thesis,
Kristin Nuckols 2:55 really? That's a great question. So I had been working in clinics for about 10 years at that time, and I just had this experience of the patient saying to me, I can do this thing when you're with me, but when I go home, I can't do it. And whether that is the clinic setting is different from their home. The height of the table is different, the layout of the cabinetry is different, all these different activities we try to do with people. Or maybe it's our coaching and our cueing or our hands that are kind of guiding someone's arm or body to do something. And they get home and they go, I can't do that thing that I was supposed to do. Or they get home and say, I don't remember what I was supposed to do, which is, which is sort of answered by this idea of connected healthcare. So how do we prompt them at home? So just those experience, those experiences I had with with my patients over a decade of working in stroke, really inspired me to try to ask the question, how can we make that better? And so what you do, you know, to answer the question is, look to the literature. What is, what's been, sort of proven by other people to be the best, um, answers to to those questions. And so the literature really guided me towards telehealth. And that was, again, like a pre COVID. So there's many, many, many solutions that have come out because of COVID. Oh, we'll just do that over telehealth. Oh, we'll do that. So this was, you know, something that I decided on before, before it was necessary for, you know, public safety in 2020, and the idea is, and to some degree, because it was better, you know, and because it was needed. So tell us a little bit about, like, what, what it was, or what, you know, how the how it works, how the digitization of that works in the home. Yeah, and this is so unusual. And if you would have told me, you know, 10 years ago, when I was working in the clinic in person, that I would do this over a computer, I would have just thought, What are you talking about? This stroke rehab is really it is hands on. I have to touch them. I have to use my kind of magical hands to make someone's body function differently. And the literature about telehealth tells us that if you give the same intervention in person or over telehealth, then the patient typically has the same response. So that's part of it, that you can just basically give the same the same intervention with some benefits, like over telehealth, there tends to be less cancelation, because all you have to do is open, open up your computer to jump on the call you didn't, you know, you don't have to drive across town. So that's kind of in the in the broader spectrum, like maybe musculoskeletal or maybe a little bit simpler conditions, not necessarily stroke or brain injury. Those are very complicated, very complex and they require specialists. So this is kind of the other nuance of what we do, is that you really can't get stroke therapy at the shop down the street. It's not just the every, every PT, you know, practice on the corner. It is very specialized. And we, you know, follow, kind of the best evidence. We've just synthesized that and put that into our practice. And so we can provide that you don't have to be right next to us in order to get that. We can take, you know, a therapist who has this skill training that we provide, and they can serve an entire state. So we can serve someone in the panhandle of Florida, and we can serve somebody who lives in the Florida Keys and everywhere in between. And that's just not something that you can do with a kind of a local practice,
Megan Antonelli 6:26 right? So convenience in the home and then access right, and to some degree, certainly scalability of the specialists, right? And specialists, in terms of who, you know, clinicians that are available, right? That's amazing. And then, what about the, you know, tell us a little bit about the actual, you know, interface for the patients and how they're you know, how do they get prescribed? This
Kristin Nuckols 6:56 good question. So, you know, we we do our therapy sessions just like you and I are talking right now, we use a HIPAA compliant zoom platform, and it really, I mean, I can see into your house. I can see your blue chair. I could see the dog a little while ago. And so we really can customize therapy to your house and your experience and to the things that matter to you. So that part's really important to us. Tell me the other question.
Megan Antonelli 7:20 Well, just in terms of how patients get the get access to it,
Kristin Nuckols 7:24 right? Yes. So, you know, we have an intake team. We built the structure on our side that once somebody finds out about us from, say, our online advertising, or from a provider, like a physician, who knows about us and will refer we do the back end so we will look at their insurance and see if we're in network or out of network, we can work on what's called single case agreements. If they if we're out of network, we really try to still serve people through their insurance, and if they are in a state that requires referrals, then we we make that happen. So, you know, we try to take all the burden away from folks their their lives are already difficult, so finding healthcare should not be one of the things that's really difficult, but right now it is. So we're trying to just solve as many of those problems as possible, bringing healthcare to your house, bringing healthcare right onto your computer, using your actual items in your house to become therapeutic to you, and then kind of all those the business side of things, you know, we try to just smooth all that out for people
Megan Antonelli 8:21 and in terms of payment so insurance does cover it, you have,
Kristin Nuckols 8:26 yeah. So we're able to just utilize, you know, existing therapy codes. We provide the same services that you would get in clinic. We just provide them virtually. And we're able to bill, you know, Medicare and all the states that were active, we're open in seven states, and so we can bill Medicare, and then, you know, the top payers in every state,
Megan Antonelli 8:47 amazing. So, you know, I mean, because that's one of the biggest hurdles for digital health tools and applications, is getting coverage, certainly from CMS. So tell us, in order to do that, you must be showing the value. There must be some, you know, evidence based around that. So talk a little bit about, you know, how it's working and the results you're seeing.
Kristin Nuckols 9:07 Yes, absolutely. And this is kind of the interesting thing, and it was a bit of the gamble in the beginning, because, you know, telehealth for people with stroke is not something that other groups are really doing. This was theoretically from my thesis. This is what I thought would happen. And so, luckily, it is what happens. And over and over, we're impressed by our own outcomes, but really we expect it. Now, you know, in the beginning we were like, Oh, look at this. Look at this. Number is so good every time. And now two and three years in, we're like, here's what we expect. You're going to make this amazing gain, and it continues for longer than you know, it's not just the first few months, it's it's six and seven months, it's longer than that. So we're kind of get into the details here. So we do standardized assessments, just like you you might do in an outpatient clinic. Like, if you are at a place that does really stroke specific care, you might get these. If you're at a clinic that does more general care, you probably won't get these assessments. So we're very, you know, stroke specific. I don't want to get too far into the weeds, because it's a little bit complicated, but, you know, we use one of the gold standard assessments for looking at movement following a stroke, and you're looking for a change of basically six to eight points on that test. That means that something is different in your daily life. You can move better, and so you should be able to use your arm better, if we're just talking about kind of the upper limb. That's my more my specialty. So we're looking for six to eight points, and our average is above 12, so double what you're looking for. So that means maybe instead of being able to do five more activities, you can do 10 or 15 activities that you couldn't do before. So we kind of corroborate those findings with another assessment that looks at how much you use your arm in daily life. And so we also see, you know, double the number you're looking for in that assessment. So people are moving better, and they're using their they're using their arm better, and so that is a testament to, you know, people actually carrying over what we recommend to them. You know, if you've ever had therapy, kind of just take a minute to reflect. If you've ever had therapy before for shoulder pain or for something, you know, did they give you a handout of exercises when you left right? And did you lose
Megan Antonelli 11:28 them? You know?
Kristin Nuckols 11:30 You know. So that's kind of the standard of care that that we that it's exercise based, and that it's sort of like here, do this stuff, but not really going to tell you how, and, you know, I won't really know if you do it or not. That's kind of the standard of care. So we're trying to break all those bad habits in the therapy world by really customizing people's home program to them, to their environment, to what they can actually do, to the things that will actually make them better. And that really doesn't involve just sets of exercises, so it's very different type of therapy. And then we find that it actually works when we do these assessments, right? And so is it always a clinician and a patient in engaging and interacting, or are there elements of sort of digitized health coaching? And yeah, that's a good question. So I would say that more of the digital only is a bit more of like what we're developing and what we are, what we see more in the future. Right now, we're all, you know, one to one service, and then we have a lot of did, I won't call it digital health coaching, but sort of like digital programs that the patients can work off of that really mimic the things that we say and mimic the way that we coach them through these moments. We're sort of still teaching them when they use our home. So it's, it's not a list of exercises, it's not 10 of this, 10 of this, and that's the way that therapy has been done for decades. So we're really changing, changing how people are experiencing a home program,
Megan Antonelli 13:00 right? And if you think about it, I mean, I think about my house, you know, I mean, I have three flights of stairs. I have this, you know, there's so that ability to be in the home to see where these people are, you know, aging in place, if you will, or, you know, rehabbing and and what they need to be able to improve, to improve their quality of life, which is what it's all about, right? Yeah. That's amazing. And so as you, you know, kind of look at that, and, you know, look at your, you know, with that kind of evidence, what are your, you know, sort of expansion plans that you said you're in seven states, you know, how, how do we get it in 50?
Kristin Nuckols 13:39 Yeah, that's a great question, money is generally the answer, which we've told other people. They think we're kidding, but really, that's kind of true. You know, there are costs associated with expansion. So there's certain regulatory documentation, there's, you know, bit of Office presence, a bit of, you know, registration that has to happen. There's time spent, you know, credentialing therapists into that state, or credentialing them to a payer. So, you know, they're they're actually there. There are just, you know, systems that are in place for allowing us to expand. And that's something that we've worked really hard on, something I learned early on about, you know, being in a startup is that, or CO founding a startup is that you anything that depends on you personally is not going to work, right? You have to develop a system. So that felt really difficult in the beginning, where a lot of this was just coming out of my head. This is this is how I treat. This is how I know is the best way to provide this and this and this intervention. So having to document everything and make it trainable and record it and, you know, so just that that, but creating a system so that the system can scale, because an individual cannot scale. So that's a lot of what we've done. We're also looking to expand into other populations that we can serve. So the kind of therapy model that I talked to. Is really about behavior change. And so behavior change model can be applied to just about anything. But there are some, some certain populations, like cardiovascular that we're also very interested in making an impact in. These are folks who, you know, the standard of care is going to a cardiac rehab clinic in a hospital, and so you've got to get there, you know. So it's, it's 60 rides back and forth, right? So that's that could just feel insurmountable, and it is only about 10% of people who are prescribed cardiac rehab actually end up going to all the sessions they're prescribed. So it's just a group with really high drop off rate. And so if we can make that therapy accessible, convenient, you know, personalized to their home, personalized help them to change their change behavior in a lot of ways, then that would be really effective as well.
Megan Antonelli 15:50 Absolutely, yeah, no, it's super interesting to think about. I mean, you know, going back to the their neurological, you know, sort of interventions and areas where, you know, I mean getting that access. I mean, one, it's a highly specialized area to the ability to travel and and go to these places is that much more challenging. And I think about it in like, you know, in pediatric cases with, you know, you know, disabilities and things like that, you know, what the what, what's possible around that, you know, it's not only the person that's getting the therapy. It's also a caregiver. It's also, you know, people are rearranging. We hear it all the time. You know, we have, let's say we have someone's mother in therapy, and they're the adult child is trying to work from home, and they've also got to pick up kids from school. And there's just layers upon layers of complications. So whatever we can do to make, you know, make this easier for our our patients, that's going to really benefit them. And then we hope that the word gets out to other people. And so you mentioned, in terms of money, in terms of, you know, we we like to focus on female founders and co founders here at Digital Health talks. And so tell us a little bit about your experience there, and tell us a little bit about where you guys are in terms of that fund, the funding rounds,
Kristin Nuckols 17:06 yep, so it's been a journey. I am very glad to have a team that has really celebrated the idea of having a female founding team and female really, a female driven workforce, too. So it's not only just, you know, female, female founded business, but also, I think, see, if I remember the numbers, 96% of speech therapists are female, 90% of occupational therapists. And 86 or 80, it's 80 something percent of physical therapists are female. So you know, we do have male therapists on our team as well. But you know, overwhelmingly, our workforce is likely to be female, so that's very impactful as well. And something that's very unusual about imango is that we're offering therapists remote work. That is not something that is usual for people in the therapy in the therapy field. You know, we have some therapists who just tell us, you know, my body is worn out. I'm, you can't tell, because I'm, you know, on a video, but I'm five one. And so you, you walk into a hospital room and there's, you know, a guy with either a stroke or, say, two knee replacements or what have you, spinal cord injury, and he's six, five, and your job is to get them out of bed. So, you know, it's very tough on our bodies and and we just, you know, day after day after day, so year after year. So having a remote option is really exciting. We've watched other, other people in other other darn what's the word I'm thinking of? We've watched people in other professions. Be able to switch to remote work, and just previously, that was not something that was available to people in the therapy community. So, right? Great to be able to offer something different.
Megan Antonelli 18:53 Yeah. Well, it makes me think of two conversations I've had recently. I mean, one with, you know, a nurse who you know, has been working in the field for years, and, you know, has so much still more to give, but it is. It's a physically exhausting job, you know. And you know, sort of that time on your feet and and all of that. And where can they then, you know, how can they, you know, she was talking about in the context of virtual nursing, right? You know. I mean, we have this incredible staffing crisis that we hear about all the time, and yet, you know, we've made it almost, you know, more difficult for them to continue to practice. So that's really interesting. And you know, certainly in an area that you know, you don't think about, but, and it is, it's funny. I think about my son who wants to be a physical therapist, who is a very, you know, strong and able bodied 19 year old, you know, with big aspirations. But I even, you know, in thinking about him as the generation that he is, which is, you know, as much as he's a tough guy, when he was thinking about, did he want to do? So intern in a hospital setting versus at like the local PT office, right? So what do you want to be exposed to? You know, his experience with the local PT offices, a bunch of athletes who have ACL whereas when you go into the hospital setting, it's a very different environment. And I was like, you want to go to the office if you really are going to continue end up in in events, as opposed to being a doctor. So, you know, it's a it's a heart, you know, the environment that you're in, but certainly it doesn't change the expertise or the capabilities. And so that ability to to do that, I mean, is great. So that's exciting around just your experience as you know, as you're looking to get more funding, but tell us a little bit about your journey as a female founder, getting investments. You know, you guys have done a great job with your initial rounds, seed round. So yeah, which goes a little bit about that, as we have lots of female founders who listen to digital health talks,
Kristin Nuckols 21:09 yeah, we have been blessed with very supportive and hard working investors who are part of our story. We have some venture capital backing. Have Angel backing, and so we also have some grant funding that that has been helpful for us as well, because it's non dilutive. So we kind of have a variety of funding, and Overwhelmingly, people have been very supportive of our team and our expertise. You know, I have close to 20 years of experience in this field, and as we've brought on other team members. They bring decades of experience. So we have a really amazing team who has been able to just, you know, jump into, say, CEO role and the COO role. So we've brought in just teammates that are fantastic. There's only been kind of one, one challenging moment as a as a female founder, where an investor, before we got to pitch to the entire team of, you know, 50 white men told us, you know, we don't invest in female founding companies. Traditionally, it was like, Oh, I think you said the quiet part out loud. But you know, overwhelmingly, people have been very respectful, very complimentary to what we're doing. You know, we're really, we're innovating. We're bringing something new and fresh. We are an impact investment. So we are, you know, really telling the story of people who get kind of left behind. Stroke is a lifelong condition. So you have a stroke and you survive. And that's really something that is actually changed a lot in the last 15 years. People are surviving strokes they used to die from, and so that is fantastic. They're able to live with their families for years and decades after a stroke, and they're living with way more disability. So that's kind of like a difficult scenario. But so what part of what we bring is an impact investment, and our investors can feel wonderful about actually helping to bring just a really necessary and kind of life giving experience to these people. Well, that's that is a story I wish you know in terms of the male investor opening, opening his mouth a story that I wish I didn't hear similar stories often, but I'm glad you are able to persevere and get other other funding, you know? We just look for, there's, there's a lot of fish in the sea, as they say, you know. And if someone isn't comfortable having, having a female founded business, then we're just not the right partner for them. So,
Megan Antonelli 23:39 yeah, right. And well, and that's, you know, I think everyone else, yeah. And one of the things that I've, you know, seen through our work with the American Heart Association and and the health tech competition that we help with, like, is how much you know of cardiovascular innovation has been centered around male research, right? And, you know, and that it is such a you know, so their women in red program and all that stuff is a great program, but certainly it is good to see that there are a number of investors out there who are interested in both funding female founded businesses, but also funding the research around women's health. And it's at least increasing a little, and the awareness is there, which is good. But you know, so as we look to the future, we always like to sort of look to the positive and the and kind of that intersection of digital health and occupational therapy. What are the areas that you know you're most excited about, and where you see, you know the significant you know, where you're expecting to see significant improvements?
Kristin Nuckols 24:43 Yeah, it's a great question. You know, the So, the way we kind of describe a Mongo rehab is that we have a telehealth business serving adults with stroke and other neurologic conditions, and we also have this technology arm where we are, you know, innovating in this space we're bringing you. Wearable robots into people's homes. We're bringing sensor based capability where we can, you know, tell people how to move, when to move, where to move, using sensors and wearables, and actually working towards AI models that will help us to provide the best type of therapy and to be able to provide therapy when the therapist is not actually live with the patient. So boy, the future is going to be exciting. And those are all things that we're working towards, and we're one of the only groups doing that, and that's a great place to be, yeah, that's amazing. Yeah, no. We're talking to a lot of folks about, you know, that hospital at home, the aging in place, you know, and all those opportunities that are there. And it's just exciting and, and then I always see it being, you know, being a mom. You know how it all has applications to pediatrics and children and you know, and any you know that population, it's not just the elderly or the ill who you know, need that. Need this. There's so many, so many applications. So that's that's so exciting. So tell us, tell our audience, thank you so much for being here. Because then it's, you know, mind opening to me. I was a, I was a biopsychology major. So neurology is like my, you know, I started in Parkinson's and all of that. So I it is my, um, kind of passion. And I, you know, so it's just exciting to see the field going, going in this direction, and how much potential there is. But tell our listeners how to, you know, support your your mission, and get in touch with you, and hopefully, you know, send some send some funding and support that experience. Yeah, we always take funding. So you can just check out our website, which is Imago rehab.com, the name Imago, we get a lot of questions about it's a phase of metamorphosis. So it's actually the phase in metamorphosis when the exoskeleton comes off, and then the creature is different. So it's really a reference to our wearable robot, but the idea of change, and, you know, really becoming something new after you experience our therapy. So it's Imago rehab.com and if you are looking for our services, you just click contact us or get started, I think, is what the button says. You just click the big button in the corner and our team will reach out. We have an intake team that will reach back out to you in a day. And if you want to contact us for funding, you can just reach out to me. I'm kristin@imagorehab.com
Megan Antonelli 27:15 Perfect. Well, thanks, Kristin, so much. I look forward to hearing more about all your successes and hopefully seeing you at future health impact and events. But thank you to our audience for listening, and don't hesitate to reach out to Kristen or me with more information and subscribe below.
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