Accessible rehabilitation for infants with cerebral palsy

Childhood disability is a global public health concern due to its lifelong impact on physical and psychological wellbeing. An estimated 80% of childhood disability occurs in low- and middle-income countries (LMICs). 

Cerebral palsy (CP) is one of the leading causes of childhood disability, with an estimated 50 million people living with CP worldwide. CP is a clinical description for non-progressive motor disorders caused by injury to the developing brain. Preterm and low-birth-weight infants have a higher risk of developmental disabilities like cerebral palsy. Global estimates of prematurity and LBW range from 15% to 20%. In 2015, an estimated 20.5 million live births were LBW, with 91% of those being from LMICs.

Children with CP require support from a multidisciplinary team of medical and rehabilitation professionals including physiotherapists, occupational therapists and speech and language therapists to improve function, prevent secondary complications and enhance autonomy. Today, rehabilitation can start as early as 4 months. If started early, and performed at an optimal schedule, it can achieve almost full recovery. 

However, patients and their caregivers, particularly from LMICs have difficulties accessing rehabilitation services, mostly due to the provenance from rural areas, the lack of transport facilities, shortage of services, and/or high costs, causing a high dropout rate. Delay in or no early rehabilitation causes complications to the child, as well as high emotional and financial burden to the caregiver. 

The United States alone spends about $30 billion every year on physical rehabilitation. Of the above-mentioned costs, the majority represent labor costs (therapist time), and economic pressures tend to make rehabilitation interventions shorter than in prior years. 

The existing rehabilitation devices (GipDi Project, Neofect Smart Glove) that can be used outside of medical facilities cannot meet customized needs of individuals with different type and level of muscles weakness. Moreover, there is no treatment that can be introduced with newborn babies. 

The 2030 Agenda for Sustainable Development Goals warrants that children with disabilities should enjoy equal access to health care and rehabilitation (Goal #3 Good health and wellbeing) regardless of their abilities and socio-economic status (Goal #10 Reduce inequality). The care of the preterm and LBW infant is a global priority and a component of the United Nations Every Woman Every Child Global Strategy for Women’s, Children’s and Adolescents’ Health 2016–2030, the UNICEF Every Child Alive campaign, the WHO 2025 global nutrition targets, and the joint WHO–UNICEF Every Newborn Action Plan  to end preventable deaths.

Our solution aims to close the gap of accessibility to rehabilitation services for children with CP in LMIC and take us one step closer to offering millions of children with CP a chance at a healthier life. 

Our project aims to support home-based management of cerebral palsy, by developing a baby carrier with embedded haptic technology that would deliver physiotherapeutic stimulation to the baby. By using our carrier, every mother of a child diagnosed with CP, or a LBW baby, at high risk of developing CP, can ensure her child receives the much needed and effective physiotherapeutic stimulation without having to travel (for hours, in some cases) to receive such treatment at a medical facility. Early rehabilitation may enhance outcomes and delay disability progression, attenuating children’s suffering, caregivers’ burden, and long-term costs for public health services.

The haptic system will deliver vibrotactile stimuli through electric motors located along the carrier, focused on the back, arms and hips of the babies. The haptic stimulation should be customisable according to the needs of every child, under the guidance of a trained physician. The final outcome is a smart haptic baby carrier that can stimulate the baby without causing discomfort for the baby or for the caregiver. The testing and validation will be done in partnership with the St Maartenskliniek in the Netherlands, a leading specialist in early intervention treatment of children with CP across Europe.

The carrier is coupled with a smart phone application that allows the modification of the physical stimulations, their duration and intensity. The app also contains a guide with specialists recommendations for the parents on how and when perform the treatment, as well recommendation on how to adapt the family daily life to support this special need that is crucial for the future of the children, and include necessary safeguarding mechanisms. The baby carrier must be completely washable and poo and vomit proof. It is designed to support the natural C-shape curvature of the infant spine, and grow with the baby for each step of the spine development. It is simple to use and equipped for complete adjustability and weight distribution without pressure points. 

The haptic system is seamlessly integrated into the e-textile of our baby carrier, which complies with the WHO requirements for the cost effective and routine care for preterm and LBW infants, known as the Kangaroo Mother Care (KMC). KMC is defined by WHO as early, continuous and prolonged skin-to-skin contact between the mother (or other caregiver) and the baby, which befits the baby's wellbeing. While using the baby carrier, the mother's hands and movement are unrestricted, offering her the freedom to engage in her daily duties, while providing therapeutic care to her child. 

Our solution today supports the WHO recommendation to move from using simple carriers to using solutions which support infant-attachment. We leverage millennia of effective parenting, by replacing common baby carriers with engineered baby-wearing solutions to achieve better infant & toddler healthcare outcomes. 

The main target population that our solution aims to impact are the infants that have been born prematurely, or with low-birth-weight, who are at risk of or diagnosed with CP, as well as their caregivers, particularly from developing countries, with limited access to rehabilitation facilities. 

Fewer than 5% of children who live in absolute poverty in many LMICs have access to basic physiotherapy and other support services, while they have no or limited access to basic health, education, and social services. This lack of access to quality long term physical rehabilitation, creates a myriad of negative ramifications for the child and the caregiver. 

Children with disabilities might require more care, attention, and resources than their typically developing peers. Having a child with disability may lead to a double burden for both the parents and the child, where the observed worse health and lower educational level among individuals with disabilities are due to both the disability itself and financial challenges. 

Grown children with CP experience higher levels of mental health problems, have poorer relationships with their peers, encounter negative attitudes towards disability. 

A 2021 study issued recommendations for Ghanian policymakers to support home-based management of cerebral palsy with continuous community-based rehabilitation training for caregivers by qualified providers. Home-based interventions eliminate the need for transportation, reduce caregiver burden, and preserve resources that health facilities or centers can use otherwise.

Our smart carrier is able to deliver physiotherapeutic stimulation to the baby, at different times throughout the day, while the child is comfortably attached to the mother's body. The WHO recommended attachment to the mother's body delivers clinically proven health benefits, via the improved ancient practice of baby wearing. 

Our solution will allow the mother (or caregiver) to provide the child with much needed physiotherapy, without having to travel to a rehabilitation facility, while being free to move and attend to their other duties. Having a home based rehabilitation solution will also ensure that physiotherapeutic stimulation is offered for as long as needed, for optimal results. 

In the longer term, our solution may help unburden the caregiver of a child with CP, allowing them to participate in economic life more fully, unburden the healthcare and social protection services, as well as supporting the full recovery of infants with CP, offering them a chance at an independent life. 

Babymoon has been producing baby carriers for over 16 years. All of our carriers have been produced in partnership with the mothers, each new version being updated according to their feedback. In 2021 we have clinically validated our KMC carrier during a trial in the neonatal unit of Temeke Hospital in Tanzania, thus qualifying as CE Class 1 Medical Device. 

We were founded as a social venture and have been recognized by the United Nations UNDP as a 2020 standout for Growth Stage Impact Ventures for SDGs (UN’s Sustainable Development Goals). We are recognized for helping moms throughout the world to adopt babywearing, also aplicable for premature and low birth weight infants for KMC.

Babymoon Team:

Geta Rasciuc - CEO and Founder of BabyMoon Care. For over 16 years she has been active in the field of developing; producing and commercializing a medical- and developmental tools for babywearing in the 21 st century, by engineering soft full buckled textile carriers and promoting the practice of infant carrying including skin-to-skin contact for Kangaroo Care. Herself a mother of four, Geta is in constant contact with mothers, educating and supporting them on their babywearing journey. Geta is also a board member of the International Board of Babywearing Consultancy Schools

Riccardo O'Nascimento - is a wearable tech creator with more than 10 years of experience on the creation, development and evaluation of wearable technologies. Riccardo is in the epicentre of e-textile development, making him qualified to propose best solutions of materials for the delicate task of baby care

Deborah Maufi - MD / MBA, Chief Medical Officer, develops and implements health care strategies for babywearing, an Ambassador of HIMSS - a global health equity network, where she collaborates with members from diverse communities, to share insights, best practices and resources through virtual and in-person education events. 

Partners:

St Maartenskliniek, Netherlands - As a specialized hospital, it is a leader in the Netherlands and Europe in the treatment of posture and movement disorders. The professionals of this Clinic have been closely working with parents and children with CP, and are actively experimenting with new treatment options. This institution will collaborate with us in developing optimal stimulation patterns for the haptic system, education modules for caregivers as well as testing and validating the smart carrier through a larger scale testing in its own hospital and partner hospitals. 

ZorgDragen Babywearing School, Netherlands - offers accredited courses and lectures about carrying children in slings and carriers, specifically aimed at healthcare professionals and physiotherapists. The school's staff  have extensive experience with wearing in the healthcare field, and are pioneers in the field of integrating wearing solutions in healthcare.

Loughborough University - technology development partner

Fraunhofer Institute - technical oversight 

LabelFuse, Netherlands - a no code platform for Machine Learning & Computer Vision

Our textile KMC baby carrier has been clinically validated in a 2020-2021 study in Tanzania. It is now classified as a CE Class 1 Medical Device. 

The conducted study proved the benefits of our carrier in the care of preterm and low birth weight infants - the use of our carrier promoted increased weight gain and a faster hospital discharge. 

Our team has been working for the past four years on the haptic technology to be integrated into the carrier through lab testing. Between 2017-2023 we have been prototyping the smart carrier and the prototypes have been presented at several Wearable Tech events like Dutch Design Week and Wear.IT Festival in Berlin. We are now at the stage of enhancing the carrier with the lab tested haptics, awaiting trials to be performed in partnership with the patients and medical experts from the St Maartenskliniek. 

The solution presented in this application is still in development and not yet actively serving the identified and interviewed stakeholders. We are engaged in a co-development process with 20 beneficiary families, about to enter validation phase.

First and foremost we care about joining a network of pioneers in the field of medical technology. Our current team members are with us because of their enthusiasm for our common vision, and we are excited to getting to know more people who share our desire of eradicating inequalities when in comes to access to primary, life saving medical help. 

The traditional approach to CP rehabilitation is centred mostly around physiotherapy delivered in specialised facilities, inaccessible by millions of patients in need. 

Currently available home based solutions cannot substitute physiotherapy performed by a professional as they are not customisable. Thus, millions of infants are missing out on critical time of receiving treatment, while caregivers are trapped in a cycle of despair, loneliness and financial burden. 

Our solution is able to bring much needed physiotherapy right in the homes of those that need it the most - caregivers of infants with CP, thus dramatically decreasing the impacts of this motor deficiency. 

Our solution delivers customisable vibrostimulation to the child’s torso, hips and arms, operated via a mobile app, matched to the child’s current needs, under the guidance of the best professional advice in the field of physiotherapy. In the meantime the mother or respective caregiver can be engaged and active, being free to move as she pleases while the baby is securely and comfortably attached to their body. 

Our solution also includes AI algorithm which recognises the baby's cry and delivers the haptic sequences necessary for each occasion. 

The app accompanying the baby carrier includes an AI algorythm aimed at processing the baby’s vital signs and data on its development. All collected health data is processed by AI algorithm. 

The proposed product can provide new opportunities for healthcare providers, health insurance companies and public health organisations.

Our solution is directly impacting the health and development of fragile infants and children affected by CP, as well as the wellbeing of their families, freeing up time and mobility for caregivers and allowing for their more efficient social integration.

During the first 12 months we intend on training 20 trainers, who will be facilitating implementation of the rehabilitation program with 100 families that will be involved in the validation of the solution.

In the following 5 years, we intend on scaling the program aiming to reach cca 200000 families via Health Insurance Companies.

The goals are to be reached gradually, upon refining the technology and manufacturing processes, as well as regulatory compliance. 

We intend on prganising 4 pilot studies in various regions - BeNeLux, Scandinavia, US & East Africa  that will allow us to refine the business model and set the premise for global scaling

Babymoon commitment to SDGs - link to our SDG commitment document

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We track our indicators through our B-Corp accounts, focusing speciffically on the following indicators:

3.2.1

Under-five mortality rate

3.2.2

Neonatal mortality rate

8.5.1

Average hourly earnings of female and male employees, by occupation, age and persons with disabilities

11.3.2

Proportion of cities with a direct participation structure of civil society in urban planning and management that operate regularly and democratically

11.7.1

Average share of the built-up area of cities that is open space for public use for all, by sex, age and persons with disabilities

Problem: Currently, almost all of early physical rehabilitation of infants with CP is offered at medical facilities, inaccessible to millions of patients from LMICs. The high rate of drop out from rehabilitation programs means children develop complications while caregivers are burdened with emotional and financial difficulties. 

Intervention: A home based rehabilitation device that will eliminate the need for transportation, while delivering clinically tested physiotherapeutic stimulation to the infant, under the guidance of leading professionals in the field. 

Inputs: A smart baby carrier with an integrated haptic system that offers mobile device operated vibrostimulation 

Mobile app with guidance from leading physiotherapists treating CP

Outputs: Increased caregiver engagement, increased caregiver confidence in successful outcome, full length of rehabilitation program delivered

Outcomes: Improved accessibility to rehabilitation treatment,

Improved health outcomes for children with CP and their caregivers, 

Policy change regarding home based care, 

reduce neonatal mortality, 

Increased access to quality early childhood development for children, 

Increased opportunities for women’s full and effective participation and equal opportunities at all levels of decision making, political, economic and public life 

Impact: Reduced number of adult population with CP, reduced costs for the healthcare system, Increased number of employed women.

Our solution delivers physiotherapeutic stimulation to infants via haptic technology which is seamlessly incorporated into an e-textile baby carrier. Our proposal utilizes textile as the medium to deliver the therapeutical stimulation. The technology embedded in it should be as unperceivable as possible and at the same time be strong enough to maintain its optimum functionality level after wearing and washing.

Electronic textiles or e-textiles are fabrics that enable electronic components such as batteries, lights, sensors and microcontrollers to be embedded in them. 

Haptic technology (also kinaesthetic communication or 3D touch) is technology that can create an experience of touch by applying forces, vibrations, or motions to the user. Haptic feedback when used for neurorehabilitation, stimulates the targeted muscle or group of muscles, thus prompting the patient to use it, strengthening it in the meantime. This technology thus mimics physiotherapy as provided by a healthcare specialist. Furthermore, we envision the use of vibrotactile technology for actuation technology. This choice is based on a literature review of wearable haptic artefacts, which provides extensive useful information regarding body threshold level and best practices for its implementation and use.

We envision to explore the conductive printing technology to create the flexible haptic circuit we need in the carrier. It also makes sense to leverage the integration of electronics on textile knowledge to develop wearable electronics and manufacture techniques. It is desirable that detailed instruction on methods and techniques for scalability accompany the working prototypes.

However, we value the opportunity to investigate other techniques, materials and approaches that might be able to deliver other types of sensation on the skin. Promising approaches include the use of Shape Memory Alloys in the fabric and electromagnetic motors. We will also utilise 3D printing to create detachable cases that host the microcontroller and battery and possibly a charging station that is part of the design experience around the product.

On top of the hardware prototyping, there will be the software development phase as well, where we will program the movement sequences.

One example of software developing includes AI cry recognition algorithm, which will deliver specific haptic sequences as response to each particular cry. The algorithm will process the baby's vital signs and data on its development. We had preliminary discussions with WHO representatives on access to our API dashboard for the health data. 

For future work we want to integrate the haptic technology with biosensors and wireless communication with the hospitals, etc. There’s urgent need to fill this gap and innovations that bring health monitoring closer to the women and children in the communities can facilitate a reduction in negative health outcomes. Sensors help monitor the health of the infant remotely, reducing unnecessary trips to the facility while enhancing communication between health providers and service users. Altogether, the data collected is useful to parents and healthcare providers.

We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of race, color, sex, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, ancestry, or national or ethnic origin.

We believe that when people feel respected and included they can be more creative, innovative, and successful. 

As our work contributes to ensuring women have an opportunity to be involved in decision making processes in all aspects of life, we strive to have a team that lives by and respects the standards of equity. 

Social Busines Canvas in the image below

As a project that is set to be commercial and reach financial sustainability, we are looking at implementing paid pilots and partnerships with insurance companies in the first stage of market release, to further expand sales of our products via distribution partnerships in key regions.

Our product line includes textile child positioning devices, to be further completed with the Smart product line.

As mentioned above, our company produces textile child positioning devices, that are to generate revenue from sales as of Q3 2023. 

The haptic Carriers are expected to generate revenues as of year 3 of the project with paid pilots via partnerships.

We expect to break even within the next 3 years