Josh Rabinowitz, Co-Founder & CEO of Articulate Labs, a MedTech startup making wearables that mimic biological systems, is making an impact with his influential leadership. With his team of passionate individuals, Josh relentlessly works towards making physical therapy more comfortable, more wearable, and more adaptive.
In an interview with Aspioneer, Josh shared some key insights into his leadership, the products, and his vision for his organization.
Aspioneer (A): Can you tell us a little bit about your company and the impact your products are having on people’s lives?
Josh Rabinowitz (J): “Articulate Labs. It started in 2012, paused in 2015, and restarted in 2017. We develop devices that accelerate joint rehabilitation by integrating physical conditioning into everyday activity using movement-synchronous electrical muscle stimulation. AL’s first device, KneeStim, is a light, low-profile device that uses neuromuscular electrical stimulation (NMES) to dynamically stimulate quadriceps muscles in sync with regular activity, accelerating rehabilitation by strengthening and training muscles with each step. KneeStim accomplishes this through a unique mix of AI, motion-tracking hardware, and patented joint modeling OS that enables rapid gait and treatment personalization. Even limited usage has shown trackable change in important metrics like knee range-of-motion and walking speed which can improve mobility and quality of life for users dealing with a wide variety of knee conditions. Also, the same motion-tracking hardware we’re using to drive therapy can also be used to collect physiologic data that can be used to optimize rehab, track compliance, and enable recurring reimbursement. We currently have only one location in Dallas, TX.”
"The need exists to bring physical therapy to the patient when the patient can’t come to physical therapy."
(A): What inspired you to begin developing wearable technologies for users with knee impairments?
(J): “We started with knees mainly because of my co-founder, Herbie Kirn’s, own personal needs. He lost his right leg in a motorcycle accident over fifteen years ago and quickly wore down the cartilage in the knee of the fully intact leg as he relearned to walk. He was told he was too young for knee replacement, but he was advised to go through all of the conservative options available and found braces, injections, and medications each to have unacceptable drawbacks or side effects. What did work for him was physical therapy (PT), with an emphasis on quadriceps strengthening, but he didn’t have time for all of the rehab he needed without impacting his work and family responsibilities. While at PT, he was using a neuromuscular electrical stimulation unit while doing leg lifts and started wondering why this process wasn’t more fully automated.
We discovered that Herbie wasn’t the only one lacking PT access, nor were his positive results from strengthening all that unique. Poor quadriceps muscle strength correlates with pain, poor mobility, and a lower quality of life, creating $3B in avoidable healthcare spending. Physical therapy is effective, but we see that <20% of patients attend all prescribed sessions or remain compliant with their home-based regimens. The need exists to bring physical therapy to the patient when the patient can’t come to physical therapy.”
(A): Can you tell us a bit about your competitors and how you plan to maintain your lead?
(J): “Short-term, our main competitors will be in the knee brace manufacturing market ($0.5B) and the electrical stimulation devices ($4.7B). Companies like DJO (now Enovis) and Ossur are in both and, to us, represent ideal partners rather than adversaries. Longer-term, we’ll run into more challenges with full remote/virtual physical therapy platforms like Hinge and Sword Health that can offer one device/setup to address all joints, not just one. In all cases, we believe our response has to be to prove that we offer higher quality rehab outcomes and greater convenience for end-users.”
(A): How do you keep yourself updated? Is there anything specific you refer to?
(J): “For where we are in the medical device, orthopedics, and physical therapy spaces, I get a lot of value from following Osteoarthritis Action Alliance, Rock Health, Fitt Ventures, Orthoworld, and SportsTechie Daily. Specific to Texas and looking for local opportunities and trends, I’d point to Dallas Innovates, Texas Squared, AustinInno, and CultureMap Houston. Completely outside of those spaces, I’ve found a lot of solid self-improvement content, especially around maintaining focus and self-awareness, with Nir Eyal’s work, and I enjoy the Sunday Long Read compilation of long-form journalism compiled by Don Van Natta.”
(A): How has the pandemic changed your business?
(J): “The biggest changes for us have been the steady shift from fee-based to value-based care and the acceleration of virtual/remote care due to COVID-19. Part of our initial failure to launch was because, in a fee-based model, our ability to offer care outside of the clinic would only serve to reduce revenue for medical facilities, which was a non-starter. Value-based care and the expansion of remote patient monitoring make a device like ours far more palatable now. Likewise, with the general acceptance by medical societies and insurance companies of remote and virtual care.”
(A): Your industry has undeniably undergone significant changes in the past. Can you discuss some additional key risk factors and megatrends that your industry may face, as well as how you intend to stay on top of them?
(J): “Changes in reimbursement with CMS and private insurers are both our short-and long-term risks. Reimbursement for durable medical equipment is fraught in large part because of CMS’s strong reaction to previous fraud and abuse. Remote therapeutic monitoring, as it has been explained so far, seems like a potential new source of fraud as well. We have to find ways to navigate the reimbursement process, secure existing codes, adapt our model as those codes change year over year, and make sure that we don’t get overly dependent on any one revenue source. I don’t have any clever plans or ideas for sustaining competency other than to just keep proving that our devices do what we say they do both in terms of efficacy and health economics.”
(A): Where does Articulate Labs go from here? What will be your primary focus in the future?
(J): “Medium-term, we’re working on applying base technology to other joints and conditions. We have the initial outlines of a wearable device to assist with hip rehabilitation. We also have initial, informal positive results from regulating prosthetic limb fit through the integration of a movement-synchronous NMES unit within a prosthetic liner. Long-term, the most exciting thing to me has always been the prospect of a body area network of intelligent NMES devices working together to address more complex rehabilitation needs such as those caused by strokes, multiple sclerosis, or cerebral palsy.
The planned launch of our device next year, which has been impending for years now, is highly exciting. This will involve us starting with a controlled launch within Texas, primarily in Dallas and Houston. Here, we can test how our devices work in different types of medical settings and in different areas (rural, urban, and suburban) to see what works and what doesn’t before moving on to larger coverage areas and distribution partnerships. We’ll also continue to build partnerships with research facilities to look into all of the different musculoskeletal conditions where we see our initial devices being of use, such as rehabilitation from ACL repair or patellofemoral pain syndrome, so that we can start to expand into new market segments.”
