Strolll - walking better with Parkinson's

I had low expectations of a recent meeting with a company that claimed it could radically improve the way people with Parkinson’s walked. I had only the vaguest idea about their technology but I knew it involved cueing, a technique that uses visual, auditory or physical signals to treat the motor symptoms of Parkinson’s. I had tried a number of cueing gadgets - some impressive, some not - but none of them seemed to work for me.

But after ninety minutes in the basement conference room of a private club near Marble Arch, I emerged thinking that Strolll really could be a useful tool for treating those of us for whom a walk is becoming a bit of a challenge.

What this young company only formed in 2018 showed me was a headset using augmented reality and a suite of apps and games designed to give people with Parkinson’s - and other conditions which limit their mobility - visual cues to get them walking more confidently. Battling a terrible wifi connection in the rented conference room, Strolll’s clinical director Ben Wain was unable to see what I was seeing through his headset - the idea is that the trainer, usually a physiotherapist, guides the patient through the routine the first time - but still pulled off a compelling demo.

First, I gave him a demonstration of the shuffling head down walk I find myself doing towards the end of my drug cycle - I was about half an hour away from my next dose of levodopa when we met. Then he had me trying to clear a set of hurdles projected across the floor of the conference room floor, which meant I had to pick up my feet rather than shuffle.

Next he placed a bird a few yards away from me which moved away as I started to walk - but I could only see it if I held. my head up high, rather than staring down at the pavement. Finally, I played Mole Patrol, a game where I had to spot moles emerging from mole holes and stamp on them - this was one of a number of games designed for anyone who needs a daily does of exercise and finds it hard to get motivated.

I felt pretty good after my short burst of activity but as I sat down with Ben and with Stroll’s CEO Jorgen Ellis, I wanted to be convinced that this was more than just a shiny gadget that might be used a couple of times, then left on a shelf to gather dust. I was reassured to learn that Strolll is aimed not at consumers but at hospitals and medical professionals.

Ben Wain, who spent 15 years as a senior NHS physiotherapist specialising in Parkinson’s, explained that typically his patients would come to the hospital for 6 sessions, quite a commitment for both them and those treating them. Strolll’s technology would change that:

“Instead they come in for the first session in the clinic, get given an augmented reality device, and then take it home, and then you can do daily rehabilitation at home.” I admitted that although my physiotherapist gives me exercises to do at home, I rarely do them. Ben explained that Stroll enabled the clinical staff to save time, while monitoring what the patient did at home: “The clinician's just spending 10 minutes logging onto their laptop, reviewing the data -  looking at your data coming back from your exercise, seeing whether you're adhering to what they've prescribed.”

In late 2020 Jorgen Ellis, a young New Zealander who had done well from his first start-up, a flatpack furniture business, had recently arrived in the UK when he heard about Strolll: “I decided fairly quickly that I needed to do a startup again, because for me, that's my love, but I wanted it to be something that I was more passionate about than flat pack furniture.”

Strolll’s founder Tom Finn had come up with the idea after learning about cueing from a physiotherapist treating his father, who had vascular dementia with similar symptoms to Parkinson’s. He tried placing some coloured bands on the floor, and soon his father was throwing away his walking stick.

A grant from the augmented reality company Magic Leap which wanted a showcase for its technology got things going but by 2020 the business was running out of money. Tom Finn decided he needed to professionalise this project and so he recruited Jorgen, whose family history made him take a chance on what seemed an unpromising offer: “My grandfather had Parkinson's for over a decade, so I didn't care that the company couldn't afford to pay a salary and all that sort of stuff, I was more interested in what they were building and what they were doing.”

Unlike many cue-ing businesses, Strolll focused on proving that its technology worked. It has partnered with a Dutch university to win a grant to run a randomised control trial, and has persuaded a number of NHS trusts to try out the Strolll system.

In one trial they will give one group the augmented reality syste, and a control group traditional physiotherapy: “So one appointment (or one and a half appointments) and the technology versus six appointments and no technology - what's the best outcome?”

The company has grown quickly over the last two years, raising around £3 million from investors and now employing 26 people, 3 of them in the United States, where it is getting a lot of interest in its technology. This made me wonder whether Strolll, like some other healthtech businesses I have spoken to recently, might eventually decide that the slow-moving NHS was a less attractive market than the United States.

But Jorgen Ellis was keen to dismiss that idea, insisting that the NHS was a great customer: “You have to do your time, but actually if you are prepared to do the steps and put in the hard work that they need you to put in, then the NHS is actually great. They've been wonderful to us, so we have to really give them kudos.”

One other thing struck me as Ben Wain explained how Strolll could transform the physiotherapy service given to people with Parkinson’s - how many people actually get such a service? One of the demands in the Parky Charter put together by the Movers and Shakers podcast is for more holistic care - not just drugs, but advice on nutrition, exercise and other aspects of Parkinson’s from healthcare professionals such as speech therapists and physiotherapists.

Of the six Movers and Shakers, none has been offered NHS physiotherapy and Ben Wain told me that Strolll’s research shows only around 30% of people with Parkinson’s get free access to a physio. Ben says this is partly because of a skills shortage:”The specialised therapist is a dying breed..it's a growing problem, because you have an increasing number of patients, a reducing number of clinicians, so you have this workforce shortage and long waiting lists.”

But technology may be part of the answer. Strolll is making big claims about its system, insisting that it can prove more cost effective as well as more beneficial to patients. Let’s hope that it lives up to its early promise.