A ‘wearable airbag’ belt that prevents hip fractures due to falls (updated)

click to enlargeEditor’s Note: We are reprinting this article (originally from 23 November 2016) due to the comments by the CEO of ActiveProtective, Drew Lakatos, on 10 and 12 January, responding to the reasoned misgivings of one of our Readers. (Click ‘read more’ and scroll to comments at the end of the article.) This unusual step is being taken because this Editor believes that the problem is major–adults at high risk of falling and hip fractures. A technology solution such as this is worthy of examination by our Readers and further debate.

Do you believe older adults at high fall risk would voluntarily wear a belt that would deploy cushioning air bags around the hips in the event of a fall? This Editor was initially skeptical reading the MedCityNews article on ActiveProtective‘s $2.6 million Seed 3 round raise. The belt, looking at their photo and the one on the ActiveProtective website (left above), looks like a hard and uncomfortable ring, which didn’t make much sense as the ring in a fall impact could itself create injury. There was also a brief mention of fall detection but not how they worked together.

But before nominating this as a Thanksgiving Fowl, this Editor wanted to Dig Deeper. In their press, this TEDMED video with founder/presenter Drew Lakatos, while originally from 2014, explained its workings far better. First, the ‘fall detection’ sensor data aren’t trying to confirm a fall–the algorithms are looking for the absence of stereotypical human motion to determine that a fall is happening. When that is detected, the airbags deploy, which takes about 60 milliseconds. Second, the airbags (below left) fall around the hip sides and rear, which is important as many falls are to the back. Their claim is that their device can reduce the impact force by 90 percent. The airbags in the belt use cold gas inflation which is less dramatic than automotive airbags, and it is equipped with a PERS using Bluetooth to alert for help.

click to enlargePhiladelphia-based ActiveProtective earlier this year raised $2.4 million and a minority investment by Key Safety Systems (KSS), a developer of safety components for automotive and non-automotive products (KSS release). The device was originally developed by a former trauma surgeon at Temple University Hospital and St Mary Medical Center in Langhorne, Pennsylvania, Dr Robert Buckman. They intend to test on a large scale in two senior living communities. Potential uses for the technology, according to their website, are for fitness, equestrian and other sports, high-risk occupations, and the military.

WearableTechnologies.com also examines other airbag/protective products such as Hip-Hope, Wolk, Alpinestars, Hövding and Dainese.

Most of us are well acquainted with the disastrous statistics around hip fractures. Each year over 300,000 people over 65 are hospitalized for them, with more than 95 percent caused by falls, usually by falling sideways. Falls are also the most common reason of traumatic brain injury (CDC).

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Comments

  1. This is a completely insane product. Who is going to wear – next to their body – a device that contains a (potentially explosive) compressed gas cylinder? What healthcare organisation in its right mind would recommend the use of such a dangerous device? What happens if the fall detection algorithm does not work 100% – which it won’t? How or why would anyone wear this in bed at night, a time when 40% of all falls occur? What happens if the wearer falls onto the gas cylinder? What happens when there are false alarms and the device inflates unnecessarily? Crazy, when there are hip protectors readily available without dangerous gas cylinders, in every country that absorb over 80% of the force of a fall, which is more than enough to prevent fracture even in the worst possible fall scenario.

    • Hello William, I’m the CEO of Active – I was just forwarded this link. You raise questions which all have explanations, but you insert your very wild speculation. This made more sense after learning you sell passive hip pads. Calling it ‘insane’, ‘explosive’, ‘dangerous’, and saying you visited us at Medica (we’ve never been to Medica) is simply misleading.
      Passive pads (similar to yours) do work. But the reason for our efforts is that most older adults find compression shorts with plastic pads in them to be uncomfortable, unsanitary, and difficult to put on and take off multiple times a day. Facilities can’t fit them into their workflow. We worked thoughtfully with the target patient population, caregivers, and extensive user research to arrive at a form-factor that is soft (not a rigid ring!), comfortable, and older adults find them more acceptable than compression shorts which have been around for 20 years. Because our protection is on demand, we have significantly more coverage and better impact attenuation. Because its a smart device, we monitor for other characteristics that will help the user. And no – our device does not ‘tip the head’ as you speculate. We have data showing reduced accelerations at the head and extremities due to the tuned softness of the airbag.
      Happy to have a dialogue, but please don’t presume, speculate, or mislead. We are first class product developers and have thought through all the issues you raise.

      • Firstly I visited several manufacturers such as yours at Medica, with similar, if not identical devices. Secondly the cylinder has to be rigid – and several inches long. I did not say the rest of the belt was rigid. We have never used “compression shorts”, our pants are 95% cotton and 5% elastane, and a lot less cumbersome than a bulky belt like yours that cannot be worn comfortably at night – a time when about 30-40% of all falls occur. “Facilities” have had no difficulty including such devices and clothing as ours in their “workflow” for the past twenty years or more. In any case we are moving over to a double-sided breathable adhesive film that holds the pads gently but firmly to the hip. Our users much prefer this and it completely negates what I take to be the main argument you are putting forward in favour of your device.
        There is no evidence that your device achieves better “impact attenuation”, (our Fall-Safe® device achieves greater than 70% force attenuation, sufficient to prevent all but “spontaneous fractures” which occur prior to the fall, not as a result of it) not least because your device relies on a falls detection algorithm to work at all and in those cases where it does not, it will provide no protection whatever. Our device works 100% of the time for years.
        As you would have seen from our website, our Fall-Safe Assist falls detection system, which will shortly be incorporated soon into the pads, also sends alarms after a fall and monitors wearer’s activity, as well as accumulating data on each and every fall, which it records and transmits to the cloud for subsequent analysis, thus it is a great deal “smarter” than anything you are proposing, and a lot less expensive.
        There is plenty of evidence that people find wearing even a small pendant round their neck objectionable as it advertises their disability, so what they will think of a large belt that has to be worn outside their clothing, heaven knows. Clearly you have not done research on this aspect either. If the dummy was not going to fall on its head why the video showing it falling from a position half way to the floor?
        So who would not consider a device dangerous that, when positioned on a belt tight to the body, has to release a significant quantity of gas in a very short space of time, akin to an explosion? Do you really think it likely that the FDA will sanction such a device? What happens if the gas cylinder accidentally ruptures, or is damaged in some way? What happens if your falls detection algorithm puts out a false alarm and activates the device? – not a great experience for the wearer, I would guess. What happens if the airbag is ruptured either before, or as a result of, the inflation? And, as I understand it, such devices as yours, assuming they ever get to market, (heaven forbid), cost in the order of $300-$400, plus every time they are activated a new gas cylinder has to be purchased – and fitted by someone – @$50 or so. Also bear in mind that frequent fallers may actually fall again within a few minutes, and so with your device they would not be protected – unless they had bought two of them! For all these reasons, and a whole raft of others that I have already detailed, I think that most objective people would feel that the product lacked a grounding in reality. Whether that amounts to insanity, I leave for others to judge.
        The reason I have been fairly assertive about this issue is that the hip protection market hardly needs new entrants that might appear to be designed to obscure the real issues, which are that millions of people are falling over every year and breaking a hip, and that maybe 20% of them die as an indirect result. This is an important problem with very high concomitant costs and, as far as I can see, products like yours will not provide any sort of solution, given that there already exists a much cheaper, more effective, and 100% reliable solution.

        • William, please stop speculating. I do not call your device ‘identical’ to all other passive hip pads, and you have never met me or seen my device (you should not be saying we met at Medica.) Your last statement is that “hip protection hardly needs new entrants,” which I find odd. We designed our belt thoughtfully, alongside patients and providers, to protect the many older adults that find passive pads unacceptable. For people that find our belt unacceptable, I hope they find passive pads a good compromise, as I believe our common mission is to protect high fall-risk adults. Some brief points:
          1. In our long-term studies, many people did choose to wear our comfortable belt at night. Its thickness rivals your pads
          2. There are numerous peer-reviewed behavioral studies regarding the difficulty and compliance issues of passive pads in senior care (I can provide them to you)
          3. We do have significant evidence of better impact attenuation than the best passive pads, using peer-reviewed international consensus testing apparatus
          4. If your pad attenuates impact force by only 70% as you state above, there are some high-impact falls that our belt will provide better protection
          5. Because we protect a much larger anatomical area, we can protect in more posterior falls in a way passive pads can’t
          6. Quick note – the proof-of-concept image included in this article is from a TEDMED talk I did in 2014, it does not represent the current design
          I wish you the best, and hope we are both successful in protecting older adults from this injury. Let’s both get back to work.

  2. Donna CusanoDonna Cusano

    @ William. You are right to question all of this. But consider that we routinely drive cars with airbags up front and at the sides which (explosively) can go off in a front end crash.

    My major concern as noted would be hardness of the ring (I’ve seen views of the product with a padded exterior) creating injury or discomfort. Most ‘fall detectors’ using algorithms (used in PERS) don’t work very well–they false alarm but worse, don’t alarm in many falls (e.g. slump or gradual falls)–this one seems to be a bit different based on the video.

    Absolutely this would be no solution for nights–well acquainted with the high propensity of falls at night and on arising in the morning, with the first visit usually the bathroom. That is best solved with motion/activity sensors monitoring bedroom-bathroom transit or in future, a sensor patch connecting to a monitoring system.

    Based upon their videos and website, I believe the designers meant this for ambulatory high-fall-risk patients or residents in hospital or rehab.

    • Donna. There are several other concerns, highlighted by a visit I made to the supplier at Medica recently. One is that even the suppliers claim that the fall detection device will only work 75% of the time, so the wearer is unprotected in a quarter of all falls, secondly that when it inflates it tends to tip the wearer on their head (check the animation), thirdly that if it goes off by accident, e.g. a false alarm, then the “surprise” element in that instance could well trigger a fall. It could also make getting back on their feet difficult for the faller. Lastly it is about 8 times the cost of the best hip protectors, a major consideration for the elderly on fixed incomes. It obviously has to be worn outside the clothing since otherwise it would either not inflate or would burst the clothing and given that people are very reluctant to wear even a small pendant as it advertises their disability, then they are hardly likely to wear a massive belt thing! The very fact that the suppliers of this ridiculous device don’t have any video of it in action is a pretty sure indication of the fact that it won’t work.

      • Chuck Powell says “by 2050 this technology could be everywhere, we won’t even think about it… we could get used to never getting hurt, ever.” Really? Who would want to carry “a small explosive device/charge”, plus compressed gas cylinder, around 24/7. What responsible medical authority would allow this, even if the company could persuade people to wear a 2lb belt day and night with a hard gas cylinder in the buckle? Interesting that the dummy is not shown actually falling from an upright vertical standing position, but is dropped from halfway down already. This is presumably because if the dummy faller had fallen from the vertical with much greater velocity, the ‘bounce’ effect generated by the inflated airbag would almost certainly have tipped the dummy onto his head! So this device trades a protected hip for a fractured skull! Will the company’s next product be a collar that cushions the head with another airbag, after the one on the hip has been triggered? What about the elbow, or knee? There is no mention of the reliability, or otherwise, of the fall detection algorithm, which is obviously the critical element in the effectiveness of the device. Nice buckle though, maybe they should patent that and market it? This is clearly a case of poor technology transfer from a satisfactory car-mounted device, to a bad person-mounted device. Mad, bad and dangerous to know…

  3. First of all I was not speculating, I have been in this business since 2009, have supplied hip protectors all over the world and have read all the relevant papers, so I have done thorough research on all aspects of what you choose to call “passive hip pads”, though what is “passive” about a high-tech reactive material ours whose molecules lock on impact – relaxing to their previous state immediately afterwards – I should like to know. I think you have misunderstood our product which ALWAYS reacts to an impact, as opposed to yours that may or may not do so depending on whether the falls detection algorithm has worked, or not. I at least do you the honour of responding to all your points, something which you have not afforded me.

    1). We have thousands of people who, day and night, wear our pads, stick-on or in pants, and have done so for years. I doubt that you can provide such evidence.

    2). There are no behavioural studies, peer-reviewed or otherwise, that mention our pads, which are significantly cooler (ie breathable), softer, more flexible and more comfortable to wear than any other “passive”, or for that matter “active” products. The studies you mention used 1st or 2nd generation pads that were often rigid polyethylene shells or else airbags filled with foam, or occasionally textiles. None of these are satisfactory and all compare unfavourably to our 3rd generation product, both in comfort and in impact attenuation. You might care to note that identical or very similar materials to ours with identical properties are used in hundreds of different impact absorbing applications, including virtually all contact and extreme sports, by the paramilitary police in France and elsewhere, and by the Special Forces in the USA and UK, amongst many others. The material has been tested hundreds of times by scores of companies and government agencies and not found wanting. But perhaps, if they believe your hype, they will all change immediately to unreliable explosive inflating airbags with dangerous gas cylinders and dodgy fall detection algorithms? I don’t think so.

    3) & 4). There are no “peer-reviewed international consensus testing apparatus” – ask ProfessorJulian Minns, the leading expert on test apparatus for hip protectors, or Intertek, the leading independent testing house. I can provide introductions if you wish. Our pads reduce the average impact force from 3.6k Newtons to 0.4k Newtons and the extreme impact force from 4.7k Newtons to 1.5k Newtons, sufficient to prevent hip fracture for either the average female faller, or the heaviest and tallest male faller – and roughly twice as much reduction as any other hip protector on the market. I notice that you do not state how often your device does not detect falls at all, and therefore provides zero attenuation.

    5). It has been proven that posterior falls (almost) never result in hip fracture. Landing on your arse seems to be more of a problem for you however…

    I do agree with you that further discussion is pointless since you have not troubled to answer the many difficult/impossible-to-answer points that I put to you.

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