Almost 800,000 strokes happen each year in the United States. A product created in a Clemson lab shows great promise in helping stroke victims recover use of their arms.

Nancy Bunch says that when she suffered a stroke, she lost the ability to lift one of her arms.
The simplest of tasks, such as picking up a pencil, were but a memory. Then a therapist asked Bunch to try using a new video game, “Duck Duck Punch,” as part of her recovery.
“My first thought,” says Bunch, “was, ‘I can’t even move my arm. How can I do that?’” But then she remembered the promise she made to herself when she went into the rehab hospital. “I decided at that point,” she says, “I will not say ‘no.’”

She punched virtual rubber ducks off the screen to relearn how to extend her arm. Within a week, she was once again able to pick up a pencil. Just over a year later, Bunch drove herself to the grocery store.

“This really needs to be in hospitals all around the country,” Bunch says. “For me, it represented hope — hope for the hopeless. I am so thankful.”

“Duck Duck Punch” is the product of Recovr, a company that started as a research project in Clemson’s College of Engineering and Science and at the Medical University of South Carolina. The company’s founders, Austen Hayes ’11 and Larry Hodges, joined together in a Clemson lab in July to offer the general public its first look at their stroke-recovery game. They say it could be only a matter of months before the game becomes a part of patient therapy nationwide.
Recovr has raised seed capital from Concepts to Companies and has received 510(k) clearance from the Food and Drug Administration, which allows Recovr to market the game as a medical device.

“We’re on the cusp of something big,” says Hayes, the company’s CEO. “There is a $17 billion stroke rehabilitation market in the U.S. alone. The need for this kind of therapy is expected to more than double by 2030, according to the National Stroke Association.”

Almost 800,000 strokes happen each year in the United States. More than seven million survivors live with long-term stroke disability, the vast majority suffering arm-movement impairment.
“Duck Duck Punch” is in trials in two clinics and two hospitals across South Carolina. Tests have shown as much as 15 percent improvement in arm mobility in one week of using the game.
With “Duck Duck Punch,” therapy becomes a game that patients want to play instead of a chore that needs to be done. Patients stand or sit in front of a TV or computer, and rubber ducks go by on the screen like a carnival game. When patients reach out, a virtual arm on the screen knocks down the ducks. Patients earn points for each duck they knock down. The game can be played in hospitals and clinics, or sent home with the patient.
“That’s key,” Hayes says. “You have to follow up with daily therapy in the home. On average, pilot participants in the home are using this 49 minutes a day. It has just blown away therapists that patients are following up on their own between therapy sessions.”

Bunch, of Eutawville, South Carolina, says that she doesn’t usually consider herself competitive, but the spirit rose in her when she played “Duck Duck Punch.”

“It’s like mind over matter,” she says. “It’s amazing what your brain can do even though you don’t think you can do it.”
A Microsoft Kinect tracks patient movements, so no controller is needed. Patients can pick the skin tone of their virtual arm — many prefer green — and the game’s theme, Hodges said. “We’ve got Wild West Ducks, we’ve got Seascape Ducks, and we have everybody’s favorite, which is Ducks in Space,” he says. The next generation, currently in development, features Cows in Space.
The game can also be customized according to patient ability. In the setup, patients extend their arms as far as they can. The game makes up the difference so that patients with very limited motion can still play.
Therapists can use “Duck Duck Punch” to track patients’ progress and provide analytic data, which is important under the Affordable Care Act, Hodges says.
Hayes and Hodges have been working with Michelle Woodbury, an associate professor and director of the Upper Extremity Motor Function Lab at Medical University of South Carolina. “Everything about the game was developed in conjunction with her,” Hodges says. “We’re the computer guys. She knows what stroke survivors really need to regain reuse of their arms.”
The origins of the game go back to 2011 when Hodges and Woodbury met at a MUSC conference that brought researchers together to look for possible collaborations. Woodbury told the group about her idea for a game that would encourage patients to do stroke-recovery exercises. Hodges knew that the technical know-how could be found at Clemson, where he is a professor in the Human-Centered Computing Division in the School of Computing.
Hodges told Hayes, then a Ph.D. student, about the game idea. They began work on a prototype and a year later, it took second place out of more than 500 entries at the 2012 Microsoft Imagine Cup in Sydney, Australia.
The team formed Recovr in 2013 to help expand “Duck Duck Punch.” Hayes set aside his Ph.D. plans to become the company’s full-time CEO.

“I knew that if it just stayed in the research lab, it was going to be awesome but for a limited number of people,” Hayes says. “We wanted to pull it out and see it help more people in more locations. I really wanted to do well and do good at the same. To make an impact on someone’s daily life — that’s really rewarding for me.”

Hodges serves as chief operating officer. Kevin Jett, scheduled to graduate in December 2015 with a bachelor’s degree in computer science from Clemson, is the company’s software engineer.
Recovr is now one of two companies, both from Clemson, in the Concepts to Companies portfolio. The founders, John Warner and Brian McSharry, help turn academic ideas into commercial enterprises by investing capital and offering their business expertise.
“‘Duck Duck Punch’ is a great illustration of collaboration between Clemson University and Medical University of South Carolina,” Warner says. “It shows that South Carolina has high quality intellectual capital. There is a huge need for this kind of product, and it’s growing. We’re expecting big things from Recovr.”
Eileen Kraemer, the C. Tycho Howle director of the School of Computing, says she is proud that Recovr’s roots trace back to the school. [pullquote]“‘Duck Duck Punch’ could have a global impact on stroke survivors not only in the United States but around the world,” she says. “We’ve got some of the best, brightest and most inventive students and faculty members in the country.”[/pullquote]
According to Anand Gramopadhye, dean of the College of Engineering and Science, “Duck Duck Punch” is an excellent example of how “translational research” can take projects from the lab to a patient’s bedside.
“We’re creating a new generation of entrepreneurial leaders,” Gramopadhye says. “They are not only qualified to take jobs, but they are also prepared to create jobs. It’s exciting to see Clemson students, alumni and faculty members put that into practice. The Recovr team has a bright future.”
For more about Duck Duck Punch and Recovr, you can contact Austen Hayes at  or go to the company website at www.recovrinc.com.
Paul Alongi is a technical and feature writer for the College of Engineering and Science.
Listen to Clemson News Now student reporter Jackie Veliz’s story on Duck Duck Punch: