Frequently Asked Questions
1. What is SmartStep™? SmartStep™ is an innovative biofeedback and monitoring system
for lower limb rehabilitation. The system enables physical therapists and clinicians to
assess, treat and monitor patients who have compromised lower limb functions.
2. Which patients can benefit from SmartStep™? Post-operative orthopedic and trauma
patients; Patients who suffer from neurological impairment or disability; Sport injury
3. How does the SmartStep™ system work? SmartStep™ is composed of four integrated
elements: A flexible, lightweight, force-sensing insole A wireless portable, miniature
microprocessor control unit User-friendly software for gait analysis, display and long-term
storage of patient performance records Multimedia interactive training software The unique
SmartStep™ insole measures the force applied by the heel and forefoot of the affected
limb. The data is received and analyzed by the wireless miniature portable control unit
worn around the ankle. Data is transmitted to a computer running the SmartStep™
software, which also maintains patient medical records and functions as an assessment
and therapeutic tool. The interactive training software enables self training and exercise in
front of a multimedia display, increasing patient motivation and performance, and
improving the effectiveness of each therapy session.
4. How many insoles come with SmartStep and do they very in size? The SmartStep now
comes with five (5) insoles and vary is size from pediatric to adult (4.5-5.5, 6-7, 7.5-8.5,
8.5-10 and 10.5-11.5).
5. What does the SmartStep™ software analyze? The SmartStep™ software analyzes four
key gait parameters: Body Weight (BW) on the hind, fore and entire foot Heel-to-toe gait
pattern The gait cycle temporal characteristics: stance and swing duration, cadence, and
6. What kind of feedback does the SmartStep™ control unit provide? SmartStep's control
unit can be programmed to provide the patient with real-time auditory indications of
correct or incorrect gait performance as per the specific patient’s prescribed regime.
7. How is SmartStep™ patient data stored? All data, including a full list of all patient
sessions and relevant information for each, is automatically saved in the patient’s file for
8. How does SmartStep™ help clinicians? The system is an accurate tool that helps
clinicians and physical therapists quantify patient performance, determine therapy goals
and monitor patient progress. SmartStep™ also helps clinicians determine: The type of
facilitation desired in the treatment The degree of physical independence The safest level
9. What types of treatment can SmartStep™ offer? Gait training exercises using auditory
or visual display in different threshold levels as per patient ability and medical prescription
Gait training exercises with interactive multimedia display games
10. What is SmartStep Clinical Interactive Training Program? This new proprietary software
consists of a ski game, which engages patients in a total interactive play. Limits are set by
the physical therapists to enable their patients to reach their targeted weight bearing
goals while swooshing and jumping through the Alps. Not only will patients gain the
confidence they need to reach their optimal functional performance, but they will also have
fun doing it. The program will increase patient motivation, performance and improve the
effectiveness of each therapy session.
11. How does using SmartStep™ assist in rehabilitation and re-education? One of the
most significant re-education stages is the ‘fixation’ or practice stage. At this vital
juncture, the system facilitates: Self-treatment and exercise with multiple repetitions
Instantaneous visual and auditory feedback throughout the entire exercise Practice in
different environments, various platforms and various conditions The interactive training
software enables self training and exercise in front of a multimedia display, thus
increasing patient motivation and performance, and increasing the effectiveness of each
12. How were SmartStep’s results validated? Results of an analysis of SmartStep™ vs.
force plate concluded that the overall accuracy of the SmartStep™ was statistically
significant (p=0.004) with a high level of correlation (R²=0.907). Analysis of the
SmartStep™ vs. Gaitmate showed a high correlation with Gaitmate measurements time
interval measurements for the Stance/ Swing/ Cycle Time (R²=0.996/0.995/0.997
respectively) and resulted in a relatively small standard error between methods.
13. Do you have a reference list of clinical studies, poster presentations, published
articles, etc. using SmartStep?
Our references include:
1. Isakov E., Avni A., Gait rehabilitation by means of a new body weight measuring system,
8th Congress of European Federation for research in Rehabilitation (EFRR) June 13-17th
2. Avni A., Isakov E., In-patient short-term gait rehabilitation by means of a new body
weight measuring system, 5th Mesiterranean Congress of Physical Rehabilitaion Medicine,
Sep. 30th –Oct 4th 2004, Antalya.
3. Burger, Helena; Rudolf, Marko; Drole, Simon: Use of SmartStep Biofeedback for Gait
Training in Stroke Patients and Amputees, 6th Mediterranean Congress of PRM, October
4. Isakov E, Gait Rehabilitation: A new biofeedback device for monitoring and enhancing
weight bearing over the affected lower limb. Europa Medicophysica 2007; 43:21-6.
5. Kaplan, Y., The use of a new biofeedback insole weight-bearing measuring device in the
assessment and rehabilitation of soccer players: A case study review. Journal of Sports
Science and Medical (2007) Suppl. 10
6. Young, M., Gender & The Musculoskeletal System: Pain, Gait & Rehabilitation
Considerations. University of Maryland.
7. Garcia, RK., Onefactor G., Kolodoly Y., The Reliability and Validity of Select Gait
Parameters of the SmartStep System Touro College Department of Physical Therapy Senior
Research Presentations - DPT 2008 May 06, 2008
8.. Hershoko E., Tauber C., Carmeli E.: Biofeedback Versus Physiotherapy in Patients With
Partial Weight-Bearing. The American Journal of Orthopedics, May 2008, E92-E96.
9. Dickstein, R. , Yoeli, Y., Holtzman, S., Faust, A., Markoviz, E., Weight bearing on the
affected lower limb in residents of a geriatric rehabilitation hospital Am. J. Phys. Med.
Rehabil. Vol. 89, No. 2, February 2010; 1-6
10. Rubin, G., Monder, O., Zohar, R., Oster, A., Konra, O., Rozen, N., Toe-Touch Weight
Bearing: Myth or Reality Journal of ORTHOPEDICS October 2010; 33(10):729
11. Kaplan Y., Barak Y., Speiler N., Normal Percentage Body-Weight/Weight-Bearing Values
and Gait Characteristics in Activities of Daily Living: An Original Research Study.
Jerusalem Physical Therapy and Sports Medicine Institute Lerner Sports Center, Hebrew
University, Mount Scopus, Israel. (Pending Publication).
12. Kaplan, Y., The use of a new biofeedback insole weight-bearing measuring device in
determining weight-bearing deficits following Anterior Cruciate Ligament Reconstruction,
from the Jerusalem Physiotherapy and Sports Medical Institute, Lerner Sports Center,
Hebrew University, Jerusalem, Israel. (Pending publication)
13. Hustedt JW, Blizzard DJ, Baumgaertner MR, Leslie MP, Grauer JN. Is age a significant
predictor of ability to comply with partial weight-bearing instructions? [abstract] 42nd
Annual Meeting of the Eastern Orthopaedic Association. Williamsburg, VA. Oct 19-22, 2011.
14. Hustedt JW, Blizzard DJ, Baumgaertner MR, Leslie MP, Grauer JN. Is it possible to train
patients to bear limited weight on a lower extremity? Orthopedics, January 2012 Volume 35
Number 1 Page E31-E37.
14. Is there reimbursement available when using SmartStep?
Yes. The use of SmartStep by clinicians is reimbursable under a specific untimed
procedure CPT code 90901 (Biofeedback with modality), therefore enabling practitioners to
quickly and easily incorporate the SmartStep into their therapeutic programs. There are
also three timed procedure CPT codes 97530 (Therapeutic Activity), 97112 (Neuromuscular
Re-Education) and 97116 (Gait Training).
15. Where is SmartStep being used today?
Andante has already placed the SmartStepTM Clinic in over 100 rehabilitation
hospitals/clinics in the US (HealthSouth, Kessler, Fusion Healthcare, Accelerated
Rehabilitation, Genesis Healthcare, Life Care, Yale Orthopaedic & Rehabilitation) and
started opening markets in the Pacific Rim. In April 2011, the Company received a 5-year
Federal Supply Schedule Contract from the US Veterans Administration to provide the
SmartStepTM Clinic to the 153 VA hospitals in the US and Puerto Rico. This is very exciting
news for Andante and we are poised to supply our Veterans with the SmartStep™, a
unique tool that is essential to reach optimal functional performance.
16. Is there a home version available to the consumer?
Yes. Andante has developed a home version of the SmartStep Clinic: the iSmartStep®
Basic. iSmartStep allows the patient to continue his/her specific training program right
at home. This advanced motor learning tool is now for use with iPod touch® (2nd. 3rd.
and 4th generation) and iPhone® 4, iPhone 3GS, iPhone 3G, and iPhone. It is
programmed by the Physical Therapist to fit the patient’s specific needs. Choose from six
training programs (Sit to Stand, Standing, Weight Shift (Anterior Post), Weight Shift
(Medial Lateral), Walking and Stairs. iSmartStep, which has been programmed by the
Physical Therapist, will personally guide the patient every step of the way through instant
verbal instructions, auditory/visual or vibration cues to achieve better weight bearing, gait
pattern, symmetrical loading and balance control. The SmartStepTM Secure Server has
been set up to allow clinicians to monitor from their clinic their patients’ compliance at
home (Telemedicine). The patient’s home training data compliance in treatment or weight
bearing control is transmitted from his/her home through our secure server to the clinic for
close monitoring and direct communication with the therapist.