Rehabilitation robotics

Rehabilitation robotics is a field of research dedicated to understanding and augmenting rehabilitation through the application of robotic devices. Rehabilitation robotics includes development of robotic devices tailored for assisting different sensorimotor functions[1](e.g. arm, hand,[2][3] leg, ankle[4]), development of different schemes of assisting therapeutic training,[5] and assessment of sensorimotor performance (ability to move)[6] of patient; here, robots are used mainly as therapy aids instead of assistive devices.[7] Rehabilitation using robotics is generally well tolerated by patients, and has been found to be an effective adjunct to therapy in individuals suffering from motor impairments, especially due to stroke.

Overview

Rehabilitation robotics can be considered a specific focus of biomedical engineering, and a part of human-robot interaction. In this field, clinicians, therapists, and engineers collaborate to help rehabilitate patients.

Prominent goals in the field include: developing implementable technologies that can be easily used by patients, therapists, and clinicians; enhancing the efficacy of clinician's therapies; and increasing the ease of activities in the daily lives of patients.

History

The International Conference on Rehabilitation Robotics occurs every two years, with the first conference in 1989. The most recent conference was held in June 2019 in Toronto, as part of the RehabWeek. Rehabilitation robotics was introduced two decades ago for patients who have neurological disorders. The people that you will most commonly find using rehabilitation robots are disabled people or therapists.[8] When the rehabilitation robots were created they were not intended to be recovery robots but to help people recognizing objects through touch and for people who suffered from nervous system disorder. Rehabilitation robots are used in the recuperation process of disabled patients in standing up, balancing and gait.[8] These robots must keep up with a human and their movement, therefore in the making of the machine the makers need to be sure that it will be consistent with the progress of the patient. Much rigorous work is put into the design because the robot will work with people who have disabilities and will not be able to react quickly in case something goes wrong.[9]

Function

Rehabilitation robots are designed with applications of techniques that determine the adaptability level of the patient. Techniques include but are not limited to active assisted exercise, active constrained exercise, active resistive exercise, passive exercise, and adaptive exercise. In active assisted exercise, the patient moves his or her hand in a predetermined pathway without any force pushing against it. Active constrained exercise is the movement of the patient’s arm with an opposing force; if it tries to move outside of what it is supposed to. Active resistive exercise is the movement with opposing forces.[10] These machines MIT-Manus,[11] Bi-Manu-Track[12] and MIME make the active resistive exercise possible. Passive exercise needs to be pushed from the patient. Finally, an adaptive exercise is an excessive workout that the robot has never done and is adapting to the new unknown pathway. These devices Bi-ManuTrack and MIME support the adaptive exercise possible. The active constrained exercise is supported by all the machines that are mentioned.[9]

Over the years the number of rehabilitation robotics has grown but they are very limited due to the clinical trials. Many clinics have trials but do not accept the robots because they wish they were remotely controlled. Having Robots involved in the rehabilitation of a patient has a few positive aspects. One of the positive aspects is the fact that you can repeat the process or exercise as many times as you wish. Another positive aspect is the fact that you can get exact measurements of their improvement or decline. You can get the exact measurements through the sensors on the device. While the device is taking a measurement you need to be careful because the device can be disrupted once it is done because of the different movements the patient does to get out.[9] The rehabilitation robot can apply constant therapy for long periods. The rehabilitation robot is a wonderful device to use according to many therapists, scientists, and patients that have gone through the therapy. In the process of a recovery the rehabilitation robot is unable to understand the patient’s needs like a well experienced therapist would.[8] The robot is unable to understand now but in the future the device will be able to understand. Another plus of having a rehabilitation robot is that there is no physical effort put into work by the therapist.

Lately, rehabilitation robotics have been used in training medicine, surgery, remote surgery and other things, but there have been too many complaints about the robot not being controlled by a remote. Many people would think that using an industrial robot as a rehabilitation robot would be the same thing, but this is not true. Rehabilitation robots need to be adjustable and programmable, because the robot can be used for multiple reasons. Meanwhile, an industrial robot is always the same; there is no need to change the robot unless the product it is working with is bigger or smaller. In order for an industrial robot to work it would have to me more adjustable to its new task.[9]

Current products

Hand of Hope is an intention-driven exoskeleton hand that focuses on improving motion of the hand and fingers in stroke victims, developed by Rehab-Robotics. The robotic hand is controlled by EMG signals in the forearm muscles, meaning that patients can move their hand using only their brain. The device also has a continuous passive motion mode, where the actions of hand opening and closing are done involuntarily.[13]

Ekso Bionics is currently developing and manufacturing intelligently powered exoskeleton bionic devices that can be strapped on as wearable robots to enhance the strength, mobility, and endurance of soldiers and paraplegics. Tyromotion is currently developing and manufacturing a set of intelligent rehabilitation devices for the upper extremity. The hand rehabilitation robot called AMADEO offers a range of rehabilitation strategies including passive, assistive, ROM, force and haptic training. The arm rehabilitation robot called DIEGO offers bilateral arm therapy including assistive force for weight reduction and full 3D tracking of the arm movement for augmented feedback training in a virtual reality environment.

Reasons to use this device

The number of disabled people in Spain had gone up due to aging. This means the number of assistance has gone up. The rehabilitation robot is very popular in Spain because it is an acceptable cost, and there are many people in Spain that has strokes and need assistance afterward. Rehabilitation robotics are very popular with people who have suffered a stroke because the proprioceptive neuromuscular facilitation method is applied. When you suffer a stroke your nervous system becomes damage in most cases causing people to have disability for six months after the stroke. The robot would be able to carry out exercises a therapist would carry out but the robot will do some exercises that are not so easy to be carried out by a human being.[8] The pneumatic robot helps people who have had strokes or any other illness that has caused a disorder with their upper limb[14]

A 2018 review on the effectiveness of mirror therapy by virtual reality and robotics for any type of pathology concluded that: 1) Much of the research on second-generation mirror therapy is of very low quality; 2) Evidence-based rationale to conduct such studies is missing; 3) It is not relevant to recommend investment by rehabilitation professionals and institutions in such devices.[15]

Types of Robots

There are primarily two types of robots that can be used for rehabilitation: End-effector based robots & powered exoskeletons. Each system has their own advantages & limitations. End-effector systems are faster to setup & are more adaptable. On the other hand exoskeletons offer more precise joint isolation & improve gait transparency.

InMotion 2[16] can be used, it allows participates to practice reaching movement in horizontal plane with a reduction of gravity. The motions that are performed require shoulder flexion and extension and external rotation. It is very easy to set up the usage of this robot. The procedure of using this robot is the following. The participant sits down at a desk and places her or his into a trough. Then the participants’ looks at a computer screen and try to reach out for the target. As you are reaching out for the target the device gives guidance so that your therapy can be successful.[17]

Another example of rehabilitation robot is called Hipbot. The Hipbot is a robot used in patients with limited mobility. The hip is an important joint in the human body, it supports our weight and allows the movement and statically position. When people suffer a fracture by an accident or have problems in this location, need to improve a rehabilitation process. This robot helps in this cases, because it combines movements of abduction/adduction and flexion/extension that help the patients to restore their mobility. The robot has 5 degree of freedom mechanism necessary to all positions for the rehab, it is controlled by a PID controller and can be used for both legs (separately).[18]

Some workers are working on robots that support a patient’s body, so that the patient can concentrate on something else while he or she is walking.[8]

Current Areas of Research

Current robotic devices include exoskeletons for aiding limb or hand movement such as the Tibion Bionic Leg, the Myomo Neuro-robotic System, MRISAR's STRAC (Symbiotic Terrain Robotic Assist Chair) and the Berkeley Bionics eLegs; enhanced treadmills such as Hocoma's Lokomat; robotic arms to retrain motor movement of the limb such as the MIT-MANUS, and finger rehabilitation devices such as tyromotion's AMADEO. Some devices are meant to aid strength development of specific motor movements, while others seek to aid these movements directly. Often robotic technologies attempt to leverage the principles of neuroplasticity by improving quality of movement, and increasing the intensity and repetition of the task. Over the last two decades, research into robot mediated therapy for the rehabilitation of stroke patients has grown significantly as the potential for cheaper and more effective therapy has been identified.[19] Though stroke has been the focus of most studies due to its prevalence in North America,[7] rehabilitation robotics can also be applied to individuals (including children) with cerebral palsy,[4] or those recovering from orthopaedic surgery.[19]

The MIT-MANUS in particular has been studied as a means of providing individualized, continuous therapy to patients who have suffered a stroke by using a performance-based progressive algorithm.[20] The responsive software allows the robot to alter the amount of assistance it provides, based on the patient's speed and timing of movement. This allows for a more personalized treatment session without the need for constant therapist interaction.

A great example of how commercial available robots are repurposed for post surgery/stroke rehabilitation is ROBERT. The Aalborg based outfit of Life Science Robotics developed ROBERT (CE certified in 2018[21]) to provide active resistive, active assistive & passive mobilization based rehabilitation for lower extremities. Such a solution reduces the strain on Physiotherapist & ensures earlier recovery due to high repetitions possible

An additional benefit to this type of adaptive robotic therapy is a marked decrease in spasticity and muscle tone in the affected arm. Different spatial orientations of the robot allow for horizontal or vertical motion, or a combination in a variety of planes.[7] The vertical, anti-gravity setting is particularly useful for improving shoulder and elbow function.

Rehabilitation robotics may also include virtual reality technology.

See also

References
  1. Brewer, Bambi R.; McDowell, Sharon K.; Worthen-Chaudhari, Lise C. (2007). "Poststroke Upper Extremity Rehabilitation: A Review of Robotic Systems and Clinical Results". Topics in Stroke Rehabilitation. 14 (6): 22–44. doi:10.1310/tsr1406-22. PMID 18174114.
  2. Balasubramanian, Sivakumar; Klein, Julius; Burdet, Etienne (2010). "Robot-assisted rehabilitation of hand function". Current Opinion in Neurology. 23 (6): 661–70. doi:10.1097/WCO.0b013e32833e99a4. PMID 20852421.
  3. Kang, Yongsuk; Jeon, Doyoung (2012). Rehabilitation robot control using the VSD method. System Integration(SII) IEEE/SICE International Symposium. p. 192. doi:10.1109/SII.2012.6427313. ISBN 978-1-4673-1497-8.
  4. Michmizos, Konstantinos P.; Rossi, Stefano; Castelli, Enrico; Cappa, Paolo; Krebs, Hermano Igo (2015). "Robot-Aided Neurorehabilitation: A Pediatric Robot for Ankle Rehabilitation". IEEE Transactions on Neural Systems and Rehabilitation Engineering. 23 (6): 1056–67. doi:10.1109/TNSRE.2015.2410773. PMC 4692803. PMID 25769168.
  5. Marchal-Crespo, Laura; Reinkensmeyer, David J (2009). "Review of control strategies for robotic movement training after neurologic injury". Journal of NeuroEngineering and Rehabilitation. 6: 20. doi:10.1186/1743-0003-6-20. PMC 2710333. PMID 19531254.
  6. Balasubramanian, Sivakumar; Colombo, Roberto; Sterpi, Irma; Sanguineti, Vittorio; Burdet, Etienne (2012). "Robotic Assessment of Upper Limb Motor Function After Stroke". American Journal of Physical Medicine & Rehabilitation. 91 (11 Suppl 3): S255–69. doi:10.1097/PHM.0b013e31826bcdc1. PMID 23080041.
  7. Krebs, Hermano; Ferraro, Mark; Buerger, Stephen P; Newbery, Miranda J; Makiyama, Antonio; Sandmann, Michael; Lynch, Daniel; Volpe, Bruce T; Hogan, Neville (2004). "Rehabilitation robotics: pilot trial of a spatial extension for MIT-Manus". Journal of NeuroEngineering and Rehabilitation. 1 (1): 5. doi:10.1186/1743-0003-1-5. PMC 544952. PMID 15679916.
  8. Carrera, Isela; Moreno, Héctor A.; Saltarén, Roque; Pérez, Carlos; Puglisi, Lisandro; Garcia, Cecilia (2011). "ROAD: domestic assistant and rehabilitation robot". Medical & Biological Engineering & Computing (Submitted manuscript). 49 (10): 1201–11. doi:10.1007/s11517-011-0805-4. PMID 21789672.
  9. Munih, Marko; Bajd, Tadej (2011). "Rehabilitation robotics". Technology and Health Care. 19 (6): 483–95. doi:10.3233/THC-2011-0646. PMID 22129949.
  10. http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=5ecab354-724d-427f-a5cd-38090fcf44b0%40sessionmgr112&vid=8&hid=103%5B%5D%5B%5D
  11. http://www.inmotionrobots.com%5B%5D
  12. http://www.reha-stim.de/cms/index.php?id=60%5B%5D
  13. Tong, K Y; Ho, S K; Pang, P M K; Hu, X L; Tam, W K; Fung, K L; Wei, X J; Chen, P N; Chen, M (2010). An intention driven hand functions task training robotic system. 2010 Annual International Conference of the IEEE Engineering in Medicine and Biology. 2010. pp. 3406–9. doi:10.1109/IEMBS.2010.5627930. hdl:10397/38074. ISBN 978-1-4244-4123-5. PMID 21097247.
  14. Tefertiller, Candace; Pharo, Beth; Evans, Nicholas; Winchester, Patricia (2011). "Efficacy of rehabilitation robotics for walking training in neurological disorders: A review". The Journal of Rehabilitation Research and Development. 48 (4): 387–416. doi:10.1682/JRRD.2010.04.0055. PMID 21674390.
  15. Darbois, Nelly; Guillaud, Albin; Pinsault, Nicolas (2018). "Does Robotics and Virtual Reality Add Real Progress to Mirror Therapy Rehabilitation? A Scoping Review". Rehabilitation Research and Practice. 2018: 6412318. doi:10.1155/2018/6412318. PMC 6120256. PMID 30210873.
  16. http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=5ecab354-724d-427f-a5cd-38090fcf44b0%40sessionmgr112&vid=9&hid=103%5B%5D
  17. Flinn, Nancy A.; Smith, Jennifer L.; Tripp, Christopher J.; White, Matthew W. (2009). "Effects of robotic-aided rehabilitation on recovery of upper extremity function in chronic stroke: a single case study". Occupational Therapy International. 16 (3–4): 232–43. doi:10.1002/oti.280. PMID 19593735.
  18. Guzmán-Valdivia, C. H.; Blanco-Ortega, A.; Oliver-Salazar, M. A.; Gómez-Becerra, F. A.; Carrera-Escobedo, J. L. (2015-09-01). "HipBot – The design, development and control of a therapeutic robot for hip rehabilitation". Mechatronics. 30: 55–64. doi:10.1016/j.mechatronics.2015.06.007.
  19. Hillman, Michael (2004). "2 Rehabilitation Robotics from Past to Present – A Historical Perspective". In Bien, Z. Zenn; Stefanov, Dimitar (eds.). Advances in Rehabilitation Robotics. Lecture Notes in Control and Information Science. 306. pp. 25–44. doi:10.1007/10946978_2. ISBN 978-3-540-44396-4.
  20. Krebs, H.I.; Palazzolo, J.J.; Dipietro, L.; Ferraro, M.; Krol, J.; Rannekleiv, K.; Volpe, B.T.; Hogan, N. (2003). "Rehabilitation Robotics: Performance-Based Progressive Robot-Assisted Therapy". Autonomous Robots. 15 (1): 7–20. doi:10.1023/A:1024494031121.
  21. "MiR investor sees great opportunities in ROBERT® - Life Science Robotics". www.lifescience-robotics.com. Retrieved 2020-08-05.

Further reading
  • Selzer, Michael E.; Clarke, Stephanie; Cohen, Leonardo G. (2006). Textbook of Neural Repair and Rehabilitation: Medical neurorehabilitation.
  • Cooper, Rory A. (1995). Rehabilitation Engineering Applied to Mobility and Manipulation.

Current Groups studying rehabilitation robotics

This list is not meant to be exclusionary, but meant to direct interested readers to institutions working with rehabilitation robotics:

This extensive list of labs in the United Kingdom: http://rehabilitationrobotics.net/cms/?q=node/2

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