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] leg, ankle[3]), development of different schemes of assisting therapeutic training,[4] and assessment of sensorimotor performance (ability to move)[5] of patient; here, robots are used mainly as therapy aids instead of assistive devices.[6] 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 Seattle, USA in 2013 ; an upcoming conference is scheduled for 2015 in Singapore. 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.[7] 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.The Rehabilitation robot is used in the process of recoperation of a disabled persons in a standing up, balnacing and gait.[7] Since, these robots are rehabilitation robots it needs to keep up with a human and their movement. In the making of a rehabilitation robot the makers need to be sure that the robot will be able to be consistent with the human. These robots are designed and put together very carefully because they are working with people who are in disabled and not able to react quickly in case something goes wrong.[8]

Function

The rehabilitation robots are designed with applications of techniques that determine the adaptability level of the patient. There are different techniques such as: 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 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. These machines MIT-Manus, Bi-Manu-Track 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 [19,20] support the adaptive exercise possible. The active constrained exercise is supported by all the machines that are mentioned.[8]

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.[8] The rehabilitation robot can apply constant therapy for long periods. The rehabilitation robot is a wonderful device to use according to many therapist and scientist 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.[7] 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, the rehabilitation robotics has 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 multi 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 would have to me more adjustable to its new task.[8]

Current products

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 augemented 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.[7] The pneumatic robot helps people who have had strokes or any other illness that has caused a disorder with their upper limb[9]

Types of Robots

There are different types of robots that can be used in the results of a stroke. The InMotion 2 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. [10]

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).[11]

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.[7]

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.[12] Though stroke has been the focus of most studies due to its prevalence in North America,[6] rehabilitation robotics can also be applied to individuals (including children) with cerebral palsy,[3] or those recovering from orthopaedic surgery.[12]

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.[13] 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. 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.[6] 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, BR; McDowell, SK; Worthen-Chaudhari, LC (Nov–Dec 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): 661–670. doi:10.1097/WCO.0b013e32833e99a4. PMID 20852421.
  3. 1 2 Michmizos, K.,Rossi, S., Castelli, E., Cappa, P., & Krebs H. I. (2015). Robot-Aided Neurorehabilitation: A Pediatric Robot for Ankle Rehabilitation, IEEE Transactions on Neural Systems and Rehabilitation Engineering, 1-11. doi:10.1109/TNSRE.2015.2410773
  4. ↑ Marchal-Crespo, L; Reinkensmeyer, DJ (Jun 16, 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. PMID 19531254.
  5. ↑ Balasubramanian, S; Colombo, R; Sterpi, I; Sanguineti, V; Burdet, E (November 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.
  6. 1 2 3 Krebs, H.I.; et al. (2004). "Rehabilitation robotics: Pilot trial of a spatial extension for MIT-Manus". Journal of Neuroengineering and Rehabilitation 1 (5).
  7. 1 2 3 4 5 Carrera, I.; Moreno, H.; Saltarén, R.; Pérez, C.; Puglisi, L.; Garcia, C. (2011). "ROAD: domestic assistant and rehabilitation robot". Medical & Biological Engineering & Computing 49 (10): 1201–1211. doi:10.1007/s11517-011-0805-4.
  8. 1 2 3 4 Munih, M.; Bajd, T. (2011). "Rehabilitation robotics". Technology & Health Care 19 (6): 483–495.
  9. ↑ Tefertiller, C.; Pharo, B.; Evans, N.; Winchester, P. (2011). "Efficacy of rehabilitation robotics for walking training in neurological disorders: A review". Journal of Rehabilitation Research & Development 48 (4): 387–416. doi:10.1682/JRRD.2010.04.0055.
  10. ↑ FLINN, N. A., SMITH, J. L., TRIPP, C. J., & WHITE, M. 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), 232-243. doi:10.1002/oti.280
  11. ↑ 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.
  12. 1 2 Hillman, M. (2004). Rehabilitation robotics from past to present: A historical perspective. In Z.Z. Bien & D. Stefanov (Eds.), Advances in Rehabilitation Robotics (25-44). Berlin: Springer-Verlag.
  13. ↑ Krebs, H.I.; et al. (2003). "Rehabilitation robotics: Performance-based progressive robot-assisted therapy". Automatic Robots 15: 7–20.

Textbook of Neural Repair and Rehabilitation: Medical neurorehabilitation(2006) by Michael E. Selzer, Stephanie Clarke, Leonardo G. Cohen

Rehabilitation Engineering Applied to Mobility and Manipulation (1995) by Rory A. Cooper

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

Additional External links

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