Rehabilitation robotics

Abstract

This chapter focuses on rehabilitation robotics which can be used to augment the clinician's toolbox in order to deliver meaningful restorative therapy for an aging population, as well as on advances in orthotics to augment an individual's functional abilities beyond neurorestoration potential. The interest in rehabilitation robotics and orthotics is increasing steadily with marked growth in the last 10 years. This growth is understandable in view of the increased demand for caregivers and rehabilitation services escalating apace with the graying of the population. We provide an overview on improving function in people with a weak limb due to a neurological disorder who cannot properly control it to interact with the environment (orthotics); we then focus on tools to assist the clinician in promoting rehabilitation of an individual so that s/he can interact with the environment unassisted (rehabilitation robotics). We present a few clinical results occurring immediately poststroke as well as during the chronic phase that demonstrate superior gains for the upper extremity when employing rehabilitation robotics instead of usual care. These include the landmark VA-ROBOTICS multisite, randomized clinical study which demonstrates clinical gains for chronic stroke that go beyond usual care at no additional cost.

Fig. 23.1

Percentage of population above 65 years of age (UN 2008 Data Series). (Courtesy of IEEE Robotics and Automation Magazine and Professor Henrik Christensen: IEEE, 2010.)

Fig. 23.2

Number of hits of academic papers and keywords.

Fig. 23.3

Myomo e100 and Tybion. They can actuate the elbow and knee of stroke patients. (Courtesy Tybion and J. Stein, Department of Rehabilitation and Regenerative Medicine, Columbia University and Division of Rehabilitation Medicine, Weill Cornell Medical College.)

Fig. 23.4

Re-Walk from Argo. (Courtesy of A. Esquenazi, Department of Physical Medicine and Rehabilitation, Moss Rehabilitation Hospital.)

Fig. 23.5

MIT Gym of Robots (commercialized by Interactive Motion Technologies, Watertown, MA). (A) MIT-Manus to promote neurorecovery of the injured brain and control of the shoulder and elbow segments; (B) the antigravity to promote training of the shoulder against gravity. (C) The wrist robot which affords training of the 3 degrees of freedom of the wrist and forearm; (D) the hand module for grasp and release. (E) The combination of shoulder and elbow robot with the wrist module mounted at the tip of first affording training for both transport of arm and object manipulation; (F)a sketch of the alpha-prototype of the MIT-Skywalker for gait training. (G) Pediatric population working with the MIT-Manus and (H) our pediatric Anklebot that affords training in dorsi/plantarflexion and inversion/eversion.

Fig. 23.6

Examples of rehabilitation robots. (A) The Lokomat (Hocoma, Switzerland) which is an exoskeletal robot to manipulate patient’s hip and knee. (B) The Gait Trainer I and (C) the G-EO (Reha-Stim, Germany), which are end-effector robots that manipulate tje patient’s foot. (D) The Bimanutrak for bimanual training of wrist and forearm (Reha-Stim, Germany). (E) Osaka University’s shoulder and elbow robot (Asahi Chemical Industry) and (F) the Amadeo to manipulate the individual fingers (Tyromotion, Austria).

Fig. 23.7

Meta-analysis of robot-assisted therapy trials on motor recovery following stroke. (Kwakkel et al., 2009).

Fig. 23.8

Burke inpatient studies (N = 96). Mean interval change in the Motor Power Scale (Volpe et al., 2001) (significance p<0.05). Mean ± standard error Motor Power scores (maximum score 20) of 96 patients on admission before rehabilitation, at discharge after rehabilitation, and robotic training or control, and at follow-up evaluation approximately 3 years after stroke. Robot-trained patients maintain the motor improvements. *P<0.05, versus control.

Fig. 23.9

ROBOTICS (CSP-558) primary results at 12 weeks (therapy completion). Left panel shows the changes in the primary outcome for the robot and usual care groups during the initial half of the trial. Right panel shows the changes in the primary outcome for the robot and intensive comparison training groups during the whole duration of the trial. Red vertical arrow indicates the change in the primary outcome of the complete robot group in relation to the usual care group.

Fig. 23.10

ROBOTICS (CSP-558) results at 36 weeks (after 6 months follow-up). The figure shows the changes in the primary outcome over the duration of the intervention (evaluations at 6 and 12 weeks) and during the 6-month follow-up period (evaluations at 24 and 36 weeks). Both panels also show the estimated changes at 36 weeks using a fixed-model to fit all the data (overall). Left panel shows results for robot and usual care groups during the initial half of the study. Right panel shows results for the robot and intensive comparison training groups during the whole duration of the trial. Note that the robot group continues to improve after the intervention is completed (see evaluations at 24 and 36 weeks). Red vertical arrow indicates the actual change in the primary outcome of the complete robot group in relation to the intensive comparison training group at 36 weeks (instead of the overall fixed-model estimate shown on the right).