Summary: Robot-assisted devices are a key tool in neurorehabilitation. Their utilization, however, has been a subject of heated controversy. Critics consider the benefits of these therapy devices to be insufficiently evidence-based and too costly to use. Proponents of the great benefits of robotics, on the other hand, are convinced of their efficacy, if used properly. These technologies aim to support training for patients and therapists, to make it more motivating and to perform it at the highest possible repetition level, thereby improving the overall forecast. Technological progress has brought about a variety of robotic therapy systems for neurorehabilitation in recent years. This article describes the challenges and opportunities in the clinical integration of the robot-assisted rehabilitation technology.
Robot-assisted devices are an important tool in neurorehabilitation. They bring great benefits to therapists and patients.
Robots are used where they can perform repetitive human activities reliably and with at least the same precision, but often faster and without getting tired. Neurorehabilitation aims at restoration of functions that have been lost. Robots can be used effectively because the lost functions are best regained through high-frequency, repetitive exercises.
In neurological disorders, there are often physical and mental limitations that require individualized concepts to enable safe and effective implementation of the training and rehabilitation programs. Commonly used training aids, such as treadmill, bicycle ergometer or leg press in strength training are particularly suitable for moderately restricted patients who have a certain degree of motor control. Patients with severe motor impairments are faced with great challenges due to their intensive and individual sports training programs. Inability to walk, poor posture control or dyscoordination of the affected limbs, and inadequate cognitive functions can affect or even prevent the implementation of the training and rehabilitation measures. In this regard, robot-assisted systems can be helpful in overcoming such obstacles by supporting and controlling the required movements. In addition, these can be used in combination with virtual reality to turn repetitive movement exercises into exciting tasks with playful features.
What is a robot?
A robot is currently defined as a multiaxial, programmable, sensor-guided, automated moving machine that can manipulate objects. In neurorehabilitation, various robot-based therapy systems are used. Basically, a distinction is made between:
- Exoskeleton-based technology: A body-adapted exoskeleton that moves the extremities directly.
- End effector-based technology: Limbs are moved via foot plates and / or handles.
For the upper extremities, mainly stationary solutions have been developed, which allow for the training of the shoulder-arm-hand functions. In the area of the lower extremities, the development is concentrated mainly on restoring the ability to walk. A major challenge is the introduction of practical everyday training programs using location-independent systems. There are also highly specialized robot-based systems that try to relieve or guide the body weight of humans as efficiently as possible to create a challenging training environment.
The latest developments include the so-called wearable robots adapted to the human body, which ensure precisely adapted support for physical movements.
The next generation of portable robotic technologies is being developed. The so-called soft robots are innovative materials that simulate the muscles, tendons and ligaments of the human body to support movements and avoid overloads.
Complementary rather than substitutive
The fear that the therapeutic efforts could be replaced by robots and dehumanized is unfounded. Research findings show that robot-assisted training effectively complements conventional therapy. A meta-analysis confirms that the persons provided with locomotion therapy after a stroke regain walking ability faster than those treated with conventional measures alone.
Traditionally, training sessions are offered by therapists in intensive sessions. Robot-assisted training could increase the therapeutic efficiency because the personal care ratio improves and one therapist can treat more patients at the same time, thus making the work of specialist healthcare staff much easier and providing more time for clinical decision-making, counseling and patient motivation. In addition, there are benefits for patients, as they can be treated at the same cost with higher therapeutic intensity, which has a positive effect on the treatment results.
What does the future have in store?
The development and establishment of technology-based training, research and development and educational centers is necessary for implementing the latest scientific findings in the rehabilitation of functional, sensomotoric and cognitive disabilities.
The medical, demographic and sociocultural development with the increasingly aging active population who want to maintain their independent living for as long as possible, will increase the demand for neurorehabilitation services in the future, which is why the resources must be used very efficiently.
Robotics and other digital forms of therapy will shift therapeutic tasks to counseling and motivational coaching. Implementation of this technological development and its integration into therapeutic training programs pose a real challenge for therapeutic professions.
Co-authored by Dr. Oliver Stoller and Dr. med Daniel Zutter (Chief Physician) of the Rehabilitation Clinic Zihlschlacht. The Rehabilitation Clinic Zihlschlacht, a VAMED healthcare facility, is a leading Swiss clinic for neurologic Rehabilitation.
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