WRITE A NOTE ON ROLE OF ROBOTICS IN REHABILITATIVE PRACTICE ? 10 MARKS
A 2 INTRODUCTION
1 Rehabilitation robotics is a field of research dedicated to understanding and augmenting rehabilitation through the application of robotic devices.
2 Rehabilitation robotics includes development of robotic devices tailored for assisting different sensorimotor functions (e.g. arm, hand, leg, ankle ), development of different schemes of assisting therapeutic training and assessment of sensorimotor performance (ability to move) of patient; here, robots are used mainly as therapy aids instead of assistive devices.
3 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.
4 Rehabilitation robotics can be considered a specific focus of biomedical engineering, and a part of human-robot interaction.
In short , In this field - clinicians, therapists, and engineers collaborate to help rehabilitate patients.
PURPOSE / GOAL
Prominent goals in the field include -
1 developing implementable technologies that can be easily used by patients, therapists, and clinicians; enhancing the efficacy of clinician’s therapies
2 increases the ease of activities in the daily lives of patients.
3 help people recognizing objects through touch and for people who suffered from nervous system disorder.
4 The Rehabilitation robot is used in the process of recoperation of a disabled persons in a standing up, balancing and gait
FUNCTION
1 The rehabilitation robots are designed with applications of techniques that determine the adaptability level of the patient.
A ) There are different techniques such as -
1 ) active assisted exercise - In active assisted exercise, the patient moves his or her hand in predetermined pathway without any force pushing against it.
2 ) active constrained exercise -
( 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 )
OR
3 ) active resistive exercise -
A ) Active resistive exercise is the movement with opposing forces.
B ) These machines MIT-Manus, Bi-Manu-Track and MIME make the active resistive exercise possible
4 ) passive exercise
5 ) adaptive exercise.
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.
2 Having Robots involved in the rehabilitation of a patient has a few positive aspects -
A ) One of the positive aspects is the fact that you can repeat the process or exercise as many times as you wish.
B ) Another positive aspect is the fact that you can get exact measurements of their improvement or decline - can get the exact measurements through the sensors on the device.
C ) The rehabilitation robot can apply constant therapy for long periods.
D ) are very popular with people who have suffered a stroke because the proprioceptive neuromuscular facilitation method is applied.
E ) are helpful in restoring functions of upper limb ( vv imp )
TYPES OF ROBOTS USED IN STROKE ***
1 IN MOTION 2 -
A ) 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.
2 HIP BOT
A ) The Hipbot is a robot used in patients with limited mobility.
B ) The hip is an important joint in the human body, it supports our weight and allows the movement and statically position.
C ) When people suffer a fracture by an accident or have problems in this location, need to improve a rehabilitation process.
D ) This robot helps in this cases, because it combines movements of abduction/adduction and flexion/extension that help the patients to restore their mobility.
E ) 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).
3 NEWER ROBOTS / ROBOTIC TECHNOLOGY
A ) 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
B ) enhanced treadmills such as Hocoma’s Lokomat
C ) robotic arms to retrain motor movement of the limb such as the MIT-MANUS, and finger rehabilitation devices such as tyromotion’s AMADEO.
ADVANTAGES OF ROBOTS / ROBOTIC TECHNOLOGY
A ) attempts to leverage the principles of neuroplasticity by improving quality of movement, and increasing the intensity and repetition of the task.
B ) 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
C ) Though stroke has been the focus of most studies due to its prevalence in North America, rehabilitation robotics can also be applied to individuals (including children) with cerebral palsy,or those recovering from orthopaedic surgery.
D ) 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 -
1 The responsive software allows the robot to alter the amount of assistance it provides, based on the patient’s speed and timing of movement.
2 This allows for a more personalized treatment session without the need for constant therapist interaction.
3 An additional benefit to this type of adaptive robotic therapy is a marked decrease in spasticity and muscle tone in the affected arm.
4 Different spatial orientations of the robot allow for horizontal or vertical motion, or a combination in a variety of planes - The vertical, anti-gravity setting is particularly useful for improving shoulder and elbow function.
5 Rehabilitation robotics may also include virtual reality technology.
SUMMARY - EVIDENCE BASED PRACTICE
A ) In summary, robotic therapy involves an interactive high-intensity, intention-driven therapy based on motor learning principles and assist-as-needed leads to better outcomes than usual care in chronic stroke (and probably with even greater impact in acute/subacute stroke).
B ) On September 28, 2010 the American Heart Association (AHA) issued “The Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient: A Scientific Statement from the American Heart Association” (Miller et al., 2010).
C ) It is recommended that: “Robot-assisted therapy offers the amount of motor practice needed to relearn motor skills with less therapist assistance.
D ) Most robots for motor rehabilitation not only allow for robot assistance in movement initiation and guidance but also provide accurate feedback; some robots additionally provide movement resistance.
E ) Most trials of robot-assisted motor rehabilitation concern the upper extremity (UE), with robotics for the lower extremity (LE) still in its infancy. . . Robot-assisted UE therapy, however, can improve motor function during the inpatient period after stroke.”
F ) The AHA suggested that robot-assisted therapy for the upper extremity has already achieved Class I, Level of Evidence A for Stroke Care in the Outpatient Setting and Care in Chronic Care Settings.