Paralysis Treatment with Robotic Devices: Arm and leg functions should be restored in order to restore the independence of the stroke patient in daily living activities. This requires rehabilitation. Stroke rehabilitation consists of intensive, repetitive, and task-oriented movements. Exercises that meet these conditions improve muscle strength, fluidity in movements, and functional use parameters of patients with stroke. One way to reach the required intensity in stroke rehabilitation is the use of robotic devices. Paralysis treatment with robotic devices, along with other components of stroke rehabilitation, enables task-specific movements to be performed with abundant repetitions under the supervision of a physiotherapist. In addition to exercising, robotic devices allow to objectively measure the patient’s characteristics such as range of motion and muscle strength.
Integration of robotic devices with physical therapy is also beneficial for giving rehabilitation to each patient at a certain standard. The physical fatigue of the physiotherapist is reduced and he can focus his attention on the more functional part of the exercise. Thus, the total effect and efficiency of rehabilitation increases.
Movement of the arm and leg joints with the help of a machine is a part of robotic treatment. The other part of the treatment is to give feedback to the patient about his / her movement. There are devices that provide visual, auditory, and tactile feedback to the patient. Virtual reality and augmented reality technologies are integrated with most robotic devices. Thus, treatment motivation increases, and the patient is immediately informed about the success of his movement. Exercises involving manipulation of surrounding objects and simulating daily life activities are more effective in hand and arm rehabilitation instead of repeating purposeless movements. Robotic rehabilitation is suitable for doing exercises for the purpose.
Paralysis Treatment with Robotic Devices
Paralysis Treatment with Robotic Devices: Machines used for arm and hand rehabilitation
Existing hand and arm robotic devices can be classified as follows:
- The hand-arm function they focus on (unilateral or bilateral shoulder, elbow, wrist, and hand movements);
- Mechanical properties (exoskeleton or operational machines);
- Control strategy; robots can be programmed to do a variety of exercises.
Machines used for leg joints and walking rehabilitation
Automatic electromechanical walking machines began to be developed in the 1990s.
- Robotic exoskeleton orthosis; for example Lokomat.
- Electromechanical devices simulating walking phases (end-effector system), comprising two movable footplates; for example Gait Trainer.
Stroke treatment efficiency with robotic devices
The first robotic system for rehabilitation was introduced in 1995 (MIT-Manus). Since then, the effect of robotic therapy in stroke patients has been extensively studied. The results are generally satisfactory. While there is no doubt about the potential benefits of robotic therapy, whether it is superior to traditional physical therapy approaches is still a controversial issue. The general belief and common practical applications are that robotic rehabilitation alone is not enough, it is a tool that can be used in combination with other physical therapy methods. Appropriate robotic treatment should be selected by considering the clinical condition and needs of the patient.
Leg and arm joints
Hand and arm robots improve arm function and performance in daily life activities of stroke patients. Although the effect of intensive treatment is faster in the early post-stroke period, robotic treatment can be beneficial even in strokes that have passed years. There is no standard procedure for robotic treatment for hand and arm functions, treatment is planned according to the patient’s condition.
Scientific studies show that the use of walking robots in combination with traditional physical therapy increases the rate of independent walking again.
Proximal and distal joints to the trunk
There is a trend towards using devices that focus on the shoulder and elbow joints near the body in arm robots. Although scientific studies show that these devices reduce the duration of hospital stay and physiotherapist workload, it is still controversial whether they make a difference in terms of the final functional level reached by the patient.
The right-left bilateral and unilateral approach
Stroke patients are usually affected by the right or left half of the body. However, there are unilateral and bilateral motion approaches among robotic devices. Although it is thought that devices that operate these limbs right and left bilaterally may be more successful in restoring both arm and leg functions, scientific data are still insufficient. In fact, both approaches can be superior in some areas of rehabilitation over the other.
End-effector and exoskeleton robots
In end-effector robots, the patient’s hands or feet, that is the end organs, are placed on a support surface and their movement is provided in a certain line. The exoskeleton moves the joints. For example, in robotic walking training, ankles, knees, and hips are controlled by the robot. Both types of robots have body weight support. With bodyweight support, exercises can be done longer and with more repetitions.
End-effector devices allow the patient to open the knee more easily. However, maintaining balance can be more difficult. The walking cycle is more easily controlled with exoskeleton devices. There are not many scientific studies comparing these two systems with each other in patients with stroke.
Who benefits most from robotic physical therapy?
Is robotic therapy beneficial for all stroke patients? Patients with more severe impairment of walking function benefit more from walking robots. Patients with a mild stroke can start standing and walking exercises early, even without robotic devices. Robotic methods do not replace classical physical therapy methods, they are used to support each other. The psychological state of the patient affects the success of robotic therapy. Its effect may be limited in patients with high anxiety-anxiety level.
The top-down and bottom-up approach
Most robotic devices and traditional physical therapy methods are based on the “bottom-up” approach, in which arm and leg movements affect the central nervous system, increasing recovery. However, it is becoming widespread that the “top-down” approach, in which the active participation of the patient is prominent, should be integrated into treatments. Brain-computer interface systems allow specific neurophysiological signals to be recorded and deciphered and expressed as a movement in movement organs. Brain-computer interface systems provide the patient with movement-related biofeedback. Another “top-down” approach is non-invasive brain stimulation. Research continues on the use of this technique with robotic devices.
In the light of the rapid developments in rehabilitation technologies, the value of robotic physical therapy methods in the ideal rehabilitation program is increasing. Robotic treatments are applied for both arm and leg movements in order to increase the function, activity and participation of the stroke patient. Exactly how different rehabilitation approaches affect the central nervous system’s self-rearrangement is still under investigation and is not known in full detail.
Stroke and stroke treatment using robotic devices is rapidly developing, new technologies such as virtual reality and tactile interfaces are being integrated in the light of neuroscience and rehabilitation theories. Robotic rehabilitation is increasingly used in the rehabilitation of stroke, brain injury and spinal cord injuries. On the other hand, machine-mediated neurorehabilitation also faces some difficulties in terms of engineering and clinical practice. Robotic devices should be designed to maximize patient compliance and provide a safe treatment environment for the patient and therapist. The ease-of-use of the devices is another matter to be considered. The benefit of new devices must be supported by clinical studies.
Ideally, machine-mediated rehabilitation should be accessible for stroke or brain injured patients within a few days of the first event and can be used during the rehabilitation process at the direction of the physical therapy and rehabilitation specialist and physiotherapist. Intensive rehabilitation with hand and arm robots is more efficient, especially in terms of achieving daily life activities in the early period.
The ideal walking robot may differ for patients with early moderate to severe paralysis and mild paralysis. In the early stages of moderate-severe stroke, robotic devices can be used to enable the passive patient to stand up and perform walking exercises. In mild strokes, walking robots with more participation of the patient can be preferred.
- Masiero S, Poli P, Rosati G, Zanotto D, Iosa M, Paolucci S, Morone G. The value of robotic systems in stroke rehabilitation. Expert Rev Med Devices. 2014 Mar; 11 (2): 187-98.