Rehabilitation applied with robotic devices is called robotic rehabilitation. It is most commonly used in the physical therapy of neurological problems such as stroke, brain injury, and spinal cord paralysis. With robotic rehabilitation, standardized, long-term, repetitive, and intensive treatment can be applied to the person. It is a rehabilitation method with high patient compliance. Even people who cannot move their arms and/or legs at all can do many exercises with robotic devices, including walking exercises. The patient’s motivation can be further increased by combining the treatment program with virtual or augmented reality. Rehabilitation of neurological diseases is a kind of learning process in which neural circuits are reconstructed. Being motivated and plenty of repetition is the basis of learning.
Physical therapy of many diseases affecting the central nervous system is based on the principle of retraining movements such as hand grasping or walking. Robotic rehabilitation is a great tool in this regard. However, it should not be seen as a miracle cure alone. When used with other physical therapy methods, it supports them and increases their effect. The majority of patients who can benefit from robotic rehabilitation actually need a multidisciplinary and inclusive rehabilitation approach.
In Which Diseases Can Robotic Rehabilitation Be Used?
- Post-stroke paralysis (hemiplegia)
- Traumatic brain injury
- Paralysis due to spinal cord injury (paraplegia, tetraplegia)
- Children with cerebral palsy
- Parkinson’s disease
- Multiple sclerosis
- Various muscle diseases
Robotic Rehabilitation for Arm and Hand
It is mostly used to provide movement to the shoulder, elbow, and hand joints in patients with post-stroke paralysis (hemiplegia). However, it can also be preferred in other neurological problems with arm weakness. Hand robotic rehabilitation should be considered as a complementary and enhancer, not an alternative to one-to-one therapy with a physiotherapist and occupational therapist.
Robotic Rehabilitation for Walking
It is mostly applied in patients with post-stroke (hemiplegia) and spinal cord paralysis, but it is also used in other diseases mentioned above.
For normal walking, the brain, spinal cord, nerves to the muscles, muscles, sensory nerves, and the balance system must work in coordination. Problems with any of these items can lead to gait disturbance or inability to walk.
While walking, we do not think about exactly where we stretch our feet, which muscle we contract, and how much we bend which joint. Our brain gives general instructions for walking, and the nerve circuits in our spinal cord provide the nerve impulses needed for walking to the muscles largely automatically. This instruction, which is available in our spinal cord for the act of walking, shows itself in the stepping movement of babies who are only 2-3 months old when they are held upright and their feet touched a surface. Many rehabilitation approaches to re-run patients with spinal cord paralysis are based on this basis.
Does Robotic Rehabilitation Make Spinal Cord Paralyzed Patients Walk Again?
In spinal cord paralysis, the connection between the brain and the lower parts of the spinal cord is cut. But mostly this is not a complete rupture. In most patients, there are connections that remain intact, although clinical signs are not visible.
The more we repeat an action, the stronger the connections associated with that action in the central nervous system. The basis of learning is repetition. This is a double-sided path. Just as commands go from the brain to the muscles, the body sends feedback signals to the brain. Bodyweight-assisted treadmill or robotic physical therapy, even if the person cannot walk on their own when you stand up with walking movements, the signals of the pressure caused by walking, muscle lengthening and shortening, changes in joint position are transmitted to the central nervous system. After this spinal cord injury, it can stimulate the nerve circuits that went into shock and remained idle due to the effect of not receiving stimulation for a long time. Of course, these applications have a greater effect on people who can make voluntary muscle contraction and movement, even if a little. However, we know that even people with no measurable movement or sensation have solid conduction pathways that are asleep, and rehabilitation is also beneficial for these individuals. Standing up and performing walking movements passively is also beneficial in terms of the prevention of osteoporosis, improvement of blood pressure, and circulation.
Sensors in the robotic rehabilitation device can measure the degree to which the patient participates in motion and give clues as to which movement he/she needs to develop more. It can be combined with virtual reality and increase patient motivation. Motivation and attention are factors that facilitate the establishment of new neural circuits.
Who is Robotic Rehabilitation Applied to?
Robotic rehabilitation for legs is applied to patients who cannot stand up on their own or with assistive devices. There may be a risk of injury when people who have no strength and feeling in their legs are tried to be kept alive with human power. When robotic rehabilitation is performed by experts, the risk of harm to the patient is low and treatment can be applied for longer periods compared to manpower. Apart from this, robotic rehabilitation is used to strengthen the weak muscles and correct the walking style for people who can stand up on their own but have impaired walking style.
Robotic rehabilitation for hand and arm is used in people who cannot move these limbs due to paralysis or whose movements are reduced.
In general, robotic rehabilitation should be considered not alone, but as complementary to other physical therapy and rehabilitation methods.
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