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. 2006 Sep 1;94(9):1727-1738.
doi: 10.1109/JPROC.2006.880721.

Therapeutic Robotics: A Technology Push: Stroke rehabilitation is being aided by robots that guide movement of shoulders and elbows, wrists, hands, arms and ankles to significantly improve recovery of patients

Hermano Igo Krebs  1 , Neville Hogan
Affiliations

Therapeutic Robotics: A Technology Push: Stroke rehabilitation is being aided by robots that guide movement of shoulders and elbows, wrists, hands, arms and ankles to significantly improve recovery of patients

Hermano Igo Krebs et al. Proc IEEE Inst Electr Electron Eng. .

Abstract

In this paper, we present a retrospective and chronological review of our efforts to revolutionize the way physical medicine is practiced by developing and deploying therapeutic robots. We present a sample of our clinical results with well over 300 stroke patients, both inpatients and outpatients, proving that movement therapy has a measurable and significant impact on recovery following brain injury. Bolstered by this result, we embarked on a two-pronged approach: 1) to determine what constitutes best therapy practice and 2) to develop additional therapeutic robots. We review our robots developed over the past 15 years and their unique characteristics. All are configured both to deliver reproducible therapy but also to measure outcomes with minimal encumbrance, thus providing critical measurement tools to help unravel the key question posed under the first prong: what constitutes "best practice"? We believe that a "gym" of robots like these will become a central feature of physical medicine and the rehabilitation clinic within the next ten years.

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Figures

Fig. 1
Fig. 1
Planar shoulder-and-elbow stroke therapy. The left photo shows a person with acute stroke (inpatient), while the photo on the right shows a child with cerebral palsy during robot training at Spaulding Rehabilitation Hospital.
Fig. 2
Fig. 2
Vertical 1-DOF module using linear electromechanical technology. This commercial version of MIT’s prototype module can be operated in standalone fashion or integrated with the planar module to allow spatial movements. Note that in the standalone mode it can be operated at any angle relative to the horizontal and vertical planes with adjustable handle positions. The left photo demonstrates an example of subject positioning during therapy aimed at neurological recovery. The right photo demonstrates an example of subject positioning during therapy aimed at orthopedic recovery following rotator cuff surgery (Courtesy Baltimore Veterans Administration Medical Center).
Fig. 3
Fig. 3
Wrist robot. The top row shows solid models of the prototype design. The middle row shows the device during therapy at Burke Rehabilitation Hospital (left) and the achievable impedance range of the device (right) in pronation and supination. The bottom row shows measurement of a person with chronic left hemiparesis due to stroke prior to (left) and after (right) training with the wrist robot.
Fig. 4
Fig. 4
Hand robot. The left columns show solid models of the device. The middle column sketches the principle of operation, while the right column shows the device during operation (some shells were removed for clarity). Note the black line indicating the rotation of both the rotor and stator.
Fig. 5
Fig. 5
Reconfigurable robotic modules. The robotic therapy modules can operate in standalone mode or be integrated into a coordinated functional unit. The left panel shows a solid model and the right panel shows a hardware implementation of the planar (elbow & shoulder) and wrist modules integrated into a single unit.
Fig. 6
Fig. 6
Anklebot Beta-prototype for foot drop. (a) Shows shoes and knee-braces of different sizes. (b) Shows quick connect/release cleat, while (c) shows a solidworks representation of the shoe stepping into the locking mechanism, (d) shows the actual prototype, (e) shows an unimpaired subject using the device in a sitting position during driving-simulator training, and (f) and (g) show the same subject during treadmill walking.
Fig. 7
Fig. 7
Anklebot kinematic comparison during treadmill training with asymmetric loading due to the ankle prototype with unimpaired subject. The left column shows plantar-dorsiflexion (deg), the middle columns shows inversion-eversion (deg), and the right column shows knee angle (deg). The top row shows an unimpaired subject walking in the device (teach mode) and the bottom row shows data from another unimpaired subject during training (playback mode). The teach mode reference gait is wrapped-around, which allows to extend the duration of training as needed.
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References

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