RehabWire - Volume 9, Number 3, April 2007.

Robotics in Rehabilitation

Is the future of rehabilitation in the hands of robots? Visit this month's projects to find out!

NIDRR Grantees on the Cutting Edge.

University of Pittsburgh Brain Injury Model System (UPBI), University of Pittsburgh (H133A020502) led by Ross D. Zafonte, DO. Phillip Beatty, Project Officer.
Abstract: The research focus of the University of Pittsburgh Brain Injury Model System is on innovation in rehabilitation technology for persons with TBI. The project evaluates the impact of selected innovations in technology on service delivery, functional outcome, and as a therapeutic intervention. Collaboration with the Robotics Institute at Carnegie Mellon University allows researchers to perform a randomized trial evaluating the efficacy of virtual reality and robotics for persons with TBI.
Find out more at: www.umc.pitt.edu/tbi/

RRTC on Technology Promoting Integration for Stroke Survivors: Overcoming Social Barriers, Rehabilitation Institute Research Corporation (H133B031127) led by Elliot J. Roth, MD. Thomas Corfman, Project Officer.
Abstract: This project develops and evaluates a sequence of robotic training and assistive devices that are designed with the idea of promoting efficient function in the workplace or at home, and with the further intent that they form a basis for the development of appropriate technologies to allow people with disabilities ready access to existing facilities in the community. Other projects at this center include: the use of emotionally expressive and narrative writing to facilitate coping and adaptation after stroke; computerized training for conversational scripts that facilitate access to the community and work force; and a consumer-directed, dynamic assessment methodology for evaluating community living and work participation environments and technologies for use by people who have had a stroke.
Find out more at: www.rrtc-stroke.org/

RERC on Rehabilitation Robotics and Telemanipulation: Machines Assisting Recovery from Stroke (MARS), Rehabilitation Institute Research Corporation (H133E020724) led by W. Zev Rymer, MD, PhD. Thomas Corfman, Project Officer.
Abstract: MARS-RERC focuses its research and development on restoring function in hemispheric stroke survivors. Five projects assess different approaches that have the potential to improve performance of the upper extremity, and one project attempts to restore gait and fluid locomotion to the lower extremities. These projects include: the ARM Guide, a robotic therapy for force training of the upper extremity in chronic hemiparetic stroke; Lokomat-Gait restoration in hemiparetic stroke patients using goal-directed, robotic-assisted treadmill training; Augmented Reality Robotic Rehabilitation, which is in the development of a robotic system with an augmented reality interface for rehabilitation retraining of arm function for brain-injured individuals; Robotic Assisted Finger Extension, rehabilitation of finger extension in chronic hemiplegia; and T-WREX, a home-based telerehabilitation system for improving functional hand and arm movement recovery following stroke utilizing an anti- gravity orthosis and video games to track progress. In addition to these projects, MARS- RERC purpose is train undergraduate engineering students, medical students, physician residents, graduate students in engineering and neuroscience, and allied health clinicians, including physical and occupational therapists in the area rehabilitation robotics. The broad intent of MARS-RERC is to develop robotic devices or machines that assist the therapist in providing treatments that are rationally based, intensive, and long in duration.
Find out more at: www.smpp.northwestern.edu/MARS/mars.html

The International Standards Organization (ISO) Definition 8373 defines a robot as "An automatically controlled, reprogrammable, multipurpose, manipulator programmable in three or more axes, which may be either fixed in place or mobile for use in industrial automation applications."

RERC on Spinal Cord Injury: Keep Moving: Technologies to Enhance Mobility and Function for Individuals with Spinal Cord Injury, Los Amigos Research and Education Institute, Inc. (LAREI) (H133E020732) led by Philip Requejo, PhD;Robert Waters, MD. Theresa San Agustin, MD, Project Officer.
Abstract: This RERC improves the lives of individuals with SCI by promoting their health, safety, independence, and active engagement in daily activities. Activities include: (1) monitoring trends and evolving product concepts that represent future directions for technologies in SCI, (2) conducting research to advance the state of knowledge, (3) disseminating the information to the population, (4) developing and testing prototype devices that are useful and effective and transferring them to the marketplace, (5) advancing employment opportunities for individuals with SCI, and (6) developing ways to expand research capacity in the field of SCI. An active Mobile Arm Support for adults allows those with limited arm function greater independence. The shoulder-preserving wheelchair, gait training robotic assist device, and adaptive exercise equipment are all specifically geared to preserve or enhance mobility in individuals with SCI.
Find out more at: www.larei.org

Rehabilitation of Reaching in Chronic Stroke Using an Anti-Gravity Force Field, Rehabilitation Institute Research Corporation (H133G060169) led by Randall F. Beer, PhD. Thomas Corfman, Project Officer.
Abstract: The major goal of this project is to develop, implement, and evaluate a novel robot- mediated therapy to allow stroke survivors to perform reaching movements while gradually integrating the control of posture and movement. The specific aims of this project are: (1) to characterize deficits in reaching as a function of movement direction, external load, and limb orientation with respect to gravity; (2) to investigate potential mechanisms underlying external load effects on reaching kinematics; and (3) to demonstrate the efficacy of a robot-mediated "anti-gravity" force field to rehabilitate reaching in a group of chronic stroke survivors with moderate or severe impairment. Thirty chronic stroke survivors, matched for initial impairment level, are assigned to either Force Field or Free Reaching protocols. The Force Field group trains movements on the Multi-Axial Cartesian-based Arm Rehabilitation Machine (MACARM). The MACARM is used to implement an elastic virtual table that provides subject-specific partial support of the limb against gravity. The Free Reaching group practices unassisted reaching movements. Both groups train three times weekly for eight weeks, with the goal of increasing reaching extent. Therapeutic efficacy is determined based on pre/post comparisons of the outcome measures provided by Aim 1 and clinical measures of motor function, functional independence, and quality of life. Researchers also evaluate the transfer of training effects to untrained movement directions, load conditions, or limb orientations.

Please note: These abstracts have been modified. Full, unedited abstracts, as well as any available REHABDATA citations, are available at naric.com.

The first patented, digitally operated, and teachable robots were used in industrial plants. These days, robots operate vehicles, deliver medical supplies in hospitals, dispose of bombs in combat zones, and even vacuum the family room while you’re at work.

At the robotics lab at Northwestern, a participant demonstrates the ARM Guide, a device to test the efficacy of different upper extremety exercises for stroke survivors.

color photograph of a person using a robotic arm

Current Literature: Selections from REHABDATA

Ivlev, O., Martens, C. (2005) Rehabilitation robots FRIEND-I and FRIEND-II with the dexterous lightweight manipulator. Technology and Disability, 17(2), 111-123. NARIC Accession Number: J49386.
Abstract: Article presents an overview of the semi-autonomous rehabilitation robotic systems, FRIEND-I and FRIEND-II, which are used to support people with upper-limb impairments in daily life situations, as well as in the working environment. The hardware of FRIEND-I is described, which consists of an electric wheelchair and a robot arm, as well as features such as: speech control interface; camera-controlled grasping facility; object identification, grasping, and manipulation; and implementation of the “serve the beverage” task. The newly developed FRIEND-II is equipped with a lightweight robot arm that has a 5-finger artificial hand for dexterous manipulation and humanlike 7-joint kinematics.

Galvez, J., Reinkensmeyer, D. (2005) Robotics for gait training after spinal cord injury. Topics in Spinal Cord Injury Rehabilitation, 11(2), 18-33. NARIC Accession Number: J49699. Project Number: H133E020732.
Abstract: Article reviews research on ways to automate locomotor training through the use of robotics. Robotic devices that have been developed to automate partial body weight support treadmill training include the Mechanized Gait Trainer, the Lokomat, and the AutoAmbulator. Clinical studies involving these systems, the benefits of robotic devices that assist only as needed during motor training, and directions for future research are discussed.

Patton, J., Dawe, G. (2006) Robotics and virtual reality: A perfect marriage for motor control research and rehabilitation. Assistive Technology, 18(2), 181-195. NARIC Accession Number: J51594.
Abstract: Article outlines the motivations, progress, and future objectives for the development of a state-of-the-art device that allows humans to visualize and feel synthetic objects superimposed on the physical world for the purposes of rehabilitation. The platform under development, the Virtual Reality Robotic and Optical Operations Machine (VRROOM), is an augmented reality system combined with a haptic-interface robot. It provides a platform for exploring how the nervous system controls movements, teaching new movements, exploring new strategies for training and rehabilitation, assessing and tracking functional recovery, and testing existing theories of rehabilitation. Because VRROOM is a prototype, it is expected to lead the way to determining the necessary quality levels for future design cycles and related technology.

Huang, G., Peduzzi, P. (2006) Guest editorial: Robotics and clinical research: Collaborating to expand the evidence base for rehabilitation. Journal of Rehabilitation Research and Development, 43(5), xiii-xvi. NARIC Accession Number: J51736.
Abstract: Article provides an overview of robotics-related research funded by the Department of Veterans Affairs (VA). One example shows how the VA has bridged its clinical trials expertise with neurorehabilitation experts in a novel project that uses robots for stroke rehabilitation. The VA studies demonstrate how collaborative clinical research efforts are helping to build scientific evidence for the use of robotics in the medical and rehabilitative care of veterans.

Jaeger, R. (2006) Guest editorial: Rehabilitation robotics research at the National Institute on Disability and Rehabilitation Research. Journal of Rehabilitation Research and Development, 43(5), xvii-xx. NARIC Accession Number: J51737.
Abstract: Article provides an overview of robotics-related research funded by the National Institute on Disability and Rehabilitation Research (NIDRR). NIDRR funding mechanisms for rehabilitation robotics include Rehabilitation Engineering Research Centers, Small Business Innovation Research grants, and field initiated project grants.

Weinrich, M. (2006) Guest editorial: National Institutes of Health support of rehabilitation robotic research. Journal of Rehabilitation Research and Development, 43(5), xxi-xxii. NARIC Accession Number: J51738.
Abstract: Article provides an overview of rehabilitation robotics research funded by the National Institutes of Health (NIH). Current NIH support for research on robotics in rehabilitation includes support for basic science, including fundamental engineering and clinical applications. Support mechanisms range from individual fellowship and career development awards to research project awards and center grants.

Carignan, C., Krebs, H. (2006) Telerehabilitation robotics: Bright lights, big future? Journal of Rehabilitation Research and Development, 43(5), 695-710. NARIC Accession Number: J51746.
Abstract: Article examines the future of using robotic technology to provide rehabilitation services over the Internet. Current trends in telerehabilitation systems are reviewed, the technical challenges still facing researchers are described, and some promising results are presented for a new bilateral system in which both the patient and the therapist use robots to interact with each other over the Internet. The future directions and commercial outlook for rehabilitation robots over the next 15 years are discussed.

Mayhew, D., Bachrach, B. (2005) Development of the MACARM - a novel cable robot for upper limb neurorehabilitation. NARIC Accession Number: O16452. Project Number: H133G030204.
Abstract: Paper describes the development of the Multi-Axis Cartesian-based Arm Rehabilitation Machine (MACARM), a new cable robot for upper limb rehabilitation. The prototype is comprised of an array of 8 active modules mounted at the corners of a cubic support frame that provides 6-degree-of-freedom control of a centrally located end-effector. The active modules generate forces that interact with the end-effector through cables, which produce forces that interact with the user. Testing of the MACARM with human subjects will be completed in 2006. Paper was presented at the IEEE 9th International Conference on Rehabilitation Robotics June 28 - July 1, 2005, Chicago, IL, USA. This document is available online @ naric.com.

Kulyukin, V., Gharpure, C. (2006) A robotic shopping assistant for the blind. 29th Annual RESNA Conference Proceedings. NARIC Accession Number: O16708. Abstract: Paper describes the development RoboCart, a robotic shopping assistant for the blind and presents a small set of initial experiments with RoboCart in Lee’s MarketPlace, a supermarket in Logan, Utah. This paper was presented at the 2006 annual conference of the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) and is available on CD-ROM.

The Cochrane Collaboration includes some information on robotics as a healthcare intervention. There is one Cochrane Review Protocol: Electromechanical-assisted training for walking after stroke [2006]. In addition, there are 2 "Other Reviews," 90 Clinical Trials, 1 Methods Study, 19 Technology Assessments, and 15 Economic Evaluations. These items can be viewed at thecochranelibrary.org These reviews, plus clinical trials, economic evaluations, technology assessments, and methods studies, visit thecochranelibrary.org to review these resources.

Where Can I Find More? A quick keyword search is all you need to connect to a wealth of disability and rehabilitation research. NARIC’s databases hold more than 75,000 resources. Visit www.naric.com/research to search for literature, current and past research projects, and organizations and agencies in the US and abroad.