Robots in Physical Therapy

The United States, as well as many other countries, have a rising population of older people. Unfortunately, they can have many complications with their health including strokes; which can be a common occurrence. Strokes are the leading cause of disability in the United States, totaling nearly 750,000 cases annually (Kwakkel et al.). In fact, a person dies every four minutes because of complications related to a stroke (CDC). For survivors the physical and mental effects can often become permanent disabilities. Only about 5%- 20% of patients recover completely, meaning a large majority of this population is left with permanent disability(Kwakkel et al.). Survivors typically have a multitude of issues regarding motor skills that result in the inability to continue to live self-sufficiently. It seems wrong that with such a large number of people affected by strokes there is so little we can do about it. Luckily, the implementation of robotics in the treatment process may be the key to solving this issue.

With the help of Stanford University, researchers from the Palo Alto VA set out to develop, “a single general-purpose system that could assist a disabled individual to achieve independence in activities of daily living”(Burgar et al.). This is a difficult task to carry out because little is known about stroke recovery, and there are no methods of treatment that can be conducted with much confidence. The researchers achieved their goal by conducting a multitude of trials and experiments. This daunting process lead to the creation of five different generations of robots (Burgar et al.). Despite subtle differences and variables, most experiments were conducted in the same way. Generally, the experiments would consist of a patients being seated at an adjustable table. The patient’s arm is strapped to the machine where the movements of the robotic arm and the patient’s arm are recorded and measured. Patients respond to the stimulation by, “either remaining passive, or actively attempting to contribute to the movement”(Burgar et al.). Essentially, minute sensors are able to analyze progress or lack there of.

The second case study is a collection of clinical trials exhibited by a number of qualified scientists with the help of a number of universities and organizations such as the Faculty of Human Movement Science, University of Amsterdam, Yale University, and the VA of West Haven. Hundreds of trials were conducted on a broad range of stroke patients in order to determine whether or not robotic physical therapy is an effective form of treatment. These trials consisted of similar conditions to the aforementioned case study. This means that the testing process was quite similar and the variables used were, once again, patient variety and equipment. The data is difficult to quantify and compare simply because these case studies were carried out independently. The MIT-MANUS, the ARM-GUIDE, the MIME, and the Bi-Manu-Track were all robots created and tested with different modes of measurement (Kwakkel et al.). Some parties opted to focus on very specific improvements as acute as muscle tendons. Others looked at improvements as a whole to large sections of the afflicted patient’s bodies .

Measurements come from the therapists and computers operating the robot. The results of these trials have some range, Depending of how the scientists decide to analyze a successful therapy period.

Specific Improvements:
Data from the 20+ groups studied shows that, “robot-assisted therapy may have advantages over conventional… therapy techniques”(Burgar et al.). The study of Volpe et al. showed improvements on motor recovery of the upper paretic limb, which is very specific. In almost every case progress, although be it incremental, was made . Meticulous and Habitual robotic rehabilitation resulted in changes in patient’s motor abilities. Although not all patients achieve full recovery, a statistically significant amount of positive change was found.

Broad Improvements:
Despite improvement, there still obviously is no 100% way to regain full functionality after a stroke. The study of Fasoli et al. reported on outcome of functional ability, which is regarding overall improvements holistically. The results of this study we far less convincing as the percentage of patients improved little from the aforementioned 5%-20% recovery window (Kwakkel et al.).

Improvements to a large percentage of the patient’s health are often minimal. However, research strives to continue to find a way to help more stroke patients retain their former mobility. Robots in physical therapy are needed. If there is a device that will help stroke patients, no matter how small the percentage, it should be utilized and developed further in order to benefit as many people as possible. This is incredibly important because as the elderly population of the USA grows, the demand for stroke therapy will only continues to grow. These robots are not designed as replacements for therapists, but rather a mean to improve motor performance and allow for stroke patients to regain mobility and more importantly, their lives.




Annotated Bibliography

Burgar, Charles G., Peter Lum S., Peggy Shor C., and Machiel Van Der Loos. “Development of Robots for Rehabilitation Therapy: The Palo Alto VA/Stanford Experience.” VA Research Development, Nov.-Dec. 2000. Web. 09 Sept. 2016.

-With the help of Stanford University, a team of medical professionals and scientists set out to determine whether or not robots could have an impact on patients in need of rehabilitation. Typically stroke patients tend to have issues with their motor control. Additionally, in many stroke patients there is a window of time where treatment can be done before physical therapy’s effects are less helpful. Findings have shown that, “ robot-aided therapy has therapeutic benefits,”(Burgar et al.). These benefits can be very minuscule for some patients while others experience,” increased strength, as well as more appropriate activation of muscle groups,”(Burgar et al.).

Kwakkel, Gert, Boudewijn J. Kollen, and Hermano I. Krebs. “Effects of robot-assisted therapy on upper limb recovery after stroke: a systematic review.” Neuro-rehabilitation and neural repair (2007). Web. 08 Sept. 2016.

-The authors of this systematic review intended to utilize research to identify if robotics played a part in physical therapy. Many studies involving hundreds of patients were conducted and analyzed by the PHD professors from a multitude of Universities around the world including MIT. Robotics play a role in many different aspects of physical therapy. Research has ranged from sports injuries to stroke recovery. In many cases it has been successful. In fact tests have shown, “a significant improvement in upper limb motor function after stroke for upper arm robotics”(Kwakkel et al.).

Volpe, B. T., H. Krebs I., N. Hogan, L. Edelsteinn, C. Diels M., and M. Aisen L. “Robot Training Enhanced Motor Outcome in Patients with Stroke Maintained over 3 Years.” N.p., n.d. Web. 08 Sept. 2016.

-Robotics don’t only provide relief on a short term basis. The studies done by these medical trained professionals at the University of Cornell has shown evidence of a “significant decreases in impairment [in] the affected limb,” (Volpe et al.). Their consensus is that the addition of a robot was the turning point in ensuring progress and healing (Volpe et al.).

“Stroke Facts.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 24 Mar. 2015. Web. 11 Sept. 2016.

-The CDC provided a multitude of simple and effective facts that I intend to use throughout my argument to quantify it.

Patient Using the IPAM System to Undertake Upper Limb Therapeutic Exercise. N.d. National Instruments. Web. 2 Oct. 2016.

-This is a cited image depicting a similar robot to the robots that are referred to throughout my work.