Robotic Rehabilitation for the Lower Extremity

Original Editor - Steven Hua

Top Contributors - Steven Hua, Angeliki Chorti, Kim Jackson, Sebastian Wozniak, Dennis Riley Louie, Brandon Graham, Naomi O'Reilly, Eric Palmer Beech, Amrita Patro, Rishika Babburu, 127.0.0.1 and Rachael Lowe  

Demographic

Use of robotics in rehabilitation can benefit many patients. Some of those patients include those with:

• Stroke
• Spinal cord injury
• Cerebral palsy
• Parkinsons
• Multiple Sclerosis
  

Limitations and Challenges

As the potential benefits to using robotics for lower limb rehabilitation are apparent, there still are many challenges which need to be overcome and require further research. As of now the main limitations are high costs of acquiring and using robotic systems, lack of high clinical evidence for patient improvement, and the need for standardized measures for therapy protocol and assessment. Other limitations are their bulky size and lack of internal power supply duration with mobile units (Diaz). Patients who have spasticity can have it triggered by the robotic movement and the greater walking durations can lead to some adverse effects such as increased risk for fractures, abrasions, pressure sores and falls (Bryce, Dijkers & Kozlowsik, 2015). Specifically in regards to patients with heart conditions, being strapped into these machines can also be dangerous because, in the need for cardiac resuscitation or during other emergency situations, the patient is not accessible (Harwin 2011).

Robotic systems have the ability to take precise measurements of kinematic and dynamic values, which are far more reliable than those achieved with human error, and have the potential to be very useful for assessment purposes. This being said, there still remains a need to develop standardized procedures and protocols in order for this data to be useful. Currently some examples of the data used from the robotics systems during assessments are ROM, walking distance, gait velocity and other various dynamic measures, but we do not yet have a standardized measure for assessment, like those seen in other gait related assessments (Barthel Index, Dynamic Gait Index, etc.). Furthermore, the effectiveness of robotics has not been shown to be highly superior to that of typical manually-assisted therapy provided by therapists and this is a driving reason as to why it has not yet been implemented into regular practice (Diaz).

Future of Robotics

As rehabilitation robotics advances, it has the potential to completely change the way physiotherapists deliver treatment to patients in the future. Ultimately, physiotherapists can use robotics to benefit their practice by increasing the effectiveness of their assessment and treatment. Since demand for physiotherapists and long-term rehabilitation is raising, one of the main goals of current robotic development is to pair information technology with rehabilitation robotics to deliver assessment and treatment over the internet so that the physiotherapist can supervise the treatment in the comfort of the patient’s own home and allow one physiotherapist to see a large number of patients simultaneously. (Laut et al., 2016).

Currently, present-day gait robotics cannot generate the power and force necessary for running and jumping rehabilitation. In the future, development in this area will be beneficial to athletes rehabilitating from a spinal cord injury. Batteries are also being further developed to maximize its life, size, weight, and ease to recharge.

Other areas of robotic technology that are currently being focused on include developing lighter weight technology, making devices accessible off-the-counter and combining virtual reality and videogames to maximize patient motivation.