Robot Rehab

By Anna Lynn Spitzer

Irvine, CA, August 29th, 2012 - - Approximately 7 million people in the United States live with physical impairments caused by stroke. The answer to improving their quality of life could lie in something once considered science fiction: robots.

In a talk last week at the final event of the SURF-IT summer lunchtime seminar series, UC Irvine professor David Reinkensmeyer said robots and computer gaming platforms can help restore movement ability for a large number of stroke victims, as well as those suffering from debilitating diseases like cerebral palsy, spinal cord injury and multiple sclerosis.

Currently, he said, three approaches are utilized in the quest to overcome disabilities: replacement (prosthetic limbs, implants); assistance (wheelchairs and other devices); and retraining (helping the brain to relearn basic skills).

“Robotics is dramatically enhancing these three approaches,” he said, citing exoskeletons, brain-controlled prosthetics, and his area of focus: robotic devices used to retrain the brain.
These devices rely on the human motor system’s capacity for use-dependent plasticity. “If you have even a little bit of function left, you can make [a limb] better – sometimes a lot better,” he said.

Robotic devices, including an arm exoskeleton Reinkensmeyer is developing with an outside company, can enhance one-on-one interactions with physical or occupational therapists and possibly even replace traditional therapy. Additionally, they can track and record patient progress automatically, quantifying the effects of treatment.

“Technology has the potential to allow more therapy with less supervision,” he said. “And potentially, you can give entirely new types of therapy.”

According to Reinkensmeyer, there are approximately 1,000 robotic devices on the market, most of which are used in large rehabilitation hospitals.  In a recent survey of 1,300 therapists, 70 percent said they had used some technology in their work while only two percent had used robots.

The field, however, is growing “exponentially,” as reflected in the number of academic papers, devices and startup companies debuting. “The aging of the population in developed countries is pushing that and the number will increase,” Reinkensmeyer told the audience.

So how can a robot help? Primarily by assisting people in moving their limbs, which helps stretch out the soft tissue, increase plasticity and create sensory input that helps the brain rewire. It can also serve as a motivator. “A person who can’t touch her chin would have a hard time exercising; it’s pretty discouraging,” Reinkensmeyer said. “But if she gets into one of these exoskeletons and starts moving, [exercising] becomes much more motivating.”

One downside: robotic devices can inspire passivity on the part of the patient. One solution, Reinkensmeyer said, is using computer gaming to encourage active participation.

He and his research team developed a device called T-WREX, which did exactly that. Patients who could move their hands only slightly learned to control an avatar that could pick up objects. To test T-WREX’s effectiveness, Reinkensmeyer had one group of patients use the device while another received traditional physical therapy.

The “robot” group performed better, and six months later, had recovered more hand mobility than the control group. Equally important, perhaps, they enjoyed the therapy. “They like it because of the gaming and because they get a score,” said Reinkensmeyer. “They like it because the self-efficacy is improved; they’ve able to actually do meaningful things and it makes it more encouraging to try new things.”

So what’s next? Reinkensmeyer said the goal is full restoration of mobility in damaged limbs. Next-generation devices should be tailored to the patient, and designed with motor learning and computational neuroscience in mind.

They also should be built to prevent slacking, reduce complexity and increase intensity as needed. “We need algorithms that can automatically and judiciously set the challenge level just like a good therapist does.”

Another important component according to Reinkensmeyer: stem cell therapeutics. “Ultimately we will transform mobility by combining technology-based training with stem cells,” he said. “The science and engineering of combination therapies is forthcoming. We’re in a great place for that.”