Robotics has gotten a bad name in some circles from too many screen scenarios and “what if” thinking about manufacturing assembly lines that has often overreached actual development. However, robotics in medicine is seeing breakthroughs in post-stroke physical therapy and post-injury rehabilitation.
This has especially been true of spinal injury, when paralysis can preclude the patient’s ability to even begin recovery. In addition, the traditional diagnosis of “never walk again” can diminish the will to recover. The breakthrough concept is re-innervation, where the body creates new neural pathways to compensate for damaged nerves. Robotics-assisted devices such as ReWalk, now being used by the U.S. Veterans Administration, offer such an opportunity. An exoskeleton is integrated with a treadmill to support damaged areas of the body while increasing the patient’s mobility. This system also addresses a major obstacle to recovery, which is engaging the entire body, since regaining overall mobility also increases cardiovascular health and even bowel function. Weight loss from exercise and increased core strength further enhances self-esteem and the will to improve.
The size and cost of exoskeletons currently limit them to in-hospital physical therapy, but some neuron-recovery specialists see them replacing wheelchairs in the future. However, these devices do require significant patient strength, coordination, determination, and endurance to operate the exoskeleton. The process of attaching nerves to new prosthetic limbs and implanting sensors to guide the robotics can also speed recovery in ways never possible before.
While spinal injuries are a part of this expanding area of medical development and research, stroke victims are proving another area of application. Neuron-stimulation of paralyzed muscles can assist in their reactivation, and stroke victims have shown improvement over conventional physical therapy. The addition of such devices as Lokomat, which combines a treadmill with projected outdoor pathways while supporting the walker in a harness, have also shown promise.
In many cases, spinal injuries are not being healed, but instead brain-controlled neuro-prosthetics allow brain signals to find different paths to follow (which is being illustrated by MRI scans tracking the re-innervation). Often, post-stroke restart of brain functions and pathways can occur within the first three months after their injury.
While the focus of exoskeleton development was initially on lower-body mobility, upper-body paralysis is now being explored, with promising results. The newer suits are flexible and more comfortable, and they adapt to individual movement patterns. The Harvard School of Engineering and Applied Sciences is exploring how to further adjust that technology to fit individual patients.
“Your Robot Will See You Now” by Robert Firpo-Cappiello, Brain and Life (December 2018/January 2019).
Timothy C. Mack is managing principal of AAI Foresight Inc. and former president of the World Future Society (2004-2014). Contact him at firstname.lastname@example.org.