World Health Organisation estimates that a staggering 2.4 billion people globally are living with health conditions that can benefit from rehabilitation. Medical rehabilitation helps individuals with disabilities attain and maintain optimal functioning of their body. While the benefits of rehabilitation is immense, the sector faces a lot of challenges owing to limited access to assistive devices, shortage of staff and the physical demand that results in musculoskeletal disorders among physical therapists.
One of the most promising innovations to address these issues is the application of robotics in rehabilitation, especially exoskeletons.
What are robotic exoskeletons?
Robotic exoskeletons are wearable systems that are made up of sensors, levers, hydraulics, pneumatics, and systems of motors controlled by computer boards. More than being a mere mechanical unit, robotic exoskeletons can act as neural interface that can enhance neural plasticity.
Robotic exoskeletons can provide target-specific, repetitive training on various tasks. These tasks may include leg movements or shifting the body weight to walk or coordinating movements in the case of hand injuries.
Rehabilitation robot also helps in the case of spinal cord injuries and after-stroke rehabilitation. Patients with knee injuries, neurodegenerative diseases, or spina bifida too can benefit from robotic exoskeletons. Rehabilitation robotics is also useful in treating general paralysis or fatigue and muscular dystrophy. In general, any physical therapy of the upper or lower limbs or joints benefits from rehabilitation robotics.
Advantages of robotic exoskeletons
Robotic exoskeletons can help reduce the load on therapist by providing increased intensity and repetitions while training a patient. In some cases, they can even be used by the patient independently resulting in minimal manual intervention by the therapist. They can also provide better feedback than manual therapy leading to improved functional outcomes.
Most modern models provide software and hardware settings that allow the therapists to adjust the device to different anthropometric measurements, task difficulty levels, or the general level of motor assistance needed depending on the patients' condition. Rehabilitation robotics can provide a multi-sensory stimulation for the patient and help speed up recovery.
Studies also show that exoskeletons can help improve cardiovascular health, gait parameters, and body composition of the patients. Exoskeletons encourage patients to be physically more active than traditional rehabilitation. This increase in activity leads to an overall reduction of seating time and an increase in standing time. Even social engagements and quality family time also increase because of increased mobility and self-reliance. The use of robotic exoskeletons in rehabilitation thus results in an overall improvement in the quality of life. Hence, exoskeletons can, directly and indirectly, address several health-related consequences resulting from a sedentary lifestyle.
Different innovations in the field
Rehabilitation robotics comes in all sizes and shapes, catering to unique requirements.
The startup ReWalk Robotics is an early pioneer in robotic rehabilitation. Their exoskeleton suit was the first to receive FDA regulatory approval for personal and clinical use in the United States. Their battery-powered, lightweight exoskeletons provide lower extremity rehabilitation support. They help patients with SCI to stand, walk, and even climb stairs.
Gogoa is a startup that focuses on industrial and rehabilitation robotics. They have developed lower limb, knee, and hand exoskeletons! Their HANK exoskeleton is a lower limb rehabilitation exoskeleton which helps to achieve a 'constant gait pattern that does not exist in traditional rehabilitation'. This exoskeleton makes use of 6 motorized joints to address the rehabilitation requirements of SCI, stroke, or neurodegenerative diseases. Their Knee exoskeleton named BELK helps the rehabilitation of stroke patients or patients recovering from knee surgery. The appropriately named Hand of Hope exoskeleton is an electromyograph hand exoskeleton. This exoskeleton uses interactive games and movements to enable the functional recovery of paralyzed hands.
Life Science Robotics is another pioneer in the field. They specialize in the mobilization of lower extremities. Their rehabilitation robot named Robert helps in early-stage rehabilitation by providing active or passive resistance. The resistance level, the difficulty of the movement, and the range of motion are all decided based on the patient's functional strength. In the early stage rehabilitation of patients whose mobility is seriously compromised, Robert provides passive mobilization.
Some of the other innovations in rehabilitation robotics include the development of soft exoskeletons using space technology by a company called Tendo AB. Another startup named GenElek Technologies developed an AI-powered lower limb exoskeleton. The Engineering Design and Technological Development Group (DIDET), from the University of Alicante ArtefactosLAB, designed a handheld exoskeleton named flick. This exoskeleton is portable and helps people with low or no muscle tone caused by neurological disorders. EksoGT is another example. Their wearable suits are designed exclusively for use in clinical settings. These help SCI patients to regain proper gait.
The major limitation of rehabilitation robots and exoskeletons is the prohibitive costs associated with them and the technical expertise required by a health professional to manage the exoskeleton. Because of these factors, there is still limited exoskeleton access in clinical settings.
Another major challenge is the lack of outpatient rehabilitation options. A robotic exoskeleton is not a permanent solution. Once the user goes back home, they still need to continue the rehabilitation process. More innovations are required in rehabilitation robotics to overcome such barriers.
The use of assistive robotics and exoskeletons in rehabilitation is projected to grow at a CAGR of 12.5% during the forecast period of 2020 -2027 according to multiple research groups.
Currently, in early-stage rehabilitation, most exoskeletons provide only passive bodily movement without muscle contraction. The incorporation of functional electrical stimulation of the muscles in conjunction with the exoskeleton movement can improve the effectiveness considerably.
Future generations of exoskeletons should be more evolved, lighter, faster, and capable of covering more people in need. Lowering the price and increasing the accessibility is a much more pressing innovation than anything else in rehabilitation robotics.
Personal rehabilitation robotics is another revolution waiting to happen. Considerable innovation is required to make robot-assisted home-based rehabilitation a sustainable reality. Low-cost robotics, off the shelf technology that can be operated by patients or laypeople, integrating more gaming elements, catering to all kinds of body and injury types, home-based and tele-rehabilitation are some of the possible exploratory areas that will see more traction in the future.