Academic journal article Journal of Rehabilitation Research & Development

The Road Ahead for Rehabilitation Robotics

Academic journal article Journal of Rehabilitation Research & Development

The Road Ahead for Rehabilitation Robotics

Article excerpt

During President Barack Obama's acceptance speech on the evening of his 2008 Presidential election victory, he spoke about Ann Nixon Cooper, a 106-year-old woman who had voted in her first election. He spoke of all the great things she had seen in her long life, then stated, "If my daughters should be so lucky to live as long as Ann Nixon Cooper, what change will they see, what progress will we have made?" The same sentiment can be asked about rehabilitation robotic devices. As we move into the second decade of the 21st century, we should pause and ask a very important question: What is the future of rehabilitation robotic devices? Will these devices become commonplace in every hospital and rehabilitation clinic or will they become things of the past like so many other promising technologies? Will we, as a rehabilitation community, break down the barriers between therapists and engineers and work together or will there be continued division? As two scientists and engineers who have worked in the area of rehabilitation robotics for over a decade, we are encouraged by the future of the field but concerned that there is not enough dialog regarding how we should move forward. We are hopeful that this special issue of the Journal of Rehabilitation Research and Development dedicated to rehabilitation robotics will stimulate discussion and thought on these important questions.

Understanding the future of rehabilitation robotics is quite complex, because we must first answer a number of related questions. For example, (1) What is the goal of the robot? (2) What are the barriers to the clinical acceptance of robotic devices in rehabilitation? (3) What should future robotic devices look like; should they be more portable and perhaps stay with the patient as they transition from inpatient care to home? While these questions are difficult to answer, they are critical in shaping the future of the field. Too often we find that engineers come up with ideas for new devices, yet they have not worked with clinicians enough to adequately understand key goals for their systems, how the systems should interact with the patient, and ultimately, how the systems will be accepted in a rehabilitation clinic. While these questions are broad and require more than a short editorial to answer, we wanted to touch on them to begin a dialogue.

We often get so caught up in the technology that we overlook the obvious. For instance, what is the goal of the robot and what advantages does the robot offer the patient and/or therapist? We argue that robots should be developed to assist with therapeutic activities that are difficult or impossible for the therapist to administer alone. For example, attempting overground gait and balance training in a patient with both heavy weight and low function is difficult and unsafe for the average therapist. Devices such as ZeroG (Hidler et al. [1]) can alleviate a portion of the patient's body weight to compensate for weakness in lower limbs and can safeguard him or her against falling. The goals of such devices are to assist the therapist so that they may safely train patients in standing, walking, and performing balance activities early after injuries. These tasks are difficult for therapists; however, with robotic technologies, they are possible. Unlike treating gait and balance, in which safety is a principal concern, upper-limb therapies present other unique challenges. For example, delivering intensive hand therapy is often difficult in patients following stroke and traumatic brain injury since these patients may have tone and spasticity that results in a fist-like posture. Devices such as HEXORR [2] and HandSOME [3] can assist patients as they practice opening and closing their hands, a task that is quite difficult for a single therapist to assist with. Overall, we believe the goal of rehabilitation robotic devices should be to assist therapists in performing the types of activities and exercises they believe give their patients the best chance of a functional recovery. …

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