2023-06-30 19:57:09
by Ruggiero Corcella
A cobot model (collaborative robot) capable of guaranteeing greater balance and movement control during rehabilitation comes into operation at Villa Beretta
They are called “cobots”. The acronym stands for collaborative robot (collaborative robots). These are robots designed to work without risk together with humans, without protective barriers or other physical elements of separation. In the rehabilitation field, the use of various robotic systems has increased in the last ten years – so much so that in 2022 the Higher Institute of Health felt the need to submit a Shared document on employment criteria and recommendations – especially in functional recovery in neurological and orthopedic pathologies that compromise movement. and balance.
In the Villa Beretta rehabilitation center, Valduce hospital in Costa Masnaga (Lecco), a new generation, self-balancing and multidirectional exoskeleton model has come into operation to allow intensive, early and specific training of walking for neurorehabilitation therapy.
«Nothing miraculous – underlines Franco Molteni, clinical director of the rehabilitation center -. We are talking about a punctual, personalized, specific, selective use of technology with the ability to monitor patient results and optimize their use. It is not the solution for everything, nor the complete solution of course, but it is a significant therapeutic enhancement compared to everything we have had available to date”.
The differences compared to the exoskeletons already in use
How is it different from other exoskeletons? «The patient is able to walk with his arms free, therefore to do more tasks in addition to walking, to better coordinate his arms and trunk. The fact that the patient does not lean on anything completely changes the control of the trunk. The fact that he basically walks without being held by a physiotherapist gives a very different intentionality of movement from those who know that he walks instead with the help of a physiotherapist. So the sensation of the mode of action also changes and this reverberates on the prefrontal control systems for example and therefore also on the memory components of the movement that is then carried out», replies Molteni.
In what cases can it be used
What kind of patients could benefit? «First of all people with spinal cord injury, especially if they have incomplete lesions, to stimulate the plasticity of the system -explains the expert -, equally to stimulate the plasticity of the system people with brain injury or with neurodegenerative diseases such as multiple sclerosis rather that Parkinson’s disease and the stages of Parkinson’s disease in which there are significant changes in movement control. So from the post-acute phase of all these pathologies up to the phase after some time, however, when there is still potential for recovery ».
The possible outcomes of rehabilitation
What can a patient expect when undergoing rehabilitation with the cobot? «Potentially, in the case of a complete spinal cord injury, an exercise with this type of collaborative technological object serves to improve trunk control and balance control conditions which are then transferred, in the sitting position, in the transitions from the wheelchair to the bed or wherever you want. In those with an incomplete lesion, to direct the plasticity of the systems towards the best possible control and avoid phenomena of maladaptive plasticity, i.e. negative plasticity», adds Molteni.
I test
How many patients do you plan to start testing it on? «We have 100 dedicated beds and the robotic system works eight hours a day. We will begin a regular use in daily clinical practice and on the other hand a series of clinical trials will start to verify the electroencephalographic modifications, the methods and differences in controlling the muscle synergies of the lower limbs and we will also see biological tests on the intestinal microbiota rather than on the muscle or even on the bone structure of the patient – underlines the clinical director of Villa Beretta -. As far as clinical trials are concerned, we have already set them up but first we have to submit them to the ethics committees, in particular we will work a lot on how brain connectivity changes during different gait modes and different adjustments, as well as the controls of single muscles that all together determine then walking while using this system».
The differences compared to implantable stimulators
How does it compare to another line of research on implantable stimulators for the rehabilitation of patients with spinal cord injuries? «In rehabilitation medicine there is an absolute need to coordinate multiple treatment modalities – says Molteni -. Implantable stimulators are an enormous technological and biological advance, but the result of the stimulation must be refined and consolidated using a stimulator and a robot such as this one at the same time. So it is a perfect synergy to restructure systems which, due to their complexity, require more actions. The implanted stimulator is not like the pacemaker for the heart: it triggers biological mechanisms which then need to be consolidated”.
The «limits» of the exoskeleton
However, from the point of view of the movement, the cobot denounces the “rigid” nature of the exoskeleton. The steps taken by the patient seem very mechanical: why? «Certainly we need to work on refining the methods of controlling interaction. We who have been using it for a short time immediately realized that, within a few sessions, the fluidity of the movement can be completely changed by working on the patient’s ability to coordinate and on that of the software to improve control over the speed of execution of the gesture , the coordination between the various motors that make up the cobot. Important thing about this model, it has a motor for the ankle that coordinates with the motor that controls the trunk and here the use of the software well comes into play, otherwise it becomes a Parkinsonian-like path in some ways».
“Miraculous effects? Zero. Since we have more than twenty years of experience in the use of technologies, we know well that sometimes we expect a miracle because we are also faced with incurable diseases.
Here we are discussing a timely, personalized, specific, selective use of technology with the ability to monitor patient outcomes and optimize their use. So it’s a major therapeutic advance. It’s not the solution to everything, nor the complete solution obviously, but it’s a significant therapeutic enhancement compared to everything we’ve had available to date. It’s not miraculous because we too set the walking world record with ReWalk with a patient who managed to walk 10 kilometers and then with ExoBionics for 12 kilometers but this is proof that you could have important performances. From there to completely troubleshooting is very different. But from here to going on the road to solve currently insoluble problems we are on the right track. Even this exoskeleton is not the replacement of a series of other activities that need to be done to recover the path but it is an important method different from all those we have had available to date and with very important development potential”.
June 30, 2023 (change June 30, 2023 | 19:56)
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