Rehabilitation Robotics: An Unofficial Guide
What is a Rehabilitation Robot?
A robot1 is an automated machine that replaces human effort.
A rehabilitation robot2 is designed to improve movement in persons with impaired physical function. In clinical use, the application of rehabilitation robots is often referred to as “robot-assisted therapy,” “robotic therapy,” or “active-assistive robotic therapy”.
Typical Use Case
A classic example of its use is in stroke rehabilitation. During a therapy session, the patient interacts with the robot, which provides assistance to restore the ability to, for example, move the patient’s right arm. The robot can guide the patient’s motion, make the process easier through simulation of zero gravity, and track their progress.
The user may interact with the robot through a video screen, which may include an activity, game or other feedback system to guide them toward success.
The primary benefit of a therapy robot lies in its ability to automate and repeat this process. It can dramatically increase the intensity of an exercise, allowing the patient to get in more repetitions in a shorter time than can be achieved through manual therapy.
Studies have shown that this may lead to faster recovery and better outcomes. As seen in this systematic review and meta-analysis by Bertani et al.3
Other technological advances integrated into robotic therapy such as haptic4 technology, or artificial touch/tactile response can provide intelligent feedback to patients.
Most people experience haptic feedback every day. You use haptic technology when you set your smartphone to vibrate to alert you to an incoming call.
Robotic devices may also use artificial intelligence, (AI), which can help organize data from therapy sessions and use it to predict patient outcomes. Another advantage of some upper extremity robotic devices such as the InMotion ARM is called intelligent active-assistance. These robots provide patients with the correct amount of assistance to apply the appropriate challenge for patients in motor learning programs
Why Do Robotics Matter?
Robot-assisted therapy is an efficient way to drive patient outcomes. Kleim’s principles of neuroplasticity5 and other recent research conclude that repetitions and time matter when it comes to stroke rehabilitation. Indeed, neuroplastic changes, or the ability of the brain to change and regrow following neurologic injury, have been supported only after upper extremity motor repetitions exceed 300 repetitions per day6 in stroke patients, with no changes occurring with repetitions in the upper extremity performed below 100.7
Unfortunately one study found that the average number of repetitions performed for upper extremity sessions was only 32 repetitions. See article here.8
In contrast, a therapy robot can perform over 1,000 upper extremity movement repetitions in a single one-hour session. Even in just a 30 minute time frame many devices can perform 300-500 repetitions, at least nine times the average for upper extremity sessions.
You can read an overview of upper extremity robotic therapy devices in reference to stroke survivors with this information here.9
Therapy robots benefit therapists as well as patients. No therapist can perform the number of upper extremity repetitions that a therapy robot can in the same timeframe without running out of energy or possibly getting repetitive motion injuries themselves.
Rehabilitation robots take the burden off the clinician while allowing patients to receive a number of repetitions per day that’s sufficient to allow the brain to change and regrow.
- Robotic devices provide clinicians with the ability to meet current research standards in clinical treatment without putting too much demand on the treating clinician.
- They can provide built-in treatment metrics and outcome measures to make collecting patient data easier.
- They can track the smallest of changes in a patient’s progress at lightning speeds to inform evidence-based practice.
Types of therapy robots
Therapy robots fall into two broad categories: End-effector devices and exo-skeletons.
Exo-skeletons can provide precise control of individual joints with maximum adjustability for the therapist, although setup time can be a real struggle.
End-effector devices move the patient’s upper extremity out from a distal end-point to perform movement repetitions, maximizing setup time and ease of use for the patient and therapist
A brief history of Rehabilitation Robots
Rehabilitation robots aren’t new: The technology is well established, having been around for more than two decades.
The first therapy robot was an end-effector device: MIT Manus.10 Originally developed at MIT in the 1990’s, the Manus would evolve to become the InMotion ARM/Hand device sold today.
The Manus device was designed to improve upper extremity reach in patients with neurological injury by maximizing the intensity of motor repetitions.
With intelligent active-assistive therapy, built upon years of research on velocity and kinematic data, the veteran robot was designed for one purpose. Motor learning; and it spawned a generation of intelligent robotic systems for physical rehabilitation.
Other robots followed in the wake of Manus over the years, including exoskeletons like the ARMEO Power and Myomo as well as other “end-effector” devices. These include the InMotion ARM, the BURT, Diego, and ReoGo amongst others. Other lower extremity devices devices like the Lokomat and lower extremity exoskeletons such as the REX, Rewalk system, and Ekso, were also developed to assist in the recovery of lower extremity function.
One potential downside to therapy robots is the size of the units and the limited portability of these units, although the latest machines are much smaller than their predecessors.
In some situations clinicians might be hesitant to use therapy robots because they believe that they will be difficult to operate. Actually, the current generation of robotic therapy systems are typically user-friendly and designed specifically with the therapist in mind.
Compared to the softwares therapists use every day, therapy robots are far easier to use and learn than many electronic medical record systems (EMRs).
Another clinician concern is the perception that using a therapy robot limits therapist involvement, taking away the function of the treating therapist. In contrast, therapy robots are automation tools fully controlled and operated by the treating therapist.
Robots make the job of occupational and physical therapists easier and more efficient by automating mundane, highly repetitive tasks so they can focus on therapeutic interventions, patient outcomes and engagement.
A Revolutionary Tool
The use of rehabilitation robotics in neurological rehabilitation is growing because they provide the intensity needed for patient gains, while taking stress off treating therapists.
These systems contain state-of-the art technologies such as intelligent active-assistance, simulated gravity-elimination, haptics and AI that can be harnessed in neurological rehabilitation programs.
They are a good option for clinics hoping to improve their stroke or neurological rehabilitation programs as well as for clinics looking for a way to increase patient engagement and improve outcomes.
- Encyclopædia Britannica, inc. (n.d.). Robot. Encyclopædia Britannica. Retrieved January 12, 2022, from https://www.britannica.com/technology/robot-technology
- Encyclopædia Britannica, inc. (n.d.). Rehabilitation robot. Encyclopædia Britannica. Retrieved January 12, 2022, from https://www.britannica.com/technology/rehabilitation-robot
- Bertani R, Melegari C, De Cola MC, Bramanti A, Bramanti P, Calabrò RS. Effects of robot-assisted upper limb rehabilitation in stroke patients: a systematic review with meta-analysis. Neurol Sci. 2017 Sep;38(9):1561-1569. doi: 10.1007/s10072-017-2995-5. Epub 2017 May 24. PMID: 28540536.
- Wikimedia Foundation. (2022, January 1). Haptic technology. Wikipedia. Retrieved January 12, 2022, from https://en.wikipedia.org/wiki/Haptic_technology
- Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008 Feb;51(1):S225-39. doi: 10.1044/1092-4388(2008/018). PMID: 18230848.
- Birkenmeier, R. L., Prager, E. M., & Lang, C. E. (2010). Translating animal doses of task-specific training to people with chronic stroke in 1-hour therapy sessions: a proof-of-concept study. Neurorehabilitation and neural repair, 24(7), 620–635. https://doi.org/10.1177/1545968310361957
- Carey, J. R., Durfee, W. K., Bhatt, E., Nagpal, A., Weinstein, S. A., Anderson, K. M., & Lewis, S. M. (2007). Comparison of Finger Tracking Versus Simple Movement Training via Telerehabilitation to Alter Hand Function and Cortical Reorganization After Stroke. Neurorehabilitation and Neural Repair, 21(3), 216–232. https://doi.org/10.1177/1545968306292381
- Lang, C. E., Macdonald, J. R., Reisman, D. S., Boyd, L., Jacobson Kimberley, T., Schindler-Ivens, S. M., Hornby, T. G., Ross, S. A., & Scheets, P. L. (2009). Observation of amounts of movement practice provided during stroke rehabilitation. Archives of physical medicine and rehabilitation, 90(10), 1692–1698. https://doi.org/10.1016/j.apmr.2009.04.005
- Duret, C., Grosmaire, A. G., & Krebs, H. I. (2019). Robot-Assisted Therapy in Upper Extremity Hemiparesis: Overview of an Evidence-Based Approach. Frontiers in neurology, 10, 412. https://doi.org/10.3389/fneur.2019.00412
- Reinkensmeyer, David J.. “rehabilitation robot”. Encyclopedia Britannica, 4 Aug. 2021,
https://www.britannica.com/technology/rehabilitation-robot. Accessed 23 December 2021.
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