Robots and other

1

Lectures in Assistive Technologies


Van der Loos

Therapy Rehabilitation
Robots and other
Mechatronic Devices

H.F. Machiel Van der Loos, Ph.D.


Rehabilitation R&D Center

VA Palo Alto Health Care System, Palo Alto, CA

U.S. Department of Veterans Affairs


Consulting Associate Professor

Department of Mechanical Engineering

Department of Orthopedic Surgery

Stanford University

High Technologies Used in the Fields of Healthcare, Nursing and Rehabilitation

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Lectures in Assistive Technologies


Van der Loos

Contents


Introduction to Therapy Robots


Types, demographics, economic factors


History of Therapy Robots



Examples of Therapy Robotics


stroke, orthopedic, cognitive dev’t


R&D Project Methodology


Motivation, design rules


The Future and Expected Developments



Conclusion

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Lectures in Assistive Technologies


Van der Loos

Mobility Disabilities

Neurologic Impairments

Orthopaedic Impairments

Arthritis

SCI

Stroke

Osteoporosis

VA Palo Alto Rehabilitation
R&D Center

Focus



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Lectures in Assistive Technologies


Van der Loos

Types of Therapy Robots


Upper
-
extremity robots


Arm, wrist, hand


Passive, active


Lower extremity robots


Leg, ankle, foot


Passive, active


Pedaling, walking (gait)


Cognitive Development


Agents


Mobility devices


Pets


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Lectures in Assistive Technologies


Van der Loos

U.S. Demographics of

Potential Therapy Robot
Users


Stroke:


400,000
-

600,000 cases per year (incidence)


Cerebral palsy:


300,000
-

500,000 prevalence


8,000 incidence


Non
-
robot trainers for orthopedic interventions:


Knee, hip replacements


Ankle surgery


Trauma



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Lectures in Assistive Technologies


Van der Loos

Genesis of

Therapy Robotics


Khalili & Zomlefer:


“Intelligent robotic system for rehabilitation of joints and
estimation of body segment parameters.” IEEE Trans.
Biomed. Eng. Vol. 35, no. 2, Feb.
1988
, pp. 138
-
146.


Erlandson et al. (1989):


robot range exerciser with logging


Howell (1989):


Educational robots for children with cognitive impairment


Hogan, Krebs (1994):


MIT
-
MANUS impedance control, upper extremity


Burgar, Van der Loos (1994)


VA Palo Alto/Stanford University: MIME precursor


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Lectures in Assistive Technologies


Van der Loos

Early Years of Stroke Therapy
Robotics (1995
-
1999)


MIME: PUMA
-
560 based stroke therapy


MIT
-
MANUS: 3
-
D planar manipulator


Reinkensmeyer: ARM passive, linear guide


Driver’s SEAT: simulator training



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Lectures in Assistive Technologies


Van der Loos

Modern Years of

Rehabilitation Robotics
(2000
-

now)


MIME multi
-
site trials


MIME neural mechanism study


MIT
-
MANUS clinical trials


GENTLE haptic interface and VR


REHAROB (Hungary)


PAM+ARTHUR (UCI)


Anthrotronix (US)


Paro seal robot (Japan)


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Lectures in Assistive Technologies


Van der Loos

MIME
: Mirror
-
Image Movement Enabler


Robotic System
Characteristics



PUMA 560


Position controlled


3
-
dimensional


movement


Low compliance/


high impedence

C.G. Burgar, P.S. Lum, P.C. Shor, H.F.M. Van der Loos, Development of robots for rehabilitation therapy: the Palo
Alto VA/Stanford experience,
Journal of Rehabilitation R&D
, Vol. 37, No.6, November/December, 2000, 663
-
673.

P.S. Lum, C.G. Burgar, P.C. Shor, M. Majmundar, H.F.M. Van der Loos, Robot
-
assisted movement training
compared with conventional therapy techniques for the rehabilitation of upper limb motor function after stroke,
Archives of PM&R
, vol. 83, 2002, 952
-
959.

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Lectures in Assistive Technologies


Van der Loos

MIME
: Mirror
-
Image Movement Enabler


Robotic system
assisting upper
limb neuro
-
rehabilitation



Facilitates paretic
elbow and
shoulder
movement



Four modes of


exercise



Passive



Active
-
Assisted



Active
-
Resisted



Bimanual

http://guide.stanford.edu/Projects/2kprojects/stroke04.html

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MIME Movie

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Lectures in Assistive Technologies


Van der Loos

ARCMIME


Single dof


Adjust/reorient


Kinematic
connection l
-
r

NIH SBIR Phase 1 & 2 funding

Display

Monitor

Driver’s SEAT:

An upper limb
one
-
degree
-
of
-
freedom robotic
therapy device
that incorporates
a modified PC
-
based driving
simulator.


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Lectures in Assistive Technologies


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Split Steering Wheel

http://guide.stanford.edu/Projects/2kprojects/stroke17.html

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Lectures in Assistive Technologies


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D’SEAT Preliminary Results

in Stroke Therapy


Negative force cues to strong arm:



decrease compensatory actions


increase involvement of weak arm


promote recovery of weak
-
arm function


Driving context:


Motivates person to continue therapy


Provides social support, promotes independence


Provides carry
-
over to real
-
world situation

M.J. Johnson, H.F.M. Van der Loos, C.G. Burgar, P. Shor,. L.J. Leifer, Design and evaluation of Driver's SEAT: A
car steering simulation environment for upper limb stroke therapy.

Robotica
,
Volume 21, Issue 01. January 2003. pp.
13
-
23.

M.J. Johnson. H.F.M. Van der Loos, C.G. Burgar, P. Shor, L.J. Leifer, Experimental results using force
-
feedback
cueing in robot
-
assisted stroke therapy,
IEEE Transactions on Neural Systems and Rehabilitation Engineering

(accepted for publication, 2003).

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Lectures in Assistive Technologies


Van der Loos

MIT
-
MANUS

•
wrist robot

•
all 3
-
dof

•
(pronation/supination,

•
flexion/extension.

•
abduction/adduction)

training game

•
45 65

•

o o

Vertical Movement

Component Training

http://web.mit.edu/newsoffice/nr/2000/manus.html

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Lectures in Assistive Technologies


Van der Loos

MIT
-
MANUS

Statistically
significant
improvement in
Fugl
-
Meyer and
clinical strength
scales after 4
-
week regimen of
daily 1
-
hour
sessions.


Krebs et al.; “Increasing Productivity and Quality of Care: Robot
-
Aided Neurorehabilitation”; VA
Journal of Rehabilitation Research and Development

37:6:639
-
652, 2000.

Fasoli et al.; “Effects of Robotic Therapy on Motor Impairment and Recovery in Chronic Stroke”;

Arch. Phys. Medic. Rehab
. 84:477
-
482, 2003.

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Lectures in Assistive Technologies


Van der Loos

MIT
-
MANUS Movie

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Lectures in Assistive Technologies


Van der Loos

ARM Guide (RIC)


Linear slide with motor


6
-
dof force sensing

http://sulu.smpp.nwu.edu/arm_guide/

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Lectures in Assistive Technologies


Van der Loos

ARM Guide (RIC)

Click to view
arm_guide.wmv

http://sulu.smpp.nwu.edu/arm_guide/

http://www.eng.uci.edu/~dreinken/Biolab/biolab.htm

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Lectures in Assistive Technologies


Van der Loos

Planar Rehabilitator (RIC)


2
-
axis
manipulator


Add, then
remove force
pattern during
trajectory to
facilitate the
relearning of
proper motion

http://www.smpp.nwu.edu/robotlab/

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Lectures in Assistive Technologies


Van der Loos

‘PARIS’ VR System (RIC)


5
-
axis WAM
manipulator


Full
-
arm
movement


Projection of
objects
through glass


Virtual object
manipulation

http://www.smpp.northwestern.edu/robotLab/

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Lectures in Assistive Technologies


Van der Loos

GENTLE (EU)


Upper
-
extremity


Stroke therapy



3
-
D motion


Low rigidity arm


Force control


Gravity
compensation


VR interface

http://www.gentle.rdg.ac.uk/

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Lectures in Assistive Technologies


Van der Loos

GENTLE (EU)

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Lectures in Assistive Technologies


Van der Loos

REHAROB (Hungary)


Two robots:


Upper arm


Forearm


Hand in splint


Motions taught
by therapist

http://reharob.manuf.bme.hu/overview/workplan.html

Place
REHAROB
movie here

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Lectures in Assistive Technologies


Van der Loos

WREX


Passive (elastic elements)


Anti
-
gravity


4 DOF

Tariq Rahman, ASEL, University of Delaware

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Lectures in Assistive Technologies


Van der Loos

Lower Limb Therapy Robots


Spinal cord injury


Stroke, Brain Injury



Personalized


Instrumented


No need for a pool


Graded weight bearing
(partial or whole)


Therapist
-
controlled

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Lectures in Assistive Technologies


Van der Loos

Fraunhofer HapticWalker


Each side = 3dof


Crank
-
slider +
rotation for ankle


Natural walking,
up stairs,

down stairs


http://www.fraunhofer.de/english/index.html

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Lectures in Assistive Technologies


Van der Loos

HapticWalker


Foot trajectory
control


Weight
-
bearing

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Lectures in Assistive Technologies


Van der Loos

Lokomat Treadmill Walker


Each side = 4dof


Linear actuators


Supported
treadmill walking


Patients with SCI


http://www.research
-
projects.unizh.ch/med/unit43000/area198/p1237.htm

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Lectures in Assistive Technologies


Van der Loos

Lokomat Treadmill Walker

http://www.hocoma.ch/

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Lectures in Assistive Technologies


Van der Loos

ARTHUR walking aid


Treadmill
-
based


walking assist

to foot


Linear actuators
on same rail to
provide foot
motion assist

Put

UCI_tread
-
step

here

http://www.eng.uci.edu/~dreinken/Biolab/biolab.htm

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Lectures in Assistive Technologies


Van der Loos

PAM + ARTHUR walking aid


Treadmill
-
based


Pelvis assist
(PAM) + walking
assist (ARTHUR)



PAM: linear
actuators to
support pelvis


Linear actuators
on rail to provide
foot motion assist

Click to play

art and pam.wmv

http://www.eng.uci.edu/~dreinken/Biolab/biolab.htm

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Lectures in Assistive Technologies


Van der Loos

Cognitive Aid Robots


Children with
developmental
impairment


Cerebral Palsy


Robots allow
control


Robot facilitate
communication
and expression

http://www.anthrotronix.com

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Lectures in Assistive Technologies


Van der Loos

Cognitive Aid Robots


Children with
developmental
impairment


Cerebral Palsy


Robots allow
exploration,
contact and
playing at the
level of other
children

http://rehabrobotics.org/icorr1999/attendees/papers/wright
-
ott.html

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Lectures in Assistive Technologies


Van der Loos

Robots and Autism


Removes
complexity of
communi
-
cation


Repeatable
stimuli


Encourages
engagement

http://adapsys.feis.herts.ac.uk/

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Lectures in Assistive Technologies


Van der Loos

Cognitive Aid Pet Robots


Children with
developmental
impairment


Elders in Nursing
Homes


Robots promote
social
engagement,
communication

http://www.mel.go.jp/soshiki/robot/biorobo/shibata/shibata.html

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Lectures in Assistive Technologies


Van der Loos

Factors
Influencing
Therapy
Effectiveness

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Lectures in Assistive Technologies


Van der Loos

Motivation

Michelle J. Johnson, “Embedded Corrective Force Cueing.” Mechanical
Engineering Thesis, Stanford University, April, 2002.

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Lectures in Assistive Technologies


Van der Loos

Motivation and

Stroke Therapy

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Lectures in Assistive Technologies


Van der Loos

Design Rules for

Therapy Robots



Patient
-
Centered Activities
: Use activities that are
functional and meaningful.


Comprehensive Feedback Strategies
: Provide
incentives that are linked to life goals and meet
individuals’ needs for reinforcement and feedback.


Arm Use
: Decrease the effort to engage in restorative
behaviors.


Arm Need
: Create a functional need for the impaired
arm (generalize
arm

to
affected body part
) in tasks.


Decrease Compensation
: Increase the effort to
engage in compensatory behaviors.

Michelle J. Johnson, “Embedded Corrective Force Cueing.” Mechanical
Engineering Thesis, Stanford University, April, 2002.

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Lectures in Assistive Technologies


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Final

Thoughts

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Lectures in Assistive Technologies


Van der Loos

Future Developments
-

tech


Hardware & Software


Better real
-
time software


Lower
-
cost Internet connectivity


Sensors


More robust, cheaper


Wireless communication


Easier portability of devices


Easier home use


“Always
-
on” computing


Therapy anywhere, everywhere


Connection to physician for motivation, compliance


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Lectures in Assistive Technologies


Van der Loos

Future Developments
-

soc



Economics of care


Home
-
based therapy can be made more effective


Interfaces, programming motivate use


More effective care for same expense



Demographics of disability


Aging society means more rehabilitation needed


Lack of people to provide therapy


Better medical care means longer lives and more rehab

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Lectures in Assistive Technologies


Van der Loos

Conclusions




Reduction in
cost

due to
personalization of therapy through
robot technology


Connection

between home
-
based
devices and clinic
-
based personnel
and computers

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Lectures in Assistive Technologies


Van der Loos

Acknowledgments


Department of Veterans Affairs
Rehabilitation R&D Service


VA Palo Alto Rehabilitation R&D Center


Stanford University


Department of Mechanical Engineering


Department of Computer Science


Department of Orthopedic Surgery


Rehabilitation R&D Center:

http://guide.stanford.edu

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Lectures in Assistive Technologies


Van der Loos

Rehabilitation of another type:


Videotape

of robot dance

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Lectures in Assistive Technologies


Van der Loos

(E)Motion