Robots and other

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Nov 13, 2013 (3 years and 9 months ago)

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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


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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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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


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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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MIT
-
MANUS Movie

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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


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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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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


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GENTLE (EU)

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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


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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


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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


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Lokomat Treadmill Walker

http://www.hocoma.ch/

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Lectures in Assistive Technologies


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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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Factors
Influencing
Therapy
Effectiveness

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Lectures in Assistive Technologies


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Motivation

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

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Van der Loos

Motivation and

Stroke Therapy

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Lectures in Assistive Technologies


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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


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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


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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


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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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Rehabilitation of another type:


Videotape

of robot dance

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(E)Motion