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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Lectures in Assistive Technologies
Van der Loos
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
Van der Loos
Split Steering Wheel
http://guide.stanford.edu/Projects/2kprojects/stroke17.html
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Lectures in Assistive Technologies
Van der Loos
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
Van der Loos
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
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