Robotics in Physical Rehabilitation: Systematic Review
Abstract
:1. Introduction
- Exploring the diversity of robotic technologies applied in motor recovery, from exoskeletons and robotic arms to personal assistant robots and brain–computer interfaces;
- Analyzing the advantages and limitations of each category of robotic systems in the specific context of motor recovery;
- Investigating the technical, economic, social, and cultural barriers that may limit access to or acceptance of robotic technology for motor recovery;
- Identifying facilitating factors that promote the adoption of robotic technologies, including funding initiatives, training programs for medical staff, and awareness campaigns.
2. Materials and Methods
2.1. Literature Search
2.2. Inclusion and Exclusion Criteria
- Inclusion criteria: studies published within the last 15 years, focused on the use of robotic systems in motor recovery or patient care for people with physical disabilities, reviewing and analyzing published solutions with empirical data;
- Exclusion criteria: articles without empirical data, studies that did not specifically address the use of robotic technology in motor recovery or care for physically disabled patients, and studies conducted on animals or that did not involve human subjects.
2.3. Data Extraction
2.4. Quality Assessment
2.5. Risk of Bias
2.6. Data Synthesis
3. Classification of Robotic Systems for the Rehabilitation and Care of Patients with Disabilities
3.1. The Diversity of Robotic Technologies Applied in Motor Rehabilitation, Including Exoskeletons, Robotic Arms, Personal Assistant Robots, and Brain–Computer Interfaces
- Type of assistance:
- In upper limb motor rehabilitation, devices that are designed to assist and improve the motor function of the arms and hands are used, providing repetitive and controlled exercises that aid in recovery after strokes or other conditions. Examples include InMotion robotic arms, the ARMin exoskeleton, and robotic gloves such as HandSOME.
- In lower limb motor rehabilitation, robotic lower limb systems facilitate gait rehabilitation by supporting the body weight and guiding leg movements in a way that mimics natural walking. Examples include Lokomat and the ReWalk exoskeleton.
- Some robotic systems are designed to help people with reduced mobility to perform various daily activities, such as feeding, dressing, and handling objects. Examples include the PR2 personal assistance robot and the JACO robotic system.
- Some interactive robots, such as NAO and Pepper, and the PARO robot are used to improve social interaction and communication skills, especially among individuals with autism or neurodegenerative conditions. These robots are intended to enhance social and emotional skills, provide cognitive stimulation, improve well-being, and reduce feelings of isolation.
- Type of rehabilitation therapy:
- In passive rehabilitation therapy, the robot guides the patient’s limb through a range of motions without the patient exerting any effort. This approach is essential in the early stages of rehabilitation when the patient has limited mobility or reduced muscle strength.
- In active rehabilitation therapy, the patient initiates the movement, and the robot helps only when necessary. This method stimulates neuroplasticity and encourages the relearning of motor skills through active practice.
- Bilateral rehabilitation therapy involves the simultaneous use of both limbs, where the activity of a healthy limb is mirrored or assisted by the robot on the affected limb. This type of therapy is used to improve coordination and movement symmetry between the upper or lower limbs.
- User interaction mode:
- Direct interfaces allow users to interact directly with the device through physical buttons, touchpads, or gesture control. This includes rehabilitation systems that use touch screens or motion sensors to capture and respond to user actions, such as the HapticMaster Robotic Arm system.
- Neuromotor interfaces use the patient’s neurological signals for control, such as brain–computer interfaces (BCI) that enable robotic control through brain activity, facilitating rehabilitation for individuals with very limited movements, or EMG (electromyographic) sensors that detect the user’s movement intentions.
- AI adaptation-powered interfaces automatically adapt to the user’s needs without direct intervention, using artificial intelligence algorithms to optimize therapy. These interfaces adjust the level of assistance or resistance according to the user’s progress, such as rehabilitation systems that use machine learning to customize therapeutic exercises.
- Location of use:
- Robots used in hospital clinics or rehabilitation centers are designed to provide intensive care under the direct supervision of specialists. As an example, the BRAVO exoskeleton for upper limb rehabilitation is used in clinical environments.
- Some robotized systems have been adapted for use at home, providing patients the opportunity to continue therapy in the comfort of their own residence. For example, robotic gloves like HandSOME are used to improve hand dexterity.
- Robotic systems for parameterized and remotely controlled therapy by specialists through IoT technologies can be used in a teletherapy context.
- Mechanical structure:
- End-effector structured devices focus on interaction with one or more specific parts of the body (end effectors) such as the hands, legs, or head. They are used in specific rehabilitation exercises, providing assisted movement and sensory feedback. The Bi-Manu-Track is an example of an end-effector device.
- Exoskeletons are external robotic devices that are mounted on the body, providing motor support and assistance to people with disabilities. They are especially used for rehabilitating patients with paralysis or muscle weakness, facilitating movement of the upper or lower limbs through mechanical support and sometimes electrical stimulation. Examples of exoskeletons include ARMin III and T-WREX.
- Wearable robotics are lightweight and flexible devices that can be worn on the body, providing continuous support in daily activities or rehabilitation exercises. They are ideal for long-term use, especially in home environments.
- Soft robotics use flexible and adaptable materials that mimic the natural movements of the human body. This category is designed to provide safer and more comfortable interaction with the user, making it ideal for patients requiring gentle therapy and support in precision movements.
- Type of actuators:
- Electric motors (AC/DC) are the most common in robotic systems due to their precise control over speed and position. They are ideal for rehabilitation exercises that require fine adjustments of movement.
- Hydraulic and pneumatic motors provide significant force and are often used in exoskeletons or other devices that require support for body weight. However, they are less precise than electric motors and can be more challenging to control.
- Functional electrical stimulation (FES) involves applying electrical impulses to muscles to induce muscle contractions. It is used in combination with robotic devices to improve muscle strength and facilitate motor retraining.
- Control structure:
- Open-loop controls are used in the initial stages of rehabilitation, where precise control is less critical. These systems operate without direct feedback, applying control actions based on a predefined set of instructions without adjusting them in real time.
- Closed-loop PID controls (proportional–integral–derivative) are widely used due to their simplicity and ability to provide stable and efficient control for a variety of tasks.
- Robust control applied in robotic rehabilitation systems utilizes a fractional approach to control a seven degrees of freedom (DoF) exoskeleton, providing efficient management of friction dynamics and disturbances. The main advantage is its advanced ability to withstand uncertainties, parameter changes, and perturbations, such as a patient’s hand tremors.
- Adaptive control with active disturbance rejection (ADRC) modifies its behavior to adapt to changes in system parameters or uncertain parameters. It is preferred for its ability to simplify the control system while providing advanced disturbance and uncertainty rejection capabilities.
- Hybrid control combines elements of open and closed loop systems, providing flexibility in treatment by adapting to different stages of rehabilitation.
- The type of control structure is not the primary focus of this work, as all identified types have proven to be effective.
- Control inputs:
- Transducers for the forces and torques applied by the patient or the robot provide feedback for adjusting assistance. The major advantage arises in the measurement or generation of torque moments, which can be very precisely achieved in robotic systems compared to traditional manual therapy, where this aspect is subjective.
- Optical encoders are used to measure position and angular speed, ensuring precise motion control.
- EMG (electromyographic) signals capture muscle activity to initiate or guide robotic movement, facilitating a more natural and intuitive interaction with the user.
- Pressure measurements help determine the applied force and appropriately adjust the assistance in the case of hydraulic or pneumatic actuators.
3.2. Analysis of the Advantages and Limitations of Each Category of Robotic Systems
- Exoskeleton: Advantages, mobility support and intensive rehabilitation; Limitations, high cost and high weight.
- Robotic arms: Advantages, precision in fine movements; Limitations, the need for controlled and stable space for use.
3.3. Investigation of Technical, Economic, Social, and Cultural Barriers
- Technical: Need for constant calibration and maintenance.
- Economic: Limited budgets of medical institutions.
- Social: Negative perception of advanced technology in traditional communities.
3.4. Identifying Facilitative Factors for the Adoption of Robotic Technologies
- Funding: Government grants for the acquisition of robotic equipment.
- Training programs: Specialized courses for therapists and biomedical engineers.
- Awareness campaigns: Educational programs in the media and medical conferences.
4. Results
5. Discussion and Conclusions
5.1. Discussion
5.1.1. Full Brain–Computer Interface (BCI) Integration
5.1.2. Personalizing Robotic Therapies
5.1.3. Accessibility and Costs of Robotic Systems
5.1.4. Integration into Clinical Practice
5.1.5. Long-Term Evaluation of the Effectiveness of Robotic Therapies
5.1.6. Social and Cultural Acceptance of Robotic Technologies
5.2. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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Type | Description | Reference |
---|---|---|
Systematic reviews and meta-analyses | Synthesizes the results from multiple primary research studies on a specific topic, providing a comprehensive assessment of the availability and quality of evidence. Examines the overall effectiveness of robot-assisted therapy in upper limb or gait rehabilitation. | [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20] |
Randomized Controlled Trials (RCTs), Case and Pilot Studies | Compares the effectiveness of an intervention with a control group in a well-structured setting with randomly selected participants. Directly tests the effects of robot-assisted interventions compared to standard rehabilitation methods. Explores the impact of interventions on individual cases or small groups, providing initial data for further research. Initial use of robotic therapies for specific patients or in preliminary settings. | [21,22,23,24,25,26,27] |
Exploratory Studies and Technical Development Analyses | Focuses on the development, improvement, and evaluation of technical aspects of robotic devices, including design and implementation. Describes technological innovations in robotic rehabilitation or analyzes specific aspects of system performance. Investigates the potential and practicality of novel approaches in a research setting, often in the early stages. Tests new methodologies or technologies in rehabilitation to determine the viability of more rigorous future studies. | [28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45] |
Robotic systems for patient care | Investigates robotic systems used for dressing, eating, or washing. | [46,47,48,49] |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Banyai, A.D.; Brișan, C. Robotics in Physical Rehabilitation: Systematic Review. Healthcare 2024, 12, 1720. https://doi.org/10.3390/healthcare12171720
Banyai AD, Brișan C. Robotics in Physical Rehabilitation: Systematic Review. Healthcare. 2024; 12(17):1720. https://doi.org/10.3390/healthcare12171720
Chicago/Turabian StyleBanyai, Adriana Daniela, and Cornel Brișan. 2024. "Robotics in Physical Rehabilitation: Systematic Review" Healthcare 12, no. 17: 1720. https://doi.org/10.3390/healthcare12171720