Review of the state of robotics in rehabilitation medicine. Rehabilitation equipment Robotic medical rehabilitation equipment pdf

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2.3 Medicine and robotics

2.3.1 Scope overview

Healthcare and robots

As a result of demographic changes in many countries, health care systems are facing increasing pressure to serve an aging population. As demand for services increases, procedures are being improved, leading to improved results. At the same time, the costs of providing medical services are rising, despite a decrease in the number of people employed in the provision of medical care.

The use of technology, including robotics, appears to be part of a possible solution. In this document, the medical field is divided into three subfields:

- Robots for hospitals (Clinical Robotics): Relevant robotic systems can be defined as those that provide "caring" and "healing" processes. First of all, these are robots for diagnosis, treatment, surgery and medication administration, as well as in emergency systems. Such robots are controlled by hospital staff or trained patient care professionals.

- Robots for rehabilitation (Rehabilitation): Such robots provide post-surgical or post-traumatic care where direct physical interaction with the robotic system will either accelerate the recovery process or provide replacement of lost functionality (for example, when it comes to a prosthetic leg or arm).

- Assistive robotics: This segment includes other aspects of robotics used in medical practice, where the primary purpose of the robotic systems is to provide support either to the person providing care or directly to the patient, regardless of whether we are talking about a hospital or other medical facility.

All of these subdomains are characterized by the fact that they require safety systems that take into account the clinical needs of patients. Typically, such systems are operated or configured by qualified hospital personnel.

Medical robotics is more than just technology

In addition to the development of robotic technology itself, it is important that appropriate robots are introduced as part of hospital treatment processes or other medical procedures. Requirements for the system should be formed on the basis of clearly identified needs of the user and recipient of services. When developing such systems, it is critical to demonstrate the added value they can provide when implemented, this is critical to continued success in the market. Achieving additional benefits requires the direct involvement of medical professionals and patients in the development of this technology, both at the design and implementation stages of robot development. Developing systems in the context of their future application environment ensures stakeholder involvement. A clear understanding of current medical practice, the obvious need to train medical personnel in using the system, and knowledge of various information that may be required for development are critical factors in creating a system suitable for further implementation. The introduction of robots into medical practice will require adaptation of the entire healthcare delivery system. This is a delicate process in which technology and health care practices interact and will need to adapt to each other. From the moment development begins, it is important to take this aspect of "interdependence" into account.

The development of robots for medical purposes includes a very wide range of different potential applications. Let's consider them below, in the context of the three main market segments identified earlier.

Robots for hospitals

This segment is represented by a variety of applications. For example, the following categories can be distinguished:

Systems that directly enhance the surgeon's capabilities in terms of dexterity (flexibility and precision) and strength;

Systems that allow remote diagnosis and intervention. This category can include both tele-controlled systems, when the doctor can be located at a greater or lesser distance from the patient, and systems for use inside the patient’s body;

Systems that provide support during diagnostic procedures;

Systems that provide support during surgical procedures.

In addition to these hospital applications, there are a number of hospital support applications including sample collection robots, laboratory research tissue samples, as well as other services required in hospital practice.

Robots for rehabilitation

Rehabilitation robotics includes devices such as prosthetics or robotic exoskeletons or orthoses that provide training, support or replacement for lost activities or impaired functionality of the human body and its structure. Such devices can be used both in hospitals and in Everyday life patients, but usually require initial setup by medical specialists and subsequent monitoring of their correct operation and interaction with the patient. Post-surgical recovery, especially in orthopedics, is predicted to be the main application area for such robots.

Expert support and assistive robotics

This segment includes assistive robots intended for use in hospitals or home environments that are designed to assist hospital staff or caregivers in performing routine tasks. One can note a significant difference in the design and implementation of robotic systems associated with the place and conditions of their use. In the context of use by skilled personnel, whether in a hospital setting or in a home setting when using the robot to care for an elderly person, developers can rely on the robot being controlled by a skilled person. Such a robot must meet the requirements and standards of the hospital and healthcare system and have the appropriate certificates. These robots will assist the staff of relevant medical institutions in their daily work, especially nurses and caregivers. Such robotic systems should allow caregivers to spend more time with patients, reducing physical activity, for example, the robot will be able to lift the patient in order to perform the necessary routine operations on him.

2.3.2 Opportunities now and in the future

Medical robotics is an extremely challenging area to develop due to its multidisciplinary nature and the need to meet various stringent requirements, and also because in many cases medical robotic systems physically interact with people who may also be in a very vulnerable state . Let us present the main opportunities that exist in the segments of medicine we have identified.

2.3.2.1 Hospital robots

These are robots for surgery, diagnostics and therapy. The surgical robot market is large in size. Robot-assistive capabilities can be used in almost all areas - cardiology, vascular medicine, orthopedics, oncology and neurology.

On the other hand, there are many technical challenges associated with size limitations, capacity limitations, environmental constraints, and few technologies that are available for immediate use in hospital settings.

In addition to technological problems, there are also commercial ones. For example, related to the fact that the United States is trying to maintain a monopoly position in this market due to its extensive intellectual property. This situation can only be circumvented through the development of fundamentally new hardware, software and management concepts. Also, such developments require solid financial support for high-cost, but necessary developments and related clinical trials. Typical areas where there are opportunities now:

Minimally Invasive Surgery (MIS)

Advances can be made here by developing systems that can extend the flexibility of instrument movement beyond that provided by the anatomy of the surgeon's hands, increasing efficiency, or supplementing the systems with feedback (for example, allowing judgment of pressure) or additional data to help guide the procedure. Successful market adoption may depend on the product's cost effectiveness, reduced deployment time, and reduced additional training required to learn how to use the robotic system. Any system developed must clearly demonstrate the “added value” in the context of surgery. Clinical pilot implementation and evaluation of such testing in clinics are mandatory for the system to be accepted by the surgical community.

Compared to other areas of minimally invasive surgery, robotic-assistive systems potentially provide the surgeon with better control of surgical instruments, as well as best review during the operation. The surgeon is no longer required to stand throughout the operation, so he does not tire as quickly as with the traditional approach. Hand tremors can be almost completely filtered out by the robot's software, which is especially important for applications in surgery that deals with microscale surgery, such as eye surgery. In theory, a surgical robot could be used almost 24 hours a day, replacing the teams of surgeons who work with it.

Robotics can provide rapid recovery, a reduction in injuries and a decrease in the negative impact on the patient’s tissue, as well as a reduction in the required radiation dose. Robotic surgical instruments can free up the doctor's brain, shorten the learning curve, and improve workflow ergonomics for the surgeon. Therapy methods that are limited by the limits of the human body also become possible with the transition to the use of robotic technologies. For example, a new generation of flexible robots and instruments that allow access to organs deeply hidden in the human body, making it possible to reduce the size of the entrance incision in the human body or make do with natural openings in the human body to perform surgical operations.

In the long term, the use of learning systems in surgery can reduce the complexity of surgery by increasing the flow of useful information that the surgeon will receive during the operation. Other potential benefits include the ability to enhance the ability of paramedics to perform standard clinical emergency procedures using robots in the field, and to perform tele-surgery in remote locations where only a robot is available and no trained surgeon is available.

The following possibilities can be distinguished:

New compatible tools that provide increased safety while maintaining full handling capabilities, including rigid tools. Through the use of new control methods or special solutions (which, for example, can be built into the tool or external to it), the functioning of the tools can be adjusted in real time to ensure compatibility or stability, when that is more important;

The introduction of improved assistive technologies that guide and warn the surgeon during surgery, which allows us to talk about simplifying the solution of surgical problems and reducing the number of medical errors. This “training support” should improve “compatibility” between the equipment and the surgeon, ensuring that the system is used intuitively and without hesitation.

Application of suitable levels of robot autonomy in surgical practice up to full autonomy of specific well-determined procedures, for example: autonomous autopsy; taking blood samples (Veebot); biopsy; automation of some surgical actions (tightening knots, supporting the camera...). Increasing autonomy has the potential to improve efficiency.

- “Smart” surgical instruments are essentially controlled by surgeons. These instruments are in direct contact with the tissue and enhance the surgeon's skill level. Miniaturization and simplification of surgical instruments in the future, as well as the availability of surgical procedures inside and outside the "operating theater" is the main way for the development of such technologies.

Education: Providing physically accurate models, achieved through the use of tools with haptic feedback, has the potential to improve learning, both in the early stages of learning and when achieving confident performance skills. The ability to simulate a wide variety of conditions and challenges can also enhance the effectiveness of this type of training. Currently, the quality of tactile feedback still contains a number of limitations, which creates difficulties in demonstrating the superiority of this type of training.

Clinical samples: There are many areas for application autonomous systems for sampling - from systems for collecting blood tests and tissue samples for biopsy to less invasive autopsy methods.

2.3.2.2 Robotics for rehabilitation and prosthetics

Rehabilitation robotics covers a wide range of different forms of rehabilitation and can be divided into sub-segments. Europe has a fairly strong industry in this sector and active interaction with it will accelerate technological development.

Rehabilitation means

These are products that can be used after injury or after surgery to train and support recovery. The role of these products is to support recovery and accelerate recovery, while protecting and supporting the user. Such systems can be used in a hospital setting under the supervision of medical staff or act as a stand-alone exercise where the device controls or limits movements, depending on what is required in a given case. Such systems can also provide valuable data on the recovery process and monitor the condition more directly than even monitoring a patient in a hospital setting.

Functional replacement means

The purpose of such a robotic system is to replace lost functionality. This may be a result of aging or traumatic injury. Such devices are developed to improve the patient's mobility and motor skills. They can be designed as prosthetics, exoskeletons or orthopedic devices.

In developed rehabilitation systems, it is critical that existing European manufacturers are involved in the process as known market participants, and that relevant clinics and clinic partners are involved in the development process. Europe currently leads the world in this area.

Neuro-rehabilitation

(COST Network TD1006, European Network of Robotics for Neuro-Rehabilitation provides a platform for sharing standardization of definitions and examples of developments across Europe).

Currently, few robotic devices are used for neuro-rehabilitation because they have not yet been widely used. Robotics is used for post-stroke rehabilitation in the post-acute phase and other neuromotor pathologies such as Parkinson's disease, multiple sclerosis and ataxia. Positive results using robots (as good or better than using traditional therapy) for rehabilitation purposes are beginning to be confirmed by research results. Recently, positive results have also been confirmed by neuroimaging studies. Integration with FES has been shown to increase positive outcomes (both for muscular system, both peripheral and central motor). Exercises with biofeedback and gaming interfaces are beginning to be seen as solutions that can be implemented, but such systems are still in the early stages of development.

In order to develop workable systems, several problems must be solved. These include low device costs, proven clinical trial results, and a well-defined patient assessment process. The systems' ability to correctly identify the user's intent and thereby prevent injury currently limits the effectiveness of such systems. Control and mechatronics integrated to meet the capabilities of the human body, including cognitive load, are in the early stages of development. Improvements in reliability and operating time must be achieved before commercially usable systems can be developed. Development goals should also include rapid deployment time and adoption by therapists.

Prosthetics

Significant progress can be made in the production of smart prostheses that can adapt to the user's movement patterns and environmental conditions. Robotics has the potential to combine improved self-learning capabilities with increased flexibility and control, especially for upper limb prostheses and hand prostheses. Particular areas of research include the ability to adapt to personal, semi-autonomous control, providing artificial sensitivity through feedback, improved verification, improved energy efficiency, self power recovery, improved myoelectric signal processing. Smart prosthetics and orthoses controlled by the patient's muscle activity will allow large groups of users to take advantage of such systems.

Mobility support systems

Patients with reduced physical capacity, either temporary or permanent, may benefit from increased mobility. Robotic systems can provide the support and exercise needed to increase mobility. There are already examples of the development of such systems, but they are at an early stage of development.

In the future, it is possible that such systems could even compensate for cognitive impairment, preventing falls and accidents. The limitations of such systems are related to their cost, as well as the ability to wear such systems for a long time.

In a number of rehabilitation applications, it is possible to use natural interfaces such as myoelectrics, brain signals, as well as interfaces based on speech and gestures.

2.3.2.3 Specialist support and assistive robots.

Expert support and assistive robotics can be divided into a number of application areas.

Caregiver support systems: Support systems used by caregivers who interact with patients or systems used by patients. These may include robotic systems that provide the use medicines, take samples, improve hygiene or recovery processes.

Lifting and moving the patient : Patient lifting and positioning systems can range from precise positioning during surgery or radiation therapy to assisting nursing staff or caregivers in lifting a person out of or into a bed, or in transporting patients around the hospital. . Such systems can be designed to be configured depending on the patient's condition and used so that the patient has a certain degree of control over their position. Limitations here may be related to the need to obtain safety certifications and safely manage sufficient forces to move patients in a manner that avoids possible patient injury. Energy-efficient structures and space-saving designs will be critical for efficient implementations.

When developing assistive robotics solutions, it is important to adhere to a set of basic principles. Development should focus on supporting functionality gaps rather than creating specific conditions. Solutions must be practical in terms of their use and provide tangible benefits to the user. This may include using technology to motivate patients to do as much as possible for themselves while maintaining safety. The implementation of such systems will not be viable and in demand if they do not provide the ability to reduce the workload on personnel, creating an economic case for implementation, while simultaneously being reliable and safe to use.

Biomedical laboratory robots for medical research

Robots are already finding their way into biomedical laboratories, where they sort and manipulate samples during research. Applications to create complex robotic systems are expanding the capabilities even further, such as into advanced cell screening and manipulations related to cell therapy and selective cell sorting.

2.3.2.4 Requirements in the medium term

The following list represents "growth points" in the field of medical robotics

Lower torso exoskeletons that adapt their function to the patient's individual behavior and/or anatomy, optimizing support depending on the user or environmental conditions. Systems can be adapted by the user to different conditions and performing various tasks. Areas of application: neuro-rehabilitation and support for workers.

Robots designed for autonomous rehabilitation (e.g., play-based rehabilitation, upper limb rehabilitation after stroke) must perceive the patient's needs and reactions, and also adapt the therapeutic intervention to them.

Robots designed to support patient mobility and manipulation must support natural interfaces to ensure safety and performance in life-like environments.

Rehabilitation robots designed to enable sensor and motor integration by providing bidirectional communication, including multi-mode command input (myoelectric + inertial sensing) and multi-mode feedback (electro-tactile, vibro-tactile and/or visual).

Prosthetic arms, wrists, hands that automatically adapt to the patient, allowing him to control individually any finger, thumb rotation, wrist DOFs. This should be accompanied by the use of multiple sensors and pattern recognition algorithms to ensure natural control (constant force control) through possible DOFs. Areas of application: restoration of hand functionality for amputees.

Prosthetics and rehabilitation robots equipped with semi-automatic control systems to improve the quality of functioning and/or reduce the cognitive load on the user. Systems must allow perception and interpretation of the environment down to a certain level to enable autonomous decision making.

Prosthetics and rehabilitation robots are capable of using a variety of online resources (information storage, processing) through the use of cloud computing to implement advanced functionality that is significantly beyond the capabilities of on-board electronics and/or direct user control.

Inexpensive prosthetics and robotic solutions created using additive technologies or mass production (3D printing, etc.)

Home-based therapy that reduces the intensity of neuropathic pain or phantom pain of the upper limbs through improved interpretation of muscle signals through the use of robotic limbs (with less flexibility than in previous examples) and/or “virtual reality”.

Biomimetric control of interaction with a robot surgeon.

Adequate mechanical actuation and sensing technologies for the development of flexible miniature robots with force feedback, as well as instruments for advanced and advanced minimally invasive surgery.

Environmental charging systems for implantable micro-robots.

To obtain biomimetric control of rehabilitation processes: integration of volitional “impulses” during the movement of the subject, with the support of FES for improved re-learning of motor skills, when controlling the robot.

Developing hospital-applicable methods for restoring mobility that goes beyond the paradigm of commonly used static, manually adjusted mechanisms.

On low TRL

Automated cognitive understanding of required tasks in an ongoing environment. Seamless physical combination of man and robot for “normal” environmental conditions based on an additional control interface. Full, no-adjustment adaptability to the patient. Reliability of intent detection.

All over the world, medical robotics is actively developing in three areas: rehabilitation, service and clinical. Rehabilitation robots are designed to solve the problems of restoring the functions of lost limbs and life support for people with disabilities who are bedridden (with visual impairment, musculoskeletal disorders and other serious diseases). Medical robots for service purposes are designed to solve transport problems of moving patients, various cargo, as well as caring for bedridden patients. Clinical robotics provides full or partial automation of the processes of diagnosis, therapeutic and surgical treatment of various diseases.

The greatest practical application has been found in surgical robots used to perform robot-assisted operations in various fields of medicine. The use of robotics during operations reduces the dependence of the result of surgical intervention on the human factor and helps to expand technical capabilities when performing complex operations. With the use of robots, ergonomic indicators in the work of a surgeon are noticeably improved, and the accuracy and controllability of the impact increases. In the case of minimally invasive surgery, robots increase manipulability surgical instrument, allowing you to increase the amount of space available to the surgeon inside the patient's body. An important advantage of robotic surgery is the ability to convert traditional operations into minimally invasive interventions.

The modern stage in the development of minimally invasive surgery has been the introduction of specialized robots into clinical practice, the most famous of which is the Da Vinci robot. In many countries, work is underway to create specialized surgical robotics (USA, Germany, Japan, South Korea, France, etc.).

In Russia, for the first time, the idea of the possibility of robotic surgical intervention in relation to blood vessels was prof. G.V. Savrasov and academician A.V. Pokrovsky began to be discussed in the 80s of the last century. This was a period of development and active introduction into clinical practice of ultrasound angiosurgery technologies intended for intravascular effects.

The advantage of intravascular reconstruction lies, on the one hand, in its physiology, since the natural course of the circulatory system is restored, and on the other hand, in the possibility of minimal trauma due to the fact that the restoration of vessel patency is carried out over a considerable distance from the site of surgical access. However, the removal of the impact zone from the insertion site of the technical device, as well as the absence, as a rule, of direct visual information from the impact zone, complicates the work of the surgeon, making the results of surgical intervention directly dependent on the individual qualities of the surgeon himself. But the influence of the human factor is especially strong in cases where the main physical agent influencing the blood vessel is not the muscular effort of the surgeon, but a high-energy and fast-acting source, for example, ultrasound. In order to significantly improve the surgeon’s working conditions and at the same time increase the efficiency and quality of the operations he performs, it is necessary to fundamentally change the technique of surgical operations using mechatronics and robotics.

mobile microrobotic systems, capable of moving through tubular organs in automatic and semi-automatic modes, carrying out diagnostics and influencing pathological ones;
robotic manipulators to perform a wide range of surgical interventions in various fields of medicine.

You can see the problem in more detail in the video:

Equipment such as simulators for rehabilitation and physiotherapy are used for therapeutic purposes to restore patients after operations and injuries, as well as to prevent functional disorders of the body.

LLC M.P.A. medical partners" offers high-tech rehabilitation and physiotherapeutic equipment from world famous brands. We also design specialized rooms in hospitals, clinics, sanatoriums, sports centers, fitness clubs and provide after-sales service for exercise equipment.

Equipment for rehabilitation in our company

Devices for rehabilitation and physiotherapy, sports and aesthetic medicine. Multifunctional simulators based on electrical, ultrasonic, laser, magnetic, micro- and short-wave effects are used to improve microcirculation, regeneration and tissue trophism. Robotic vertical beds, sensor treadmills, strength and cardio equipment have many settings and are easily adjusted to the physiological characteristics of each patient.
Hydrotherapeutic and balneological equipment. Showers and baths with the option of hydromassage, baths based on mud, mineral and thermal waters provide effective therapeutic and spa procedures.
Stabilometric systems. Exercise machines with biofeedback based on the ground reaction force help restore the motor activity of bedridden, partially immobilized and outpatient patients.
Equipment for shock wave therapy. Devices for generating acoustic waves are equipped with a wide range of applicators and attachments that specifically target problem areas of patients with urological, neurological, orthopedic and other diseases.
Urodynamic systems. Fully computerized equipment provides effective training of the pelvic floor muscles. Saving session data helps track the progress of each patient's rehabilitation.

Published by: Arkhipov M.V., Golovin V.F., Zhuravlev V.V. Mechatronics, automation, control, No. 8, M., 2011, p. 42 – 50

Review of the state of robotics in rehabilitation medicine

1. Classification of medical robots

To systematize known and possible robotic systems (RTS) in medicine, a number of classifications have been proposed. The following classification criteria were used: invasiveness of the procedure, safety, mobility, ergonomics, control as management or diagnostics. One of the classification options, taking into account the latest advances in medical robotics, is shown in Fig. 1. The main three classes are robots for rehabilitation medicine, robots for life support and robots for surgery, therapy and diagnostics. They represent the main areas of medical robotics, although these classes and their subclasses are not independent according to the above characteristics. Next, sections 3 – 5 discuss representatives of the subclasses of restorative medicine designated in the classification.

Fig.1

2. The concept of development and implementation of robots in restorative medicine for healthy people

Regenerative medicine represents a system of medical activities aimed at diagnosing functional reserves, preserving and restoring human health through health improvement and medical rehabilitation. Health improvement should be understood as a set of preventive measures aimed at restoring reduced functional reserves and adaptive capabilities of the body in practically healthy individuals. The special role of preventive medicine was noted by Nobel laureate I.P. Pavlov (Fig. 2). In his words: “Preventive medicine achieves its social goals only if there is a transition from pathological medicine to health medicine.”

Fig.2

The concept of restorative medicine differs essentially from the concept of medical rehabilitation, which represents a set of diagnostic, treatment and preventive measures aimed at restoring or compensating for impaired functions of the human body and working ability in sick and disabled people.

Rehabilitation is the consolidation of the therapeutic effect in the process of recovery of the patient after an illness. Unlike rehabilitation, which ensures the restoration of health in a sick person, restorative medicine is aimed at reproducing lost health reserves. The therapeutic and health arsenal of restorative medicine provides a person with social and creative activity in his profession, that is, working capacity in the conditions in which his professional activity takes place. Rehabilitation is primarily focused on organ pathology, and accordingly its criterial apparatus assesses the degree of return to normal. The methodological tools of restorative medicine are redirected from searching for symptoms of the disease to assessing the reserve functional capabilities of the body, specifically to the loads and working conditions in which a person works.

The concept for the development of healthcare and medical science in the Russian Federation for the period up to 2010 is based on the health-centric model of the healthcare system developed by the Russian Research Center for Computer Science and Culture under the leadership of Academician A.N. Razumov (Fig. 3). The essence of the model is the emphasis on maintaining the health of a healthy person and, therefore, on restorative medicine.

Fig.3

In the future, most of the studies in this monograph will be associated with a contingent of not only people injured in military operations, at work, in sports, patients with cerebral palsy, post-stroke patients, but also healthy people, tired of physical and mental activity, reducing their performance. For example, university teachers and students. It is appropriate to talk here about the currently developing system of intensive computerized training, which, in order to increase the effectiveness of training, involves the concentration of efforts of both students and teachers without compromising their health. For them, restorative medicine discussed in the monograph is necessary.

Regenerative medicine includes a number of therapies, including non-drug therapies, one type of which is mechanotherapy. Among the many known means of mechanotherapy, robotics has the greatest potential.

The Russian scientist N.V. wrote about the need to use hardware for health massage specifically for healthy people in his dissertation “Materials on the question of the effect of massage on healthy people” in 1882. Zabludovsky (Fig. 4). “Is it not possible to take advantage of improvements in mechanics to construct machines that would replace the action of hands, or would not even the action of machines be preferable to the action of hands? It would be worth inventing a machine, the force of which could be determined at every moment in numbers and, instead of the work of a masseur, depending on the subjective muscular feeling, one could deal with work expressed in numbers. In other words, instead of taking the amount of a healing agent by eye, weigh it on precise scales.”

Fig.4

In those days it was science fiction, and the scientist only dreamed of the possibility of dosing effects on the hardware of the future. Currently, the dreams of the great predictor can be realized by turning to developed adaptive intelligent robotics. The problem for medicine, first of all, is the development of the concept of N.V. Zabludovsky about a new approach to human physical culture with the participation of not only volitional and passive movements, but also massage. Massage can have both a relaxation and mobilization function. In the optimal combination of these functions, physical culture will be able to better contribute to the preservation and increase of health reserves and increased performance in physical and mental work.

Therefore, the essence of the concept of developing and implementing robots in VM for healthy people is the use of adaptive and intelligent robots in combination with other types of therapies: aromatherapy, melotherapy, psychotherapy to maintain an increase in people’s health reserves and increase their performance.

Of course, a robotic system is an automated means, only temporarily working automatically, subordinate to a person at the level of making complex decisions, and being an intelligent, not just a physical assistant.

In accordance with the classification proposed above, a review of the state of robotics for rehabilitation medicine was carried out in three areas: joint manipulation or movement of limbs in joints; manipulation of soft tissues, i.e. various massages; active and biocontrolled prostheses.

3. Robots for performing limb joint movements

Movements of limbs in joints by the hands of a doctor are widely used in sports and rehabilitation medicine, in the treatment and training of patients with the consequences of stroke and cerebral palsy. Passive and active movements of the limbs in the joints are often performed together with massage, including for health purposes. Mechanotherapy replaces the hands of a doctor with the hands of a manipulator. Some of the first works in which a six-drive manipulative robot was proposed for massage and movement of limbs in joints appeared in 1997. . Later, single-drive robots from the American company “Biodex”, the Swiss company “Con-Trex” and a four-drive robot from the Swiss company “Lokomat” appeared.

The robot from the Swiss company “Lokomat” is the most prominent representative of the subclass of rehabilitation robots for performing limb movements in the hip, knee and ankle joints. There is the concept of neuroplasticity, which involves a “specific learning task” and is that through repeated training, daily motor performance can be improved in patients with neurological disorders. Robotic therapy on the Lokomat complex meets the requirements described above and makes it possible to conduct intensive locomotor therapy with feedback. General form the complex is shown in Fig. 5.

Rice. 5

The Lokomat consists of four drives for inducing gait movements and a system for unloading the patient's weight and the treadmill.

Patients in a wheelchair may be without special
labor are transferred to the treadmill belt and secured using special clamps. Computer-controlled drives are synchronized with the speed of the treadmill. They set the patient’s legs a trajectory of movement that forms a gait that is close to natural.

Enhanced patient motivation is achieved by controlling the load using biofeedback when displaying the current state on the monitor (Fig. 6).

Rice. 6

For the purposes of orthopedics (adults and children), sports medicine, industrial rehabilitation, prevention and treatment of osteoarthritis, a robot from the American company “Biodex” is known. The operating principle is based on electronic dynamometry. The system provides fast and accurate diagnosis, treatment and documentation of disorders that cause functional disorders of muscles and joints. The system allows for mobilization of joints in the direction of flexion/extension, abduction/adduction and rotation, which is necessary for the full restoration of their lost functions.

The package includes a set of devices for working with the hip, knee, shoulder and elbow joints, as well as with the ankle and wrist. A general view of the system working with the upper and lower extremities is shown in Fig. 7.

Rice. 7

Robots for upper and lower extremity reconstruction were presented at the Pennsylvania Medical Robotics Symposium. In Fig. 8 on the left: manipulator GENTLE /s, developed by the University of Reading, UK; in the center: ARMguide manipulator, developed by the Rehabilitation Institute of Chicago; right: Manipulandum, developed by the Rehabilitation Institute of Chicago.

Fig.8 Manipulators for upper limb restoration

In Fig. 9, top left: AutoAmbulator robot, developed by HealthSouth, USA; top right: walking trainer, developed by University of California, USA); bottom left: GaitMaster 2 robot, developed by University of Tsukuba, Japan); bottom right: robot for limb movements, as well as for massage, developed by the Russian Academy of Sciences) described in detail below.

Fig.9 Robots for restoring joints of the lower extremities

Impacts using the robots discussed above are classified as mechanotherapy. Mechanotherapy is a method of physical therapy based on the implementation of dosed movements (mainly for individual segments of the limbs) performed with the help of special devices. Mechanotherapy is used as a restorative treatment for various movement disorders, when it is necessary to increase the range of motion in the joints and the strength of certain muscle groups. Some devices can be used immediately after surgery. The choice of movements performed on mechanotherapeutic devices is determined by the nature of the limitation of movements and the anatomical features of the joint.

Robots for performing manipulations on soft tissues (robots for massage)

The history of the appearance of robots in VM for massage is as follows. In 1997, only one work using robotics for rehabilitation medicine was presented at the second IARP Forum on Medical Robotics - a massage robot. In 2002, a massage robot called Tickle, a tickling bug, appeared on the website of a Dutch company. In 2003, a Russian patent appeared - a robot for train massage. In 2005, a Silicon Valley website posted about the use of the Puma robot for massage. This robot was based on the idea outlined in the Russian work. Unfortunately, the development of this development is unknown. The works listed above represent most of the known massage robots, if you do not take into account the numerous massage hardware.

A variety of hardware has long been used to facilitate the work of a massage therapist and prevent occupational diseases of his hands. The simplest of them: vibrators, rollers, attachments for acupuncture and acupressure are means of mechanization that the massage therapist moves (Fig. 10).

Fig. 10. Regenerative medicine hardware

It should be noted that the robot may be a carrier of said hardware.

More complex are automation devices, for example, massage chairs. Massage chairs (Fig. 11) have air cushions with adjustable pressure and rollers with controlled pressing forces as actuators. Massage zones: cervical-shoulder region, back, lumbar region, buttocks, thighs, legs, feet. Types of massage: kneading, patting, effleurage, vibration, Shiatsu. From the control panel you can set the desired level of massage intensity.

Fig.11

Semi-automatic massage hardware is popular, partially relieving the massage therapist. Fig. 12 shows a hand made by the American company Meilis, which helps to perform pressing techniques.

Fig.12

The robot from the Dutch company Tickle is very simple in design (Fig. 13). The metal case contains two electric motors, a battery and four sensors that allow you to monitor the inclination of the surface on which the robot massage therapist moves. The movement is carried out using two silicone “caterpillars” covered with protrusions that create a massage effect. The principle of movement of the robot resembles the principle of movement of a tank: each of the motors drives its own caterpillar. The robot's influences are stroking and tickling, causing a relaxation effect.

Fig.13

The trail massage robot performs planar, continuous, linear stroking on large surfaces of the body (back, chest, abdomen, limbs). This kind of superficial stroking is characterized by particularly gentle and light movements that have a calming effect on the nervous system, causes muscle relaxation and improved blood circulation. The design of the robot consists of a carriage with an electric motor moving along a traverse along the patient’s body (Fig. 14). The traverse is profiled according to the relief of the back surface of the nominal patient and cannot be reprogrammed. Stroking brushes hang from the carriage and are pressed against the patient with elastic plates.

Fig.14

In 2007, a facial massage robot WAO-1 (Waseda Asahi Oral Rehabilitation Robot 1) was developed in Japan. The robot (Fig. 15) is equipped with two 50-centimeter mechanical arms that massage the patient's face on both sides. Safety is ensured by a force-metric limiting system, which pushes the robot's arms to the sides if it only applies too much force.
Facial massage is recognized as a very effective way to combat dry mouth, as it stimulates additional salivation and also helps correct problems with the oral structure.

Rice. 15

The effectiveness of massage hardware is determined by the adequacy of mechanical contact with the patient. This contact is made through the hardware tool. Therefore, in techniques that reproduce human hands, the tool must imitate the contact properties of the human hand: elasticity, warmth, humidity, frictional properties (roughness, smoothness, slipperiness), coordination capabilities (multi-finger, ability to grip). To a greater extent, the listed properties can be provided by a multi-joint manipulation robot.

A robot has been developed at the Moscow State Industrial University to perform massage techniques and move limbs in joints. The basis of this robot is the industrial robot RM-01, the manipulation arm of which is anthropomorphic in size and kinematics (Fig. 16). In contact with the body, the robot develops a force of up to 60 N. The necessary forces are developed and controlled through a positional-force control system that expands the capabilities of the standard robot.

Fig.16

A six-drive robot with the specified data can perform many well-known manipulations directly on soft tissues, i.e. a variety of massages, as well as manipulations of the joints in the form of passive and active movements of the limbs, post-isometric relaxation in the form of combinations of loading and unloading of the muscles of the limbs. In Fig. 17, the robot is squeezing the long muscles of the girl’s back.

Fig.17

Active biocontrolled prostheses of the upper and lower extremities

Bioprosthetics of upper and lower limbs lost as a result of injury or disease relies on simpler solutions. Some simple solutions, to some extent, only aesthetically restore the appearance of the limbs, while other solutions restore some functions. Figure 18 shows the classification of prostheses, which identifies the classes of active and biocontrolled prostheses.

Fig.18

Designed based on the theory of ballistic synergies, lower limb prostheses are not active and do not use biosignals, but effectively utilize the elasticity of the prosthetic springs.

In traction prostheses of the upper limbs, initially as passive ones, hand grip movements were caused by additional movements of the preserved part of the arm or by movement of the torso. At first, the transmitting link was flexible rods; later, active traction prostheses appeared, in which the movements of the rods were reproduced by built-in motors.

Active, but not biocontrollable, are myotonic prostheses, in which the control signals are the efforts of the disabled person. Sensors in the form of microswitches or strain gauges measure these forces and transmit them to the actuators of the hand.

The considered methods of prosthetics without the use of biosignals have a number of disadvantages. Control rods burden the disabled person, complicate the movements of the shoulder girdle; the number of control commands, as with myotonic control, is limited (one or two commands). Interference with control is caused by random external shocks into the prosthesis stump sleeve. However, the simplest prostheses are designed as modular structures and are mass-produced.

The development of biocontrolled prostheses was facilitated by advances in the field of electrophysiology, biomechanics, microelectronics, and adaptive feedback control systems.

Currently, the German company “Otto Bock” is known, mass-producing passive and active prostheses. Figure 19 shows an active knee joint prosthesis.

Fig.19

The most significant results in bioprosthetics in the 70-80s in Russia are known from the work of the Central Research Institute of PP. In the work of the Central Scientific Research Institute of Industrial Equipment, a fundamentally new direction in limb prosthetics was born - the creation of prostheses with a bioelectric control system or biocontrolled prostheses. The essence of the new principle of constructing artificial limbs is that the control of external energy sources, due to which the prosthesis operates, is basically similar to the natural coordination of movements of a healthy person.

In a living organism, control influences are transmitted to the muscles through bioelectric impulses that reflect commands from the central nervous system. Similarly, in a bioelectrically controlled prosthetic arm, the role of command signals is performed by biocurrents diverted from the truncated muscles of the stump. The mechanism that executes commands is an artificial hand equipped with a small-sized electric drive with self-powered power.

Based on the materials of the 2004 symposium in Pennsylvania, active prostheses and exoskeletons are known, shown in Fig. 20.

Fig. 20 Active prostheses and exoskeletons

Some of the first works in the field of active prostheses and exoskeletons are the works of Miomir Vukobratović. Under his leadership, exoskeletons were developed, in one version with electric, in another with pneumatic drives of the hip, knee and ankle joints for both legs of the patient (Fig. 21). The exoskeleton was intended to strengthen the dystrophically weak muscles of the human lower extremities while walking.

Fig.21

The Japanese company Matsushita has developed a robotic suit that will help rehabilitate partially paralyzed people (Fig. 22). When a person with paralysis in one arm makes a movement with his unaffected arm, the paralyzed arm makes the same movement, tensing and flexing the compressors, which act as muscles. By repeating the movements of the healthy arm, a person in a robotic suit can train his sore arm until the limb returns to normal function.

Fig.22

The suit weighs 1.8 kg. It was developed jointly by the company

The suit has been tested in a hospital, and there are plans to commercialize the suit. The approximate price of a suit for use in rehabilitation clinics will be $17,000, for home use - about $2,000.

Another Tokyo company, Cyberdine, has developed an automated suit, HAL (Hybrid Assistive Limb) (Fig. 23), which helps the elderly and people with limited walking abilities. The device with sensors will be available in Japan for a rental price of $2,200 per month. A 22-pound battery-powered computer system is attached to the waist. It operates actuators on brackets that are strapped to the hips and knees to provide automated walking assistance.

Fig.23

conclusions

1. Judging by the publications of development organizations and medical centers, the areas of application of medical robots, including for restorative medicine, are expanding and the demand for them is increasing.

2. Medical robots have a number of advantages compared to other hardware. These are fast reprogrammability, high accuracy of repetition of movements, tirelessness, absence of subjective factors (conscientiousness), a friendly interface (psycho-emotional contact), partnership (for children, involvement in games, in various movements, for example, in morning exercises). Also adaptation to individual characteristics of a person (positional-force control), the presence of intelligence (accumulation of experience, analysis, generation of programs), increased safety due to adaptation and intelligence.

3. Compared to a doctor's hands, today's medical robots often lack sensitivity and coordination in complex movements.

4. The concept of the development and implementation of robots in VM for healthy people is the use of adaptive and intelligent robots to preserve and increase the health reserves of the population and restore the working capacity of workers.

5. When developing and implementing robots in a virtual machine, a compromise choice should be made between multifunctional robots and economical specialized ones with a small number of drives.

6. For the developed VM hardware, including robots that manipulate soft tissues and joints, active and biocontrolled prostheses, tactile and force-metric information is effectively used for both open and closed power and positional force control systems.

7. Bioinformation is used directly as control signals, forms closed systems or forms biological feedback through vision and the human nervous system.

Bibliography

Golovin V.F. Problems of development of robotics in restorative medicine. Proceedings of the conference “Mechatronics”, St. Petersburg, 2008

Savrasov G.V. Medical robotics: status, problems and general principles design. // Bulletin of MSTU named after. Bauman N.E. Special issue “Biomedical equipment and technology, series “Instrument making”, 1998

Razumov A.N., Golovin V.F. Massage as a culture of everyday life of healthy people, Bulletin of Health Medicine, M.: 2010, No. 6

Razumov A.N., Health of a healthy person. - M. “Medicine”, 2007

Razumov A.N., Ponomarenko V.A., Piskunov V.A. Health of a healthy person. M.: Medicine, 1996

Dubrovsky V.I., Valeology. Healthy image life. – M.: Retorika-A, 2001.

Razumov A.N., Pokrovsky V.I. Health of a healthy person, scientific foundations of restorative medicine, M.: RAMS RSC VMK, 2007

Zabludovsky V.I., dissertation “Materials on the question of the effect of massage on healthy people” - St. Petersburg: 1882

Golovin V.F. Robot for massage. Proceedings of JARP 2nd Workshop on Medical Robotics Heidelberg, Germany, 1997

Biodex system 3. Manual, 20 Ramsay Road, Shirley, New York 11967-4704

Kovrazhkina E.A., Rumyantseva N.A., Staritsyn A.N., Suvorov A.Yu., Ivanova G.E., Skvortsova V.I. Robotic mechanical simulators in restoring walking function in patients with stroke. // M.: Rasmirbi, No. 1 (24) 2008, p. 11-16.

Assistive technologies. Proceedings IARP, Workshop on medical robotics. Hidden Valley, Pennsylvania, USA, 2004

Rehabilitation robotics, Proceedings IARP, Workshop on medical robotics. Hidden Valley, Pennsylvania, USA, 2004

Mansurov O.I., Mansurov I.Ya. A method of hardware-based surface massage and a robot for trail massage that implements this method. Russian patent No. 2005130736/14 dated 10/05/2005

Jones, Kenny C., Du, Winncy, “Development of a Massage Robot for Medical Therapy,” Proceedings of the IEEE/ASME International Conference on Advanced Intelligent Mechatronics (AIM'03), July 23-26, 2003, Kobe, Japan, pp . 1096-1101

Golovin V.F., Grib A.N. Mechatronic system for manual therapy and massage. Proc. 8th Mehatronics Forum International Conference, University of Twente, Netherlands, 2002

Golovin V.F. Robot for massage and mobilization. Proceedings of workshop of AMETMAS-NoE, Moscow, Russia, 1998

Golovin V.F., Grib A.N. Computer assisted robot for massage and mobilization. Proc. “Computer Science and Information Technologies”, Conference Greece University of Patras, 2002

Golovin V.F., Samorukov A.E. Method of massage and device for its implementation. Ross. patent No. 2145833, 1998

Golovin V.F. Mechatronic system for soft tissue manipulation. / Mechatronics, automation, control. – M.: 2002, No. 7

Pitkin M.R. Biomechanics of construction of prostheses of the lower extremities.-SPb.: Publishing house “Man and Health”, 2006.-131p.

Designs of prosthetic and orthopedic products. Ed. Kuzhekina A.P. M. “Light and food industry”, 1984

Yakobson Ya. S., Moreinis I. Sh., Kuzhekin A.P. Designs of prosthetic and orthopedic products / Edited by A.P. Kuzhekina. M.,: Light and food industry, 1984

Vukobratovich M. Walking and anthropomorphic mechanisms. Publishing house “Mir”, M. 1976

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