The robotic rehabilitation can be sought at any stage of a disease. However, it is reported that the recovery rate increases, the patients become more independent in the activities of daily life and the post-disease dysfunction reduces if it is started at an early stage.
Then, what are the diseases that the robotic rehabilitation can help?
Physiotherapist Ali Mert Özcan from the Physical Medicine and Rehabilitation Department of Güven Çayyolu Surgical Medicine Center informs us about the robotic rehabilitation.
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What Is Robotic Rehabilitation?As is the case with all areas of the life, the technology is ever increasingly used in the field of health. Based on these advancements, the robotic rehabilitation is an efficient treatment modality in the field of physiotherapy and rehabilitation.
The robotic rehabilitation is a treatment modality used to restore the walking ability in patients with total or partial loss of the gait function, but it also involves the virtual reality processes.
The walking robot, called Lokomat, consists of a virtual reality screen, a wearable orthesis (exoskeleton) and a treadmill that works synchronously with the orthesis.
How does Robotic-based walking device work?
For the Robotic rehabilitation, the patient is, first, evaluated to decide if the robotic rehabilitation can help the condition. Next, the body weight, height and other bodily indices (the distance from the hip to the knee and from the knee to the ankle) are measured. The data is entered to the robotic system; the artificial intelligence of the robot determines the patient-specific gait angles, velocity and other parameters.
The patients are safely connected to the device using special straps and a harness and they are integrated to the orthesis. After the ratio of the body weight to be hold by the robot is identified, physiotherapist will determine the rate of contribution to the gait by the patient and the device.
In the robotic rehabilitation, the device may make the patient walk or it may help the patient walk. The robot can manage the gait functions completely (100%) in the patients with total loss of the walking ability, but the rate can reduce down to 10% in patients with gait problem.
The sensors attached to the hip and the knee parts of the orthesis (exoskeleton) help the patient see the motion in each leg. These sensors measure the motions in hips and knees and reflect the readings in Newton/meter on the main screen that is operated with special software. The muscle contraction and the increase in the muscle tone are checked in each step during a dynamic gait to enable comparison with other sessions. The patient is represented by an avatar (a human figure) on the screen and the patient is given biofeedback on a graphic screen to have the patient control the steps while walking. The lokomat continues operating while the patient maintains the natural gait pattern. However, the device stops urgently to prevent an injury when a sudden-onset impairment of the gait function or any condition that is beyond the motion range and may injure the patient is sensed.
What is the mechanism of action in the Robotic Rehabilitation?
The “Neuroplasticity” is defined as the ability of the brain to modify and adapt the operation of the nervous system in response to internal and external stimuli by re-checking the structure and connections of the nervous system. Although it was believed years ago that the brain can develop for only first several years after the birth and also that the brain lesions would never heal, the neuroplasticity concept, now, evidences that the vital areas, such as brain and spinal cord, can heal even after a lesion.
The Robotic Rehabilitation is one of the important treatment modalities that supports the neural plasticity through task-oriented trainings and intensified repeats. The repeated movements ensure communication of strong signals to the brain and the spinal cord, resulting with activation of relevant regions and the nerve cells at their periphery. This activity accelerates the recovery rate of the disease.
The lokomat ensures re-organization of the brain through sensorial and motor stimuli transmitted from the legs in combination with the visual perception. The major aim is to teach the brain and the spinal cord how to start a movement again and to correct the abnormal gait pattern, if any.
What are the advantages of the Robotic Rehabilitation?
The major advantage of the robotic rehabilitation is the ability to have you make movements intensely that resembles the usual activities of the daily life, translating into continuous stimulation of relevant centers in the brain and the spinal cord.
Advantages of the robotic rehabilitation are as follows:
Who are good candidates for the Robotic Rehabilitation? Who are not good candidates?
The robotic rehabilitation is primarily considered for the patients with neurological problems, but also for patients with age-related gait problem and others who have undergone hip and/or knee surgery.
Robotic rehabilitation can be sought in following conditions:
Although the robotic rehabilitation has a wide portfolio of patients, the patients with following conditions are not good candidates for robotic rehabilitation;
When should the Robotic Rehabilitation be started?
The robotic rehabilitation can be sought at any stage of a disease. However, followings are observed in patients who are started on the treatment at an early stage;
It is appropriate to start a stroke patient on the robotic rehabilitation after the cognitive functions are restored or in other words 2 to 3 weeks, on average, after the cerebral hemorrhage. Considering the spinal injuries, the treatment can be started after the surgical site is stabilized and the active bleeding in the surgical wound ceases. On the other hand, the treatment should be started in patients with MS, Parkinson’s disease and muscle diseases immediately after the gait pattern impairs.
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