Robotic rehabilitation is a medical discipline that utilizes robotics to assist individuals with motor disabilities in recovering or improving their functions. It is an innovative approach that is rapidly gaining popularity due to its numerous advantages.

The robots used in robotic rehabilitation are designed to provide personalized support and feedback, helping the patient perform specific and targeted exercises. This enables better and faster results compared to traditional rehabilitation.

Robotic rehabilitation can be used to treat a variety of conditions, including:

• Stroke
• Multiple sclerosis
• Parkinson’s disease
• Spinal cord injuries
• Cerebral palsy
• Sports injuries

The benefits of robotic rehabilitation are manifold:

1. Improved motor recovery: Robotic rehabilitation allows for more intense and repeated exercises, promoting the recovery of strength, coordination, and flexibility.
2. Pain reduction: The support and feedback provided by robots can help reduce the pain and stress associated with rehabilitation.
3. Better quality of life: Robotic rehabilitation can assist individuals with motor disabilities in improving their autonomy and participation in daily life.

Robotic rehabilitation is a safe and effective treatment that can significantly enhance the quality of life for people with motor disabilities

Type of robotic rehabilitation device

There are many types of robotic rehabilitation devices. The first major distinction is between end-effector robotic devices and exoskeletons.

• End-effector systems interact with the patient by attaching to the terminal part of the body segment to be rehabilitated through a point of contact to which the subject is connected through a mechanical interface that can be a handle, knob, or pedal. This type of robotic device is easily applicable to the patient, and the set-up times are limited.
• Exoskeleton systems, on the other hand, are wearable mechatronic systems, whose movement is analogous to that performed physiologically by the patient, and in which the robot/patient interface is extended to the entire limb or body district to be rehabilitated. The number of degrees of freedom of movement of the exoskeleton is the same as that of the joints on which the rehabilitation treatment is to be carried out. Although more precise than end-effector robotic devices, they can sometimes be more complex to wear on the patient and require longer set-up times.

In general, robotic rehabilitation is very effective when used in combination with other rehabilitation methods, such as traditional physical therapy or occupational therapy. However, it is important to note that robotic rehabilitation is not a substitute for traditional physical therapy but rather a complement to it.

Robotic devices are tools in the hands of therapists who can use them for the execution of various therapies:

Passive mobilization

Passive mobilization consists of making the patient perform a series of movements passively and guided. Such movements can be generated by the physiotherapist himself or by robotic devices. The aim is to prevent and/or treat complications due to immobilization (edema, stiffness, spasticity, etc.) by reducing pain, improving local blood circulation both arterial and venous, reducing sweating, and accelerating the return to the physiological range of motion.

Passive mobilization with MAESTRO by GLOREHA: https://www.youtube.com/watch?v=MYHKrdSNQSc&list=PLtlmczjmg_5aOYdOEbUJSCZFuFPMNDxjr&index=14

Action Observation Therapy (AOT)

This is learning through observation, and this therapy is based on the discovery of mirror neurons. Mirror neurons are a special class of neurons that activate both during the execution of a manual motor act and during the observation of the same actions performed by others. Many studies show how action observation is effective in terms of improving and increasing motor skills[1] and manual dexterity[2]. The therapy is more effective the more the action is aimed at a purpose, and the more it belongs to the familiar and known motor sphere of the treated subject.

[1] [Buccino G., Action observation treatment: a novel tool in neurorehabilitation. Philos Trans R Soc Lond B Biol Sci 2014;369(1644):20130185.] [2] [ Sale P.,Ceravolo M., Franceschini M. Action Observation Therapy in the Subacute Phase Promotes Dexterity Recovery in Right-Hemisphere Stroke Patients. BioMed Research Internationa, 2014]

Robotic rehabilitation and Action Observation Therapy with GLOREHA devices

Functional Rehabilitation

Task-oriented training, i.e., training in the performance of typical activities of daily living, is becoming increasingly important[1]. In order to promote the functional independence of the individual. Rehabilitation after a trauma should not be exclusively motor and muscular. The possibility of training some specific functions and actions. Even through robotic devices, helps to make the treated subject more autonomous. Such rehabilitation cannot be standardized but must be tailored to the patient. A robotic rehabilitation device must therefore allow such personalization as to promote the construction of ad hoc exercises that allow interaction with real objects and that allow adaptation to the residual capacities of the treated subject.

[1] [Winstein CJ, Rose DK, Tan SM, Lewthwaite R, Chui HC, Azen SP. A randomized controlled comparison of upper-extremity rehabilitation strategies in acute stroke: A pilot study of immediate and long-term outcomes. Arch Phys Med Rehabil, 85(4):620–628, 2004. ]

Functional robotic rehabilitation with GLOREHA

Active-assisted therapy

Active-assisted therapy refers to the AAN “Assist-as-needed” approach peculiar to robotic systems: the patient is supported only if he or she cannot perform the task independently. Mobilization and patient participation in movement reduce motor disability and help to reorganize motor movement patterns themselves[1][2]. Active-assisted therapies are highly encouraging and limit the disadvantages of compensatory strategies that lead to the phenomenon of learned non-use of the affected upper limb[3].

Interactive games

Interactive games are highly innovative therapeutic approaches that have been spreading in recent years also in robotic rehabilitation field. An important review [4]confirmed the effectiveness of virtual reality on motor recovery and its impact on activities of daily living.

Interactive Therapies with GLOREHA: https://www.youtube.com/watch?v=Br_NPQDde8k&list=PLtlmczjmg_5aOYdOEbUJSCZFuFPMNDxjr&index=8

Mirror Therapy

The rehabilitative method of mirror therapy consists of placing a mirror between the upper limbs on the sagittal plane. The patient is invited to move the upper limbs symmetrically, while observing the movement of the healthy limb in the mirror. In this way, the patient has the impression that the affected limb is moving correctly. This technique improves motor functions of the distal part of the upper limb, increases ability in activities of daily living, and reduces pain[5].

[1] [Reinkensmeyer D, Galvez JA,  Marchal L, Wolbrecht ET, Bobrow JE Key problems for robot-assisted movement therapy research: a perspective from the University of California. Rehabilitation Robotics ICORR, 2007] [2] [ Liepert J, Blauder H, Miltner W, Taub E, and Weiller C. Treatment induced cortical reorganization after stroke in humans. Stroke. 2000;31:1210–1216] [3] [Kim GY, Lim SY,  Kim HJ,   Lee BJ,   Seo SC,  Cho KH,  Lee WH,  Is robot-assisted therapy effective in upper extremity recovery in early stage stroke? —a systematic literature review. J Phys Ther Sci. 2017 Jun; 29(6): 1108–1112] [4] [Laver K, George S, Thomas S, Deutsch JE, Crotty M. Cochrane review: virtual reality for stroke rehabilitation. Eur J Phys Rehabil Med. 2012 Sep;48(3):523-30. Epub 2012 Jun 20] [5] [ Thieme H, mehrholz L, Pohl M, Behrens J, Dohle C, Mirror Therapy for improving motor function after stroke. Chchrane Database Sysr Rev. 2012 Mar 14; 3:CD008449. Epub 2012Mar14.]

Mirror herapy and robotic rehabilitation with Gloreha

Bilateral Therapies

Most activities of daily life require coordinated intervention from both hands. Individuals who have suffered complete or partial paralysis of one limb experience a serious limitation in all these activities. Although further studies are still needed to outline a unique and shared strategy in bimanual robotic rehabilitation, it shows good results for rehabilitative purposes[1].

Neurocognitive exercises

Robotic devices can also be utilized for neurocognitive rehabilitation to assist patients in recovering their cognitive function after a stroke or head trauma. This type of robotic rehabilitation is particularly beneficial. Because robots can provide a variety of cognitive stimuli that aid the patient in regaining lost brain functions. (such as memory, problem-solving, shifting skills, attention, etc.).

[1] [Sleimen-Malkoun R, Temprado JJ, Berton E. A dynamic systems approach to bimanual coordination in stroke: implications for rehabilitation and research Medicina (Kaunas). 2010;46(6):374-81.]

Interactive and cognitive rehabilitation with GLOREHA