A cobot model (collaborative robot) capable of guaranteeing greater balance and movement control during rehabilitation comes into operation at Villa Beretta
They are called “cobots”. The acronym stands for collaborative robot (collaborative robots). These are robots designed to work without risk together with humans, without protective barriers or other physical elements of separation. In the rehabilitation field, the use of various robotic systems has increased in the last ten years – so much so that in 2022 the Higher Institute of Health felt the need to submit a Shared document on employment criteria and recommendations – especially in functional recovery in neurological and orthopedic pathologies that compromise movement. and balance.
In the Villa Beretta rehabilitation centerValduce hospital in Costa Masnaga (Lecco), a new generation, self-balancing and multidirectional exoskeleton model has come into operation to allow intensive, early and specific training of walking for neurorehabilitation therapy.
«Nothing miraculous – points out Franco Molteni, clinical director of the rehabilitation center —. We are talking about a punctual, personalized, specific, selective use of technology with the ability to monitor patient results and optimize their use. It is not the solution of everything, nor the complete solution of course, but And
significant therapeutic enhancement compared to everything we’ve had available to date».
The differences compared to the exoskeletons already in use
How is it different from other exoskeletons? «The patient is able to walk with his arms free therefore to do more tasks in addition to walking, of better coordinate arms and trunk
. The fact that the patient does not lean on anything completely changes the trunk control. The fact that you basically walk without being held by a physiotherapist gives an intentionality of movement that is very different from those who know that they walk instead with the help of a physiotherapist. So the feel of the mode of action also changes and this reverberates on the prefrontal control systems for example and therefore and therefore on the memory components of the movement that is then carried out», Molteni replies.
In what cases can it be used
What kind of patients could benefit? «First of all people with spinal cord injury, especially if they have incomplete lesions, to stimulate the plasticity of the system -explains the expert -, equally to stimulate the plasticity of the system people with brain injury or with neurodegenerative diseases such as multiple sclerosis rather that Parkinson’s disease and the stages of Parkinson’s disease in which there are significant changes in movement control. So from the post-acute phase of all these pathologies up to the phase after some time, however, when there is still potential for recovery ».
The possible outcomes of rehabilitation
What can a patient expect when undergoing rehabilitation with the cobot? «Potentially, in the event of a spinal cord injury, completing an exercise with this type of collaborative technological object serves to improve trunk control and balance control conditions which are then transferred, in the sitting position, in the passages from the wheelchair to the bed or wherever you want. In who has one incomplete injuryto direct the plasticity of the systems towards the best possible control and avoid phenomena of maladaptive plasticityi.e. of negative plasticity», Molteni adds.
The tests
How many patients do you plan to start testing it on? «We have 100 dedicated beds and the robotic system works eight hours a day. We will start a regular use in daily clinical practice and on the other side a series of clinical trials will start to verify the electroencephalographic modifications, the modalities and the differences of control of muscle synergies of the lower limbs and we will also see biological tests on the intestinal microbiota rather than on the muscle or even on the patient’s bone structure – underlines the clinical director of Villa Beretta -. As far as clinical trials are concerned, we have already set them up but first we have to submit them to the ethics committees, in particular we will work a lot on how brain connectivity changes during different walking modes and different adjustments, just as the controls of individual muscles change which all together then determine the walking during the use of this system».
The differences compared to implantable stimulators
How does it compare to another line of research on implantable stimulators for the rehabilitation of patients with spinal cord injuries? «In rehabilitation medicine there is an absolute need to coordinate multiple treatment modalities – says Molteni -. Implantable stimulators are a huge technological and biological advance, but the result of the stimulation must be refined and consolidated using stimulator and robot at the same time like this one for example. So it is a perfect synergy to restructure systems which, due to their complexity, require more actions. The implanted stimulator is not like the pacemaker for the heart: it triggers biological mechanisms which then need to be consolidated”.
The «limits» of the exoskeleton
However, from the point of view of the movement, the cobot denounces the “rigid” nature of the exoskeleton. The steps taken by the patient seem very mechanical: why? “For sure it is necessary to work on refining the methods of controlling the interaction. Those of us who have just been using it immediately realized that, within a few sessions, it is possible completely change the fluidity of movement working on the patient’s ability to coordinate and on that of the software to improve the control of the speed of execution of the gesture, the coordination between the various motors that make up the cobot. Important thing about this model, it has an ankle motor that coordinates with the motor that controls the trunk and this is where using the software well comes into play, otherwise it becomes a parkinsonian-like path in some ways».
“Miraculous effects? Zero. Since we have more than twenty years of experience in the use of technologies, we know well that sometimes we expect a miracle because we are also faced with incurable diseases.
Here we are discussing a timely, personalized, specific, selective use of technology with the ability to monitor patient outcomes and optimize their use. So it’s a major therapeutic advance. It’s not the solution to everything, nor the complete solution obviously, but it’s a significant therapeutic enhancement compared to everything we’ve had available to date. It’s not miraculous because we too set the walking world record with ReWalk with a patient who managed to walk 10 kilometers and then with ExoBionics for 12 kilometers but this is proof that you could have important performances. From there to completely troubleshooting is very different. But from here to going on the road to solve currently insoluble problems we are on the right track. Even this exoskeleton is not the replacement of a series of other activities that need to be done to recover the path but it is an important method different from all those we have had available to date and with very important development potential”.
June 30, 2023 (change June 30, 2023 | 19:56)
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